Sensorineural Hearing Loss in Cholesteatoma.

Sensorineural Hearing Loss in Cholesteatoma.

Otol Neurotol. 2016 Jan 20;

Authors: Rosito LS, Netto LS, Teixeira AR, da Costa SS

Abstract
OBJECTIVE: To determine whether middle ear cholesteatoma is associated with, sensorineural hearing loss, and whether patient age, cholesteatoma growth pattern, or, air bone gap size contribute to inner ear impairment.
STUDY DESIGN: Cross-sectional comparative.
SETTING: A tertiary hospital.
PATIENTS: The subjects were 115 patients with middle ear cholesteatoma in one ear, and normal video-otoscopy in the contralateral ear (CLE).
INTERVENTIONS: Otoendoscopy, pure-tone audiometry.
MAIN OUTCOME MEASURES: Bone conduction (BC) threshold differences between the normal CLE and the cholesteatoma ear. Comparisons of these differences between different cholesteatoma growth patterns. Correlation between the air bone gap size in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears.
RESULTS: The cholesteatoma ear was associated with greater BC thresholds than the CLE. With regard to different cholesteatoma growth patterns, the differences between associated BC thresholds were also significant in all groups at all frequencies, with the exception of the two routes of cholesteatoma group at 500 Hz. Comparing BC threshold differences, they were greater in the adult group at 500 Hz. The correlation between the air bone gap media in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears was direct and moderate.
CONCLUSION: Cholesteatoma was associated with greater BC thresholds at all frequencies tested. The differences were independent of cholesteatoma growth patterns. As bigger the air bone gap in the ear with cholesteatoma, greater the inner ear damage.

PMID: 26808554 [PubMed - as supplied by publisher]

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Lower facial reanimation techniques following cancer resection and free flap reconstruction.

Lower facial reanimation techniques following cancer resection and free flap reconstruction.

Laryngoscope. 2016 Jan 25;

Authors: Kejner AE, Rosenthal EL

Abstract
OBJECTIVES/HYPOTHESIS: Evaluate outcomes of the standard static sling and orthodromic temporalis tendon transfer reanimation for facial nerve paralysis.
STUDY DESIGN: Retrospective case series at a tertiary care hospital of head and neck cancer patients with facial nerve palsy secondary to malignancy or resection.
METHODS: From 2004 to 2014, patients undergoing resection of malignancy that involved facial nerve palsy requiring facial reanimation were identified. All procedures were performed by the senior author (e.l.r.). Demographics, methods, revision rates, combination with other procedures, and complications were evaluated.
RESULTS: A total of 77 patients underwent 92 procedures, with two patients requiring more than one revision, for a total of 20 revisions. Average time to revision was 9 months. Age, sex, race, side of repair, paralysis prior to procedure, sling type or method, timing of procedure, and radiation therapy were not significantly different between those requiring revision and those who did not. There was no difference in complications between patients who received radiation and those who did not (P = .5), nor between static versus orthodromic temporalis muscle transfer (P = .5). Complication rate was low at 5.4%.
CONCLUSIONS: Sling procedures can be successfully performed in patients with facial nerve palsy secondary to cancer resection with radiation therapy, with a low revision rate and few complications.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2015.

PMID: 26808491 [PubMed - as supplied by publisher]

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Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Minami K, Haji T

Abstract
Conclusion Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis. Objective HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT. Methods Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy. Results Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.

PMID: 26808464 [PubMed - as supplied by publisher]

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Meta-Analyses of Microarray Datasets Identifies ANO1 and FADD as Prognostic Markers of Head and Neck Cancer.

Meta-Analyses of Microarray Datasets Identifies ANO1 and FADD as Prognostic Markers of Head and Neck Cancer.

PLoS One. 2016;11(1):e0147409

Authors: Reddy RB, Bhat AR, James BL, Govindan SV, Mathew R, Dr R, Hedne N, Illiayaraja J, Kekatpure V, Khora SS, Hicks W, Tata P, Kuriakose MA, Suresh A

Abstract
The head and neck squamous cell carcinoma (HNSCC) transcriptome has been profiled extensively, nevertheless, identifying biomarkers that are clinically relevant and thereby with translational benefit, has been a major challenge. The objective of this study was to use a meta-analysis based approach to catalog candidate biomarkers with high potential for clinical application in HNSCC. Data from publically available microarray series (N = 20) profiled using Agilent (4X44K G4112F) and Affymetrix (HGU133A, U133A_2, U133Plus 2) platforms was downloaded and analyzed in a platform/chip-specific manner (GeneSpring software v12.5, Agilent, USA). Principal Component Analysis (PCA) and clustering analysis was carried out iteratively for segregating outliers; 140 normal and 277 tumor samples from 15 series were included in the final analysis. The analyses identified 181 differentially expressed, concordant and statistically significant genes; STRING analysis revealed interactions between 122 of them, with two major gene clusters connected by multiple nodes (MYC, FOS and HSPA4). Validation in the HNSCC-specific database (N = 528) in The Cancer Genome Atlas (TCGA) identified a panel (ECT2, ANO1, TP63, FADD, EXT1, NCBP2) that was altered in 30% of the samples. Validation in treatment naïve (Group I; N = 12) and post treatment (Group II; N = 12) patients identified 8 genes significantly associated with the disease (Area under curve>0.6). Correlation with recurrence/re-recurrence showed ANO1 had highest efficacy (sensitivity: 0.8, specificity: 0.6) to predict failure in Group I. UBE2V2, PLAC8, FADD and TTK showed high sensitivity (1.00) in Group I while UBE2V2 and CRYM were highly sensitive (>0.8) in predicting re-recurrence in Group II. Further, TCGA analysis showed that ANO1 and FADD, located at 11q13, were co-expressed at transcript level and significantly associated with overall and disease-free survival (p<0.05). The meta-analysis approach adopted in this study has identified candidate markers correlated with disease outcome in HNSCC; further validation in a larger cohort of patients will establish their clinical relevance.

PMID: 26808319 [PubMed - as supplied by publisher]

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Validation of a French-Language Version of the Spatial Hearing Questionnaire, Cluster Analysis and Comparison with the Speech, Spatial, and Qualities of Hearing Scale.

Validation of a French-Language Version of the Spatial Hearing Questionnaire, Cluster Analysis and Comparison with the Speech, Spatial, and Qualities of Hearing Scale.

Ear Hear. 2016 Jan 20;

Authors: Moulin A, Richard C

Abstract
OBJECTIVES: To validate a French-language version of the spatial hearing questionnaire (SHQ), including investigating its internal structure using cluster analysis and exploring its construct validity on a large population of hearing-impaired (HI) and normal-hearing (NH) subjects, and to compare the SHQ with the speech, spatial, and qualities of hearing scale (SSQ) in the same population.
DESIGN: The SHQ was translated in accordance with the principles of the Universalist Model of cross-cultural adaptation of patient-reported outcome instruments. The SSQ and SHQ were then presented in a counterbalanced order, in a self-report mode, in a population of 230 HI subjects (mean age = 54 years and pure-tone audiometry [PTA] on the better ear = 28 dB HL) and 100 NH subjects (mean age = 21 years). The SHQ feasibility, readability, and psychometric properties were systematically investigated using reliability indices, cluster, and factor analyses and multiregression analyses. SHQ characteristics were compared both to different literature data obtained with different language versions and to the SSQ scores obtained in the same population.
RESULTS: Internal validity was high and very good reproducibility of scores and intersubject variability were obtained across the 24 items between the English and French SHQ for NH subjects. Factor and cluster analyses concurred in identifying five correlated factors, corresponding to several SHQ subscales: (1) speech in noise (corresponding to SHQ subscales 7 and 8), (2) localization of voice sounds from behind, (3) speech in quiet (corresponding to SHQ subscale 1), (4) localization of everyday sounds, and (5) localization of voices and music (corresponding to parts of the SHQ localization subscale). Correlations between SSQ subscales and SHQ factors identified the greatest correlations between SHQ factors 2, 4, and 5 and SSQ spatial subscales, whereas SHQ factor 1 had the greatest correlation with SSQ_speech. SHQ and SSQ scores were similar, whether in NH subjects (8.5 versus 8.4) or in HI subjects (6.6 for both), sharing more than 80% of variance. The SHQ localization subscale gave similar scores as the SSQ spatial subscale, sharing more than 75% of variance. Construct validity identified better ear PTA and PTA asymmetry as the two main predictors of SHQ scores, to a degree similar to that seen for the SSQ. The SHQ was shorter, easier to read and less sensitive to the number of years of formal education than the SSQ, but this came at a cost of ecological validity, which was rated higher for the SSQ than for the SHQ.
CONCLUSIONS: A comparison of factor analysis outcomes among the English, Dutch, and French versions of the SHQ confirmed good conceptual equivalence across languages and robustness of the SHQ for use in international settings. In addition, SHQ and SSQ scores showed remarkable similarities, suggesting the possibility of extrapolating the results from one questionnaire to the other. Although the SHQ was originally designed in a population of cochlear implant patients, the present results show that its usefulness could easily be extended to noncochlear-implanted, HI subjects.

PMID: 26808287 [PubMed - as supplied by publisher]

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HPV prevalence in HIV patients with head and neck squamous cell carcinoma.

HPV prevalence in HIV patients with head and neck squamous cell carcinoma.

