Sunday, June 27, 2021

Prognostic significance of human papillomavirus status and treatment modality in hypopharyngeal cancer

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Abstract

Background

Management of hypopharynx cancer is often extrapolated from larynx cancer. This report analyses treatment patterns and survival limited to hypopharynx cancer using the National Cancer Database (NCDB).

Methods

There are 9314 patients diagnosed with hypopharynx cancer between 2004 and 2016. The association between treatment modality and survival was analyzed using Kaplan–Meier survival curves and multivariable Cox regression.

Results

Five-year overall survival ranged from 45% for stage I to 21% for stage IVB. Treatment modality did not influence survival in stage I/II. For stage III/IV, chemoradiation and surgery + adjuvant therapy were equivalent. Surgery yielded improved survival for T4 disease. Human papillomavirus (HPV)-positive tumors were present in 21% and were associated with improved hazard ratio of death (0.60, p = <0.0001).

Conclusions

Survival is superior for T4 hypopharynx cancer managed with surgery, while treatment modality does not impact outcomes for other T-stages. HPV-positive tumors are associated with improved survival regardless of treatment.

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Endonasal access to lower cranial nerves: From foramina to upper parapharyngeal space

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Abstract

Lesions arising from the upper parapharyngeal space (UPPS) often involved the jugular foramen region (JFR), occasionally extending into the posterior cranial fossa. This study aims to investigate the surgical anatomy of the JFR and UPPS from the perspective of an expanded endoscopic approach (EEA), tracing the lower cranial nerves from their extracranial foramina to the UPPS. Six cadaveric specimens (12 sides) underwent a transpterygoid EEA to expose the JFR and UPPS. Distances from the medial pterygoid plate (MPP) to the internal carotid artery (ICA), hypoglossal canal (HC), and jugular tubercle (JT) were measured on anonymized Computed tomography angiography images previously obtained from 30 patients with pulsatile tinnitus. Full access to the JFR, and its medial, superior, and anterior aspects, could be adequately achieved via an EEA. Upon exiting the jugular foramen, the glossopharyngeal nerve courses posterior to the ICA, traveling inferiorly into the UPPS between ICA and IJ V. The vagus nerve is in close proximity to the hypoglossal nerve traveling posterior to the ICA. The accessory nerve courses lateral to the vagus nerve, running posterior to the IJV. The minimal distances from the MPP to ICA, HC, and JT were 2.52 ± 0.34, 2.86 ± 0.36, and 3.18 ± 0.33 cm, respectively. This anatomical study strongly suggests the feasibility of using an EEA to access to the medial, superior, and anterior aspects of the jugular foramen and the adjacent UPPS.

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Outcomes of primary radiotherapy with or without chemotherapy for advanced oral cavity squamous cell carcinoma: A systematic review

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Abstract

Background

Surgery with adjuvant radiotherapy is the accepted standard for treatment of advanced oral cavity squamous cell carcinoma (OCSCC); however, alternative evidence suggests that definitive (chemo)radiotherapy may have similar outcomes.

Methods

Systematic review was performed to assess the therapeutic value of radiotherapy or chemoradiotherapy as a primary modality for treating OCSCC. Meta-analysis of outcomes was performed between articles comparing radiotherapy and primary surgical treatment.

Results

Meta-analysis showed less favorable results of radiotherapy compared to surgery: overall survival at 3-years (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.34–0.77) and 5-years (OR = 0.42; 95% CI = 0.29–0.60); disease-specific survival at 3-years (OR = 0.55; 95% CI = 0.32–0.96) and 5-years (OR = 0.55; 95% CI = 0.32–0.96). Odds of feeding tube dependency were higher in primary radiotherapy group (OR = 2.67; 95% CI = 1.27–5.64).

Conclusions

Results of this study support the current perspective favoring primary surgical treatment for OCSCC in the absence of surgical contraindications.

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Evaluation of Triclosan-induced reproductive impairments in the accessory reproductive organs and sperm indices in the mice

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Acta Histochem. 2021 Jun 21;123(5):151744. doi: 10.1016/j.acthis.2021.151744. Online ahead of print.

ABSTRACT

Highly effective antimicrobial properties of triclosan (TCS) make its use as a widely used preservative in different types of consumer products. TCS is reported as an emerging endocrine disruptor causing reproductive impairments in the males as well as in the females. The present study describes the adverse effects of various doses of TCS (40, 80, 160 and 320 mg/kg B W/day, for 42 consecutive days) on the weights and histopathology of the epididymis and seminal vesicle, sperm indices (motility, viability, count and morphology), concentrations of epididymal sialic acid and seminal vesicular fructose, along with TCS accumulated in these accessory reproductive organs of the laboratory mouse. TCS induced significant reductions in the weights of the epididymis and seminal vesicle along with noticeable histopathological alterations in these organs. TCS caused significant reductions in the count, percentage of motile and viable spermatozoa while a significant increase in the percentage of abnormal spermatozoa in the epididymis. Concentrations of epididymal sialic acid and seminal vesicular fructose declined significantly in the treated mice. A significant increase was noticed in the concentration of TCS, accumulated in the epididymis and seminal vesicle following TCS exposure at a high dose (320 mg/kg BW/day). The results thus suggest that the accessor y sex organs are also affected deleteriously following TCS exposure, leading to impairment in the male reproductive health.

