Latex allergy, a special risk for patients of otorhinolaryngology and head and neck surgery?

A total of 206 patients of the otorhinolaryngology (ORL) department and 204 of the visceral surgery department of the Ludwig Maximilians University of Munich were preoperatively evaluated for latex-specific sensitization. A prick test, a questionnaire, and an enzyme-linked immunosorbent assay immunoprecipitation for IgE antibodies were performed. Latex is a widely spread allergen, and it does not only concern healthcare populations. Within the ORL surgery group, 43 (20.9%) patients were sensitized against latex allergen, and 2 of them were reported to manifest symptoms in consorting with latex. In the cohort of visceral surgery patients, we detected only 23 patients (11.3%) with sensitization against latex. Moreover, most patients were positively detected with the skin prick test (86.4%), whereas the enzyme-linked immunosorbent assay method was less sensitive (18.3%). Patients of the ORL department were considerably more frequently exposed to latex protein particles than patients of the visceral surgery department. This difference attributes to their significant difference in mean age: 44 years in the ORL patients group versus 58 years in the visceral patients cohort. Furthermore, we did not find any correlation to the number of past operations--although undergoing any surgical procedures is a well-known risk factor in other studies about latex sensitization in surgical patients.     

Ex-vivo-chemoresponse testing of head and neck cancer: an old hat?

Reliable prediction of the chance of a successful treatment of head and neck squamous cell carcinoma by cytostatics and targeting therapies would be very valuable, since HNSCC due to their heterogenic biology mostly respond non-uniformly and moreover with low response rates. To raise the prospect of chemotherapy by using multimodal therapies usually goes hand in hand with a higher incidence of severe adverse events and acute toxicity but also chemo-associated increased cancer risk following successful treatment. In addition, the increasing numbers of treatment options without availability of reliable prognostic biomarkers for a probably successful outcome make the decision for one or the other medication to something rather like gambling. Therefore, quite early a pre-therapeutic predictive exvivo chemoresponse testing of bioptic specimens was intended. However, the results gained mostly were disillusioning and allowed not for reliable prediction of chance of successful outcome of treatment with tolerable doses of the pharmaceuticals and in particular their combinations. Predictive testing, hence, was belittled as improper for the clinical context. Based on advanced methods, some working groups reassume this subject. This review describes recent advances in ex-vivo chemoresponse testing, discusses pre-requisites which have to be fulfilled before their inclusion into decision-making, and outlines why ex-vivo chemoresponse testing probably is not an old hat.     

Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences?

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.     

Readability assessment of online patient education materials from academic otolaryngology–head and neck surgery departments

Purpose

The aim of this study was to compare the readability of online patient education materials among academic otolaryngology departments in the mid-Atlantic region, with the purpose of determining whether these commonly used online resources were written at a level readily understood by the average American.

Methods

A readability analysis of online patient education materials was performed using several commonly used readability assessments including the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Coleman-Liau Index, the New Fog Count, the Raygor Readability Estimate, the FORCAST test, and the Fry Graph.

Results

Most patient education materials from these programs were written at or above an 11th grade reading level, considerably above National Institutes of Health guidelines for recommended difficulty.

Conclusions

Patient educational materials from academic otolaryngology Web sites are written at too difficult a reading level for a significant portion of patients and can be simplified.     

Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas?

Objective

To evaluate the frequency of brain metastasis at the time of diagnosis for patients with cutaneous head and neck melanoma (CHNM).

Can we get rid of hospital infections in head and neck surgery?

Infection rate registered on the basis of clinical symptoms and of microbiological forms in patients treated in Surgery Division, Head & Neck Cancer Department during 2001-2003, was analyzed. Total number of patients treated was 2343. In 664 preoperative microbiological cultures have been obtained from suspected areas and in 52.8% of these a pathogen has been found. Patients undergoing major surgery received a prophylactic antibiotic selected by an infection control team and Microbiology Department. If preoperative cultures showed resistance to standard prophylactic antibiotic, another was selected on the antibiogram basis. Particular attention was paid to all the elements of prophylactic against infection in the ward, examination and dressing rooms, operating theatre. In 48% of patients, mainly those after extensive, prolonged surgery, antibiotics (usually 3rd generation cephalosporins) were used for 5-7 days. During 2001, 2002 and 2003 correspondingly 148, 97 and 58 infections were registered with positive culture and infection with clinical symptoms occurred in 30, 21 and 20 patients (4%, 2,8% i 2,3%). Comparisons of hospital infection rates between different institutions are very difficult, but relatively low rate in our material and decreasing number of infections registered during consecutive years show that persistent and multifaceted prophylactic interventions can result in significant reduction of hospital infections also in patients wits contaminated surgical field.     