AIDS. 2016 Jan 23;

Authors: Picard A, Badoual C, Hourseau M, Halimi C, Pere H, Dib F, Barry B, Albert S

Abstract
OBJECTIVE: The implication of HPV in head and neck squamous cell carcinoma (HNSCC) is well established, especially in oropharyngeal SCC. HIV patients have a higher risk of persistent HPV infection. We investigated the role of HPV in HNSCC carcinogenesis in HIV population.
DESIGN: Retrospective monocentric study.
METHODS: We studied HIV patients who presented with HNSCC between 1994 and 2014. For each patient, tumor characteristics, HIV disease and survival information were collected. Tumor HPV testing was performed using p16 immunohistochemistry, in situ hybridation and PCR. We assessed the percentage of HPV in this population of HIV patients with HNSCC and compared HIV disease characteristics based on HPV status.
RESULTS: Forty seven patients were included: 11 women/36 men, the median age was 50 years. Tumor HPV testing was performed in 40 patients. Tumors were located in oropharynx (32%), oral cavity (32%), larynx (21%) and hypopharynx (11%). At the time of diagnosis, median CD4 level was 385/mm, 31% of the patients were stage CDC C. The percentage of HPV linked to HNSCC for all locations in HIV patients was 30% (n = 12). HPV16 accounted for 50% of all HPV genotypes. HPV positive status was associated with a CD4 nadir of less than 200 (p = 0.026), but not with CD4 level at time of diagnosis (p = 0.414). HPV negative tumors tend to be associated with poorer 5-year overall survival (HR = 2.9, p = 0.0711).
CONCLUSION: HPV plays a critical role in HNSCC development in HIV population. HIV immunodeficiency may increase HPV persistence and progression of HNSCC.

PMID: 26807970 [PubMed - as supplied by publisher]

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Interaction between osseous and non-osseous vibratory stimulation of the human cadaveric head.

Interaction between osseous and non-osseous vibratory stimulation of the human cadaveric head.

Hear Res. 2016 Jan 22;

Authors: Sim JH, Dobrev I, Gerig R, Pfiffner F, Stenfelt S, Huber AM, Röösli C

Abstract
Bone conduction (BC) stimulation can be applied by vibration to the bony or skin covered skull (osseous BC), or on soft tissue such as the neck (non-osseous BC). The interaction between osseous and non-osseous bone conduction pathways is assessed in this study. The relation between bone vibrations measured at the cochlear promontory and the intracranial sound pressure for stimulation directly on the dura and for stimulation at the mastoid between 0.2 - 10 kHz was compared. First, for stimulation on the dura, varying the static coupling force of the BC transducer on the dura had only a small effect on promontory vibration. Second, the presence or absence of intracranial fluid did not affect promontory vibration for stimulation on the dura. Third, stimulation on the mastoid elicited both promontory vibration and intracranial sound pressure. Stimulation on the dura caused intracranial sound pressure to a similar extent above 0.5 kHz compared to stimulation on the mastoid, while promontory vibration was less by 20-40 dB. From these findings, we conclude that intracranial sound pressure (non-osseous BC) only marginally affects bone vibrations measured on the promontory (osseous BC), whereas skull vibrations affect intracranial sound pressure.

PMID: 26807795 [PubMed - as supplied by publisher]

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Influence of geometry and materials on the axial and torsional strength of the head-neck taper junction in modular hip replacements: A finite element study.

Influence of geometry and materials on the axial and torsional strength of the head-neck taper junction in modular hip replacements: A finite element study.

J Mech Behav Biomed Mater. 2016 Jan 7;60:118-126

Authors: Fallahnezhad K, Farhoudi H, Oskouei RH, Taylor M

Abstract
The assembly force is important in establishing the mechanical environment at the head-neck taper junction of modular hip replacements. Previous experimental results of the assembled taper junctions with different material combinations (Co-28Cr-6Mo and Ti-6Al-4V) reported similar axial strengths (pull-off loads), but lower torsional strengths (twist-off moments) for the CoCr/CoCr junction. However, mechanics of the junction and the strength behaviour have not been understood yet. A three dimensional finite element model of an isolated femoral head-neck junction was developed to explore the assembly and disassembly procedures, particularly the axial and torsional strengths for different material combinations and geometries. Under the same assembly load, the contacting length between the CoCr head and titanium neck was greater than that of in CoCr/CoCr. The contact length in the titanium neck was more sensitive to the assembly force when compared to the CoCr neck. For instance, with increasing the assembly force from 1890 to 3700N, the contact length increased by 88% for CoCr/Ti and 59% for CoCr/CoCr junctions. The torsional strength of the junction was related to the lateral deformation of the neck material due to the applied moment. The angular mismatch existing between the head and neck components was found to play the main role in the torsional strength of the junction. The smaller mismatch angle the higher torsional strength. It is suggested to consider reducing the mismatch angle, particularly in CoCr/CoCr junctions, and ensure a sufficiently high assembly force is applied by impaction for this combination.

PMID: 26807768 [PubMed - as supplied by publisher]

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Vascular anomalies of the head and neck in children.

Vascular anomalies of the head and neck in children.

Quant Imaging Med Surg. 2015 Dec;5(6):886-97

Authors: Mahady K, Thust S, Berkeley R, Stuart S, Barnacle A, Robertson F, Mankad K

Abstract
Sixty percent of vascular anomalies in children are found in the head and neck. These lesions can present throughout antenatal, perinatal and childhood development. They broadly fall into two categories: vascular tumours and vascular malformations. Their clinical and, often, psychological impact is determined by both pathological type and location: many lesions follow an uncomplicated natural course and other more complex, extensive or progressive lesions can present a threat to life from mass effect, haemorrhage or large volume arteriovenous shunting. Vascular tumours include infantile haemangioma (IH), congenital haemangioma (CH) and kaposiform hemangioendothelioma (KH); of which IH is the most common. Management options for vascular tumours include conservative approaches, oral medications and surgical intervention as determined by tumour type, location and associated complications. Vascular malformations can be categorised into low flow and high flow lesions. Low flow lesions include capillary, venous and lymphatic malformations (LMs). High flow lesions describe the arteriovenous malformations (AVMs), a highly heterogeneous group of lesions which can present in a variety of ways-the mainstay of treatment for these dynamic lesions is endovascular or surgical obliteration. We provide a practical framework for clinical classification of vascular anomalies of the head and neck in children. We also explore principles of their clinical and radiological assessment along with management, highlighting the importance of a multi-disciplinary approach.

PMID: 26807370 [PubMed]

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Effects of EZH2 promoter polymorphisms and methylation status on oral squamous cell carcinoma susceptibility and pathology.

Effects of EZH2 promoter polymorphisms and methylation status on oral squamous cell carcinoma susceptibility and pathology.

Am J Cancer Res. 2015;5(11):3475-84

Authors: Su KJ, Lin CW, Chen MK, Yang SF, Yu YL

Abstract
Oral squamous cell carcinoma (OSCC), which is malignant tumors in oral cavity, is the fourth most common male cancer in Taiwan. EZH2 plays a key role in transcriptional repression through chromatin remodeling and in cancer development. Although the EZH2 expression in OSCC is highly correlated with tumorigenesis, it has not been determined if specific EZH2 genetic variants are associated with OSCC risk. The aim of this study was to investigate the relationship between genetic polymorphisms of EZH2 and susceptibility to OSCC in Taiwan. Here, four SNPs of EZH2 (rs6950683, rs2302427, rs3757441, and rs41277434) were analyzed by a real-time PCR genotyping in 576 patients with oral cancer and 552 cancer-free controls. After adjusting for other co-variants, we found that carrying CC genotype at EZH2 rs6950683 and rs3757441 had a lower risk of developing OSCC than did wild-type carriers. The CCCA or CCTA haplotype among the four EZH2 sites was also associated with a reduced risk of OSCC. Furthermore, OSCC patients who carried CC genotype at EZH2 rs6950683 had a higher methylation than TC genotype. Our results suggest that the two SNPs of EZH2 (rs6950683 and rs3757441) might contribute to the prediction of OSCC susceptibility. Moreover, rs6950683 CC genotype exhibits hypermethylation in EZH2 promoter. This is the first study to provide insight into risk factors associated with EZH2 variants and epigenetic changes in carcinogenesis of OSCC in Taiwan.

PMID: 26807327 [PubMed]

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Poly (ADP) ribose polymerase inhibition: A potential treatment of malignant peripheral nerve sheath tumor

10.1080/15384047.2015.1108486<br/>Christine M. Kivlin

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Emerging technologies with potential for objectively evaluating speech recognition skills.

Emerging technologies with potential for objectively evaluating speech recognition skills.

Int J Audiol. 2016 Jan 25;:1-10

Authors: Rawool VW

Abstract
Work-related exposure to noise and other ototoxins can cause damage to the cochlea, synapses between the inner hair cells, a auditory nerve fibers, and higher auditory pathways, leading to difficulties in recognizing speech. Procedures designed to determine speech recognition scores (SRS) in an objective manner can be helpful in disability compensation cases where the worker claims to have poor speech perception due to exposure to noise or ototoxins. Such measures can also be helpful in determining SRS in individuals who cannot provide reliable responses to speech stimuli, including patients with Alzheimer's disease, traumatic brain injuries, and infants with and without hearing loss. Cost-effective neural monitoring hardware and software is being rapidly refined due to the high demand for neurogaming (games involving the use of brain-computer interfaces), health, and other applications. More specifically, two related advances in neuro-technology include relative ease in recording neural activity and availability of sophisticated analysing techniques. These techniques are reviewed in the current article and their applications for developing objective SRS procedures are proposed. Issues related to neuroaudioethics (ethics related to collection of neural data evoked by auditory stimuli including speech) and neurosecurity (preservation of a person's neural mechanisms and free will) are also discussed.

