Cytomorphological Analysis of Keratinocytes in Oral Smears from Tobacco Users and Oral Squamous Cell Carcinoma Lesions——A Histochemical Approach

Aim To analyse the cytomorphological features of keratinocytes in smears obtained from the oral mucosa of tobacco users and from oral squamous cell carcinoma lesions.Methodology Oral smears were obtained from clinically,normal appearing mucosa of oral squamous cell carcinoma patients (n=20) and from the mucosa of smokers (n=20),and apparently healthy individuals (n=20) were used as controls.The smears were histochemically stained and cytomorphological assessment of the keratinocytes was carried out.One-way ANOVA (Analysis of Variance) was used for comparing the parameters among multiple groups and Tukey-HSD test was used to compare the mean values between groups.Results The mean nuclear area of keratinocytes from the mucosa of tobacco users was 46±2.57 and that of the oral squamous cell carcinoma lesion was 81.54±4.31.While there was a significant (P=0.001) reduction in the cellular area of keratinocytes from oral squamous cell carcinoma lesion when compared with those from oral smears of tobacco users.Conclusion Cytomorphometric analysis of keratinocytes can serve as a useful adjunct in the early diagnosis of oral squamous cell carcinomas.     

Clinical Electrocochleography in the Diagnosis and Management of Menière's Disorders

Patients with a fluctuating hearing loss, episodic vertigo and tinnitus with no known aetiological cause were investigated as cases of Menière's disorder. Transtympanic electrocochleography was found to be helpful in reaching the diagnosis of an inner ear disorder. In 65% of the patients, a large DC potential was recorded which caused an apparent widening of the summating potential/action potential (SP/AP) waveform. This potential was thought to be an SP which was enhanced relative to the AP component, and believed to be related directly to the presence of endolymphatic hydrops. A method is described which 'scores' the clinical history with respect to the certainty of the diagnosis of Menière's disorder. It was found that the more certain cases, with high scores, were statistically more likely to show an abnormal SP/AP waveform. The results of endolymphatic sac surgery were also assessed over 1 year in 28 cases, and it was found that those patients whose ECochG had revealed an abnormal SP/AP waveform prior to surgery benefitted in a statistically significant manner more from the operation.     

Endoscopic Management of the Frontal Recess in Frontal Sinus Fractures: A Shift in the Paradigm?

OBJECTIVES: To evaluate alternative management strategies for anterior table frontal sinus fractures involving the frontal sinus outflow tract. STUDY DESIGN: A prospective cohort of patients with anterior table frontal sinus fracture with frontal outflow tract involvement documented by computed tomography (CT) scan was examined between 1999 and 2001. METHODS: A select group of patients with anterior table frontal sinus fracture involving the frontal outflow tract was treated with open reduction of bony fracture without osteoplastic obliteration of the frontal sinus. Serial CT scans were obtained starting at 8 weeks after injury. Patients with persistent frontal sinus obstruction after medical treatment underwent an extended endoscopic frontal sinusotomy or a modified endoscopic Lothrop procedure. RESULTS: Fourteen patients sustained frontal sinus fractures and were treated during the study period. Seven patients were included in the modified treatment algorithm, with a mean follow-up of 18 months. All patients had concurrent facial fractures: superior orbital rim (n = 5), naso-orbital-ethmoid complex (n = 2), mandible (n = 2), and midface (n = 2). All 7 patients underwent open repair of the facial fractures. Postoperatively, 5 patients had spontaneous frontal sinus ventilation. Two patients, both of whom had naso-orbito-ethmoid fractures, had persistent frontal sinus obstruction clinically and radiographically. These patients were successfully managed with an endoscopic frontal sinus procedure. CONCLUSIONS: A select group of patients with frontal sinus and outflow tract fracture may be managed with open repair of the anterior table fracture without obliteration. In these cases, suspected frontal outflow tract obstruction can be managed expectantly. Failed frontal sinus ventilation may require endoscopic frontal sinus surgery to reestablish mucociliary clearance.     

Characterization of AMC-HN-9, a Cell Line Established from an Undifferentiated Carcinoma of the Parotid Gland: Expression of a6ß4 with the Absence of BP180 and 230

We recently reported the development of a cell line, AMC-HN-9, established from an undifferentiated carcinoma (UDC) of the parotid gland. AMC-HN-9 consists mostly of spindle-shaped cells, has poor     

Lymphatic malformation of the epiglottis—A case report and review of the literature

A 2-year-old male with a new onset dysphagia was diagnosed with a huge multicystic lesion of the epiglottis. The patient was urgently operated and several cysts were resected using cold steel instruments under microscopic view. Histopathology was consistent with lymphatic malformation. Surgery resulted in total symptoms resolution and on 1 year follow-up the patient remained free of recurrence.This is the first report of epiglottic lymphatic malformation.     

Are Somatostatin Analogs Therapeutic Alternatives in the Management of Head and Neck Paragangliomas?

