Prediction of lymph node metastasis in T1/T2 tongue squamous cell carcinoma

OBJECTIVES

In T1, T2, and clinically NO squamous cell carcinoma of the tongue, there is no reliable predictive variable to determine whether or not neck dissection is needed. Thus, we established a predictive score model based on tumour depth and other pathological variables.

METHODS

We retrospectively reviewed 115 patients with T1 and T2 stage squamous cell carcinoma of the tongue. Their pathological variables were used to construct a score model for predicting the risk of cervical lymph node metastasis.

RESULTS

A predictive score model was proposed using multivariate logistic regression analysis: Score = (2.694 x tumour depth (cm)) + (1.814 x lymphovascular invasion (yes = 1, no = 0)) + (1.175 x perineural invasion (yes = 1, no = 0)). The cutoff point was set at 2.7427. This predictive score model has a sensitivity of 91.2% and specificity of 65.4%.

CONCLUSION

A predictive score model was built and a two-stage surgical approach was suggested for T1 and T2 squamous cell carcinoma of the tongue.

Role of co-expression of c-Myc, EZH2 and p27 in prognosis of prostate cancer patients after surgery

BACKGROUND

c-Myc, EZH2 and p27 were defined to modulate the behavior of prostate cancer with pro-tumoral or anti-tumoral effects and had ability in predicting prostate cancer progression, but the research of their co-expression value of prognosis is rarely. This study aimed to investigate the prognostic value of combining tri-marker together in patients with intermediate-risk prostate cancer after surgery.

METHODS

Expression levels of c-Myc, EZH2 and p27 in 129 patients with intermediate-risk prostate cancer were assessed using immunohistochemistry in a semi-quantitative manner. The expression profiles of these three markers were analyzed and investigated for association with biochemical recurrence.

RESULTS

In all, fifty of 129 cases experienced biochemical recurrence during a median follow-up time of 31 months (range, 6 - 60 months). Of these relapse patients, one case without and 10 cases with any single positive marker were observed; 39 cases were detected with any two or all three positive markers (22 cases with any two and 17 cases with all three positive markers). Survival analysis showed that patients with over-expression of c-Myc or EZH2, and lower expression of p27 manifested significantly higher biochemical recurrence rates. Subsequent multivariate analysis revealed that c-Myc, EZH2 and p27 expression statuses showed potential in predicting relapse, respectively. Notably, combining three markers together as a "composite index" (0 or 1, vs. 2 or 3 positive markers) provided powerful prognostic value (HR 6.57, 95% CI 3.02 - 14.31, P < 0.001). There was a significant difference between the patient subgroups with 0 or 1 and those with 2 or 3 positive markers expression statuses, and tri-marker composite index was an independent risk factor for predicting relapse in patients with intermediate-risk prostate cancer after surgery.

CONCLUSION

Composite index of c-Myc, EZH2, and p27 can be valued as powerful prognosis parameter for intermediate-risk prostate cancer patients after the surgery, and postoperative adjuvant therapy can be adopted accordingly.

[Risk factors of postoperative intravesical recurrence of transitional cell carcinoma of the ureter]

OBJECTIVE

To define the clinicopathological risk factors of intravesical recurrence of primary transitional cell carcinoma of the ureter after surgical intervention.

METHODS

Patients with primary carcinoma of the ureter treated between January 2000 and December 2010 were retrospectively analyzed. The intravesical recurrence-free survival rate was calculated using Kaplan-Meier method. Multivariate analysis was conducted with Cox's regression.

RESULTS

A total of 104 patients were enrolled, who were followed up for a median of 46 months (13-89 months). Thirty-nine of the patients showed postoperative intravesical recurrence. Urine exfoliative cytology (P=0.000), number of tumors (P=0.006), tumor grade (P=0.039) and co-existence of bladder tumor (P=0.014) were found to independently influence the postoperative intravesical recurrence. Patients with more risk factors had poorer intravesical recurrence-free survival.

CONCLUSION

Urine exfoliative cytology, number of tumors, tumor grade and co-existence of bladder tumor are independent risk factors for postoperative intravesical recurrence of primary transitional cell carcinoma of the ureter. Close follow-up and rigorous treatment are essential for patients with high risk factors.

