Radiation‐Associated Sarcoma of the Head and Neck: Incidence, Latency, and Survival

xlomafota13 shared this article with you from Inoreader Radiation‐Associated Sarcoma of the Head and Neck: Incidence, Latency, and Survival Via The Laryngoscope Objectives/Hypothesis Radiation-associated sarcomas of the head and neck (RASHN) are known but rare sequelae after radiation for squamous cell carcinoma. The purpose of this study was to characterize RASHN, estimate the risk of RASHN in head and neck squamous cell patients after therapeutic radiation, and compare their survival to that of patients with de novo sarcomas of the head and neck (dnSHN). Study Design Retrospective database analysis. Methods RASHN and dnSHN cases were collected from the Surveillance, Epidemiology, and End Results Database to identify risk factors and calculate incidence and latency. Survival was compared between RASHN and dnSHN. Results The risk of RASHN was 20.0 per 100,000 person-years. The average latency period was 124.2 months (range 38–329). The cumulative incidence of RASHN at 20 years was 0.13%. Oral cavity and oropharynx primaries demonstrate increased risk. Five-year overall survival of RASHN was 22.4% compared to 64.5% for dnSHN. Conclusions RASHN are confirmed to be rare. RASHN have poor overall survival and worse survival compared to dnSHN. The impact of intensity-modulated radiation therapy protocols on this risk is unknown. Modifiable risk factors of smoking and alcohol consumption continue to dwarf radiation therapy as risk factors of second primary head and neck cancers. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Granulomatose mit Polyangiitis – Manifestationen im Kopf-Hals-Bereich

xlomafota13 shared this article with you from Inoreader Granulomatose mit Polyangiitis – Manifestationen im Kopf-Hals-Bereich Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1580-7037 Die Granulomatose mit Polyangiitis ist eine seltene chronische rheumatologische Systemerkrankung, die mit einer Vaskulitis der kleinen und mittleren Gefäße einhergeht. Am häufigsten betrifft sie die oberen Atemwege, die Lunge und die Nieren. Die Beschwerden sind unspezifisch, häufig beklagen die Patienten anfangs eine Nasenatmungsbehinderung, Borkenbildung in der Nase, Ulzera der Mundschleimhäute oder Epistaxis. Nicht selten wird deshalb der Hals-Nasen-Ohren-Arzt zu Beginn der Krankheit hinzugezogen. Langfristig können schwerwiegende kardiale, renale oder pulmonale Komplikationen auftreten. Die Ätiologie ist bis heute nicht komplett geklärt. Als Therapie wird eine Immunsuppres sion eingeleitet. Klinische und laborchemische Kontrollen sind lebenslang obligat. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES

xlomafota13 shared this article with you from Inoreader Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Nov 15. doi: 10.1007/s00405-021-07161-1. Online ahead of print. ABSTRACT PURPOSE: Oropharyngeal dysphagia (OD) is a common phenomenon in otorhinolaryngology and phoniatrics. As both sub-disciplines have a strong tradition and clinical experience in endoscopic assessment of the upper aerodigestive tract, the implementation of fiberoptic endoscopic evaluation of swallowing (FEES) was an almost self-evident evolution. This review aims to provide an update on FEES and the role of phoniatricians and otorhinolaryngologists using FEES in Europe. METHODS: A narrative review of the literature was performed by experts in the field of FEES both in the clinical context and in the field of scientific research. RESULTS: FEES is the first-choice OD assessment technique for both phoniatricians and otorhinolaryngologists. FEES is becoming increasingly popular because of its usefulness, safety, low costs, wide applicability, and feasibility in different clinical settings. FEES can be performed by health professionals of varying disciplines, once adequate knowledge and skills are acquired. FEES aims to determine OD nature and severity and can provide diagnostic information regarding the underlying etiology. The direct effect of therapeutic interventions can be evaluated using FEES, contributing to design the OD management plan. Standardization of FEES protocols and metrics is still lacking. Technological innovation regarding image resolution, frame rate frequency, endoscopic light source specifications, and endoscopic rotation range has contributed to an increased diagnostic accuracy. CONCLUSION: The rising number of phoniatricians and otorhinolaryngologists performing FEES contributes to the early detection and treatment of OD in an aging European population. Nevertheless, a multidisciplinary approach together with other disciplines is crucial for the success of OD management. < p>PMID:34779927 | DOI:10.1007/s00405-021-07161-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