BACKGROUND: Although mostly benign, head and neck paragangliomas require active management because of injury to adjacent neurovascular structures. Surgery, usually preceded by embolization, allows for complete tumor removal. However, surgery carries a significant risk of iatrogenic injury, related to tumor volume. Because paragangliomas express somatostatin receptors with high density, we investigated the effect of a long-acting somatostatin analogue (OCT-LAR) on the size of such tumors to reduce iatrogenic injury and related the percentage of tumor shrinkage to a tracer uptake index calculated on somatostatin receptor scintigraphy (SRS). METHODS: In eight of the first nine patients, 30 mg of OCT-LAR was given intramuscularly every 28 days for 3 doses; one patient withdrew after the first dose because of side effects. Conventional imaging with computed tomography (CT) scan or magnetic resonance imaging plus SRS revealed 18 paraganglioma sites. For each lesion, a tracer uptake index was calculated on pretreatment SRS. All 18 tumors were measured by CT scan before treatment and 1 month after the third injection. RESULTS: The average percent tumor shrinkage was 4.0 +/- 10.0%, and the average tumor reduction was 1.0 +/- 3.8 cm (P = .27, NS). Only 2 of the 18 paragangliomas shrank by more than 20%; these two tumors belonged to the only one secreting patient. There was no significant relation between tracer uptake index and tumor response. CONCLUSION: These results suggest 1) that SRS results do not predict OCT-LAR efficacy on paraganglioma size, and 2) OCT-LAR is not useful in the preoperative management of paragangliomas.     

Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?

PURPOSE: The aim of this study was to determine whether tumor depth affects upstaging of the clinically node-negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step-serial sectioning (SSS) and immunohistochemistry (IHC). PATIENTS AND METHODS: One hundred seventy-two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB-assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin-eosin staining, SSS, and IHC. Patients upstaged by SSS/IHC were denoted pN1mi. RESULTS: One hundred one of 172 patients were staged pN0, with 71 (41%) patients upstaged. Increasing tumor depth was associated with higher likelihood of upstaging (P < .001). Tumor depth showed a positive correlation with nodal stage according to TNM classification (P < .001). Tumor depth greater than 4 mm appears to be the most appropriate cutoff for risk stratification, although tumors in the oropharynx may require a lower value. CONCLUSION: Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.     

Cytotoxic and Genotoxic Effects of Paclitaxel (Taxol®) and Radiation in a Squamous Cell Carcinoma Cell Line of the Larynx

Paclitaxel (Taxol^®)is an antimicrotubular agent which blocks the cells in the G2/M phase of the cell cycle. Because of this mechanism it is presumed that this drug could function as a radiation sensitizer. The cytotoxic and genotoxic effects of paclitaxel and a combination of paclitaxel and radiation were studied in the human laryngeal carcinoma cell line HLac 79. The growth of the cells was significantly reduced at concentrations of paclitaxel as low as 10 nM. Flow cytometry data showed a G2/M block after exposure to paclitaxel. Radiation at 12 and 24 h after drug treatment exerted an additive but no radiation sensitizing effect. As genotoxic effect paclitaxel induced multinucleated cells, possibly in a synergistic manner, at low concentrations (10 nM) and radiation doses up to 3 Gy.     

Influence of the Provox Flush®, Blowing and Imitated Coughing on Voice Prosthetic Biofilms In Vitro

Objective--This study investigates the effect of regular airflow, as an isolated single factor, through Groningen and Provox®2 voice prostheses on biofilm formation. Material and Methods--Groningen and Provox2 voice prostheses were placed in a modified Robbins device and inoculated with the total microflora from an explanted Groningen voice prosthesis. After 3 days, prostheses were either flushed 3 times per day with the Provox flush®, treated with an airflow using an increasing order of air pressure (10, 15 and 20 cmH₂O) or vigorously perfused by means of imitated coughing (air pressure 20 cmH₂O). As a control, prostheses were left undisturbed to promote biofilm growth. Following flushing, blowing or coughing, each artificial throat was perfused with 200 ml of phosphate-buffered saline. This procedure was repeated three times a day for 9 days. At the end of each day, the artificial throats were filled with growth medium for 30 min and left empty during the night after draining. After 12 days the microflora on each voice prosthesis was quantified by plating on blood agar for bacteria and on de Man, Rogosa and Sharpe agar for yeasts. Results--The use of the Provox flush reduced bacterial prevalence on Groningen and Provox2 voice prostheses to 71% and 45% of the control values, respectively, without affecting the number of yeasts. Increasing airflows and imitated coughing yielded reductions of 45-70% in bacterial and yeast prevalence on Provox2 voice prostheses. On the Groningen voice prostheses the effects of increasing airflows and imitated coughing were less pronounced: reductions in bacterial and yeast prevalence of 56-87% were observed. Conclusion--This study shows that use of the Provox flush has a cleansing effect, especially on Provox2 voice prostheses, and furthermore suggests that daily airflow through voice prostheses as part of a daily maintenance scheme reduces biofilm formation and can be expected to prolong the life of these devices.     