PMID: 26807789 [PubMed - as supplied by publisher]

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Prevalence and characteristics of spontaneous tinnitus in 11-year-old children.

Prevalence and characteristics of spontaneous tinnitus in 11-year-old children.

Int J Audiol. 2016 Jan 25;:1-7

Authors: Humphriss R, Hall AJ, Baguley DM

Abstract
OBJECTIVE: To estimate the prevalence of spontaneous tinnitus in 11-year-old children.
DESIGN: A prospective UK population-based study.
STUDY SAMPLE: A total of 7092 children from the Avon longitudinal study of parents and children (ALSPAC) who attended the hearing session at age 11 years and answered questions about tinnitus.
RESULTS: We estimated the prevalence of any spontaneous tinnitus as 28.1% (95% CI 27.1, 29.2%), and the prevalence of 'clinically significant' tinnitus as 3.1% (95% CI 2.7, 3.5%). Children were less likely to have clinically significant tinnitus if the tinnitus was 'soft' rather than 'loud' and if continuous rather than intermittent. Clinical significance was more likely if the tinnitus occurred more than once a week. Neither pitch nor length of history were important determinants of clinical significance. Small increases in mean hearing threshold (of up to 2.3 dB HL) were associated with clinically significant tinnitus.
CONCLUSIONS: Although the prevalence of any tinnitus in 11-year-old children appears high, the small proportion in which this was found to be clinically significant implies that this does not necessarily indicate a large unmet clinical demand. We would expect approximately one child per class of 30 to have clinically significant tinnitus which is, by definition, problematic.

PMID: 26804253 [PubMed - as supplied by publisher]

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Penser l’ordre juridique international moderne: la hiérarchie des normes et la Société des Princes

This contribution focuses on the use of contemporary legal concepts in the historical analysis of the early modern law of nations. To what extent can we apply the concepts of norm hierarchy and precedence to conflicts between, on the one hand, fundamental laws, and, on the other hand, international treaties ? Using present-day international law scholarship (Robert Kolb, James Crawford), legal theory (Martti Koskenniemi) and cultural history of the political (Lucien Bély, Barbara Stollberg-Rilinger), traditional views in legal history can be revisited, creating an inspiring dialogue. This contribution treats the question of Philip V of Spain's renunciations on the French throne in 1713. For most legal historians, these declarations were void according to French public law. Yet, this was not the only view in the early eighteenth century either. A more horizontal view of monarchical actions in connection to fellow equal sovereigns ("La Société des Princes") makes a conflict between internal and international law plausible.

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Strafuitvoering

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Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark.

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark.

Acta Oncol. 2016 Jan 25;:1-7

Authors: Wiedenbein L, Kristiansen M, Adamsen L, Hjort D, Hendriksen C

Abstract
Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n = 2) of surgical patient trajectories and 35% (n = 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n = 36) of all patients. Referral to municipal rehabilitation services was documented among 5% (n = 2) of all patients. Assessments at surgical departments were shaped by the inherent continuous assessment of rehabilitation needs within standardized fast-track colorectal cancer surgery. In contrast, the implementation of locally developed assessment tools inspired by the distress thermometer (DT) in oncology departments was challenged by a lack of competencies and funding, impeding integration of data into patient files. Conclusion Consensus must be reached on how to ensure more systematic, comprehensive assessments of rehabilitation needs throughout clinical cancer care. Fast-track surgery ensures systematic documentation of physical needs, but the lack of inclusion of data collected by the DT in oncological departments questions the efficacy of assessment tools and points to a need for distinguishing between surgical and oncological settings in national rehabilitation policies.

PMID: 26808254 [PubMed - as supplied by publisher]

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[Treatment Strategy for Gastric Carcinoma with Lymphoid Stroma].

[Treatment Strategy for Gastric Carcinoma with Lymphoid Stroma].

Gan To Kagaku Ryoho. 2015 Nov;42(12):2021-3

Authors: Kobayashi R, Takiguchi N, Nabeya Y, Ikeda A, Souda H, Kainuma O, Tonooka T, Imanishi S, Arimitsu H, Chibana T, Ishige F, Sasaki K, Yamamoto H

Abstract
Gastric carcinoma with lymphoid stroma(GCLS)is a histological type with severe lymphocytic infiltration. GCLS is very rare and few cases have been reported. We examined the clinical features, problems of preoperative diagnosis, and treatment of 14 cases(1.8%)that were diagnosed as GCLS out of 790 gastric cancers surgically resected in our hospital. The mean age was 69 years. Six, 8, and 0 cases were located in the upper, middle, and lower fields of the stomach, respectively, and 8, 1, 4, and 1 cases were macroscopically 0-Ⅱc, 0-Ⅰ, type 2, and type 3, respectively. The depth of invasion was M, SM1, SM2, MP, and SS in 0, 0, 9, 3, and 2 cases, respectively. There were 12 cases(86%)with infection by Epstein-Barr virus, and just 1 case with lymph node metastasis. All cases have had no evidence of recurrence. There were no cases that were diagnosed as GCLS before surgery. GCLS is recognized as having a more favorable prognosis compared with other types of gastric carcinoma, so an aggressive surgery might achieve good outcomes. However, preoperative diagnosis is very difficult and there is a compelling need for new techniques or criteria for diagnosis of GCLS.

PMID: 26805251 [PubMed - in process]

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[Basaloid Carcinoma of the Esophagus with Lugol-Voiding Lesions-A Case Report].

[Basaloid Carcinoma of the Esophagus with Lugol-Voiding Lesions-A Case Report].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1899-901

Authors: Shimakawa T, Asaka S, Shimazaki A, Yamaguchi K, Usui T, Yokomizo H, Shiozawa S, Yoshimatsu K, Katsube T, Naritaka Y, Fujibayashi M

Abstract
Patients with Lugol-voiding lesions of the esophagus are frequently affected with multiple cancers. Basaloid carcinoma of the esophagus is a very rare disease characterized by growth in the submucosal layer that exhibits a submucosal tumor-like shape. There have been some reports that this type of carcinoma is biologically high-grade. We report a case of metachronous squamous cell carcinoma in situ and superficial basaloid carcinoma in the esophagus with Lugol-voiding lesions. A 63-yearold man underwent gastrectomy for gastric cancer at the age of 45 years. The subsequent surveillance endoscopy found a type 0-Ⅱc lesion in the esophagus in 2000. EMR was thus performed. The pathology showed squamous cell carcinoma in situ. Dysplasia was diagnosed based on the Lugol-voiding lesions, and EMR was performed twice. In 2014, a fourth EMR was performed after a high-grade intraepithelial neoplasia was diagnosed. The pathology showed squamous cell carcinoma in situ and a basaloid carcinoma in the lamina propria, T1a-LPM, ly0, v0, pHMX, pVM0. The patient has had no recurrence for approximately 1 year after the fourth EMR.

PMID: 26805210 [PubMed - in process]

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[A Case of Synchronous Multiple Esophageal Cancers Composed of Squamous Cell Carcinoma and Barrett's Adenocarcinoma].

[A Case of Synchronous Multiple Esophageal Cancers Composed of Squamous Cell Carcinoma and Barrett's Adenocarcinoma].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1890-2

Authors: Kobayashi T, Shiozaki A, Fujiwara H, Konishi H, Arita T, Kosuga T, Morimura R, Murayama Y, Komatsu S, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Okamoto K, Otsuji E

Abstract
A 67-year-old man was admitted to our hospital for treatment for multiple superficial esophageal cancers. Screening upper gastrointestinal endoscopy examination revealed a superficial squamous cell carcinoma(SCC)at the middle thoracic esophagus and Barrett's epithelium and a superficial adenocarcinoma at the abdominal esophagus. We performed a subtotal esophagectomy with gastric tube reconstruction via the retrosternal route. Pathological examination revealed a Barrett's adenocarcinoma at the abdominal esophagus. Esophageal cancer is thought to be a multicentric disease, and we sometimes find multiple esophageal cancers. In Japan, most cases of multiple esophageal cancers are composed of SCCs, and the occurrence of multiple esophageal cancers composed of SCC and Barrett's adenocarcinoma is rare. In contrast, the number of the patients with Barrett's esophagus is increasing, and the number of the patients with Barrett's adenocarcinoma also seems to be on the rise. Therefore, it is important be aware of the possibility of multiple esophageal cancers composed of SCC and Barrett's adenocarcinoma while making diagnoses.

PMID: 26805207 [PubMed - in process]

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[Abnormal Karyotypes Involving 1q21 and 12p13 and Their Clinical Significance].

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[Abnormal Karyotypes Involving 1q21 and 12p13 and Their Clinical Significance].

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2015 Oct;23(5):1527-31

Authors: Jia R, Sun WL

Abstract
Many hematological malignances involve recurrent chromosomal abnormalities, and the reciprocal translocation is one of them. However, there are a lot of chromosomal abnormalities with lower incidence and unclear clinical significance. Among them, the one abnormal karyotype translocation, t (1;12) (q21; p13) is a rare karyotype change. Only 6 patients had been reported to have this karyotype and all of them suffered from hematologic diseases, including one case of acute myeloid leukemia, one case of high-risk myelodysplastic syndrome, two children with acute lymphoblastic leukemia, one case of chronic myeloid leukemia at accelerated phase and one case of multiple myeloma. Among them, the fusion gene were detectable in two cases. In this article, the common chromoscme karyotype abnormality involving 1q21 and 12p13, and genes involving in these regious are summarized, moreover the reported cases of t(1;12) (q21;p13) are reviewed.

