Predictors of cervical lymph node involvement in patients with pharyngeal carcinoma undergoing endoscopic mucosal resection

Objective

Although detection of pharyngeal carcinoma remaining in the epithelium or subepithelial tissue layer has been difficult by routine examinations, recent advances in endoscopic technology have enabled us to detect these lesions. These patients can receive endoscopic mucosal resection (EMR) and generally have a good prognosis, but some patients have nodal involvement. The purpose was to investigate predictors of nodal involvement in patients with pharyngeal carcinoma undergoing EMR at our hospital.

Study design

Outcomes research.

Methods

Lymph node involvement, endoscopic morphology, and tumor thickness were investigated in 152 patients treated between 2001 and 2009.

Results

Pathological examination revealed carcinoma in situ (CIS) for 77 patients and subepithelial invasion (SEPI) for 75 patients. There were no patients with muscular invasion. Nodal involvement was found in none of CIS but in 7 of 75 patients (9.3%) with SEPI. In patients with SEPI, the mean tumor thickness was significantly higher in patients with lymph node involvement (1311.4 ± 300.0 μm) than those without involvement (692.6 ± 495.7 μm) (p = 0.002). Significant risk factors for nodal involvement included the tumor thickness over 1000 μm (p < 0.001) and the presence of venous or lymphatic invasion (p < 0.05). Based on analysis in relation to sensitivity and specificity, the tumor thickness over 1000 μm may serve as the most predictive factor for nodal involvement.

Conclusion

Tumor thickness can be a simple predictor for nodal involvement in cases of SEPI. Careful follow-up including neck palpation and annual imaging diagnostics such as computed tomography or ultrasonography are recommended for these patients.     

Rehabilitation of deglutition in patients with pharyngeal carcinoma

Surgical treatment of pharyngeal carcinoma implies different reconstructive procedures. Despite primary healing, in some cases cicatricial shrinkage occurs, resulting in dysphagia. Of 113 patients with carcinoma of the oro- and hypopharynx in the last 4 years, 35 patients were studied in a specific follow-up examination. Deglutition was evaluated via subjective responses to a questionnaire. Reproducible information was gained by videofluoroscopy and manometry of the pharyngo-esophageal segment. To assess deglutition, an arbitrary number scale was established with 7 for excellent and 1 for poor deglutition. After local tumour excision, partial and total pharyngectomy, pharyngolaryngectomy and additional myocutaneous grafting, the deglutition index ranged from 5.8 to 4.5 showing more striking differences in the time required for eating. Manometric analysis showed pressure peaks 10 times lower (3.5 hPa) than in normal subjects with prolongation of each swallow. Videofluoroscopy reveals even slight motility disturbances after ablative pharyngeal surgery. Typical findings are presented. The swallowing function after pharyngeal tumour operations requires the reconstruction of both the horizontal (oral) and vertical (pharyngeal) phase of deglutition. Since the base of the tongue seems to be the major driving force in bolus movement, it is not the extension of resection but the availability of remaining contractile tissue in the neopharynx, especially in the base of the tongue region, that determines the postoperative rehabilitation of deglutition.     

Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study

Purpose

Effective operative approaches for the treatment of refractory vertigo in Meniere's disease are invasive. Vestibular neurectomy can preserve hearing and has been shown to be effective; however, current approaches require an extensive craniotomy. Transcanal endoscopic approaches to the internal auditory canal (IAC) with cochlear preservation have been recently described and may offer a minimally invasive approach to selectively sectioning the distal vestibular nerves while preserving residual hearing.

A pilot study evaluating the treatment of postparotidectomy sialoceles with botulinum toxin type A

OBJECTIVE: To report our experience in treating 4 cases of recurrent siacloceles with botulinum toxin type A after partoid surgery. DESIGN: This is a prospective, nonrandomized, nonblinded pilot study describing a new use for botulinum toxin type A. SETTING: Tertiary academic medical center. PATIENTS:Four patients (2 men and 2 women) with persistent postparotidectomy sialoceles who had undergone various treatment failures were included. The diagnosis was made by fine-needle aspiration of the mass based on well-recognized cytologic features of the entity, as well as an elevated amylase level and no evidence of tumor or infection. INTERVENTIONS: Sialoceles were aspirated before local injection of botulinum toxin type A (30-50 U) subcutaneously. MAIN OUTCOME MEASURES: The patients were followed up 1 week after receiving botulinum toxin type A injection and then at monthly intervals. They were extensively questioned and examined for any evidence of side effects or recurrence. RESULTS: All patients had total resolution of sialocele or external salivary fistula within 1 month of treatment. None of the patients to date have demonstrated recurrences at 7 through 13 months, and there were no complications, particularly facial nerve weakness. CONCLUSION: Our findings suggested that botulinum toxin type A offers a highly effective, safe, and noninvasive method of treatment in postparotidectomy sialocele.     

