Publication date: Available online 16 January 2019
Source: American Journal of Otolaryngology
Author(s): Ameya Jategaonkar, Jaclyn Klimczak, Jay Agarwal, Arvind Badhey, William M. Portnoy, Angela Damiano, Raymond L. Chai
Abstract
Objective
Syphilis is a sexually transmitted infection with various presentations. Although, oropharyngeal manifestations are known to occur, the purpose of this study is to present the first case series in which the lesions were initially mistaken for human-papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC).
Methods
A multi-institutional retrospective review.
Results
Six cases of oropharyngeal syphilis were initially thought to be secondary to OPSCC due to presentation. Symptoms were vague and exam findings consisted of either a tonsillar or base of tongue mass, or lymphadenopathy. Biopsies were negative for OPSCC. Further workup diagnosed syphilis, with resolution of symptoms and lesions after antibiotic treatment.
Conclusions
Head and neck manifestations of syphilis have been reported in the literature. However, this is the first series reporting on oropharyngeal syphilis masquerading as HPV-related OPSCC. Ultimately, otolaryngologists must maintain a high suspicion for syphilis in order to ensure prompt diagnosis and treatment.
Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympan...
In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where co...
Publication date: Available online 16 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Mosaad Abdel-Aziz, Mahmoud El-Fouly, Ahmed Nassar, Ahmed Kamel, Ahmed Kamel
Abstract
Objective
Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.
Methods
Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.
Results
Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern.
Conclusion
hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance.
Publication date: Available online 16 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Sureyya Hikmet Kozcu, Erhan Demirhan, İbrahim Çukurova
Abstract
Introduction
Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial.
Methods
Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively.
Results
Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications.
Conclusion
According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.
Publication date: Available online 16 January 2019
Source: Archives of Oral Biology
Author(s): Yago Leira, Ramón Iglesias-Rey, Noemí Gómez-Lado, Pablo Aguiar, Francisco Campos, Francesco D'Aiuto, José Castillo, Juan Blanco, Tomás Sobrino
Abstract
Objective
The aim of this investigation was to determine the circulating levels of amyloid beta (Aβ) peptides using the Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS) model to induce periodontitis.
Methods
Experimental periodontitis was induced in 6 male Sprague-Dawley rats. Alveolar bone loss was measure by micro computed tomography. Serum concentrations of Aβ1-40 and Aβ1-42 prior to periodontal induction, at 24 h, 7, 14, and 21 days the last injection of Pg-LPS.
Results
The distance between the cemento-enamel junction and the bone crest (i.e., alveolar bone loss) was significantly higher at the end of periodontal induction compared to baseline (2.92 ± 0.29 mm vs. 3.8 ± 0.28 mm, P < 0.001). Periodontitis evoked a slight acute elevation of Aβ1-40 serum levels that were maintained during the whole experiment. Aβ1-42 peptide levels peak at the end of the study. A positive strong correlation was observed between alveolar bone loss and Aβ1-40 serum levels at 7 days (r = 0.695, P = 0.012) and as well as with serum Aβ1-42 concentrations at 21 days (r = 0.968, P = 0.002).
Conclusions
Periodontitis induced Pg-LPS produced increased serum levels of Aβ peptides. Further studies are needed to confirm our results and to investigate the mechanisms by which periodontitis could be associated with an overexpression of Aβ.
Publication date: Available online 16 January 2019
Source: Archives of Oral Biology
Author(s): Farhan Shah, Per Stål, Jian Li, Barry J. Sessle, Limor Avivi-Arber
Abstract
Objective
to determine if tooth loss and dental implant placement in rats induce changes in the morphological and histochemical features of the Anterior Digastric muscle.
Design
Adult maleSprague-Dawley rats had their right maxillary molar teeth extracted. 'Extraction-1' and 'Extraction-2 groups were sacrificed, respectively, 4 ) or 8 weeks later, and an Implant group had an implant placement 2 weeks after the molar extraction, and rats were sacrificed 3 weeks later (n = 4/group). Naive rats (n = 3) had no treatment. Morphometric and immunohistochemical techniques quantified Anterior Digastric muscle myofibres' cross-sectional area (CSA) and myosin heavy chain (MyHC) isoform proportions. Significant ANOVAs were followed by post-hoc tests; p < 0.05 and 0.1 were considered to reflect levels of statistical significance.
Results
In naïve rats, the peripheral regions of the Anterior Digastric muscle dominated by MyHC-IIx/b isoform and there were no MyHC-I isoforms; the central regions dominated by MyHC-IIx/b and MyHC-IIa isoforms. Compared with naive rats, tooth extraction produced, 8 (but not 4) weeks later, a decreased proportion of fast-contracting fatigue-resistant MyHC-IIa isoform (p = 0.08), and increased proportion of fast and intermediate fatigue-resistance MyHC-IIa/x/b isoform (p = 0.03). Dental implant placement following tooth extraction attenuated the extraction effects but produced a decreased proportion of fast-contracting fatiguable MyHC-llx/b isoform (p = 0.03) in the peripheral region, and increased inter-animal variability in myofibre-CSAs.
Conclusions
Given the crucial role that the Anterior Digastric muscle plays in many vital oral functions (e.g., chewing, swallowing), these changes may contribute to the changes in oral sensorimotor functions that occur in humans following such treatments.