PMID: 26524071 [PubMed - indexed for MEDLINE]

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[Rocuronium anesthesia induced anaphylactic shock: a case report].

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[Rocuronium anesthesia induced anaphylactic shock: a case report].

Beijing Da Xue Xue Bao. 2015 Oct 18;47(5):885-7

Authors: Qiu M, Zong YN, Lu J, Ma LL, Zheng Q, Guo XY

Abstract
Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen, and it could be an unpredictable and life-threatening cause during anesthesia. The main purpose of this paper is to report a case of anaphylactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period. A 63-year-old man, with a mass on his adrenal, was scheduled to a laparoscopic adrenal tumor excision. During the anesthesia induction period, after administrated sulfentanil, propofol and rocuronium, the blood pressure was decreased and the heart rate was increased. Then, the patient had rash on his whole body and developed an anaphylactic shock. After being treated with the anti-allergic agents and norepinephrine, the rash disappeared and the vital sign become stable. The patient felt nothing uncomfortable during the two weeks'follow-up. Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period. The most common inducements are muscle relaxant, latex and antibiotics. Anaphylactic reactions in the perioperative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Before anesthesia, we should acquire the allergic history. During the anesthesia period, the vital sign and the skin should be observed carefully.

PMID: 26474637 [PubMed - indexed for MEDLINE]

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[Pulmonary capillary hemangiomatosis: a case report and literature review].

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[Pulmonary capillary hemangiomatosis: a case report and literature review].

Beijing Da Xue Xue Bao. 2015 Oct 18;47(5):865-9

Authors: Xiong Y, Li XX, Mu XD, Li D, Wang Y, Li T

Abstract
We reported a case of pulmonary capillary hemangiomatosis (PCH) and introduced its diagnosis, differential diagnosis, pathogenesis and development of treatment based on the review of Dana Point 2008 Classification of Pulmonary Hypertensiona and current literatures. A 43-year-old female presented progressive dyspnea, elevated pulmonary arterial pressures and CT pulmonary angiography (CTPA) imaging of main pulmonary arterial enlargement and wide spread ill-defined centrilobular nodules of ground-glass opacity. Her histologic features were proliferation of capillary channels within alveolar walls as well as muscularization of arterioles and medial hypertrophy of muscular pulmonary arteries. The treatment with diuretics and warfarin was used promptly, but unfortunately was ineffective. The patient died three months after diagnosis. PCH is a very rare vascular disease with poor prognosis. The diagnosis of PCH rests on the integration of clinical and radiographic information with pathologic features, however pathology is the most reliable means. Because clinical symptoms, imaging and histological features of pulmonary veno-occlusive disease (PVOD) and PCH broadly overlap, differential diagnosis should be made carefully. Among the various pathologic features proliferation of capillaries within alveolar walls is the key point for diagnosing PCH, which is also the most critical criteria for differentiating PCH from PVOD. So far the only definitive treatment for PCH is lung transplantation, without which the patient will die several months after diagnosis.

PMID: 26474632 [PubMed - indexed for MEDLINE]

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Image of the Month. A polypoid lesion in the stomach: atypical endoscopic appearance and a rare cause.

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Image of the Month. A polypoid lesion in the stomach: atypical endoscopic appearance and a rare cause.

Am J Gastroenterol. 2015 Oct;110(10):1395

Authors: Tomizawa Y

PMID: 26465898 [PubMed - indexed for MEDLINE]

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Cytomorphologic and Flow Cytometric Analysis of Cerebrospinal Fluid with T-Cell Lymphoma Involvement: A Retrospective Study of Rare Cases.

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Cytomorphologic and Flow Cytometric Analysis of Cerebrospinal Fluid with T-Cell Lymphoma Involvement: A Retrospective Study of Rare Cases.

Acta Cytol. 2015;59(4):325-31

Authors: Onur I, Crane GM, Maleki Z

Abstract
OBJECTIVE: To compare the efficacy of conventional cytomorphologic analysis and flow cytometry (FC) in the diagnosis of T-cell lymphoma in the cerebrospinal fluid (CSF).
STUDY DESIGN: We performed a retrospective review of CSF samples from 2002 to 2012 that showed involvement of a T-cell lymphoma, either by cytomorphologic analysis and/or FC. Patients' demographics, clinical history and follow-up were assessed.
RESULTS: Thirty-nine CSF samples were identified from 9 patients. A definitive diagnosis of T-cell lymphoma involvement was made by cytomorphologic analysis and FC in 6 (15.4%) and 39 (100.0%) specimens, respectively. In specimens with definitive cytopathologic diagnoses, the cytomorphologic features included increased cellularity, a monotonous lymphoid population and large, atypical lymphoid cells. Considering cytomorphologic features only, 9 specimens demonstrated atypical lymphocytes not fulfilling the criteria for malignancy, and 24 specimens were negative for malignancy.
CONCLUSIONS: CSF with T-cell lymphoma involvement may yield paucicellular or acellular specimens depending on the volume of the CSF, the time interval between specimen collection and specimen processing and the application of preservative to CSF. The rate of detection of T-cell lymphoma in the CSF by FC is unequivocally higher than by cytomorphologic analysis. Careful attention to clinical history is crucial, as FC testing may be tailored to evaluate for T-cell lymphoproliferative disorders in limited samples.

PMID: 26315545 [PubMed - indexed for MEDLINE]

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Adenosquamous carcinoma of the head and neck: Molecular analysis using CRTC-MAML FISH and survival comparison with paired conventional squamous cell carcinoma.

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Adenosquamous carcinoma of the head and neck: Molecular analysis using CRTC-MAML FISH and survival comparison with paired conventional squamous cell carcinoma.

Laryngoscope. 2015 Nov;125(11):E371-6

Authors: Kass JI, Lee SC, Abberbock S, Seethala RR, Duvvuri U

Abstract
OBJECTIVES/HYPOTHESIS: Adenosquamous carcinoma (ASC) is a rare variant of head-and-neck squamous cell carcinoma (HNSCC) generally thought to be uniformly aggressive with poor prognosis. However, it remains unknown how overall survival compare with conventional HNSCC. Here we report for the first time that ASC does not necessarily indicate a worse prognosis than conventional HNSCC.
STUDY DESIGN: Case-control retrospective study.
METHODS: Forty-two primary tumors of the head and neck, treated with curative intent, were identified. Next, 2:1 matching of HNSCC was performed using the following matching criteria: gender, site, pathologic tumor stage, and pathologic node stage. Successful matching was performed for 32 of 42 tumors. Additionally, 20 samples were sent for break-apart FISH testing to evaluate for the presence of the CRTC1-MAML2 translocation.
RESULTS: There was a 1.8:1 male to female ratio, with a mean age of 62 years (range 38-84). The layrnx was the most common site (26%), followed by oropharynx (24%), oral cavity (19%), and sinonasal (17%). Kaplan-Meier analysis of adenosquamous and matched HNSCC showed similar survival curves. Median survival times for ASC and HNSCC were 4 and 6 years, respectively. A random-effects Cox model with Gamma frailty revealed no statistical difference between the two groups (P=0.25). All cases of ASC were negative for the CRTC1-MAML2 translocation.
CONCLUSION: This study directly compares primary ASC with HNSCC. No difference in overall survival was detected in contradistinction to the previously thought uniformly poor prognosis. We also highlight the importance of the CRTC1-MAML2 translocation in distinguishing ASC from mucoepidermoid carcinoma.
LEVEL OF EVIDENCE: 3b.

PMID: 26255977 [PubMed - indexed for MEDLINE]

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Serological response to Helicobacter pylori infection among Latin American populations with contrasting risks of gastric cancer.

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Serological response to Helicobacter pylori infection among Latin American populations with contrasting risks of gastric cancer.

Int J Cancer. 2015 Dec 15;137(12):3000-5

Authors: Camargo MC, Beltran M, Conde-Glez CJ, Harris PR, Michel A, Waterboer T, Carolina Flórez A, Torres J, Ferreccio C, Sampson JN, Pawlita M, Rabkin CS

Abstract
Gastric cancer is a rare outcome of chronic Helicobacter pylori infection. Serologic profiles may reveal bacterial, environmental and/or host factors associated with cancer risk. We therefore compared specific anti-H. pylori antibodies among populations with at least twofold differences in gastric cancer mortality from Mexico, Colombia and Chile. Our study included 1,776 adults (mean age 42 years) from three nationally representative surveys, equally divided between residents of high- and low-risk areas. Antibodies to 15 immunogenic H. pylori antigens were measured by fluorescent bead-based multiplex assays; results were summarized to identify overall H. pylori seropositivity. We used logistic regression to model associations between antibody seroreactivity and regional cancer risk (high vs. low), adjusting for country, age and sex. Both risk areas had similar H. pylori seroprevalence. Residents in high- and low-risk areas were seroreactive to a similar number of antigens (means 8.2 vs. 7.9, respectively; adjusted odds ratio, OR: 1.02, p = 0.05). Seroreactivities to Catalase and the known virulence proteins CagA and VacA were each significantly (p < 0.05) associated with residence in high-risk areas, but ORs were moderate (1.26, 1.42 and 1.41, respectively) and their discriminatory power was low (area under the curve < 0.6). The association of Catalase was independent from effects of either CagA or VacA. Sensitivity analyses for antibody associations restricted to H. pylori-seropositive individuals generally replicated significant associations. Our findings suggest that humoral responses to H. pylori are insufficient to distinguish high and low gastric cancer risk in Latin America. Factors determining population variation of gastric cancer burden remain to be identified.