SUVmax for predicting regional control in oropharyngeal cancer

xlomafota13 shared this article with you from Inoreader SUV<sub>max</sub> for predicting regional control in oropharyngeal cancer Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Nov 15. doi: 10.1007/s00405-021-07169-7. Online ahead of print. ABSTRACT PURPOSE: To investigate the predictive value of pretherapeutic metabolic tumor imaging using 18-fluorodeoxyglucose positron emission tomography (FDG-PET) for regional response in oropharyngeal cancer patients undergoing primary (chemo)radiation. METHODS: Retrospective analysis of oropharyngeal cancer patients treated with primary (chemo)radiation at the University Hospital Zurich from 2010 to 2019 with available FDG-PET. The SUVmax of the largest lymph node metastases was recorded. Regional response was assessed using posttherapeutic FDG-PET at 12 weeks and regional recurrence-free survival. RESULTS: 95 patients with a mean age of 68.5 years (SD 10.3) were included. The median pretherapeutic nodal SUVmax was 8.3 (interquartile range 4.4-13.3). A pretherapeutic nodal SUVmax above 6 signifi cantly predicted poorer regional recurrence-free survival (log-rank test, P = 0.009) in univariate analysis. However, in multivariate analysis SUVmax above 6 was not significant in predicting regional recurrence-free survival (Cox regression P = 0.189). Clinical N category showed a trend in which a more severe stage had a poorer regional survival (Cox regression P = 0.073). CONCLUSION: The SUVmax of the largest lymph node metastasis seems to play a role in predicting regional response in oropharyngeal cancer patients, after stratifying for N category. More research is needed to investigate whether highly metabolically active disease is less likely to respond to chemoradiation. PMID:34779928 | DOI:< a href="https://doi.org/10.1007/s00405-021-07169-7" target="_blank" rel="noopener" class="underlink bluelink">10.1007/s00405-021-07169-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma

xlomafota13 shared this article with you from Inoreader Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma Via leak of cerebrospinal fluid J Korean Neurosurg Soc. 2021 Nov 12. doi: 10.3340/jkns.2020.0326. Online ahead of print. ABSTRACT OBJECTIVE: Nontraumatic subdural hematoma (SDH) is a common disease, and spinal cerebrospinal fluid (CSF) leakage is a possible etiology of unknown significance, which is commonly investigated by several invasive studies. This study demonstrates that heavily T2-weighted magnetic resonance myelography (HT2W-MRM) is a safe and clinically effective imaging modality for detecting CSF leakage in patients with nontraumatic SDH. METHODS: All patients who underwent HT2W-MRM for nontraumatic SDH workup at our institution were searched and enrolled in this study. Several parameters were measured and analyzed, including patient demographic data, initial modified Rankin Scale (mRS) score upon presentation, SDH bilaterality, hematoma thickness upon presentation, CSF leakage sites, treatment modalities, followup hematoma thickness, and follow-up mRS scor e. RESULTS: Forty patients were identified, of which 22 (55.0%) had CSF leakage at various spinal locations. Five patients (12.5%) showed no change in mRS score, whereas the remaining (87.5%) showed decreases in follow-up mRS scores. In terms of the overall hematoma thickness, four patients (10.0%) showed increased thickness, two (5.0%) showed no change, 32 (80.0%) showed decreased thickness, and two (5.0%) did not undergo follow-up imaging for hematoma thickness measurement. CONCLUSION: HT2W-MRM is not only safe but also clinically effective as a primary diagnostic imaging modality to investigate CSF leakage in patients with nontraumatic SDH. Moreover, this study suggests that CSF leakage is a common etiology for nontraumatic SDH, which warrants changes in the diagnosis and treatment strategies. PMID:34763379 | DOI:10.3340/jkns.2020.0326 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary herpetic oropharyngitis in adults: Differences in clinical features between Herpes simplex virus type 1 and type 2. A retrospective study.

xlomafota13 shared this article with you from Inoreader Primary herpetic oropharyngitis in adults: Differences in clinical features between Herpes simplex virus type 1 and type 2. A retrospective study. Via Clinical Otolaryngology Abstract This is the first report on the differences between adult primary herpetic oropharyngitis caused by the two types of the herpes simplex virus (HSV). Forty-one (25 type 1 and 16 type 2) HSV specific antigen positive cases among 68 immunoserologically confirmed adult primary HSV infection cases were investigated. A significantly low incidence of oral lesions and high incidence of nausea were seen in HSV type 2 oropharyngitis cases, which potentially indicates an association between the vagus nerve and HSV type 2 infection. Significantly increased white blood cell count and elevated C-reactive protein level were observed in HSV type 2 oropharyngitis cases. HSV type 2 possibly causes more severe symptoms and inflammatory reactions than HSV type 1. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

