The nature of the head and neck cancer

Summary Squamous cell carcinoma of the head and neck is a disease predominantly of males and is due to a variety of known environmental irritants, notably cigarette smoke. Dietary, viral and immunological factors may also be relevant. Head and neck squamous cancers express epidermal growth factor receptors and some show weak levels of oestrogen receptor activity, but a reliable serum marker of tumour burden remains to be identified. The prognosis is found to be less favourable in females, in those with advanced T stage, in association with multiple node involvement, especially where extracapsular spread is present and where the T4/T8 ratio is elevated. Administration of heterologous blood during therapy may also have an adverse effect on prognosis. Interested clinicians must remember that most cases are preventable. Correspondence to: A.G.D. Maran     

357例新生儿高胆红素血症发病相关因素探讨

目的：探讨新生儿高胆红素血症发病相关因素。方法：对３５７例新生儿高胆红素血症发病因素进行分析。结果：３５７例新生儿高胆占同期住院新生儿的５４．２％。轻度黄疸３６．４％，中度４３．７％，重度１９．９％。病因前３位依次为围产因素（４２．０％）、感染（２２．７％）、母乳性黄疸（１８．２％），其次为原因不明（９．２％）、其它因素（７．９％）。本组预后较佳，无胆红素脑病发生。结论：对高胆红素血症的早期干预提出４点意见。     

P-选择素和内皮素-1检测在腹水鉴别诊断中的价值

目的:通过检测不同病因腹水中P-选择素(P-selectin)和内皮素-1(ET-1)的含量,探讨其在鉴别腹水性质中的意义。方法:83例来自临床上已确诊病人的腹水标本,分为3组:结核组(21例),恶性肿瘤组(29)和肝硬化组(33例)。采用酶联免疫吸附法(ELISA)检测P-选择素水平,放免法检测ET-1含量。结果:结核性腹水P-selec-tin水平为(9.27±1.55)ng/L,肿瘤性腹水水平为(4.89±1.38)ng/L,肝硬化腹水水平为(2.21±1.44)ng/L。结核性腹水ET-1水平为(68.24±19.48)ng/L,肿瘤性腹水水平为(42.17±16.40)ng/L,肝硬化腹水水平为(22.46±16.77)ng/L,P-selectin和ET-1水平在结核性腹水中明显高于肿瘤性腹水(P<0.05)和肝硬化性腹水(P<0.01),两者水平在肿瘤性腹水和肝硬化腹水之间的也存在显著性差异(P<0.05)。结论:P-selectin和ET-1的表达与机体炎症反应被激活及肿瘤的侵袭与转移有关,故结核性及肿瘤性腹水中P-selectin和ET-1水平有不同程度的增高,P-selectin及ET-1水平可作为一种筛选手段,以初步鉴别腹水的性质。     

Validation and utilisation of a digital version of the survey instrument for natural history,Aetiology and Prevalence of Patellofemoral pain studies (eSNAPPS)

ObjectiveThis study validated the newly adapted electronic SNAPPS (eSNAPPS) against the original paper SNAPPS. Subsequently, the study estimated the prevalence of PFP in running participants and spectators attending three mass-participant running events in the United Kingdom by using the eSNAPPS tool.DesignThis study had two parts. Firstly, a validation of the original paper version of the SNAPPS tool. Secondly, if validation was achieved, eSNAPPS was used in a prevalence study.ParticipantsA convenience sample of running participants and spectators aged 18–40 years attending the mass participation running events.Main outcome measureThe 12-month prevalence of PFP.Results: eSNAPPS was valid in identifying those with PFP (ICC 0.99 for Overall agreement, p < 0.0001). In the prevalence study, a total of 1080 running participants and spectators completed the eSNAPPS. The overall prevalence of PFP was 17.4% (95%CI: 15.2%, 19.8%); 20.5% of males (16.5, 24.9) and 15.7% of females (13.1, 18.7) had PFP. Prevalence was 17.4% (15.2, 19.8) in spectators and 16.7% in running participants (14.5, 19.0).ConclusionThe overall PFP prevalence in this study was slightly smaller than those previously reported in the literature. Findings also show that there were similar prevalence estimates in spectators and running participants.     

