The diagnostic value of fine needle aspiration in parotid lumps

INTRODUCTION

Fine needle aspiration (FNA) is a safe and quick method of diagnosing superficial lumps, which aids preoperative planning. However, FNA of the parotid gland has not gained the widespread acceptance noted in other head and neck lumps. The aim of this study was to determine the ability of FNA of the parotid gland to differentiate benign and malignant disease, and to determine the impact on surgical outcome.

METHODS

A retrospective analysis of 201 consecutive parotid operations with preoperative FNA in a large district hospital in the UK was performed. The diagnostic characteristics were calculated for benign and malignant disease, and the impact on surgical procedure was determined.

RESULTS

In identifying benign disease, FNA has a sensitivity of 85% and a specificity of 76%. In detecting malignant disease, FNA has a sensitivity and specificity of 52% and 92% respectively. A false positive on FNA was associated with a higher incidence of neck dissection.

CONCLUSIONS

FNA is a useful diagnostic test. However, owing to low sensitivity, it is necessary to interpret it in the context of all other clinical information.

Interaction between the ionic liquids 1-alkyl-3-methylimidazolium tetrafluoroborate and Pluronic® P103 in aqueous solution: a DLS, SANS and NMR study

The effect of three ionic liquids (ILs) 1-alkyl 3-methyl imidazlolium tetraflouroborates (C(n)mim BF(4)n=4, 6, 8) on micellar solutions of an ethylene oxide-propylene oxide block copolymer (PEO-PPO-PEO), Pluronic® P103 was examined from scattering and NMR techniques. The ILs alter the cloud point and micelle size dependant on their alkyl chain length and the results are discussed in terms of their behavior as cosolvent/cosurfactant. Cloud point data support the hydrogen bonding between the imidazolium cation and P103 while dynamic light scattering (DLS) and small angle neutron scattering (SANS) reveal that presence of ionic liquid is not conducive to the micelle formation of P103. The selective nuclear Overhauser effect (NOESY) indicates that the PPO block of the P103 interacts with the alkyl group of the C(n)mim(+) cation by hydrophobic interaction. Through this kind of interactions, C(n)mim BF(4) and P103 can form mixed micelles. This result indicates that the presence of ILs hinders the micelle formation of P103 in solution and promotes P103 to orient at air/water interface.

Outcomes in Oropharyngeal Cancer

Objective: 1) To assess outcomes, in terms of survival, quality of life (using EORTC CQOL and HN35), and swallowing in oropharyngeal cancer patients treated with transoral surgical techniques. 2) To compare these outcomes with those of patients treated with chemoradiotherapy.

Method: The study was conducted through 2011. Data were collated from the databases of 3 head and neck cancer units in the southwest of England. Patients diagnosed with oropharyngeal squamous cell carcinoma between 2006-2008 were identified. Their medical records were reviewed and questionnaires looking in to the assessed outcome measures were sent.

Results: A total of 124 patients diagnosed with oropharyngeal squamous cell carcinoma during the years 2006-2008 were identified. Of these 124 patients, 70 were still alive at the time of the study. Sixty-three of 70 patients responded to the questionnaire. Notable findings included much reduced symptom scores for swallowing difficulties in those patients treated surgically compared to chemoradiation. The combined head and neck symptom scores for stage 3 and 4 disease was a median of 12 for the surgical group versus 27 for the chemoradiation group.

Conclusion: These data add to the available evidence that suggests that patients treated with modern, minimally invasive, transoral surgical techniques may have improved quality of life and swallowing function compared to those treated with chemoradiotherapy.

The Role of Vestibular Caloric Tests in Cochlear Implantation

Objective

Vestibular function tests are often undertaken before cochlear implantation, in part to help select the side of surgery. The authors aim to determine whether implantation on the side of better vestibular function leads to greater perception of dizziness by patients than implantation on the side of worse or similar function.

Study Design

Historical cohort study.

Setting

Tertiary cochlear implantation center.

Subjects and Methods

The records of 177 adult recipients of a unilateral cochlear implant were reviewed retrospectively in 2 groups. Group A included patients with an implant in the ear with worse or similar caloric responses. Group B included patients with an implant in the ear with the stronger caloric response. All patients underwent preoperative bithermal caloric testing: a clinically significant difference was defined by a 20% lateral canal paresis. They were assessed postoperatively by the Dizziness Handicap Inventory and supplementary questions.

Results

Fifty-seven percent of both groups reported dizziness in the first 7 days postoperatively. At 2 months, 20% of group A and 34% of group B experienced some dizziness. Fourteen percent of group A and 10% of group B felt that cochlear implantation had resulted in impaired balance. The Dizziness Handicap Inventory scores of 86% of group A (median score 0) and 76% of group B (median score 10) corresponded with low handicap. None of these results differed significantly between groups A and B.

Conclusion

Although cochlear implantation may result in dizziness, it is almost always short-lived and mild, even when the ear with the stronger caloric response is implanted.

Safe and adequate placement of nasogastric tubes in the presence of a cuffed tracheostomy tube

This case report and review of the literature aims to highlight the importance of the use of a chest radiograph to check the placement of nasogastric tubes after insertion in an awake patient with an inflated cuffed tracheostomy tube regardless of an acidic pH test.