PMID:34166923 | DOI:10.1016/j.acthis.2021.151744

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Modulating Thyroid Hormone Levels in Adult Mice: Impact on Behavior and Compensatory Brain Changes

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Thyroid hormone (TH) perturbation is a common medical problem. Because of substantial public health impact, prior researchers have studied hyper- and hypothyroidism in animal models. Although most prior research focused on in utero and/or developmental effects, changes in circulating TH levels are commonly seen in elderly individuals: approximately 20% of persons older than 80 years have clinically impactful hypothyroidism and up to 5% have clinical hyperthyroidism, with women being more often affected than men. TH disease model methodology in mice have varied but usually focus on a single sex, and the impact(s) of TH perturbation on the adult brain are not well understood. We administered thyroxine to middle-aged (13 to 14 months) male and female mice to model hyperthyroidism and TH-lowering dru gs propylthiouracil (PTU) and methimazole, to induce hypothyroidism. These pharmacological agents are used commonly in adult humans. Circulating TH-level changes were observed when thyroxine was dosed at 20 µg/mL in drinking water for two weeks. By contrast, PTU and methimazole did not elicit a consistent reproducible effect until two months of treatment. No substantial changes in TH levels were detected in brain tissues of treated animals; however, pronounced changes in gene expression, specifically for TH-processing transcripts, were observed following the treatment with thyroxine. Our study indicated a robust compensatory mechanism by which the brain tissue/cells minimize the TH fluctuation in CNS by altering gene expression. Neurobehavioral changes were related to the TH perturbation and suggested potential associations between cognitive status and hyper- and hypothyroidism.
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Systemic bevacizumab as adjuvant therapy for recurrent respiratory papillomatosis in children: A series of three pediatric cases and literature review

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Publication date: September–October 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 5

Author(s): Ortiz H. Enrique, Sanchez H. Eloy, Trujillo P. Adrian, Villamor Perla

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ENT Telephone Clinics During the Coronavirus Pandemic: An Analysis of 400 Telephone Consultations at a District General Hospital

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Ear Nose Throat J. 2021 Jun 25:1455613211028091. doi: 10.1177/01455613211028091. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to the introduction of telephone consultations in order to provide specialist health care remotely. This study analyses the outcomes of ear, nose, and throat (ENT) telephone consultations.

METHODS: Retrospective analysis was undertaken of 400 ENT telephone consultations.

RESULTS: All 2-week-wait neck or face lump p atients underwent imaging and 78% were successfully discharged. 80% of vertigo patients and 100% of 2-week-wait throat symptom patients were offered face-to-face consultations. All primary hyperparathyroidism patients were managed remotely, being discharged, or with telephone follow-up. The majority of routine referrals were managed without the need for face-to-face consultation.

CONCLUSION: Vertigo patients and 2-week-wait throat symptom patients should be offered a face-to-face consultation in the first instance. For patients with neck or face lumps, initial referral for imaging may improve patient flow and facilitate safe discharge. It is appropriate to continue with telephone consultations for all other patient groups.

PMID:34167356 | DOI:10.1177/01455613211028091

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Colon Cancer With Metastatic Involvement of the Thyroid Incidentally Found at Excision of Parathyroid Adenoma

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Ear Nose Throat J. 2021 Jun 25:1455613211028060. doi: 10.1177/01455613211028060. Online ahead of print.

ABSTRACT

Metastatic disease from primary colon cancer in the thyroid is rare. The authors have submitted such a case. What makes this case particularly unusual is that it was in a man. 80% of such cases are in women. It has been speculated that there may be a humoral component. What is even more unique in this case is that it was found during the workup of a symptomatic pa rathyroid adenoma. The diagnosis was confirmed with immunochemistry using markers Cytokeratin 20 (CK20), Cytokeratin 7 (CK7), and Thyroid Transcription Factor 1 (TTF-1) .

PMID:34167381 | DOI:10.1177/01455613211028060

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An Unusual Case of Stubborn Petrified Pinna

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Ear Nose Throat J. 2021 Jun 25:1455613211028087. doi: 10.1177/01455613211028087. Online ahead of print.

ABSTRACT

Petrified pinna is clinically characterized by an unbending rigid stone hard ear. Usually, the majority of the patients are asymptomatic but occasionally may experience pain from local pressure while sleeping. This uncommon condition is reported to be in association with local trauma, hypothermia, inflammation, and several life-threatening endocrine and systemic d iseases. Awareness and knowledge to identify this entity is essential as it might be helpful in treating several systemic conditions and thus any untoward events.

PMID:34167342 | DOI:10.1177/01455613211028087

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Effects of long-term azithromycin therapy on auditory functions in children with chronic respiratory diseases

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Publication date: August 2021

Source: International Journal of Pediatric Otorhinolaryngology, Volume 147

Author(s): Hakan Yazan, Ayse Ayzit Kilinc, Remzi Dogan, Ozge Gedik, Lina Muhammed Al Shadfan, Meliha Basoz, Orhan Ozturan, Erkan Cakir

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Effects of quinolone and poloxamer otic suspension on rat tympanic membranes

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Publication date: August 2021

Source: International Journal of Pediatric Otorhinolaryngology, Volume 147

Author(s): Carolyn O. Dirain, Patrick J. Antonelli

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Buccal fat pad to improve velum competency after transoral lateral oropharyngectomy

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Publication date: Available online 24 June 2021

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): O. Laccourreye, F.C. Holsinger, G.S. Weisntein

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