Assess the impact of a clinical pathway and progressive care unit (CPW/PCU) for patients undergoing head and neck free flap reconstruction with regard to patient outcomes and resource utilization.
Methods
Retrospective chart review of 270 patients at an academic tertiary‐care center (2009‐2014). Outcomes were compared among a control, CPW/PCU transition, and CPW/PCU groups.
Results
Compared to control, the CPW/PCU group had significantly reduced medical complications (21.1%‐4.1%), intensive care unit length of stay (LOS, 5.02‐0.2 days), hospital LOS (10.5‐6.2 days), standardized total charges ($88 270‐$58 661), and hospital costs ($41 365‐$22 680). There were no observed differences in flap viability, surgical complications, reoperations, or readmissions. The CPW/PCU group achieved 100% home discharge.
Conclusions
Our proposed CPW significantly improved patient outcomes and reduced resource utilization while maintaining flap outcomes. We propose a dynamic model for resource allocation that is easily reproducible in both academic and nonacademic settings.
The prognostic relevance of extranodal extension (ENE) for salivary gland carcinoma (SGC) remains unclear. The present study is undertaken to investigate the predictive significance of pathological nodal parameters in surgically treated patients with nodal metastatic SGC.
Methods
This multicenter cohort included 114 patients with pathologically proven node‐positive SGC between 2000 and 2014. Possible correlations of clinicopathological parameters and outcomes were examined.
Results
The median follow‐up was 69 months (range, 11‐173 months). The multivariate analysis identified metastatic node number (1‐2 vs 3‐6; 1‐2 vs ≥7) as an independent predictor for regional control (P = 0.005; P = 0.02), locoregional control (P = 0.008; P = 0.04), distant metastasis‐free survival (P = 0.17; P = 0.006), disease‐free survival (P = 0.05; P = 0.002), and overall survival (P = 0.18; P = 0.009), whereas ENE was not associated with survival outcomes.
Conclusions
Metastatic node number, not ENE, is an independent node‐related prognosticator for SGC. Integration of ENE into the American Joint Committee on Cancer 8th edition staging criteria may not improve prognostic performance.
This study's aim was to identify CD68 and stabilin‐1 expressions and their prognostic implications in patients with oral cavity cancer (OCC).
Methods
Stabilin‐1 and CD68 immunochemical staining was conducted in samples from patients with OCC who underwent curative surgery in our institute. We retrospectively analyzed patients' clinical information. We investigated the relationship between CD68 and stabilin‐1 expression levels and their effect on prognostic factors and survival.
Results
Fifty‐four patients' data were analyzed. CD68 and stabilin‐1 expressions were positively correlated (P = .008). CD68 and stabilin‐1 expressions were not correlated with other prognostic factors (eg, T classification or lymph node metastasis). Stabilin‐1 expression and tumor recurrence risk were positively correlated (P = .015). CD68 expression was neither associated with recurrence‐free nor OCC‐specific survival.
Conclusion
CD68 and stabilin‐1 expressions in OCC were positively correlated. Stabilin‐1 expression was significantly associated with OCC recurrence risk, but the prognostic value of CD68 was not confirmed.
To elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer.
Methods
A total of 27 717 oral cancers mainly from a population‐based visual inspection program in Taiwan from 2004 to 2009 was followed until the end of 2012.
Results
Using lip cancer as reference, the odds ratios (95% confidence interval [CI]) of advanced stage of cancer were 2.20 (1.92‐2.51) for tongue, 2.60 (2.28‐2.97) for buccal, 2.68 (2.20‐3.28) for floor of mouth, 2.96 (2.52‐3.47) for hard palate, 6.04 (5.17‐7.05) for gingiva, and 10.83 (9.20‐12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31‐1.67) in buccal, 1.61 (1.43‐1.82) in tongue, 1.68 (1.41‐1.99) in floor of mouth, 1.79 (1.57‐2.05) in gingiva, 1.97 (1.71‐2.26) in hard palate, and 2.15 (1.89‐2.45) in oropharynx.
Conclusion
Different anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.
The associations between malignant transformation of oral potentially malignant disorders (OPMDs), oral cancer development and prognosis, and apurinic/apyrimidinic endonuclease 1 (APE1) functional polymorphisms are unclear.
Methods
Patients with OPMDs, patients with oral cancer, and healthy controls from the community were recruited to determine the effects of APE1 polymorphisms on malignant transformation, overall survival, and genetic susceptibility, respectively.
Results
The APE1 Asp148Glu polymorphisms significantly correlated with a high hazard ratio for OPMD malignant transformation (adjusted hazard ratio [AHR] = 2.29; 95% confidence interval [CI] = 1.44‐3.74) and low overall survival in oral cancer patients (AHR = 1.71, 95% CI = 1.11‐2.56) according to follow‐up and survival analysis. However, APE1 polymorphisms did not significantly correlate with development of oral cancer in the case‐control study and logistic regression analysis.
Conclusions
These results indicate that APE1 Asp148Glu polymorphisms may have indirect roles in increasing the OPMD malignant transformation rate and in decreasing overall survival in oral cancer patients.
We aimed at identifying molecular markers predictive of clinical outcome in patients with head and neck cancer based on the expression profile of cells showing epithelial‐like (EL) or mesenchymal‐like (ML) phenotypes.
Materials and methods
We analyzed the association between EL and ML cells and migration, drug resistance, or tumor growth. The differential gene expression profile between cell types was used to build a model to stratify patients according to survival.