Role of Vestibular Function Tests in Cochlear Implantation

Objective: Vestibular function tests are often undertaken before cochlear implantation, in part to help select the side of surgery. We aim to determine whether implantation on the side of better vestibular function leads to greater dizziness than implantation on the side of worse or similar function.

Method: A total of 177 unilateral implant recipients were reviewed in 2 groups. A: Those implanted in the ear with worse or similar caloric function. B: Those implanted in the ear with greater (>20%) caloric function. All were assessed with the Dizziness Handicap Inventory and supplementary questions after a minimum 2 months.

Results: A total of 57% of both groups reported dizziness in the first 7 days postoperatively. At 2 months 20% of group A and 34% of group B experienced some dizziness. A total of 14% of group A and 10% of group B felt that cochlear implantation had resulted in impaired balance. The DHI scores of 86% of group A (median score 0) and 76% of group B (median score 10) corresponded with low handicap. None of these results differed significantly between groups A and B.

Conclusion: While cochlear implantation may result in dizziness it is almost always short-lived and mild, even when the ear with a stronger caloric response is implanted.

Spontaneous third ventriculostomy: definition by endoscopy and cerebrospinal fluid dynamics

Chronic obstructive hydrocephalus is known to cause ventricular diverticula and, rarely, spontaneous ventriculostomy. The authors present the case of a patient in whom a spontaneous third ventriculostomy was identified with long-standing hydrocephalus secondary to aqueductal stenosis. To their knowledge, this is the first report in which a spontaneous stoma in the floor of the third ventricle was evaluated using endoscopy and cerebrospinal fluid dynamics studies. Both studies confirmed that the spontaneous stoma is similar in structure and function to surgical third ventriculostomy.

Robotic surgery in ear nose and throat

The arrival of a commercial surgical robotic platform at our institution has raised the question of its application and usefulness within the department of otolaryngology head and neck surgery. In order to answer this question, we sought to perform a qualitative review to examine the evolution of commercial surgical robotics and examine present and future applications of this emerging technology within our specialty. The main objective of this study is to examine the development and application of robotic surgery in otolaryngology, head and neck surgery. The study includes a qualitative systematic review. We have reviewed research papers and studies that specifically relate to the use of robots in otorhinolaryngology. More specifically, we have attempted to review those studies that have significantly added to the development of this field. In summary, we have examined eight animal studies, six cadaveric studies, nine human trials. Robotic surgery in ENT is a safe and feasible option. In certain procedures, it offers significant benefits over conventional surgery. Instrument and robotic arm size, and costs are limiting factors that prevent the use of robots being applied to many additional ENT procedures. We feel the development of new speciality-specific robots will yield a new era in the common use of robotics in ENT.

Efficacy of isavuconazole, voriconazole and fluconazole in temporarily neutropenic murine models of disseminated Candida tropicalis and Candida krusei

OBJECTIVES

The aim of this study was to assess the dose-response of isavuconazole, voriconazole and fluconazole in disseminated Candida tropicalis and Candida krusei infections.

METHODS

Mice were immunosuppressed using either one dose [temporarily neutropenic (TN)] or two doses [persistently neutropenic (PN)] of cyclophosphamide. Treatment was started 5 h after infection with oral isavuconazole (6, 15, 30, 60, 90, 120 or 150 mg/kg equivalent active compound), intravenous voriconazole (5, 20 or 40 mg/kg plus grapefruit gavage twice daily) or oral fluconazole (15, 50 or 150 mg/kg) all administered twice daily. Kidney burden was assessed for C. tropicalis, and kidney and brain burden for C. krusei.

RESULTS

Vehicle controls developed a non-lethal infection with high burdens in both models. In the TN models, isavuconazole, voriconazole and fluconazole (>50 mg/kg) reduced kidney burden compared with controls; >60 mg/kg isavuconazole and 50 mg/kg fluconazole were superior to alternative treatments (other than voriconazole 40 mg/kg). Isavuconazole (all doses) reduced brain burden (P<0.05) in the C. krusei model; fluconazole (all doses) and voriconazole (5 and 20 mg/kg) did not. In the C. krusei kidney burden model, isavuconazole 120 and 150 mg/kg and voriconazole 40 mg/kg were superior to controls and fluconazole. In the C. tropicalis model, PN isavuconazole (all doses), voriconazole (>5 mg/kg) and fluconazole (all doses) reduced kidney burden (P<0.05). Only isavuconazole (all doses) and 40 mg/kg voriconazole were effective against C. krusei in the brain, isavuconazole and voriconazole reduced tissue burden (P<0.05). Fluconazole had no significant effect on brain burden even at 150 mg/kg.

CONCLUSIONS

Isavuconazole significantly reduced kidney burden in mice infected with C. tropicalis and both kidney and brain burdens in mice infected with C. krusei. Isavuconazole was as effective as voriconazole and much more effective than fluconazole at reducing brain burden.

Evidence for a long-range component in the pion emission source in Au+Au collisions at sqrt sNN=200 GeV

Emission source functions are extracted from correlation functions constructed from charged pions produced at midrapidity in Au+Au collisions at sqrt[s(NN)]=200 GeV. The source parameters extracted from these functions at low k(T) give first indications of a long tail for the pion emission source. The source extension cannot be explained solely by simple kinematic considerations. The possible role of a halo of secondary pions from resonance emissions is explored.