Epstein-Barr virus DNA measured in nasopharyngeal brushings in patients with nasopharyngeal carcinoma: pilot study

OBJECTIVE: We measured the amount of tumour-derived Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) in the nasal brushings of nasopharyngeal carcinoma (NPC) patients to determine the correlation with tumour load and response to treatment. MATERIALS AND METHODS: Twenty-eight patients with NPC were included in the study. Baseline measurements of EBV from nasopharyngeal brushings were obtained from 26 patients prior to treatment. A follow-up sample was available from 11 of these patients post-treatment and from 2 additional patients who did not have a baseline sample. Quantitative real-time polymerase chain reaction (PCR) using SYBR Green I fluorescent dye was used to detect the EBV DNA copy number. RESULTS: Nasopharyngeal brush biopsies showed a high copy number of EBV DNA in most of the pretreatment samples (median 9714 copies/mL). The highest copy number detected was 14536944 copies/mL in one sample. In the post-treatment follow-up samples, the copy number was significantly lower (median 6 copies/mL). CONCLUSIONS: We have demonstrated that EBV DNA can be detected in the brush biopsies from NPC patients using quantitative real-time PCR. These pilot data suggest that nasopharyngeal brushings with PCR detection of EBV may be an effective tool for determining local tumour response. The potential of this technique as an NPC tumour marker for post-treatment follow-up is being validated with larger patient numbers.     

Significance of tumor thickness in soft palate carcinoma

Tumor thickness is an important prognostic factor in tumors outside of the upper aerodigestive tract, such as cutaneous melanoma, colorectal carcinoma, and cervical carcinoma. Some studies have also suggested that tumor thickness may have similar prognostic value in the upper aerodigestive tract. This study examined the relationship between tumor thickness (measured with an ocular micrometer) and nodal disease and that between tumor thickness and survival in 44 patients with soft palate epidermoid carcinoma. There was a significant correlation between tumor thickness and nodal disease. None of the 24 lesions less than or equal to 2.86 mm had cervical adenopathy. All of the 15 lesions greater than or equal to 3.12 mm had palpable adenopathy. Tumor thickness correlated more directly with nodal disease than did T stage. Thicker lesions were associated with poorer survival. Tumor thickness is an important parameter in the head and neck and deserves further study.     

Role of ultrasonography in patients with cytologically follicular thyroid tumor

Objective

The purpose of this study is to evaluate the role of ultrasonography (US) in the management of thyroid nodules when the cytology is indeterminate as follicular tumor on fine needle aspiration biopsy (FNAB).

Methods

In 2006, 6586 patients with thyroid nodules, which were detected on US underwent FNAB in our department. Of these patients, we extracted 438 patients (6.7%) whose nodules were cytologically diagnosed as indeterminate. Of them, 227 patients were diagnosed as follicular tumor were enrolled in this study. Surgery was performed according to our criteria for surgical indication. We compared the results of clinical findings including US classification and final histopathological diagnosis.

Results

One hundred thirty-seven of 227 underwent surgical treatment. Thirty-three (24%) were diagnosed as malignancy pathologically. Large nodule or high serum thyroglobulin level were not associated with an increased risk of malignancy. Ultrasonographic evaluation as malignancy was directly linked to pathological diagnosis as thyroid carcinoma (p < 0.0001).

Conclusion

US plays a crucial role in deciding whether surgical treatment is necessary for cytologically indeterminate thyroid nodules as follicular tumor.     

Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma

Dysphagia is a late sequela compromising the lives of more than one fourth of patients with nasopharyngeal carcinoma (NPC) who survive long after radiotherapy. By using fiberoptic endoscopic examination of swallowing as a modality for dysphagia evaluation, we were able to easily recognize the functional and anatomic changes in 31 dysphagic NPC patients. The majority of patients were found to aspirate after the act of swallowing (77.4%). Seventeen (54.8%) had tongue atrophy, and 9 (29%) had vocal cord palsy. Dysfunctions such as dry mouth (45.2%), velopharyngeal incompetence (58%), premature leakage (41.9%), delay or absence of swallow reflex (87.1%), poor pharyngeal constriction (80.6%), pharyngeal residue retention (83.9%), penetration or aspiration (93.5%), and silent aspiration (41.9%) were noted in these patients. Multiple dysfunctions were demonstrated in each patient. Abnormality of pharyngeal constriction and/or aberrant upper esophageal sphincter function played the major role in the postswallow aspiration of these irradiated NPC patients. Clinically compromised patients (weight loss of > or =5 kg in 1 year or pneumonia) had more of the above anatomic and functional impairments. The radiation dosage and volume bore no correlation to the time of symptom onset, or to the occurrence of functional changes.     

Serum vitamin A levels in patients with untreated T1 or T2 squamous carcinoma of the larynx: a pilot study

The serum retinol levels of 19 patients with T1 or T2 tumours of the larynx were compared with those of non-malignant smoking and non-malignant non-smoking controls matched for age, sex and weight. The cancer group had a significantly lower level of serum retinol than either control group between which there was no significant difference. It is unlikely that the lower serum retinol levels were due to either tumour or cigarette smoke.     

Safety and efficacy of endoscopic pharyngeal pouch stapling in a large UK study

• ? Endoscopic stapling of pharyngeal pouch is minimally invasive surgery, ensuing fast recovery and shorter hospitalisation, but previous small case series may have biased outcome.
• ? Perioperative and long‐term outcome of endoscopic stapling of pharyngeal pouch were examined retrospectively in the largest (n = 62) UK case series.
• ? Stapling was not possible in seven patients because of small size of the pouch. Most patients made a full recovery immediately post‐operatively. Two patients developed a leak at the stapling site, but critical complications or direct mortality were not observed.
• ? Persistence or recurrence of symptoms were observed in 18% of patients and successfully treated by revision endoscopic stapling or open procedure.
• ? We recommend endoscopic stapling for all patients with moderate or large pharyngeal pouches.

     

Efficacy of antiseptic mouthrinses against SARS-CoV-2: A prospective randomized placebo-controlled pilot study

ObjectivesCoronavirus-disease-19 (COVID-19) continues to affect millions of individuals worldwide. Antiviral activity of mouthrinses remains an important research area as the oral cavity is a site of SARS-CoV-2 initial replication. The aim of this study was to assess the effectiveness of three different mouthrinses in reducing the oral/oropharyngeal SARS-CoV-2 viral load.MethodsAdult patients, hospitalized with confirmed COVID-19 were recruited for the study. Oral/oropharyngeal baseline SARS-CoV-2 samples were collected and analyzed by Real-Time-PCR. Subsequently, patients were instructed to rinse with 1 % hydrogen peroxide (H₂O₂), 0.12 % chlorhexidine (CHX), 1 % povidone?iodine (PVP-I) or Sodium Chloride 0.9 % (placebo). Viral loads were measured right after (T1), and at 45 min (T2) from the rinse.ResultsIn the PVP-I 1 % group, 5/8 (62.5 %) patients at T1, and 3/8 (37.5 %) patients at T2, SARS-CoV-2 was not detectable in the swab specimens. In the H₂O₂ 1 % group, 2/11 (18.2 %) patients at T1, and 2/11 (18.2 %) other patients at T2 showed no SARS-CoV-2 loads. One (12.5 %) patient in the CHX 0.12 % group showed SARS-CoV-2 negativity at T2. One (9.1 %) patient at T1, and another (9.1 %) patient at T2 showed no SARS-CoV-2 loads in the placebo group.ConclusionsOral SARS-CoV-2 loads were reduced at T1 in the PVP-I 1 % and H₂O₂ 1 % groups.Clinical relevancePVP-I 1 % was the most effective rinse especially in patients with low viral copy numbers at baseline.     

