Carcinoma of the floor of the mouth: A 20-year experience

From 1955 to 1975, 116 patients with squamous cell carcinoma of the floor of the mouth were primarily treated by irradiation in the Department of Radiation Oncology, University of Maryland at Baltimore. Of these, 93 evaluable patients yielded loco-regional control rates of 83, 85, 42 and 21% for Stages I–IV, respectively. A palisading technique of radium needle implants was used, either alone or combined with external beam therapy, for early tumors (Stages I-II). Similar control rates were achieved by these two techniques: $\text{13}\text{14}$ for interstitial irradiation alone and $\text{16}\text{24}$ for combined interstitial and external irradiation. In selected early cases (Stages III), errors in staging were minimized by the systematic use of a needle biopsy of the submaxillary triangle for suspicious submaxillary swellings. Patients with early lesions and truly negative nodes (No) only received irradiation to the primary tumor bed. No subsequent nodal neck failures have occurred in 13 of such patients. The overall complication rate for the entire series was 1796 with only 8 patients requiring surgery. No differences in complication rates were found among the treatment modalities employed. The distribution of lymph nodal involvement by anatomical level, correlation of histological differentiation or tumor aggressiveness at presentation, the dosimetric analysis of the palisading interstitial technique, the spread and failure patterns and other observations are discussed.     

Doppler studies in normal kidneys of preterm and term neonates: changes in relation to gestational age and birth weight.

OBJECTIVE: The purpose of this study was to establish normative data for the flow velocity waveform indices of the renal arteries in the neonatal population and to evaluate the differentiation between birth weight and gestational age of neonates. METHODS: Color sonography was performed in 65 neonates on the fifth day of life. Mean flow velocity was assessed, and measurements of the systolic/diastolic velocity ratio, resistive index, and pulsatility index were performed by online calculation. RESULTS: All established values of renal arteries showed no significant differences in the right and left kidneys (P > .05). These values were not correlated with gestational age and birth weight (P > .05). CONCLUSIONS: Peak systolic velocity, systolic/diastolic velocity ratio, and resistive index and pulsatility index values remain stable despite gestational age or birth weight and not different between the right and left kidneys.     

A Closer Look at the Recurrent Laryngeal Nerve Focusing on Branches & Diameters: A Prospective Cohort Study

Aim: We aimed to investigate the anatomical characteristics of the recurrent laryngeal nerve (RLN) highlighting on its diameter and branching pattern. Materials and Methods: We prospectively collected 215 patients (178 female, 37 male) who underwent thyroid/parathyroid surgery during over a 2-year period. Apart from demographic features and surgical data, diameter of RLNs, and their branches and as well as branching distance (distance between the point of bifurcation and the laryngeal entry of RLN) were recorded. Results: In 215 patients, 378 RLNs were assessed and 42% (n = 159) bifurcated RLNs were observed. The bifurcation rate was similar on the right and left side(s) of the neck (40% and 44%, respectively; p = 0.47). In those, who underwent bilateral exploration, in the case of bifurcation on the first side of the neck, the possibility of contralateral bifurcation was approximately 50%, whereas this rate was found to be only 30% in those with nonbranching RLNs. Mean branching distance was 18 ± 9 mm, and it was similar on the right and left sides (17 and 19 mm, respectively). Approximately 80% of bifurcations were observed within 5–24 mm of the RLN. Mean diameter of the anterior branches was found to be significantly larger compared to posterior branches (1.09 ± 0.35 and 0.82 ± 0.36 mm, respectively; p < 0.01).Conclusions: There is great variability in RLN branching. We observed that approximately two out of three bifurcations were unilateral and anterior branches were thicker compared to posterior branches. These findings should be taken into consideration to avoid any damage to the RLN during thyroid and parathyroid surgery.     

Letter to the Editor: Single Dose Steroid Injection After Loss of Signal (LOS) During Thyroid Surgery is Effective to Recover Electric Signal Avoiding Vocal Cord Palsy and the Need of Staged Thyroidectomy: Prospective Evaluation on 702 Patients

World Journal of Surgery -     

Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

Purpose

To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs).

Methods

Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries. DA-HAIs were defined using criteria formulated by the Centers for Disease Control and Prevention. Country socioeconomic status was defined using World Bank criteria.