One dose of preoperative, intravenous, prophylactic antibiotics significantly lowers postoperative infection rate in septoplasty – a study of 772 operations

xlomafota13 shared this article with you from Inoreader One dose of preoperative, intravenous, prophylactic antibiotics significantly lowers postoperative infection rate in septoplasty – a study of 772 operations Via Clinical Otolaryngology ABSTRACT Objectives  Postoperative infection is the most common complication after septoplasty. Pre- or postoperative prophylactic antibiotics are commonly used, although no official guidelines exist. Design  We retrospectively collected data on postoperative infections from 772 septoplasties performed in 2015, 2016, and 2018, and classified the infections according to surgical-site infection (SSI) criteria by the Centers for Disease Control and Prevention (CDC). We evaluated the infections according to antibiotic use (preoperative or postoperative, both, or none) and accounted for patient and surgical confounding factors. We compared the results with three previous studies from our department to find out the trend in the occurrence of postoperative infections and in the use of antibiotics. Results  Twenty-nine cases (3.8%) fulfilled CDC infection criteria. Any kind of antibiotic prophylaxis reduced the risk of SSI (p=0.018). One dose of intravenous cefuroxime before incision was the most effective preventive measure (p=0.045). We found no significant effect of postoperative antibiotics. However, postoperative antibiotics lowered the infection rate to 1.8% compared to 6.1% among those not treated with any antibiotics. The only other factor reducing the risk of SSI was local anaesthesia compared to general anaesthesia. Conclusion  Preoperative antibiotic prophylaxis effectively reduced postoperative infection rate after septoplasty. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnostic value of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging sequences at 1.5 Tesla in management of sudden sensorineural hearing loss: Our experience in 20 patients

xlomafota13 shared this article with you from Inoreader Diagnostic value of three‐dimensional fluid‐attenuated inversion recovery (3D‐FLAIR) magnetic resonance imaging sequences at 1.5 Tesla in management of sudden sensorineural hearing loss: Our experience in 20 patients Via Clinical Otolaryngology Abstract 3D-FLAIR 1.5-Tesla MRI sequences can detect abnormalities that show as signal hyperintensity in patients with unilateral SSHL. We propose a simple objective method to detect these abnormalities based on the quantitative calculation of affected versus healthy contralateral ear signal intensity ratios. This signal hyperintensity may involve the cochlea, vestibule or the entire inner ear of affected ears. Such abnormalities were found in 45% of patients with SSHL, and hyperintensity was associated with lower initial and final hearing levels, as well as a lower ≥ 10 dB hearing recovery and more vertigo. We put hyperintensity itself forward as a marker of poor prognosis for patients with SSHL. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2)

xlomafota13 shared this article with you from Inoreader A randomised trial of single or extended dosing ciprofloxacin versus no intervention for Prevention of Ventilation Tube Otorrhoea and Obstruction (PreVenTO2) Via Clinical Otolaryngology Abstract Objectives To determine the effectiveness of ciprofloxacin 0.3% antibiotic eardrops in preventing clinically significant postoperative otorrhoea and tube obstruction following grommet insertion in children. Design 3-arm parallel assessor-blinded randomised controlled trial. Randomisation in 1:1:1 ratio to single intraoperative application of ciprofloxacin drops, extended 5-day postoperative application and no drops. Patients were assessed by blinded assessors at 6 weeks postoperatively. Setting The study was conducted in a large tertiary health network in Melbourne, Australia. Participants All children, 17 years and under, undergoing bilateral MEVT surgery with or without concurrent upper airway surgery for recurrent acute otitis media and chronic otitis media with effusion were approached. Main Outcome Measures Presence of postoperative otorrhoea and ventilation tube obstruction at 6 weeks postoperatively. Results 256 paediatric patients completed the study with a median age of 4.02 years. 153 participants were male. By ear-analysis (n=512) showed intraoperative antibiotics were more effective than no drops in preventing otorrhoea (RR=0.341, 95%CI 0.158–0.738, NNT= 11.25, p=.006). Postoperative antibiotics were more effective than no drops in preventing ventilation tube obstruction (RR=0.424, 95%CI 0.193 to 0.930, NNT=14.7 p=.032). Conclusion Intraoperative topical ciprofloxacin was effective at preventing early postoperative otorrhoea and a prolonged course was effective at preventing ventilation tube obstruction. Future studies on this topic should seek to clarify whether particular subgroups of patients benefit more from prophylactic topical antibiotics and model for cost-effectiveness. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Interpositional vein grafting for significant size discrepancy: The important role for short, sequential grafts in step-up and step-down microvascular anastomoses