Olfactory function in patients with ischemic stroke: a pilot study

The aim of this pilot study was to investigate olfactory function in unselected, cooperative patients with ischemic stroke and to gain information about olfactory perception in patients with distinct stroke localizations. Three ischemic stroke patients underwent olfactory testing using the Sniffin’ Sticks test and olfactory event-related potentials recording. All stroke patients were found to be normosmic or only slightly hyposmic when using a psychophysical testing device with age-adjusted norms. No responses or longer latencies on the affected side were found, however, when recording evoked potentials. This seems to argue for the idea that on the affected side it is often possible to document the objective lesion although the subjective perception of the patient appears normal.     

P27蛋白表达与下咽癌临床生物学行为及预后

目的 :研究 P2 7蛋白在下咽癌及癌旁正常组织中表达情况 ,探讨 P2 7表达与下咽癌临床生物学行为及预后的关系。方法 :用免疫组织化学染色 SP法检测 4 8例下咽癌手术标本和同期 15例癌旁正常组织标本 P2 7的表达 ,结合临床与随访资料进行分析。结果 :下咽癌组 P2 7阳性率为 6 8.75 % (33/ 4 8) ,癌旁组阳性率为 80 .0 0 % (12 / 15 ) ,P2 7表达水平在肿瘤组显著低于癌旁组 ,且与癌的临床分期、组织分化程度、颈淋巴结转移及预后相关 ,而与肿瘤的发生部位无显著关系。结论 :下咽癌中 P2 7的表达可能对判断肿瘤恶性程度及预后有一定的参考价值     

Efficacy of needle aspiration in patients with oral-maxillofacial abscesses: A retrospective study of 15 consecutive patients

The aim of this study was to determine the adequacy and safety of needle aspiration (NA) as an alternative to open surgical drainage for oral-maxillofacial abscesses. Fifteen consecutive patients who were diagnosed with oral-maxillofacial abscesses via contrast-enhanced CT from January 2020 to December 2020 were included. All patients were on antibiotics and treated with NA under local anaesthesia using a 20 mL syringe. Data collection included patient characteristics, signs and symptoms, physical examinations, laboratory tests, imaging findings, and outcomes. Next-generation sequencing (NGS) was used to identify the infectious microorganisms from the abscess samples. The study included 15 patients with oral-maxillofacial abscesses. None of our 15 patients required surgical incision and drainage, although repeat aspiration was required. However, after the first NA, the pain was reportedly extremely relieved for all patients. The average duration of antibiotic treatment was 9.20 ± 5.15 days (range 4–23 days). The abscess-affected spaces mainly included the masseter space and submandibular space. Odontogenic infection was the most common aetiology in 15 patients (10/15). The average volume of the abscesses on CT was 5866.26 ± 3627.18 mm³. The main pathogens identified in this study were Prevotella oris (5/15), Peptostreptococcus stomatis (4/15) and Porphyromonas endodontalis (2/15). According to the results of our study, the data support the use of NA as an effective, minimally invasive treatment modality for oral-maxillofacial abscesses. Surgeons should familiarise themselves with this technique, as it can easily be performed in the clinic using local anaesthesia, culture samples may be obtained, and airway obstruction and pain may be relieved.     

Oesophageal carcinoma: endoscopic and clinical findings in 258 patients

During the 10-year period 1971-1980, oesophagoscopy was carried out on a total of 3235 patients in the Department of Otolaryngology, Turku University Central Hospital, Finland. Oesophageal carcinoma was diagnosed in 258 patients, 113 (44 per cent) men and 145 (56 per cent) women. The diagnosis was verified in 228 cases (88.4 per cent) by using an optical rigid oesophagoscope and in 30 cases (11.6 per cent) by a fibreoptic endoscope. The most common and earliest symptom was difficulty in swallowing in 50 per cent of cases. In 44 per cent of patients the symptoms persisted over six months before diagnosis. Upper and middle thoracic portions of the oesophagus were the sites of origin of the carcinoma in 57 per cent of the patients. The macroscopic picture obtained by oesophagoscopy was regarded as malignant in 83 per cent of patients and extraoesophageal spread of the tumour was estimated to be present in 48 per cent of patients by the time of diagnosis. Histological studies showed the tumour to be squamous cell carcinoma in 62 per cent of patients and in 24 per cent well differentiated. Squamous cell carcinoma was seen more often in men than in women. In patients with carcinoma in situ, alcohol and tobacco were regarded as aetiological factors in 53 per cent of cases. The need for repeated oesophagoscopy in patients with symptoms related to swallowing is stressed.