Survivin SNP-carcinogen interactions in oral cancer

In Taiwan, oral cancer is causally associated with environmental carcinogens. Survivin is an anti-apoptotic protein and is generally considered a marker of malignancy. The current study explored the combined effect of survivin gene polymorphisms and environmental carcinogens on the risk and clinico-pathological development of oral cancer. Five single-nucleotide polymorphisms (SNPs) of survivin genes from 439 male patients with oral cancer and 424 male control participants (who did not have cancer) were analyzed. The survivin -31GG, +9194 GG, and +9809 TT homozygotes exhibited higher risk for oral cancer compared with the corresponding ancestral genotype, after adjustment for related confounders. The survivin -31, +9194, and +9809 SNPs combined with betel quid chewing and/or tobacco consumption could robustly elevate susceptibility to oral cancer. The distribution frequency of the -31 G: +9194 A: +9809 T haplotype was significantly higher in oral cancer patients than in control participants. These results suggest that survivin gene polymorphisms and their interactions with environmental carcinogens may increase susceptibility to oral cancer in Taiwanese men.

ABBREVIATIONS

AOR, adjusted odds ratio; CI, confidence intervals; PCR, polymerase chain-reaction; SNP, single-nucleotide polymorphisms.

Endoscope-assisted transoral excision of a huge parapharyngeal pleomorphic adenoma

The treatment of choice for a parapharyngeal pleomorphic adenoma is total surgical resection. We describe an endoscope-assisted transoral excision of a huge parapharyngeal pleomorphic adenoma, and discuss the benefits of this type of operation.

Metallothionein-1 genotypes in the risk of oral squamous cell carcinoma

BACKGROUND

We conducted an independent analysis of metallothionein 1 (MT-1) rs8052394, rs11076161, rs8052334, rs964372, rs7191779, and rs708274 in 587 individuals who were either healthy controls or subjects with oral squamous cell carcinoma (OSCC).

METHODS

All participants provided a nucleic acid sample (blood) as well as epidemiologic information on covariates or "risk factors" for OSCC, including tobacco, alcohol, and areca quid use. The genotyping result was used in a logistic regression model that examined main effects as well as statistical interactions while controlling for confounders.

RESULTS

MT-1 is involved in regulation of zinc and copper homeostasis. It also is a potent antioxidant and its polymorphisms correlate with the risk for OSCC. Rs11076161 A, rs964372 C, and rs7191779 C alleles were protective against OSCC (adjusted OR = 0.53, 0.49, 0.36, respectively; p < 0.05), whereas rs8052394 A alleles were associated with increased risk. Areca quid chewing and tobacco use were strong risk factors for developing the disease and were associated with 20- and 8-fold increases in adjusted risk (p < 0.05), respectively.

CONCLUSIONS

Controlling for the effects of age, gender, areca quid, tobacco, and alcohol use, individuals with inherited the MT-1 rs11076161 AA, rs964372 CC, and rs7191779 GC genotypes may experience significant protection against OSCC, whereas individuals carrying the MT-1 rs8052394 A allele seem exposed to higher risk.

A pre-paid newborn hearing screening programme: a community-based study

OBJECTIVES

To help obstetric hospitals and clinics to implement newborn hearing screening and to test the feasibility of a pre-paid model for screening.

PATIENTS AND METHODS

From July 2005 to August 2008, we organised a coordinated newborn hearing screening team with portable automated auditory brainstem response (AABR) to provide in-patient screening after delivery and out-patient re-screening at one month of age in birthing facilities throughout Changhua County, Taiwan. This was a community-based study organised by otolaryngologists at a tertiary referral centre.