PMID: 26178251 [PubMed - indexed for MEDLINE]

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Nasal Chondromesenchymal Hamartoma (NCMH): a systematic review of the literature with a new case report.

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Nasal Chondromesenchymal Hamartoma (NCMH): a systematic review of the literature with a new case report.

J Otolaryngol Head Neck Surg. 2015;44:28

Authors: Mason KA, Navaratnam A, Theodorakopoulou E, Chokkalingam PG

Abstract
BACKGROUND: Nasal chondromesenchymal hamartoma (NCMH) is a very rare, benign tumour of the sinonasal tract usually presenting in infants. We present a systematic review of NCMH cases alongside a case report of an adult with asymptomatic NCMH.
METHODS: A systematic review was conducted in accordance with PRISMA guidelines. A PubMed, EMBASE and manual search through references of relevant publications was used to identify all published case-reports of NCMH. Data was collected from each case-report on: patient demographics, laterality, size and location of NCMH, presentation, co-morbidities, investigations, treatment and follow-up.
RESULTS: The systematic review identified 48 patients (including ours): 33 male, 15 female. Mean age was 9.6 years (range: 1 day-69 years) with the majority aged 1 year or younger at presentation (n = 18). Presentations included: nasal congestion (n = 17), nasal mass (n = 15) and eye signs (n = 12). NCMH also involved the paranasal sinuses (n = 26), orbit (n = 16) and skull-base (n = 14). All patients underwent operative resection of NCMH. A small 2014 case-series found DICER1 mutations in 6 NCMH patients, establishing a link to the DICER1 tumour spectrum.
CONCLUSIONS: NCMH is a rare cause of nasal masses in young children and adults. In light of the newly established link between NCMH and DICER1 mutations surgeons should be vigilant for associated DICER1 tumours, as NCMH may be the 'herald tumour' of this disease spectrum.

PMID: 26138824 [PubMed - indexed for MEDLINE]

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Testicular Schistosomiasis Mimicking Malignancy in a Child: A Case Report.

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Testicular Schistosomiasis Mimicking Malignancy in a Child: A Case Report.

J Trop Pediatr. 2015 Aug;61(4):304-9

Authors: Ekenze SO, Modekwe VO, Nzegwu MA, Ekpemo SC, Ezomike UO

Abstract
Schistosomiasis is an important communicable disease in the developing world. However, testicular schistosomiasis is an extremely rare condition. We report a case of testicular schistosomiasis mimicking testicular tumour in a 13 year old who presented with huge unilateral testicular mass. The dilemma encountered in the diagnosis and treatment of this child is presented to highlight the need for high index of suspicion of this pathology in children with testicular mass presenting from schistosomiasis-endemic areas.

PMID: 26130620 [PubMed - indexed for MEDLINE]

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[Two cases of synovial sarcoma in the head and neck].

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[Two cases of synovial sarcoma in the head and neck].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Feb;29(4):375-7

Authors: Zhang C, Wu D, Bi L

Abstract
Synovial sarcoma is a malignant soft tissue with unknown origin. Although head and neck region is the second common site of involvement, rare cases have been reported in Para nasal sinus and larynx. We presented two cases of synovial sarcoma, one of which arised from maxillary sinus and the other from laryx, and re- view the literature to sum up the diagnosis and treatment strategies. The conclusion is that synovial sarcoma in the head and neck still raises diagnostic and therapeutic issues. Surgical excision with wide margins is essential and necessary, usually associated radiotherapy. The effect of chemotherapy remains to explored.

PMID: 26121847 [PubMed - indexed for MEDLINE]

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Genetic variants in VEGF pathway genes in neoadjuvant breast cancer patients receiving bevacizumab: Results from the randomized phase III GeparQuinto study.

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Genetic variants in VEGF pathway genes in neoadjuvant breast cancer patients receiving bevacizumab: Results from the randomized phase III GeparQuinto study.

Int J Cancer. 2015 Dec 15;137(12):2981-8

Authors: Hein A, Lambrechts D, von Minckwitz G, Häberle L, Eidtmann H, Tesch H, Untch M, Hilfrich J, Schem C, Rezai M, Gerber B, Dan Costa S, Blohmer JU, Schwedler K, Kittel K, Fehm T, Kunz G, Beckmann MW, Ekici AB, Hanusch C, Huober J, Liedtke C, Mau C, Moisse M, Müller V, Nekljudova V, Peuteman G, Rack B, Rübner M, Van Brussel T, Wang L, Weinshilboum RM, Loibl S, Fasching PA

Abstract
Studies assessing the effect of bevacizumab (BEV) on breast cancer (BC) outcome have shown different effects on progression-free and overall survival, suggesting that a subgroup of patients may benefit from this treatment. Unfortunately, no biomarkers exist to identify these patients. Here, we investigate whether single nucleotide polymorphisms (SNPs) in VEGF pathway genes correlate with pathological complete response (pCR) in the neoadjuvant GeparQuinto trial. HER2-negative patients were randomized into treatment arms receiving either BEV combined with standard chemotherapy or chemotherapy alone. In a pre-planned biomarker study, DNA was collected from 729 and 724 patients, respectively from both treatment arms, and genotyped for 125 SNPs. Logistic regression assessed interaction between individual SNPs and both treatment arms to predict pCR. Five SNPs may be associated with a better response to BEV, but none of them remained significant after correction for multiple testing. The two SNPs most strongly associated, rs833058 and rs699947, were located upstream of the VEGF-A promoter. Odds ratios for the homozygous common, heterozygous and homozygous rare rs833058 genotypes were 2.36 (95% CI, 1.49-3.75), 1.20 (95% CI, 0.88-1.64) and 0.61 (95% CI, 0.34-1.12). Notably, some SNPs in VEGF-A exhibited a more pronounced effect in the triple-negative subgroup. Several SNPs in VEGF-A may be associated with improved pCR when receiving BEV in the neoadjuvant setting. Although none of the observed effects survived correction for multiple testing, our observations are consistent with previous studies on BEV efficacy in BC. Further research is warranted to clarify the predictive value of these markers.

PMID: 26100253 [PubMed - indexed for MEDLINE]

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Vitrectomy for Proliferative Diabetic Retinopathy in a Patient with Heparin-Induced Thrombocytopenia

Introduction: In this study, we report a case of proliferative diabetic retinopathy in a patient with heparin-induced thrombocytopenia (HIT) in whom vitrectomy was performed with good results. Case: A 57-year-old man presented with a chief complaint of decreased visual acuity (VA) in the left eye. Corrected VA of the left eye was 0.03, and ophthalmic examination showed fibrovascular membranes along the vascular arcade and a combined rhegmatogenous-traction retinal detachment with a macular hole. The patient began hemodialysis for diabetic nephropathy in March 2014; thrombocytopenia developed after dialysis was started, and HIT was diagnosed after further evaluation. Argatroban hydrate was being used during dialysis. Treatment was switched from warfarin to argatroban hydrate 6 days prior to vitrectomy being performed on the patient's left eye. Although there was bleeding with somewhat difficult hemostasis during the intraoperative treatment of the fibrovascular membranes, surgery was completed without complications and the postoperative course was good. Discussion: Vitrectomy was performed with good results in this patient with HIT. Treatment with argatroban hydrate during surgery enabled surgery without the danger of intraoperative clotting.
Case Rep Ophthalmol 2016;7:67-73

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Effects of Antioxidants in Human Cancers: Differential Effects on Non-Coding Intronic RNA Expression.

Effects of Antioxidants in Human Cancers: Differential Effects on Non-Coding Intronic RNA Expression.

Antioxidants (Basel). 2016;5(1)

Authors: Menon S, Lu C, Menon R, Schwartz J, Guan Y

Abstract
The notion that dietary antioxidants can help fight cancer is popular. However, the mechanism(s) behind the effect of antioxidants in cancer is still unclear. Previous studies indicate that supplements can influence gene expression; however, all of these studies were focused on the coding/exonic gene expression. Studies are now emerging to highlight critical functional roles for RNAs expressed from the non-coding regions. This project was designed to study the effect of antioxidant supplements on non-coding intronic RNA expression in human cancers. Vitamin E, N-Acetyl cysteine (NAC) and Sulforaphane are commonly used supplements to prevent diseases including cancers. We studied the effect of these antioxidant supplements on the non-coding intronic RNA expression using publicly available datasets from a mouse model for lung cancer and prostate cancer cell lines. Although high throughput polyA-enriched RNA-Seq data characterize spliced coding mRNA regions, recent studies reveal the expression of reads from the non-coding intronic regions. Our analyses indicate that cancer cells have higher expression of introns compared to that of normal cells and that treatment with antioxidant supplements reduces the increased expression of introns of several genes. However, we did find high expression of introns of multiple genes including many oncogenes in the supplement treated groups compared to that of the control; this effect was distinct depending on the cell type and the supplement studied. Using RT-PCRs, we validated the expression of introns of two oncogenes, DLK1 and LRG1, known to be key players in lung cancer progression, and demonstrate changed intronic expression with supplement treatment in cancer cells. With regard to the antioxidant system, supplements did not change the intronic RNAs for endogenous antioxidant enzymes except for a significant decrease in the expression of superoxide dismutase (SOD) intronic RNA. Concurrently, we also found that a prolonged (48 h) exposure to Vitamin C, Vitamin E and Green tea extract reduced the enzymatic activity of SOD in lung cancer cells. The results from this study reveal that the antioxidant supplements have a significant effect on the intronic RNA expression of many genes including cancer genes that are not directly linked to the body's antioxidant system. It is important to study this novel effect of antioxidant supplements in detail as it may have a significant role in disease progression.