Aetiology of severe mental retardation and further genetic analysis by high‐resolution microarray in a population‐based series of 6‐ to 17‐year‐old children

Aim: To investigate the prevalence, co‐morbidities and aetiologies of severe mental retardation (SMR) in a cohort of Swedish children and to further penetrate aetiologies in the group with undetermined causes by application of updated clinical‐genetic methods. Methods: The study was population‐based and included children living in the County of Halland in western Sweden in 2004 (born 1987–1998; 46 000 children). Patients were identified through habilitation centres, paediatric clinics and school health services. Patients with unclear prenatal aetiology were investigated with single nucleotide polymorphism (SNP)‐array. Results: Severe mental retardation was identified in 133 children from 132 families, corresponding to a prevalence of 2.9 per 1000 children. There were more males than females (90:43).The aetiology was prenatal in 82 (62%), perinatal in 14 (10%) and postnatal in 8 (6%). In 29 (22 %) children, mainly males with autism, the cause could not be related to the time of birth. In the prenatal group, genetic causes dominated, but still 23 children remained undiagnosed; in 5/19 of these patients, a diagnosis could be made after SNP‐array analysis. One or more associated neurological handicaps were found in more than half of the children. Conclusion: Prevalence and co‐morbidity were similar to previous Scandinavian studies. High‐resolution chromosomal micro‐array techniques are valuable diagnostic tools, reducing the number of patients with unexplained SMR.     

Epidemiologic changes in bloodstream infections in Andalucía (Spain) during the last decade

ObjectivesDuring the last decade, some changes in the epidemiology of invasive infections have been reported; however, specific studies with patient-level data are scarce. The aim of this study was to describe and evaluate the epidemiologic changes in bloodstream infections (BSI) during the last decade in Andalucía, Spain.MethodsData from two prospective cohorts of BSI in adults with the same methodology performed 10 years apart in 11 hospitals (eight tertiary and three community) in Andalucía, Spain, were compared; the 2006–7 cohort study was performed between October 2006 and March 2007, and the 2016–17 cohort study was performed between October 2016 and March 2017. Population-based incidence rates were calculated and extrapolated for 1 year. Relative risk ratios were calculated between the 2 periods. Multivariate analyses were performed by logistic regression.ResultsOverall, 1262 episodes of BSI were included, 563 (44.6%) in 2006–7 and 699 (55.3%) in 2016–17. Multivariate models selected the following changes in patients' features in 2016–17, after controlling for type of acquisition: higher age (odds ratio (OR) = 1.02; 95% confidence interval [CI] 1.01–1.03), lower urinary catheter (OR = 0.37; 95% CI, 0.26–0.48) and lower Pitt score (OR = 0.76; 95% CI, 0.71–0.82). Adjusted estimations considering patients' features and exposure to procedures showed a reduction in coagulase-negative staphylococci (OR = 0.47; 95% CI, 0.32–0.69), and an increase in Proteus spp. (OR = 3.12; 95% CI, 1.18–8.23) and Candida spp. (OR = 3.01; 95% CI, 1.03–8.86).ConclusionsWe found relevant epidemiologic changes in BSI in our area, including rates, frequency of acquisition types, changes in patient's profiles and aetiologic agents.     

Pediatric maxillofacial injuries and its management

BackgroundPediatric facial injuries are common due to children's high level of activity which gradually decreases as age advances. Main etiology in cases of pediatric age group are self-fall, sports related injuries, interpersonal violence and lastly road traffic accident. Pattern and management of facial fracture in pediatric age group is different to that of adult population.Material and methodsThis study included 87 patients who had facial injuries and who reported at dental institute RIMS, Ranchi over a period of three years from 2017 to 2020. Initial assessment diagnosis and management were given to the patients.ResultsSelf-fall accounted as the leading cause of fracture (47.1%). Most frequent age group with facial injuries were from 7 to 12 years age group (49.1%). Dentoalveolar pattern of facial fracture was most common accounting for (39.1%) followed by mandible fracture in 33.3%. Closed reduction of the fracture was the most common way of treatment. Open reduction and fixation was carried out in 3.4% patients.ConclusionSelf-fall was the main etiology in our study and younger age group patients were more involved. Conservative treatment are generally given to pediatric age group, with open reduction in few cases on the basis of displacement. Close monitoring and follow up is mandatory in these age group.     

Transient Granulomatous Inflammation of the Hand

We present a granulomatous inflammatory tumour of the hand in a fit 26-year-old man. The lesion resolved spontaneously within a month of presentation. Whilst the true nature of this inflammatory lesion remains unknown the case highlights the importance of thorough investigation of all deep-seated soft tissue tumours of the hand prior to committing a patient to surgery.     

Necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a neonatal surgical emergency with potentially devastating consequences. Pre-term infants of very low birth weight are most at risk with several genetic and environmental risk factors identified. The local microbial environment plays a key role in early life to help reduce the risk of NEC. Breast milk has also shown to be protective. The disease is characterized by infection, inflammation and ischaemia of the bowel that can extend from a small segment to most of its length. The diagnosis is made based on clinical, biochemical and radiological features with perforation the most widely accepted indication for surgery. When conservative management fails, a laparotomy is indicated with the aim of resecting necrotic bowel and preserving intestinal length. Complications include strictures, stoma morbidity, short-bowel syndrome and poor neurodevelopmental outcomes. Preventative strategies include the use of probiotics and encouraging the use of breast milk.