Thrombosis of the internal jugular vein in the ENT-department — Prevalence,causes and therapy: A retrospective analysis

ObjectiveLess than 5% of deep vein thrombosis is due to thrombosis of the internal jugular vein. Genetic, malignant or inflammatory underlying diseases as well as insertion of venous catheters can be responsible for this pathology. Due to its rare occurrence, it is difficult to find systematic research about thrombosis of the internal jugular vein.MethodsWe performed a systematic analysis of present patient data from our ENT department with the electronic patient record considering the period from 2012-2017. Search terms were “thrombosis” and “jugular internal vein”. We identified 41 patients with the requested diagnosis and performed further analysis of the cases. Internal jugular vein thrombosis was diagnosed in all patients using Duplex sonography and/or CT/MR angiography.ResultsParaneoplastic thrombosis was found in 22/41 patients (54%), in 15 of the 22 (68%), the tumor was located in the ENT region. Two out of seven (29%) of the patients with tumor entities outside the head and neck region had thrombosis of the internal jugular vein as the first symptom of the disease. Another 14/41 patients (34%) had underlying inflammatory diseases – mostly streptococci-associated – for example a cervical abscess. In two patients, insertion of a central-venous catheter was causal, in three patients we could not find any reason for the development of thrombosis.ConclusionTo diagnose the rare and often asymptomatic thrombosis of the internal jugular vein, ultrasound of the cervical region should always include vascular imaging. Thrombosis of the internal jugular vein results mostly paraneoplastic or due to inflammation/abscess. It can be the first symptom of a malignant primary disease and always requires detailed diagnostic clarification.Level of evidence4.     

Influence of Human Leukocyte Antigen in the Pathogenesis of Me´nie`re's Disease in the South Korean Population

In order to study the associations of Ménière's disease (MD) with human leukocyte antigen (HLA) alleles in the South Korean population, we examined the distribution of HLA class I and II alleles in 39 MD patients and 199 healthy controls. The frequencies of HLA-Cw*0303 (relative risk (RR) = 2.5; p < 0.02) and -Cw*0602 (RR = 3.7; p < 0.03) were significantly increased in patients with MD compared to controls. However, HLA-B44 (RR = 0.2, p < 0.004) and -Cw*0102 (RR = 0.3; p < 0.03) were significantly decreased in patients compared to controls. When the association between hearing level and the presence of HLA alleles was evaluated, the frequencies of HLA-B13 (RR = 7.4; p < 0.004), -B39 (RR = 45.7; p < 0.003), -Cw*0303 (RR = 4.5; p < 0.02) and -Cw*0602 (RR = 6.5; p < 0.02) were significantly increased and those of -B44 (RR = 0.1; p < 0.02) and -Cw*0102 (RR = 0.1; p < 0.03) were significantly decreased in MD patients with hearing losses (stages II-IV) compared to controls. The frequency of HLA-B13 was significantly higher in MD patients with hearing loss (stages II-IV) than in those with normal hearing (stage I). In terms of HLA-DRB1, -DQA1 and -DQB1 allele frequencies, a significantly higher frequency of DRB1*15 was seen in the patients (RR = 2.4; p < 0.03). These results suggest that some HLA alleles may be a useful genetic marker for predicting prognosis in South Korean patients with MD.     

Effect of cyclosporine A on the hearing loss in Beh?et's disease

Thirty-five patients with Beh?et's disease (20 under cyclosporine A [CyA] treatment and 15 under the conventional therapy), 12 patients suffering from endogenous uveitis, and 35 normal subjects were evaluated audiologically before entering the study and were followed up for at least a year. Twenty-eight Beh?et patients (80%) showed some degree of hearing loss. The averaged pure tone audiogram of the Beh?et group showed statistically significant auditory deficits in comparison with that of the control group. None of either the Beh?et group or the uveitis group showed any hearing deterioration during the follow-up period. Five Beh?et patients under CyA therapy demonstrated improvement in their hearing. The difference between the two groups of Beh?et patients (CyA versus conventional treatment) was found to be statistically significant (p less than .05). Thus, CyA might serve as an important mode of treatment of sensorineural hearing loss on an inflammatory "autoimmune" background.     

Analysis of the status of treatment of benign thyroid diseases — a public health problem aggravated in the COVID-19 pandemic era

ObjectiveGoiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications.MethodsThis review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited.ResultsAll surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients’ physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions.ConclusionsSurgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.     

Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI – a preliminary report

Conclusion: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (T_peak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe.

Objective: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: T_peak and WR.

Methods: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen.

Results: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on T_peak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for T_peak optimally differentiating between the clusters was 140?s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.