PMID: 26805894 [PubMed]

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[Palliative Care for Rectal Cancer Complicated with Gastric Cancer].

[Palliative Care for Rectal Cancer Complicated with Gastric Cancer].

Gan To Kagaku Ryoho. 2015 Nov;42(12):2273-5

Authors: Furukawa T, Takahashi H, Tanaka K, Muto T

Abstract
Medical advancements have led to an increase in the number of elderly people. However, standard treatments may sometimes be difficult to use in elderly people. Here, we report the case of an elderly patient with rectal and gastric cancer who refused radical surgery. The patient was an 83-year-old man who had type-2 diabetes, hypertension, hyperuricemia, mitral valve regurgitation, and mild dementia. Furthermore, he was blind in both eyes owing to glaucoma. He first visited our hospital in 2005. In 2010, he was diagnosed with anemia, but he refused a thorough examination; however, he did consent to take iron supplements. In July 2011, he consulted our hospital for symptoms of frequent diarrhea, and agreed to an examination. After colonoscopy, he was diagnosed with rectal cancer that was becoming obstructive. There were no metastases to other organs, but he was also diagnosed with gastric cancer. As he and his family refused radical surgery, a stoma was constructed. After the operation, he received palliative care but died in September 2013.

PMID: 26805335 [PubMed - in process]

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Adherence to the world cancer research fund/american institute for cancer research recommendations and breast cancer risk.

Adherence to the world cancer research fund/american institute for cancer research recommendations and breast cancer risk.

Int J Cancer. 2016 Jan 25;

Authors: Harris HR, Bergkvist L, Wolk A

Abstract
The World Cancer Research Fund/American Association for Cancer Research (WCRF/AICR) has published 8 nutrition-related recommendations for the prevention of cancer. However, few prospective studies have examined these recommendations by breast cancer hormone receptor subtype and only one case-control study has included the dietary supplements recommendation in their evaluation. We investigated whether adherence to the WCRF/AICR cancer prevention recommendations was associated with breast cancer incidence, overall and by hormone receptor subtype, in the Swedish Mammography Cohort. Among 31,514 primarily postmenopausal women diet and lifestyle factors were assessed with a self-administered FFQ. A score was constructed based on adherence to the recommendations for body fatness, physical activity, energy density, plant foods, animal foods, alcoholic drinks and dietary supplements (score range 0-7). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During 15 years of follow-up 1,388 cases of breast cancer were identified. Women who met 6 to 7 recommendations had a 51% decreased risk of breast cancer compared to women meeting only 0 to 2 recommendations (95% CI=0.35-0.70). The association between each additional recommendation met and breast cancer risk was strongest for the ER-positive/PR-positive subtype (HR=0.86; 95% CI=0.79-0.94), while for the ER-negative/PR-negative subtype the individual recommendations regarding plant and animal foods were most strongly associated with reduced risk. Our findings support that adherence to the WCRF/AICR recommendations reduces breast cancer risk in a population of primarily postmenopausal women. Promoting these recommendations to the public could help reduce breast cancer incidence. This article is protected by copyright. All rights reserved.

PMID: 26804371 [PubMed - as supplied by publisher]

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Unmetabolized Folic Acid in Prediagnostic Plasma and the Risk of Colorectal Cancer.

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Unmetabolized Folic Acid in Prediagnostic Plasma and the Risk of Colorectal Cancer.

J Natl Cancer Inst. 2015 Dec;107(12):djv260

Authors: Cho E, Zhang X, Townsend MK, Selhub J, Paul L, Rosner B, Fuchs CS, Willett WC, Giovannucci EL

Abstract
Higher folate has been associated with a reduced colorectal cancer (CRC) risk, but excessive folate may promote tumor progression. The role of unmetabolized folic acid (UFA) from high folic acid consumption in carcinogenesis is largely unexplored. We evaluated prediagnostic plasma levels of UFA in relation to CRC risk in nested case-control studies (618 CRC case patients and 1207 matched control) with blood samples collected prior to folic acid fortification. UFA was detected in 21.4% of control UFA levels were not associated with CRC risk. Compared with undetectable levels, the multivariable relative risks (RRs) of CRC were 1.03 (95% confidence interval [CI] = 0.73 to 1.46) for less than 0.5 nmol/L and 1.12 (95% CI = 0.81 to 1.55) for 0.5 nmol/L or more (Ptrend = .32). A positive association between UFA levels and CRC risk was observed among men (RR = 1.57, 95% CI = 0.99 to 2.49 for ≥0.5 nmol/L vs undetectable, Pinteraction = .04), and a positive association was also observed among those with the methylene-tetrahydrofolate reductase (MTHFR) CT/TT genotype (RR = 2.20, 95% CI = 1.22 to 3.94 for ≥0.5 nmol/L vs undetectable, Pinteraction=0.02). In conclusion, prediagnostic plasma levels of UFA from the prefortification period were not associated with risk of CRC.

PMID: 26376686 [PubMed - indexed for MEDLINE]

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The effect of six months of elastic band resistance training, nutritional supplementation or cognitive training on chromosomal damage in institutionalized elderly.

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The effect of six months of elastic band resistance training, nutritional supplementation or cognitive training on chromosomal damage in institutionalized elderly.

Exp Gerontol. 2015 May;65:16-22

Authors: Franzke B, Halper B, Hofmann M, Oesen S, Pierson B, Cremer A, Bacher E, Fuchs B, Baierl A, Tosevska A, Strasser EM, Wessner B, Wagner KH, Vienna Active Ageing Study Group (VAAS)

Abstract
Increased DNA and chromosomal damage are linked to aging and age-related diseases like cardiovascular diseases, diabetes or cancer. Physical activity and an optimal status of micro- and macronutrients are known to reduce the incidence of MN, a marker for chromosomal instability and mutagenicity. Once older people reach a certain age they change from a home-living situation to an institutionalized situation, which is often accompanied by malnutrition, depression and inactivity. We conducted the current study to investigate the effect of a six month progressive resistance training (RT), with or without protein and vitamin supplementation (RTS) or cognitive training (CT) only, on chromosomal damage measured by the cytokinesis block micronucleus cytome assay in 97 Austrian institutionalized women and men (65-98years). All three intervention groups demonstrated a tendency of a reduced frequency of cells with MN (-15%) as well as for the total number of MN (-20%), however no significant time-effect was observed. Besides a significant increase in plasma B12 and red blood cell folate status, the six month change of B12 was negatively correlated with the six month change of the MN frequency in the RTS group (r=-0.584, p=0.009). Our results suggest that in this age group either physical or cognitive training may result in similar biochemical changes and therefore enhance resistance against genomic instability. Supplementation with the vitamins B12 and folic acid could contribute to reduced chromosomal damage in institutionalized elderly.

PMID: 25747997 [PubMed - indexed for MEDLINE]

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Coral snake bites (Micrurus spp.) in Brazil: a review of literature reports.

Coral snake bites (Micrurus spp.) in Brazil: a review of literature reports.

Clin Toxicol (Phila). 2016 Jan 25;:1-13

Authors: Bucaretchi F, De Capitani EM, Vieira RJ, Rodrigues CK, Zannin M, Da Silva NJ, Casais-E-Silva LL, Hyslop S

Abstract
CONTEXT: In the Americas, the main representatives of the family Elapidae are coral snakes of the genus Micrurus, of which 33 species are in Brazil. They are the smallest cause of venomous snakebite in Brazil. We analyzed literature reports of coral snake bites in Brazil from 1867 to 2014, and provide a brief review of case series and reports of coral snake bites in the Americas in general.
METHODS: Only reports with clinical descriptions of envenomation were included. The variables recorded included identification of the offending snake, patient's age, sex, bite site, clinical manifestations, treatment, including antivenom and anticholinesterase drugs, and general evolution of the cases. 30 published reports describing bites caused by Micrurus spp. in Brazil were identified and involved 194 distinct cases. Since no information on the clinical manifestations was available in 44 cases, the analysis was restricted to 25 reports (150 cases).
RESULTS: Most patients were from southern (61.3%; primarily Santa Catarina state, 60%) and southeastern (20%) Brazil and were male (70.7%), with a median age of 27 years (interquartile interval = 18 to 40 years). The offending snakes were described in 59 cases (M. corallinus 36, M. frontalis 12, M. lemniscatus 5, M. hemprichi 2, M. filiformis 1, M. ibiboboca 1, M. spixii 1 and M. surinamensis 1); in 22 cases only the genus (Micrurus spp.) was reported. Of the 143 cases in which the bite site was recorded, most involved the hands (46.2%) and feet (26.6%). The main clinical features were local numbness/paresthesia (52.7%), local pain (48%), palpebral ptosis (33.3%), dizziness (26.7%), blurred vision (20.7%), weakness (20%), slight local edema (16%), erythema (16%), dysphagia (14.7%), dyspnea (11.3%), inability to walk (10.7%), myalgia (9.3%), salivation (8%) and respiratory failure (4.3%). Fang marks were described in 47.3% of cases and 14% of bites were classified as asymptomatic. A slight increase in total blood creatine kinase was reported in 3 children, suggesting mild myotoxicity. Therapeutic procedures included coral snake antivenom (77.3%), anticholinesterase drugs (6%), and mechanical ventilation (3.3%). Two patients reported in 1933 developed paralysis/respiratory failure and died 6 h and 17 h post-bite. Four more deaths probably caused by coral snakes were reported (2 in 1867, 1 in 1959, 1 in 1962), but no clinical information was available.
DISCUSSION: Neuromuscular blockade was the hallmark of systemic envenomation by Micrurus spp., with signs of myasthenia such as weakness and ptosis that may evolve to paralysis and respiratory failure. Local features, mainly numbness/paresthesia and pain, were frequently reported, with the pain being intense in some cases. Although myotoxicity has been detected in experimental studies with Micrurus spp. venoms, few human reports described laboratory findings compatible with myotoxicity.
CONCLUSION: Most coral snake bites reported in Brazil were caused by M. corallinus and M. frontalis, with several patients showing signs of acute myasthenia. Serious complications such as paralysis with respiratory failure were observed but comparatively rare. The deaths occurred where respiratory support (mechanical ventilation) was unavailable when needed.