xlomafota13 shared this article with you from Inoreader Interpositional vein grafting for significant size discrepancy: The important role for short, sequential grafts in step-up and step-down microvascular anastomoses Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 8:S1748-6815(21)00447-2. doi: 10.1016/j.bjps.2021.09.012. Online ahead of print. ABSTRACT INTRODUCTION: Anastomotic vessel size discrepancy may be addressed by numerous techniques, including the end-to-side. Most of these conventional methods are less suited with larger flap vessels relative to recipients, such as the vessel-depleted oncological neck with prior radiotherapy or in supermicrosurgical techniques with perforator recipients. We describe how short segment (single or double) interpositional vein grafts can be used to safely graduate this discrepancy in a 'step-up' or 'step-down' manner. METHODS: We conducted a retrospective review of all cases where interpositional vein grafts had been utilised. Furthermore, the technique for harvest, vessel preparation and anastomotic sequence is described. RESULTS: Over fifteen years, 116 short segment interpositional vein grafts (in 83 pa tients) were employed to address vessel discrepancy. Concerning patient demographics, there were 81 male:2 female, mean age 51 years (range 27-68 years), and aetiology was oral cancer (75), trauma(7) and congenital(1). Single (50) and double (33) grafts were used for 65 arterial anastomoses (8 step-down: 57 step-up) and 18 for venous anastomoses (12 step-down: 6 step-up). Flaps employed were osteocutaneous fibula (28), anterolateral thigh (24), free ileocolon (11), radial forearm (11), SCIP (7) and others (2). Six flaps (of 83) were lost (5 arterial and 1 venous thrombosis). CONCLUSION: Short segment interpositional vein grafts may be safely utilised for 'step-up' and 'step-down' anastomoses. Planned use in the primary case, minimum required length and meticulous preparation are fundamental for success and to dispel traditional concerns over poorer outcomes when vein grafts are used. PMID:34764041 | DOI:10.1016/j.bjps.2021.09.012 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pneumatosis intestinalis associated with lenvatinib during thyroid cancer treatment: a case report

xlomafota13 shared this article with you from Inoreader Pneumatosis intestinalis associated with lenvatinib during thyroid cancer treatment: a case report Via radioactive iodine J Med Case Rep. 2021 Nov 12;15(1):556. doi: 10.1186/s13256-021-03158-w. ABSTRACT BACKGROUND: Pneumatosis intestinalis is a rare disease characterized by gas-filled cysts within the submucosa or serosa of the intestinal tract. In recent years, pneumatosis intestinalis was reported in patients undergoing cancer treatment, and some case reports exist that report that pneumatosis intestinalis occurs during administration of vascular endothelial growth factor inhibitors, such as bevaciz umab and sunitinib. Here, we report the first case of pneumatosis intestinalis during lenvatinib treatment. CASE PRESENTATION: A 77-year-old Japanese man presented to our hospital with a chief complaint of numbness in the right leg and weakness of the lower limbs 9 years after right thyroid lobectomy. Computed tomography showed a tumor 90 mm in size from the lumbar spine to the sacrum, causing spinal cord compression. Blood tests showed that the patient's thyroglobulin level was increased to 11,600 ng/ml. We diagnosed him with thyroid cancer with bone metastases. External beam radiotherapy (39 Gy/13 Fr) was performed on the bone metastases, followed by total thyroidectomy and radioactive iodine therapy. Four months after radioactive iodine therapy, lenvatinib was introduced because the symptoms of numbness and weakness recurred. Lenvatinib was introduced at dose of 24 mg, and then it was reduced to 14 mg owing to Common Terminology Criteria for Adverse Event grade 3 paronychia of the right foot. Although no further significant adverse events occurred, a scheduled computed tomography image showed pneumatosis intestinalis of the ascending colon 14 weeks after the introduction of lenvatinib. No abdominal or digestive symptoms were observed; therefore, we selected conservative treatment. We discontinued lenvatinib for a week, but we were required to restart lenvatinib as the numbness in the right leg worsened after withdrawal. Since the introduction of lenvatinib, 3 years and 5 months passed; we continued lenvatinib treatment, and the therapeutic effect remains partial response. There has been no recurrence of pneumatosis intestinalis. CONCLUSIONS: Although rare, it is important to recognize that pneumatosis intestinalis can occur in association with lenvatinib and should be differentiated from intestinal perforation. Pneumatosis intestinalis association with lenvatinib can be improved by withdrawal. PMID:34763724 | DOI:10.1186/s13256-021-03158-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.