Results
EL cells were sensitive to cisplatin and cetuximab, showed low migration, and generated squamous differentiated tumors in mouse. A differential 93‐gene expression signature between ML and EL cells was used to build a three‐gene (EFS, GPX2, and SPRR1A) survival model by analyzing the RNA‐seq data of the TCGA‐HNSC project. Its prognostic value was confirmed in two independent cohorts.
Conclusion
EFS, GPX2, and SPRR1A are prognostic markers able to distinguish clinical outcome among subtypes sharing an EL phenotype.
Recently, nivolumab was approved in the second‐line setting of squamous cell cancer of the head and neck (SCCHN). The benefits of PD‐(L)1 inhibitors in PD‐L1(−) tumors are unclear, and no reports exist on the activity of these agents in brain metastases from SCCHN. Little is known regarding the mechanisms underlying acquired resistance to PD‐(L)1 inhibition.
Methods
A patient with PD‐L1(−) metastatic SCCHN progressing to cetuximab‐based chemotherapy received third‐line nivolumab. T cell infiltration and mRNA expression of immune‐related genes were compared in prenivolumab and postnivolumab biopsies from a progressing tumor lesion.
Results
An exceptional local and systemic response was achieved, including complete devitalization of brain metastases that lasted for more than a year. Increased T cell infiltration and upregulation of genes related to T cell exhaustion and resistance to PD‐1 inhibition were found.
Conclusion
Durable responses to PD‐(L)1 inhibitors may be observed in biomarker‐negative SCCHN. Mechanisms of resistance should be studied.
The objectives of this study are to determine the incidence and survival rate of patients with head and neck squamous cell carcinoma (HNSCC) with multiple primary tumors (MPT) in the HN‐region, lung, or esophagus.
Methods
Patient and tumor specific data of 1372 patients with HNSCC were collected from both the national cancer registry and patient records to ensure high‐quality double‐checked data.
Results
The total incidence of MPTs in the HN‐region, lung, and esophagus in patients with HNSCC was 11% (149/1372). Patients with lung MPTs and esophageal MPTs had a significant worse 5‐year survival than patients with HN‐MPTs (29%, 14%, and 67%, respectively, P < 0.001). The 5‐year survival rate for synchronous HN MPTs was only 25%, whereas it was surprisingly high for patients with metachronous HN MPT (85%, P < 0.001).
Conclusions
One of 10 patients with HNSCC develop MPTs in the HN‐region, lung, or esophagus. The 5‐year survival of patients with metachronous HN MPTs was surprisingly favorable.
In clinical trials of recurrent and metastatic head and neck carcinoma, Argiris et al have identified prognostic factors for overall survival (OS) and progression‐free survival (PFS), weight loss, Eastern Cooperative Oncology Group performance status (ECOG‐PS), tumor primary site, tumor differentiation, prior radiotherapy, deriving a two‐group prognostic classification. This study evaluates Argiris's classification in "field‐practice" patients.
Methods
The main analysis included 327 cases; a secondary analysis excluded 31 patients with oropharyngeal carcinoma (OPC) p16‐positive and/or human papilloma virus (HPV)‐positive. OS and PFS curves were estimated with the Kaplan‐Meier method; multivariable Cox analyses were also performed.
Results
In the full series, OS was significantly different in patients with 0‐2 and ≥3 adverse features (median, 14 vs 10 months; P = .03). PFS was statistically different in the two groups (median, 7 vs 5 months; P = .02). At a multivariable analysis investigating additional prognostic features, site of relapse and disease‐free interval were significant predictors of OS and PFS.
Conclusion
The Argiris's model was confirmed in a "field‐practice" population. Moreover, we found additional putative prognostic factors.
Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed.
Methods
Patients (n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin.
Results
Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time.
Conclusion
PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.
There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa‐based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care.
Methods
An observational study was conducted by emailing questionnaires to past fellows.
Results
All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care.
Conclusion
Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion.
We studied the relationship between trismus (maximum interincisor opening [MIO] ≤35 mm) and the dose to the ipsilateral masseter muscle (iMM) and ipsilateral medial pterygoid muscle (iMPM).
Methods
Pretreatment and post‐treatment measurement of MIO at 13 weeks revealed 17% of trismus cases in 83 patients treated with chemoradiation and intensity‐modulated radiation therapy. Logistic regression models were fitted with dose parameters of the iMM and iMPM and baseline MIO (bMIO). A risk classification tree was generated to obtain optimal cut‐off values and risk groups.
Results
Dose levels of iMM and iMPM were highly correlated due to proximity. Both iMPM and iMM dose parameters were predictive for trismus, especially mean dose and intermediate dose volume parameters. Adding bMIO, significantly improved Normal Tissue Complication Probability (NTCP) models. Optimal cutoffs were 58 Gy (mean dose iMPM), 22 Gy (mean dose iMM) and 46 mm (bMIO).
Conclusions
Both iMPM and iMM doses, as well as bMIO, are clinically relevant parameters for trismus prediction.
Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification.
Methods
Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure.
Results
The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5.
Conclusion
Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.
Increased detection of papillary thyroid cancer (PTC) has led to overtreatment of the largely indolent follicular variant (fvPTC). To guide management of non‐aggressive lesions, we investigated whether race predicts PTC variant and tumor behavior.