PMID: 26808120 [PubMed - as supplied by publisher]

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Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence.

Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence.

Scand J Gastroenterol. 2016 Jan 25;:1-6

Authors: Brueckner J, Schneider A, Messmann H, Gölder SK

Abstract
Objective Flexible endoscopic treatment for Zenker diverticulum (ZD) is well established. Although recurrence of symptoms is relatively frequent, it has hardly been studied. In the present study, we analyse the long-term development of ZD patients' symptoms after successful endoscopic mucomyotomy, as well as interventional safety, sustainability of success, and predisposing factors for clinical recurrence. Methods Forty-six consecutive patients (54% male, mean age 67 years) with symptomatic ZD were treated using a hook knife and soft diverticuloscope. Follow-up interviews at 1 and 6 months inquired about a broad pool of symptoms and the dysphagia score. For further analysis, patients were retrospectively stratified into a 'recurrence' and 'no recurrence' group. Results After 100% initial success, 30% of patients reported recurrence of symptoms after 4.4 months (range 1-40) and were re-treated (mean 1.39 sessions/patient). Though the 'recurrence' group showed a higher dysphagia score and frequency past intervention, endoscopic re-treatment achieved equally good results as in the 'no recurrence' group. Before treatment, 'recurrence' patients had more severe symptoms, such as vomiting (frequency score 2.13 vs. 0.92; p < 0.05), ZD-related insomnia (1.65 vs. 1.08, n.s.), and a higher dysphagia score (2.25 vs. 1.59, n.s.). Also, the 'recurrence' group had larger diverticula, more men, slightly younger age and a longer duration of symptoms. Conclusions Endoscopic treatment of ZD with hook knife and soft diverticuloscope is safe and effective. Despite considerable clinical recurrence, re-treatment achieved a long-lasting freedom of symptoms. Male patients with a high dysphagia score and severe symptoms were more likely to experience recurrence.

PMID: 26807604 [PubMed - as supplied by publisher]

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Novel methods of drug administration for the treatment and care of older patients.

Novel methods of drug administration for the treatment and care of older patients.

Int J Pharm. 2016 Jan 22;

Authors: Quinn HL, Hughes CM, Donnelly RF

Abstract
The number of older people globally is increasing, contributing to a growing burden of morbidity and mortality. With this shift in population demographic, comes a new challenge in terms of appropriate healthcare for the over 65 years age group. As medication is the principal therapeutic intervention, it is essential that it be fully optimised, to meet the needs of this heterogeneous population. The most common routes of drug administration are oral and injectable, which may display some limitations for older people, in cases of dysphagia or frailty for example. This review considers alternative methods of drug delivery to the norm, specifically discussing the nasal, pulmonary and transdermal routes, as well as novel orally disintegrating tablets. The changing physiology as ageing occurs must be considered in the development of novel drug delivery devices. This review considers the various aspects of ageing that will influence future drug formulation design and development.

PMID: 26807530 [PubMed - as supplied by publisher]

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Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series.

Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series.

Surg Obes Relat Dis. 2015 Oct 1;

Authors: Casella G, Soricelli E, Giannotti D, Collalti M, Maselli R, Genco A, Redler A, Basso N

Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has gained great popularity as a stand-alone bariatric procedure because short- and mid-term outcomes in terms of weight loss and resolution of co-morbidities have been very positive. However, long-term results from large series still are sparse.
OBJECTIVES: To evaluate the long-term clinical outcomes of SG in a large series of patients undergoing SG as a stand-alone procedure.
SETTING: University hospital in Italy.
METHODS: A retrospective analysis of prospectively collected data from 182 patients undergoing SG between 2006 and 2008 in the authors' institution. Long-term outcomes at 6 and 7 years were analyzed in terms of weight loss and co-morbidities resolution.
RESULTS: Mean initial body mass index (BMI) was 45.9±7.3 kg/m(2). Major postoperative complications occurred in 8 patients (5.4%): 4 leaks, 2 bleeding, 1 abdominal collection, and 1 dysphagia. All complications were managed conservatively. One hundred forty-eight patients (81.4%) completed the 72-month (6-year) follow-up. Thirty-seven patients (25%) reached a follow-up of 84 months. At year 6 follow-up the mean BMI and the mean percentage of excess weight loss (%EWL) were 30.2 kg/m(2) and 67.3%, respectively. Mean total body weight loss was 44.9 kg, while a %EWL >50 was registered in 123 patients (83.1%). Preoperative BMI did not significantly influence postoperative %EWL. Remission of type 2 diabetes mellitus, arterial hypertension, obstructive sleep apnea syndrome, and gastroesophageal reflux disease symptoms occurred in 83.8%, 59.7%, 75.6%, and 64.7% of patients, respectively.
CONCLUSION: %EWL and resolution of co-morbidities appear to be sustained 6 and 7 years after SG. Preoperative BMI is not predictive for weight loss outcomes.

PMID: 26806727 [PubMed - as supplied by publisher]

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[Laparoscopic Gastrostomy for a Patient with Wernicke's Encephalopathy after Gastrectomy-A Case Report with a Literature Review].

[Laparoscopic Gastrostomy for a Patient with Wernicke's Encephalopathy after Gastrectomy-A Case Report with a Literature Review].

Gan To Kagaku Ryoho. 2015 Nov;42(12):2037-9

Authors: Arita T, Komatsu S, Kosuga T, Konishi H, Morimura R, Murayama Y, Kuriu Y, Shiozaki A, Ikoma H, Nakanishi M, Ichikawa D, Okamoto K, Otsuji E

Abstract
Wernicke's encephalopathy is usually related to alcoholism, malnutrition, or hyperemesis gravidarum. We report a case of Wernicke's encephalopathy after distal gastrectomy for gastric cancer. A 58-year-old man underwent distal gastrectomy with Billroth Ⅰreconstruction for early gastric cancer. Nine months later, he developed anorexia and vomiting for a few days. Brain MRI showed no significant findings, and he resumed ingestion 5 days after admission. On the 8th day of hospitalization, dysphagia suddenly developed and brain MRI indicated Wernicke's encephalopathy. Vitamin B1 was immediately injected, and neurological symptoms gradually improved. However, dysphagia did not adequately improve, leading to severe aspiration pneumonitis. Laparoscopic gastrostomy was performed for aspiration of the stomach contents and initiation of enteral nutrition. After gastrostomy, the patient made good progress and was transferred to a rehabilitation hospital. We should recognize that gastrectomy can cause Wernicke's encephalopathy.

PMID: 26805256 [PubMed - in process]

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[Clinical Significance of Placing a PEG during Chemoradiotherapy for Advanced Esophageal Cancer].

[Clinical Significance of Placing a PEG during Chemoradiotherapy for Advanced Esophageal Cancer].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1929-31

Authors: Matsuyama J, Yamamoto Y, Yamato H, Takeda M, Hashimoto Y, Shirakawa M, Tokuoka M, Ide Y, Yokoyama S, Fukushima Y, Kodama K, Sasaki Y

Abstract
BACKGROUND: Unresectable advanced esophageal cancer is often treated with chemotherapy or chemoradiotherapy(CRT). Nutritional disorders caused by dysphagia may lead to a poor prognosis.Placing a PEG before starting CRT for advanced esophageal cancer may maintain better nutritional status.
PURPOSE: The purpose of this study is to evaluate the clinical significance of placing a PEG before starting CRT for advanced esophageal cancer.
RESULTS: Fifty-one cases were evaluated, 22 PEG (+)and 29 PEG(-).The rate of a CRT was better in PEG(+)than PEG(-)cases(91% vs 79%).Infection around the PEG was the only type of complication, affecting 5%.
CONCLUSION: PEG feeding during CRT is important in the development of effective treatments for unresectable advanced esophageal cancer.

PMID: 26805220 [PubMed - in process]

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[A Case of Advanced Esophageal Cancer Patient with Schizophrenia Successfully Treated with Chemoradiation Therapy with S-1 and CDDP].