Is open surgery for head and neck cancers truly declining?

In the past two decades, major modifications in the way we treat head and neck cancers, due to advances in technology and medical oncology, have led to a decline in the use of open surgery as first-line treatment of cancers arising from several primary tumor sites. The incidence of tobacco- and alcohol-related squamous cell carcinoma of the pharynx and larynx has been steadily decreasing, with a rise in the incidence of human papillomavirus-related oropharyngeal tumors and the use of minimally invasive endoscopic surgery and non-surgical treatment modalities has increased in the treatment of all of these tumors. However, open surgery remains the initial definitive treatment modality for other tumors, including tumors of the skin, oral cavity, sinonasal cavities and skull base, salivary glands, thyroid and sarcomas. Selected group of nasal, paranasal, base of the skull and thyroid tumors are also candidates for minimally invasive procedures. For some indications, the rate of open surgery has actually increased in the past decade, with an increase in the incidence of oral cavity, thyroid and skin cancer, an increase in the number of neck dissections performed, and an increase in salvage surgery and free flap reconstruction. The use of minimally invasive, technology-based surgery—with the use of lasers, operating microscopes, endoscopes, robots and image guidance—has increased. Technology, epidemiology and advances in other domains such as tissue engineering and allotransplantations may further change the domains of competencies for future head and neck surgeons.     

Will the presence of the patient at multidisciplinary meetings influence the decision in head and neck oncology management?

Objectives: Multidisciplinary team meetings (MTM) are essential in the choice of a therapeutic strategy in head and neck cancer. In many centres patients attend MTMs and are examined by the team. The aim of this study was to assess the influence of the patient’s presence on therapeutic decisions.

Study design: Prospective study of 119 consecutive patients.

Methods: Two therapeutic situations were compared: the therapeutic decision taken following discussion of the patient’s file in the MTM (D1) and the therapeutic decision taken after examination of the patient during MTMs (D2). Concordance between the two situations was measured.

Results: Concordance between D1 and D2 was 97%. No factors likely to decrease concordance were identified. Decisions taken during MTMs were acted upon for 97% of the patients.

Conclusion: The presence of the patient during MTMs is not essential if the files are thoroughly presented and discussed.     

Castleman’s disease of the head and neck

Castlemans disease is an uncommon benign disease that causes progressive lymph node enlargement. We report 12 cases of Castlemans disease in the head and neck region in a retrospective review of the medical records of all patients with the pathological diagnosis of Castlemans disease during the period of 1993 through 2002. In the 12 patients, the neck was the most commonly involved site with 9 (75%) cases. Level III was the most common subsite (five cases). The most common sign in our study was an asymptomatic neck mass. No patient had any past histories that required medical attention. Preoperative work up such as fine-needle aspiration and radiographic study was not helpful for diagnostic confirmation. The histopathologic evaluation was the only way to make a definitive diagnosis. The histopathologic subtype of our study was hyaline-vascular type. Excision was curative for all cases. There was no evidence of recurrence with a minimum follow-up duration of 24 months.     

Nanomedicine in otorhinolaryngology: what does the future hold?

Nanotechnology and nanomedicine are new and rapidly developing areas which are concerned with the utilisation of structures and devices, one billionth of a metre in scale and how their special properties may be utilised in the diagnosis and treatment of diseases. In otorhinolaryngology, there have been some inroads into utilising these new treatment modalities and there is future prospect for significant developments. Their impact may be to revolutionise the current practice of otorhinolaryngology. This review considers current developments and future prospects for nanotechnology in our specialty and considers the pitfalls that may be encountered. The online medical reference databases PubMed, Google Scholar, ISI Web of Science and Science Direct were searched with search terms “Nanotechnology, Nanomedicine” in combination with “Otolaryngology, ENT, Rhinology, Otology, Head and Neck Surgery, Laryngology” in turn. A number of developments are already showing promise in animal models, particularly for nanoparticle delivery of drugs, which may avoid some of the inherent systemic side effects seen with conventional application. Other possibilities include nanoscale reconstruction and regeneration of tissues and even unexpected spin-off technologies such as haemostatic agents. The future treatment of otorhinolaryngological diseases could be revolutionised by advances in nanomedicine and nanotechnology and diseases, such as olfactory disorders may become radically more amenable to medical treatment.     

Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma?

Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.