Methods
Analysis of 258 973 patients from the National Cancer Database diagnosed with PTC in 2004‐2014. Clinical and tumor information was compared by race. Multivariate logistic regression was used to predict fvPTC, extrathyroidal extension (ETE), and lymph node metastasis (LNM) of fvPTC.
Results
Blacks had the highest fvPTC rate (40% vs white 30%, Hispanic 26%, Asian 25%, P < .001). Blacks had higher odds of fvPTC (aOR = 1.33, 95% CI: 1.28‐1.37) and lower odds of ETE than whites (aOR = 0.90, 95% CI: 0.82‐0.99) (P < .001). Hispanics and Asians had lower odds of fvPTC (aOR = 0.89, 95% CI: 0.86‐0.92 and aOR = 0.81, 95% CI: 0.79‐0.84) and higher odds of LNM and ETE than whites (P < .001).
Conclusions
Racial disparities in fvPTC incidence and behavior should be considered to optimize diagnosis and treatment planning.
Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of malignant supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique with extension of the use of TORS to excise a laryngeal cyst.
Results
Laryngeal cyst resection, along with its tract, was accomplished with preservation of both false and true vocal cords. There was no perioperative or early postoperative complications. The patient was extubated immediately after surgery. Oral diet was initiated within 24 hours. No tracheostomy was required. A video demonstration of the surgical technique is included on Head & Neck's website.
Conclusion
TORS is a safe and feasible procedure for excision of selected laryngeal cysts.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289
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Abstract
Objectives
To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.
Design and Setting
This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.
Participants
We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.
Main outcome measures
We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.
Results
A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn's arc), but the sensitivities were all below 50%.
Conclusions
MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.
Salivary gland carcinomas (SGC) are rare malignancies and data regarding treatment outcomes stratified by histologic subtype are currently limited. This study aims to examine current, national treatment patterns and overall survival (OS) of patients with the major histologic subtypes of salivary gland carcinoma.
Subjects and methods
A review was performed of the National Cancer Database (NCDB) of patients with confirmed diagnoses of mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma, or carcinoma ex pleomorphic receiving curative treatment between 2004 and 2014. Univariate and multivariate regression modeling were performed to identify risk factors significantly associated with overall survival (OS). Adjusted survival analyses stratified by treatment and staging were performed with the primary outcome of overall survival (OS) and were further stratified based on histologic subtype.
Results
The final analysis included 7342 patients [3547 men (48.3%) and 3795 women (51.7%); mean age 58.3 years (range 18–90 years)]. Mucoepidermoid carcinoma was the most common histology encountered [n = 2669 (36.4%)]. Unadjusted and adjusted analysis demonstrated improved survival with surgery and radiation therapy (RT) for adenoid cystic (HR = 0.69; p = 0.029), adenocarcinoma (HR = 0.61; p < 0.001), high-grade mucoepidermoid carcinoma (HR = 0.70; p = 0.026), and carcinoma ex pleomorphic (HR = 0.64; p = 0.028), while surgery with chemoradiation therapy (CRT) was associated with worse OS regardless of histologic subtype. The impact of advanced stage on survival varied amongst the histologic subtypes but portended the worst prognosis for patients with adenocarcinoma and carcinoma ex pleomorphic.
Conclusions
The results of this NCDB review demonstrate unique treatment patterns and survival outcomes for SGC based on major histologic subtype.
In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.
Methods
We conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease.
De-identified patient information was acquired through TOH Data Warehouse and included a patient's sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission.
We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.
Results
The average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).
Conclusions
The estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.
Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity.
Methods
Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m2 at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5–4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE.
On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment.
For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5–14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables.
Results
Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz.
Conclusions
Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes.
Trial registration
ClinicalTrials.gov, NTC02281006, Registered 3 November 2014.
Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue, and cause sleep apnea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors.
Design
Retrospective case‐control study.
Setting
University‐based tertiary medical center.
Participants
Adult patients over 19‐years‐old who visited out‐patient clinics with complaints of sleep‐disordered breathing symptoms between January 2010 and December 2017 were investigated.
Main outcome measures
The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analyzed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway, and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analyzed.
Results
232 OSA patients with BMI less than 25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analyzed 138 patients of control group and 94 of torus mandibularis group. AHI was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (p=0.006). RDI was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (p=0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (p=0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnea, such as AHI (p=0.007) or RDI (p=0.034).
Conclusions
We newly found that the presence of torus mandibularis affects not only severity of OSA and also position dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome.
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Hemopatch (HE) advanced hemostatic pad composed of collagen and a synthetic, protein‐reactive monomer which polymerises on contact with protein containing body fluids such as blood and CSF to seal tissues.
HE is readily available which shortens the operating time, and may be manipulated intra‐nasally to reconstruct defects of the anterior skull base.
Reconstruction using HE reduces the morbidity compared with traditional facia lata graft harvesting techniques.
Length of stay and operative times might be decreased due to lower morbidity from donor site complications.
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With the intensification and utilization of multimodal treatment, acute toxicities have increased; however, the frequency of treatment sequelae in long‐term head and neck cancer (HNC) survivors are poorly described. The purpose of this analysis was to determine the prevalence and predictors of patient‐reported late and long‐term treatment‐related sequelae in HNC survivors.
Methods
We performed a cross‐sectional analysis of patient‐reported outcomes from 228 survivors attending a multidisciplinary HNC survivorship clinic. The primary outcomes comprised quality of life (QOL), symptoms of anxiety and depression, and swallowing dysfunction.