[A Case of Advanced Esophageal Cancer Patient with Schizophrenia Successfully Treated with Chemoradiation Therapy with S-1 and CDDP].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1923-5

Authors: Tsuruda Y, Okumura H, Uchikado Y, Megumi K, Urata M, Kawagoe K, Satake S, Kita Y, Uenosono Y, Arigami T, Mori S, Baba K, Ishigami S, Owaki T, Natsugoe S

Abstract
A 67-year-old man who was hospitalized at a mental hospital because of schizophrenia was admitted to our hospital with a complaint of dysphagia and vomiting. He was found to have advanced cancer in the middle thoracic esophagus. With the cooperation of a radiologist, a psychiatrist, and a nurse, we successfully performed chemoradiation therapy with S-1 and CDDP. The patient had adverse events of esophagitis and anuria during chemoradiation therapy. However, such adverse events were well controlled through the cooperation with a palliative care team and a urologist. Finally, we were able to enforce chemoradiation therapy with S-1 and CDDP without interruption.

PMID: 26805218 [PubMed - in process]

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[A Case of Esophageal Cancer Complicated with Idiopathic Thrombocytopenic Purpura].

[A Case of Esophageal Cancer Complicated with Idiopathic Thrombocytopenic Purpura].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1911-3

Authors: Nakahara Y, Yamasaki M, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y

Abstract
The patient was a 58-year-old woman. She was diagnosed with idiopathic thrombocytopenic purpura(ITP)when she was 41 years old. Splenectomy was performed at age 55; however, there was no response(NR). Therapy with prednisolone was continued. She underwent endoscopic examination because of dysphagia, and an esophageal tumor was revealed. She was diagnosed with esophageal squamous cell carcinoma(Mt, cT3N1M0, Stage ⅢA). She received high-dose g-globulin therapy and platelet transfusion before surgery, and the platelet count subsequently increased to 11.0×10/4mm3. A subtotal esophagectomy was performed. The platelet count was low immediately after surgery; however, it increased after POD5. The patient was discharged without complications. She is alive without recurrence 9 years after surgery. This is the first report of esophageal cancer complicated with ITP that was not responsive to splenectomy. We report this case along with a discussion.

PMID: 26805214 [PubMed - in process]

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Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia.

Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia.

J Am Geriatr Soc. 2016 Jan 25;

Authors: Rogus-Pulia N, Rusche N, Hind JA, Zielinski J, Gangnon R, Safdar N, Robbins J

Abstract
Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengthening-device-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapy-with the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P < .001) and posterior locations (effect estimate = 85.4, P < .001) over 8 weeks. Statistically significant improvements occurred on eight of 11 subscales of the Quality of Life in Swallowing Disorders (SWAL-QOL) Questionnaire (effect estimates = 6.5-19.5, P < .04) and in self-reported sense of effort (effect estimate = -18.1, P = .001). Higher Functional Oral Intake Scale scores (effect estimate = 0.4, P = .02) indicated that participants were able to eat less-restrictive diets. There was a 67% reduction in pneumonia diagnoses, although the difference was not statistically significant. The number of hospital admissions decreased significantly (effect estimate = 0.96; P = .009) from before to after enrollment. Findings suggest that the Swallow STRONG multidisciplinary oropharyngeal strengthening program may be an effective treatment for older adults with dysphagia.

PMID: 26804715 [PubMed - as supplied by publisher]

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Botulinum toxin-A injections vs radiotherapy for drooling in ALS.

Botulinum toxin-A injections vs radiotherapy for drooling in ALS.

Acta Neurol Scand. 2016 Jan 25;

Authors: Weikamp JG, Schinagl DA, Verstappen CC, Schelhaas HJ, de Swart BJ, Kalf JG

Abstract
OBJECTIVES: Botulinum neurotoxin (BoNT) injections in the salivary glands and radiotherapy (RT) on these glands are commonly used to alleviate severe drooling in patients with amyotrophic lateral sclerosis (ALS). This study compares BoNT type A with RT based on patient-rated evaluations.
MATERIALS & METHODS: A prospective randomized controlled pilot study to compare RT (n = 10; on the parotid and the posterior part of the submandibular glands) with BoNT-A treatment (n = 10; in the parotid glands only, because of the risk of increasing oropharyngeal weakness) in patients with ALS. The primary outcome was the drooling status (burden of drooling), and our secondary interests were the degree of salivation, global change of drooling after treatment, and level of satisfaction with the treatment and negative experiences.
RESULTS: There were no statistically significant between-treatment differences for the drooling status after treatment. Only at twelve weeks more saliva reduction was achieved by RT (P = 0.02). Patients treated with RT also described more transient negative experiences (like pain in mandible) directly after treatment. Subgroup analysis showed that patients with very severe dysphagia (no oral intake) were less satisfied and experienced a lower global change of drooling after treatment.
CONCLUSIONS: This pilot study showed no significant difference in the burden of drooling between the treatments. However, with RT more saliva reduction was achieved, including negative experiences directly after treatment, but without the risk of decreasing oropharyngeal function. In addition, patients with very severe dysphagia do not seem to benefit from either treatment.

PMID: 26803950 [PubMed - as supplied by publisher]

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Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy.

Related Articles

Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy.

J Otolaryngol Head Neck Surg. 2015;44:17

Authors: Kerr P, Myers CL, Butler J, Alessa M, Lambert P, Cooke AL

Abstract
BACKGROUND AND PURPOSE: To compare early (3 and 6 month) and later (12 and 24 month) functional outcomes of stage III and IV (M0) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal (3DCRT) or intensity modulated radiotherapy (IMRT).
PATIENTS AND METHODS: 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospectively assessed at pre-treatment and 3, 6, 12 and 24 months post treatment. A standard functional outcomes protocol including performance status (KPS, ECOG), 3 Performance Status scales for Head and Neck (PSS-HN), the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), Voice Handicap Index-10 (VHI-10) and self-rated xerostomia were applied.
RESULTS: Mean age at diagnosis was 59 years. The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients. Median follow up was 2.5 years for the second cohort. Concomitant therapy was used in 159 (79.5%). Overall survival at 3 years was 75.6% and 71.5% for IMRT and 3DCRT cohorts respectively (not significant). A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias. KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment. The 3 PSS-HN scales, Eating in Public (p < 0.001), Understandability of Speech (p = 0.009) and Oral Diet Texture (p = 0.002) and all showed significantly better outcomes in favor of IMRT. The RBHOMS showed a difference in favor of IMRT which appeared during 3 to 6 months (p < 0.001). The VHI-10 also showed a difference in favor of IMRT (p = 0.015). Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 CONCLUSIONS: A prospectively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early (3-6 months) and later (12-24 months) in the treatment of oropharyngeal carcinoma with equivalent survival. These data support the adoption of IMRT as the standard radiation treatment method for patients with stage III and IV (M0) oropharyngeal squamous carcinoma. KPS and ECOG may not be sensitive to oropharyngeal cancer patients' functional outcomes by treatment.

PMID: 25964113 [PubMed - indexed for MEDLINE]

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Beliefs about GI medications and adherence to pharmacotherapy in functional GI disorder outpatients.

Related Articles

Beliefs about GI medications and adherence to pharmacotherapy in functional GI disorder outpatients.

Am J Gastroenterol. 2015 Oct;110(10):1382-7

Authors: Cassell B, Gyawali CP, Kushnir VM, Gott BM, Nix BD, Sayuk GS

Abstract
OBJECTIVES: Pharmacotherapy is a mainstay in functional gastrointestinal (GI) disorder (FGID) management, but little is known about patient attitudes toward medication regimens. Understanding patient concerns and adherence to pharmacotherapy is particularly important for off-label medication use (e.g., antidepressants) in FGID.
METHODS: Consecutive tertiary GI outpatients completed the Beliefs About Medications questionnaire (BMQ). Subjects were categorized as FGID and structural GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific medications and doses were recorded, and adherence to medication regimens was determined by patient self-report. BMQ domains (overuse, harm, necessity, and concern) were compared between FGID and SGID, with an interest in how these beliefs affected medication adherence. Psychiatric measures (depression, anxiety, and somatization) were assessed to gauge their influence on medication beliefs.
RESULTS: A total of 536 subjects (mean age 54.7±0.7 years, range 22-100 years; n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%) with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05 for overuse, harm, necessity, and concern). SGID subjects had higher necessity-concern framework (NCF) scores compared with FGID subjects (P=0.043). FGID medication adherence correlated negatively with concerns about medication harm (r=-0.24, P<0.001) and overuse (r=-0.15, P=0.001), whereas higher NCF differences predicted medication compliance (P=0.006). Medication concern and overuse scores correlated with psychiatric comorbidity among FGID subjects (P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a greater medication necessity (17.4±0.4 vs. 16.2±0.4, P=0.024) and found their GI regimen to be more helpful (P=0.054). FGID subjects not on TCAs expressed a greater apprehension about medication overuse (10.7±0.3 vs. 9.7±0.2, P=0.002) on the BMQ.
CONCLUSIONS: FGID subjects report medication necessity and concern scores comparable to patients with SGID but have negative perceptions about medications, particularly in the presence of psychiatric comorbidity; these factors may affect treatment adherence and willingness to initiate neuromodulator regimens.

PMID: 25916226 [PubMed - indexed for MEDLINE]

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Tolerance to octyl nitrite in achalasia of the cardia.

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Tolerance to octyl nitrite in achalasia of the cardia.

Lancet. 1946 May 18;1(6403):737

Authors: ROBSON T, WILKINSON RS

PMID: 20982390 [PubMed - indexed for MEDLINE]

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Achalasia of oesophagus, following depressed fracture of base of skull.

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Achalasia of oesophagus, following depressed fracture of base of skull.

Lancet. 1946 Mar 16;1(6394):381-3

Authors: FLEMINGER JJ, SMITH MC

PMID: 21017415 [PubMed - indexed for MEDLINE]

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