Results

Central-line-associated bloodstream infection (CLA-BSI) rates in NICU patients were significantly lower in private than academic hospitals (10.8 vs. 14.3 CLA-BSI per 1,000 catheter-days; p < 0.03), but not different in public and academic hospitals (14.6 vs. 14.3 CLA-BSI per 1,000 catheter-days; p = 0.86). NICU patient CLA-BSI rates were significantly higher in low-income countries than in lower-middle-income countries or upper-middle-income countries [37.0 vs. 11.9 (p < 0.02) vs. 17.6 (p < 0.05) CLA-BSIs per 1,000 catheter-days, respectively]. Ventilator-associated-pneumonia (VAP) rates in NICU patients were significantly higher in academic hospitals than in private or public hospitals [13.2 vs. 2.4 (p < 0.001) vs. 4.9 (p < 0.001) VAPs per 1,000 ventilator days, respectively]. Lower-middle-income countries had significantly higher VAP rates than low-income countries (11.8 vs. 3.8 per 1,000 ventilator-days; p < 0.001), but VAP rates were not different in low-income countries and upper-middle-income countries (3.8 vs. 6.7 per 1,000 ventilator-days; p = 0.57). When examined by hospital type, overall crude mortality for NICU patients without DA-HAIs was significantly higher in academic and public hospitals than in private hospitals (5.8 vs. 12.5%; p < 0.001). In contrast, NICU patient mortality among those with DA-HAIs was not different regardless of hospital type or country socioeconomic level.

Conclusions

Hospital type and country socioeconomic level influence DA-HAI rates and overall mortality in developing countries.     

Electrocardiographic Findings at Initial Diagnosis in Children with Isolated Left Ventricular Noncompaction

Background: The aim of this study was to comprehensively evaluate electrocardiographic (ECG) findings of isolated left ventricular noncompaction (IVNC) patients at initial diagnosis and to explore the correlation between them and the clinical, echocardiographic, and magnetic resonance imaging (MRI) findings. Methods: Twenty‐three patients diagnosed with IVNC by echocardiography and cardiac MRI between January 2006 and June 2010 were enrolled in this study. The patients were examined with standard ECG and 24‐hour Holter ECG. For comparison purpose, ECGs of 50 healthy children of similar ages and demographic characteristics were taken. Results: In 87% of patients, ECG abnormalities were found. The most frequently seen ECG findings were left ventricular hypertrophy, ST‐segment depression, and negative T wave related to abnormal repolarization particularly in DII, DIII, and V_4–6 leads, as well as prolonged PR and QTc intervals. No ECG features or patterns were found that were specific to the disease. In contrast to adult patients, while no intraventricular conduction defects (particularly in the left bundle brach) were found in any of our patients, 13% had considerable bradycardia and one required a pacemaker. The Holter ECG recordings showed supraventricular tachycardia attacks in two patients and a short ventricular tachycardia attack in one. Patients whose echocardiograms and MRI showed left ventricular systolic dysfunction and left ventricular dilatation had signs of left ventricular hypertrophy and repolarization abnormality on their ECGs, but there was no significant difference in PR, QRS, and QTc intervals. Conclusion: Regardless of how frequently left ventricular hypertrophy and repolarization abnormalities are found on IVNC patients’ initial ECGs, we think that they are not unique to the disease but are related to the severity of the cardiomyopathy. Ann Noninvasive Electrocardiol 2011;16(2):184–191     

Diagnostic imaging of the upper airway

Diagnostic imaging plays an essential role in the evaluation of disease processes that affect the upper airway. Imaging allows for the localization and characterization of various conditions that are often occult on physical examination. Plain radiography maintains a limited role in airway evaluation, whereas advanced imaging modalities, including computed tomography and magnetic resonance imaging, have emerged as indispensable tools in patient evaluation. Common disease entities affecting the upper airway in the adult population, including trauma, infectious/inflammatory diseases, and neoplastic diseases, as well as other common pathologic conditions are reviewed in this article.     

The frequency of infections in patients with juvenile idiopathic arthritis on biologic agents: 1-year prospective study

Clinical Rheumatology - The most effective and concurrently the safest treatment regimen selection is important to provide early control of juvenile idiopathic arthritis (JIA) and to have an...     

Glomerular hyperfiltration and albuminuria in children with sickle cell anemia

Early manifestations of sickle nephropathy include glomerular hyperfiltration and proteinuria, typically microalbuminuria. Over time, a subset of patients develops histologic changes, decreased glomerular filtration, and ultimately renal failure. This study was designed to determine the rate of glomerular hyperfiltration and prevalence of albuminuria in a cross-sectional analysis of untreated children with sickle cell anemia (SCA), and to identify correlates of both complications. Measured glomerular filtration rate (GFR) by plasma clearance of 99-technetium diethylenetriaminepentaacetate was compared to GFR estimates calculated from published formulas. Eighty-five children (mean age 9.4 ± 4.8 years) were studied; 76% had glomerular hyperfiltration with mean GFR = 154 ± 37 ml/min/1.73 m². GFR declined in teenage years and was significantly correlated with increased serum cystatin C levels and higher systolic blood pressure. Measured GFR had only modest correlations with GFR estimates (Pearson correlation coefficients ≤0.5). Albuminuria, usually microalbuminuria, occurred in 15.9% and was associated with higher diastolic blood pressure and lower white blood cell and absolute neutrophil counts. Cystatin C levels inversely reflect GFR changes and are associated with albuminuria; serial monitoring may provide a sensitive and accurate marker of nephropathy in children with SCA.