Results
Male gender, tumor sites in the oropharynx and larynx, longer time since treatment, and treatment with surgery alone were associated with higher physical QOL (P < .05). Male gender, longer time since treatment, and treatment with surgery alone were associated with higher social‐emotional QOL (P < .05). A reduction in anxiety symptoms and a higher QOL were related to longer time since treatment; however, a reduction in swallowing dysfunction symptoms was only related to longer time since treatment until approximately 6 years. After 6 years, survivors reported worse swallowing dysfunction (P < .05). One hundred thirty‐two survivors (56%) reported at least three treatment‐related effects that impacted their daily life. Finally, advanced stage disease at diagnosis (stage III–IV) was also associated with severe swallowing dysfunction (P = .004).
Conclusion
These data indicate the remarkable prevalence of treatment‐related effects in HNC survivors. These results highlight the need for de‐intensification of therapies, where appropriate, and for a better understanding of pathophysiology and new approaches to mitigating treatment effects.
Bei der Rhinoplasik werden postoperative periorbitale Ödeme und Ekchymosen v. a. durch die konventionelle nasale Osteotomie mit Hammer und Meißel verursacht. Möglicherweise führt die Piezochirurgie zu einem verbesserten frühpostoperativen Verlauf durch Schonung des Weichgewebes. Ziel dieser Arbeit war eine systematische Übersicht über Methoden und Ergebnisse von Studien zum Vergleich einer konventionellen mit einer piezoelektrischen Osteotomie.
Methoden
Es erfolgte eine systematische Literaturrecherche in den elektronischen Datenbanken PubMed/MEDLINE und Google Scholar. Bei der primären Selektion wurden alle Studien über den Vergleich konventioneller und piezoelektrischer Osteotomie hinsichtlich postoperativer periorbitaler Ödeme und/oder Ekchymosen erfasst. Die sekundäre Selektion umfasste nur Publikationen mit einer Kontrollgruppe.
Ergebnisse
Die primäre Selektion ergab 15 thematisch relevante Publikationen mit deutlicher Zunahme an jährlichen Veröffentlichungen zwischen 2007 und 2017. Es wurden 6 Studien mit Kontrollgruppen sekundär selektiert, die qualitativ und methodisch sehr heterogen waren. Die Ergebnisse von 5 der 6 Studien wiesen auf einen deutlichen Vorteil der Piezotechnik im Vergleich zur konventionellen Osteotomie hin. Nur in einer Studie wurde kein signifikanter Unterschied bezüglich des untersuchten Ergebnisses festgestellt.
Schlussfolgerung
Nach piezoelektrischer Osteotomie fand sich eine geringere Neigung zu postoperativer Ödembildung und Ekchymose als bei konventioneller Osteotomietechnik. Derzeit sollten die Ergebnisse als Trend interpretiert werden. Eine abschließende Empfehlung zur Überlegenheit einer Methode kann erst bei Vorliegen von mehr Studien mit größeren Patientenzahlen erfolgen.
The objectives of this study were to examine patient outcomes using a 36‐month age cutoff as a strict admission criterion following tonsillectomy, and review the safety and determine the plausibility of same‐day discharge of children under 3 years old following tonsillectomy.
Study Design
Retrospective chart review.
Methods
A chart review of patients aged 24 to 42 months undergoing tonsillectomy over a 3‐year period was conducted. Patients were stratified into <36 months and ≥ 36 months cohorts. Data collected included demographics, medical/sleep history, inpatient records, 30‐day emergency department visits, and readmission data. Bivariate comparisons were made using χ2 and Wilcoxon tests for categorical and continuous variables.
Results
Between July 2014 and July 2017, 427 patients aged 24 to 42 months underwent tonsillectomy at our institution. Thirty‐day emergency department visit, readmission, and greater‐than‐expected length of stay rates were 3.0% versus 3.7% (P = .75), 1.0 versus 1.8% (P = .61), and 4.7% versus 4.5% (P = 1.00) between the younger and older cohorts, respectively, with no difference in complication rates identified based on age.
Conclusions
No significant difference in adverse outcomes was appreciated based on a cutoff of 36 months of age at a tertiary center over 3 years. There should continue to be ongoing studies addressing strict age‐related admission criteria.
Publication date: Available online 14 January 2019
Source: American Journal of Otolaryngology
Author(s): Michael Chang, Alanna Coughran, Yu-Jin Lee, Jeremy Collins, Davud Sirjani
Abstract
Objective
To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).
Methods
A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center.
Results
Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1–2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free.
Conclusion
In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
Publication date: Available online 14 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Zernotti ME, Chiaraviglio MM, Mauricio SB, P.A. Tabernero, Zernotti M, M.F. Di Gregorio
Abstract
Objectives
The objective of this study is to evaluate the safety and efficacy of the transcutaneous Bone Conduction Implant, the Bonebridge, in patients with congenital aural atresia.
Methods
Audiometry, speech recognition test and free field audiometry were performed. Word recognition scores and speech perception was evaluated using Spanish phonetically-balanced disyllables word list.
Results
Fourteen subjects were implanted with the Bonebridge (seven bilateral placements). The study cohort comprised seven males and seven females aged from 3 to 17 years (mean age 9.76yrs). All patients accepted and benefited from the implanted Bonebridge system. The pre-operative PTA4 was 66.4 dB (64.2-68.6, 95-%CI) and improved after activation to 19.2 dB (16.9-21.5, 95%-CI), resulting in a mean functional gain of 48 dB. Regarding speech discrimination, the pre-operative outcomes of the disyllabic measurements were 34.3% and for monosyllables 27.4%. Following activation the speech discrimination improved to 98.6% and 97.9%, respectively. No infections or adverse device related effects occurred in patient group.
Conclusion
We have concluded that the Bonebridge implant is an innovative solution for patients with conductive or mixed hearing loss and unilateral loss suffering from congenital atresia. Different surgical techniques may be used for implant placement, based on the patient's anatomy. Studies show improved functional gain, better speech perception, and lower rates of percutaneous complications associated with this implant.
Publication date: Available online 14 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Jolien Faes, Steven Gillis
Abstract
Auditory brainstem implantation (ABI) is a recent technique in children's hearing restoration. Up till now the focus in the literature has mainly been the perceptual outcomes after implantation, whereas the effect of ABI on spoken language is still an almost unexplored area of research. This study presents a one-year follow-up of the volubility of two children with ABI. The volubility of signed and oral productions is investigated and oral productions are examined in more detail. Results show clear developmental trends in both children, indicating a beneficial effect of ABI on spoken language development.
The effect of concurrent endurance and resistance training on cardio-respiratory capacity and cardiovascular risk markers among sedentary overweight or obese post-menopausal women
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Anahita Shabani, Ramin Shabani, Setila Dalili, Afagh Hassanzadeh Rad DOI:10.4103/JNMS.JNMS_34_18
Context: Exercise training has been inversely associated with cardiovascular risk factors. However, the clinical trials examining the effect of exercise training on reducing cardiovascular risk factors have produced conflicting results. Aims: We aimed to assess the effect of concurrent exercise training on cardiorespiratory capacity and cardio-vascular risk factors among sedentary overweight or obese post-menopausal women. Settings and Design: This randomized controlled trial was done in 2016. Materials and Methods: This study was conducted on 22 healthy post-menopausal overweight and obese females, which randomly divided into concurrent endurance and resistance (ER) exercise (n = 12) and control (n = 10) groups. The participants did not have any history of any serious medical condition or using drugs. Demographic questionnaire was completed, vital signs and biochemical tests were measured, and Rockport one-mile submaximal exercise test for assessing maximal oxygen consumption (VO2max) was performed before and after the study. Statistical Analysis Used: Mean, standard deviation, and paired and independent t-test were used for statistical analysis. Results: The data from the ER groups showed that the body mass index (BMI), heart rate (HR), systolic and diastolic blood pressure, triglyceride, high-sensitivity C-reactive protein (CRP) decreased, high-density lipoprotein, and VO2max increased significantly, during the 8 weeks (P < 0.05). Moreover, no changes were found in the cardiovascular risk factors of women who did not exercise (P > 0.05). Conclusion: Concurrent ER training can be a suitable exercise program for improving plasma lipid profile as well as reducing body composition, high-sensitivity CRP, and increasing VO2max in postmenopausal women.
The effect of staff training on the amount of sound pollution in the intensive care unit
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Kobra Zamani, Hossein Ali Asgharnia, Jamshid Yazdani, Zohreh Taraghi DOI:10.4103/JNMS.JNMS_38_18
Context: Sound pollution is a common problem in intensive care units (ICUs) with unfavorable consequences.Aims: The aim of the current study was to determine the effect of staff training on the amount of sound pollution in the ICU. Setting and Design: This quasi-experimental study was conducted in the ICU of Rouhani Hospital in Babol. Materials and Methods: Level of equivalent (leq) sound was measured in three work shifts for 2 weeks, before and after training, in 2 workdays and a holiday, using a systematic network stationing method. The sample size was determined based on the days of measurement, work-shift, and measuring stations (6 × 3 × 10 = 180). Indirect training was performed. A 2-week opportunity was given to study materials. Statistical Analysis Used:Data were analyzed using paired t-test and RMANOVA. Results: Following the training, the mean leq in all stations (ten stations) decreased from 67.21 to 62.11 dB (P = 0.002). Conclusion: Although the amount of sound pollution decreased significantly after training, it was still higher than standard. To achieve the desired level of sound, continuous monitoring of sound at intervals of 6 months, along with structural engineering and equipment, is suggested.
Context: Recognizing effective interventions for improving women's positive emotion can improve mental health and self-confidence in anxious women, at least during pregnancy. Aim: This study aimed to investigate the effect of relaxation training on positive and negative emotions of primigravida women. Setting and Design: In this randomized quasi-experimental study, 100 primigravida women with gestational age of 28–32 weeks, who were referred to the prenatal care centers in Famenin City (Hamadan, Iran), were randomly assigned into two groups of intervention and control, using randomized blocking. Methods and Material: All the pregnant women completed the positive and negative affect schedule questionnaire. In the intervention group, eight sessions were held twice a week with emphasis on relaxation techniques. The control group received routine prenatal care.Statistical Analysis Used: Descriptive statistics, independent and paired t-tests were used to compare the difference between and within two groups. Results: The mean score of positive emotion increased from 31.92 ± 6.39 to 34.12 ± 5.41 after intervention (P = 0.034). In contrast, the mean score of positive emotion in the control group reduced from 33.62 ± 6.58 to 26.92 ± 6.35 after the intervention (P < 0.001). In addition, there was a significant difference between the mean scores of positive emotion in the two groups after the intervention (P < 0.001). The mean score of negative emotion reduced from 24.12 ± 7.06 to 17.18 ± 5.95 in the intervention group (P < 0.001). On the other hand, the mean score of negative emotion in the control group increased from 22.08 ± 6.85 to 28.42 ± 7.24 after the intervention (P < 0.001). There was a significant difference between the mean scores of negative emotion in the two groups after the intervention (P < 0.001). The mean score of positive emotion of the women increased after the intervention (from 31.92 ± 6.39 to 34.12 ± 5.41) (P = 0.034). In contrast, the mean score of positive emotion of the women in the control group reduced after the intervention (from 33.62 ± 6.58 to 26.92 ± 6.35) (P < 0.001). Also, the mean score of negative emotion reduced in the intervention group (from 24.12 ± 7.06 to 17.18 ± 5.95). On the other hand, the mean score of negative emotion of the women in the control group significantly increased after the intervention (from 22.08 ± 6.85 to 28.42 ± 7.24).Conclusion: Research findings suggest that relaxation training may increase positive emotion and reduced negative emotion in pregnant women. It is recommended that relaxation techniques are used in prenatal care centers as a simple and available health intervention in pregnancy.
Context: Parental education in sexuality plays a vital role in children's lives. Aims: The purpose of this study was to explore Iranian parents' perspectives about the needs of children sexuality education. Setting and Design: This qualitative study was done in 2016. Materials and Methods: In this qualitative inquiry, seven sessions of community group interview and focus group discussions were conducted with the parents of Ghaemshahr, Iran, using purposive sampling (n = 39, 27 mothers and 12 fathers). Statistical Analysis Used:We employed thematic analysis method to extract our findings. Results: The findings were categorized into three essential needs: (1) parents' preparedness, (2) efficacious parental management, and (3) supportive environments. The sub-theme describing the theme 1 includes "the need for adequate knowledge to answer the sexual questions and the child's sexual curiosity" and "the need for awareness about the time of beginning an appropriate sexuality education for children." Moreover, the sub-theme describing theme 2 includes "the need for sufficient skills to begin proper and intimate communication," "the need for effective monitoring and care," and "the need for capability in managing the child sexual behavior." Moreover, the sub-theme describing theme 3 includes "the need to receive training from sexual health professionals," "the need for authorized sexuality education programs," "the need for national-wide policy-making and strategy planning in sexuality education," and "the need for a comprehensive and complete educational resource." Conclusion: Our findings suggest that to address the goals in sexuality education for children, parents' need to be prepared in knowledge, and gaining positive attitude and practical skills. To achieve these goals, supportive environments must be provided by policy-makers and health providers with culturally appropriate strategy planning.
Context: The spread of HIV is growing, so that its way of transmission has created worries in the field of sexual and reproductive health, because the wave of transmission has changed from injection to sexual activities.Aims: To evaluate the perspectives of sexual and reproductive health experts and providers on strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health using the nominal group technique (NGT). Setting and Design: Mazandaran University of Medical Sciences, Sari, Iran. NGT. Materials and Methods: It was a semiquantitative/qualitative methodology research through NGT, based on the opinions of 30 experts and sexual and reproductive health providers in the field of health in Mazandaran (2016).Statistical Analysis Used: Semiquantitative/qualitative analysis. Results: In total, 15 cases got the scores of 2–62 as strategies to improve the integrated program of HIV/AIDS with sexual and reproductive health. The highest scores were found in society-centered level and stigma management, and the lowest scores were found in individual-centered level and negotiation skill training. Conclusion: One of the strategies to improve the integrated program of HIV/AIDS was the empowerment of women and men in sexual and reproductive health and stigma management. Based on the results, the NGT is a useful tool for doing researches and prioritizing the programs. Based on the expert opinion, it can be concluded that designing strategies based on individual-, community-, and society-centered approach would be an appropriate approach for improving the integrated program of HIV/AIDS with sexual and reproductive health issues in Iranian society.
Evaluation of occupational hazards for nurses in intensive care units of tertiary care centers
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Kobra Abdi Zarrini, Akram Sanagoo, Leila Jouybari, Mohammad Ali Vakili, Ali Kavosi DOI:10.4103/JNMS.JNMS_52_18
Context: Nursing is a high-risk occupation, and intensive care units (ICUs) are one of the most sensitive hospital wards. Aim: This study aimed to determine the level of occupational hazards among nurses in the ICUs. Setting and Design: This descriptive-analytical study was conducted on a total of 281 nurses in the ICUs of tertiary care centers in Golestan and Mazandaran Universities of Medical Sciences in 2017. Materials and Methods: Data were collected using a five-dimensional occupational hazard questionnaire. Statistical Analysis Used: Data analysis was performed in SPSS software (version 16) and descriptive and inferential statistics were considered statistically significant (P < 0.05). Results: In this study, 75.1% of the nurses were female and 50.9% of the participants were within the age range of 26–35 years. The total mean and standard deviation of occupational hazards was 3.20 ± 0.66. In addition, the mean values and standard deviations of chemical, ergonomic, biological, psychosocial, and organizational, as well as physical hazards were reported to be 2.43 ± 1.06, 2.6 ± 0.82, 2.63 ± 0.91, 3.38 ± 0.7, and 3.38 ± 0.86, respectively. According to the results, significant differences were observed between occupational hazards and variables of gender, marital status, educational level, and work experience (P = 0.0001). Conclusion: Occupational hazard level was moderate among nurses in the ICUs, and most of the damages were related to the physical dimension. In addition to holding educational workshops in tertiary care centers by the related officials, proper preventive plans must be designed to reduce occupational injuries.
Incidence and risk factors of pressure ulcers among general surgery patients
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Ensieh Ramezanpour, Amir Emami Zeydi, Mohammad Ali Heidari Gorji, Jamshid Yazdani Charati, Mahmood Moosazadeh, Vida Shafipour DOI:10.4103/JNMS.JNMS_23_17
Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score <15 (P = 0.017), type of surgery (P = 0.003), and type of anesthesia (P = 0.015).Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.
The relationship between the quality of nursing care and the satisfaction of pregnant mothers
p. 165
Ali Hatami, Zohreh Saeidlandi, Azam Jahanghiri Mehr, Akram Hemmatipour DOI:10.4103/JNMS.JNMS_44_18
Context: The Health System Development Plan is one of the key steps taken by the eleventh government to promote health services in the country. Aims: The aim of this study was to determine the relationship between the quality of nursing care and the satisfaction of pregnant mothers from the implementation of the health system development plan. Settings and Design: This research was an analytic cross-sectional study. The study population included 163 mothers who were hospitalized before delivery and 18 nurses from maternity sections who were selected by the census method during the 3 months of September 2017–November 2017. Material and Methods: The data collection tool was a demographic data form, quality patient care scale, and a researcher-made questionnaire on the satisfaction of hospitalized mothers in maternity sections of the implementation of the Health System Reform Plan. Statistical Analysis Used: Data were analyzed using descriptive statistics, Mann–Whitney test, and correlation coefficient in SPSS-16 software. Results: The results showed that the quality of care in nurses at the desired level (63%) and the satisfaction of mother maternity sections of the delivery system had a moderate level of implementation of the Health System Development Plan (56.3%). The results of Pearson's correlation test showed that there is a statistically significant relationship between the quality of nursing care and patient satisfaction (P = 0.001). Conclusions: The satisfaction of the mothers participating in the research was that the quality of nursing care was often modest after implementing the Health System Reform Plan.
The incidence of oropharyngeal squamous cell carcinoma is increasing with a growing proportion of diagnoses associated with human papillomavirus (p16 + OSCC), which generally confers a favorable prognosis. For...
Im Rahmen einer sanierenden Mittelohroperation werden vielerorts routinemäßige histologische Untersuchungen veranlasst, obwohl ein Mittelohrcholesteatom im Normalfall klinisch sicher diagnostiziert werden kann.
Ziel der Arbeit
Ermittlung der Übereinstimmung aus der Diagnose des Operateurs und der des Pathologen und Vergleich mit Literaturdaten. Überprüfung der Rate unerwarteter Diagnosen. Analyse der Kostenseite und Umfrage an deutschen HNO-Kliniken in Bezug auf die Handhabung der histologischen Untersuchung bei Cholesteatomverdacht.
Material und Methoden
Retrospektive Auswertung der Cholesteatomfälle der HNO-Klinik der Universitätsmedizin Mainz der Jahre 2010–2015. Deutschlandweite postalische Umfrage an HNO-Kliniken.
Ergebnisse
n = 449 Mittelohroperationen zur Sanierung eines Mittelohrcholesteatoms, davon n = 312 (69,5 %) Erstdiagnosen und n = 137 (30,5 %) Rezidivfälle. Eine histologische Untersuchung wurde in 78,6 % veranlasst. Bei Erstdiagnosen lag die Sensitivität der klinischen Einschätzung bei 97,9 %, die Spezifität bei 10 %, der positiv prädiktive Wert bei 96,3 % und der negativ prädiktive Wert bei 16,7 %. Bei Rezidiven zeigten sich Werte von 100 %, 40 %, 97,1 % und 100 %. Unerwartete maligne Befunde ergaben sich nicht. An 58,6 % der befragten deutschen HNO-Kliniken erfolgt eine routinemäßige histologische Untersuchung. Insgesamt 80 % der Befragten hielten dies für sinnvoll. Eine histologische Untersuchung kostete im Durchschnitt 14,06 €.
Schlussfolgerung
Intraoperativ besteht eine hohe Treffsicherheit bei der Diagnose Cholesteatom. Der Kostenfaktor der histologischen Untersuchung ist gering und sollte nicht Entscheidungsgrundlage sein. Die Ohrmikroskopie und die Erfahrung des Ohrchirurgen sollten den Ausschlag für die Entscheidung zur histologischen Untersuchung geben.
Publication date: Available online 14 January 2019
Source: Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jeffrey C. Rastatter, Jeffrey Leonard, Patrick C. Walz
Fibro-osseous lesions of the pediatric skull base are loosely associated group of bony lesions that are all uncommonly occurring clinical entities. Management differs significantly amongst the fibro-osseous lesions but clinical and radiographic presentation can overlap significantly. Fibro-osseous lesions include fibrous dysplasia, ossifying fibroma, osteoma, and aneurysmal bone cyst in addition to even less common lesions such as giant cell tumor of bone and osteosarcoma. In this chapter, the fibro-osseous lesions affecting the pediatric skull base will be reviewed with an emphasis on the clinical, radiographic, and management differences between diagnoses.