RESULTS

Ten medical facilities participated in our screening programme. 7,139 out of 12,901 neonates delivered in these facilities during the period were screened for hearing loss. 105 (1.47%) babies who did not pass the in-patient screening were re-screened at one month old. Forty (0.56%) babies referred from the re-screening were sent for diagnostic work-up and six of them failed to show up. The overall follow-up rate was 94.3% (99/105). Eleven babies with bilateral hearing loss and eight babies with unilateral hearing loss were diagnosed. The incidence of bilateral hearing loss in our programme was 1.5/1000. The screening rate descended from medical centre to clinic (p < 0.0001). There was no significant difference between the referral rates for different levels of birthing facilities (p = 0.5611).

CONCLUSIONS

Our study demonstrates that a pre-paid model using AABR is feasible at all three levels of medical facilities. Pre-paid community-based screening might be an option for developing countries in the implementation of universal newborn hearing screening.

Is planned surgery important in sinonasal inverted papilloma?

OBJECTIVE

To evaluate which clinical characteristics of inverted papilloma (IP) can result easily in misdiagnosis by clinicians and to determine the recurrence rate of inverted papilloma depending on diagnosis confirmation pre-operatively, intra-operatively or post-operatively.

PATIENTS AND METHODS

Fifty-one patients were treated for IP and 47 patients attended regular post-operative follow-up appointments for at least one year (mean: 54 months).

RESULTS

The patients were assigned to 3 groups: group Ia, in which IP was not confirmed until the post-operative pathology findings; group Ib, in which IP was confirmed during the operation; and group II, in which IP was confirmed before the operation. There were nineteen (37%) patients in group Ia, nine patients (18%) in group Ib and twenty-three patients (45%) in group II. The recurrence rates for groups Ia, Ib and II were 33%, 11% and 5% respectively.

CONCLUSIONS

The initial presentation of bilateral sinonasal disease can easily lead the doctor into the misdiagnosis of IP. Bony erosion, remodelling, and a widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. The correct diagnosis prior to surgery is a determinant of outcome. The use of frozen sections should, however, improve outcome as well. In this study we highlight the high prevalence and relatively low control rate of misdiagnosed IP (pathology undetermined pre-operatively) and hope to remind clinicians that early recognition of the tumour is most beneficial to patients.

Lethal sphenoid fungal sinusitis in an immunocompromised elderly patient

Sphenoid fungal balls are rare and typically indolent lesions, unless superinfected by bacteria or invasive to adjacent neurovascular structures. If the identification or treatment of underlying complications is delayed in an immunocompromised patient, a catastrophic outcome may result. We report the case of an elderly female patient with poorly controlled diabetes mellitus suffering from sphenoid fungal sinusitis that is complicated by cavernous sinus thrombophlebitis and carotid artery stenosis. In spite of reasonable diagnosis and therapy, the patient's general condition deteriorated and she eventually died. The clinical presentation, diagnosis, and treatment strategy are discussed.

[Effect of nitric oxide on Toll-like receptor 2/4 gene expression in the liver in acute hemorrhagic necrotizing pancreatitis in rats]

OBJECTIVE

To investigate the effect of nitric oxide (NO) on Toll-like receptors 2 and 4 (TLR 2/4) gene expression in the liver in acute hemorrhagic necrotizing pancreatitis (AHNP) in rats.

METHODS

Seventy SD male rats were randomly divided into sham-operated group (n=10), AHNP group (n=30) and L-arginine (L-Arg) treatment group (n=30). Blood samples and liver tissues were obtained at 6 hours in sham-operated group, and 3, 6, 12 hours respectively in AHNP group and L-Arg-treated group. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase in serum, NO, tumor necrosis factor-alpha (TNF-alpha) in liver tissue were determined. TLR2/4 mRNA expressions in the liver tissue were measured by reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

TLR2/4 mRNA could be detected in the liver with low values in sham-operated group [(1.150+/-0.725)x10(-6), (11.450+/-1.724)x10(-4)], but they were markedly upregulated at 3 hours in AHNP group [(1.970+/-0.362)x10(-3), (175.000+/-0.111)x10(-3)], and peaked at 12 hours [(29.400+/-3.155)x10(-4), (267.300+/-8838)x10(-2), P<0.01). At the same time serum levels of amylase, ALT and AST increased, hepatic injuries were aggravated, the levels of TNF-alpha in the liver were increased and levels of NO in the liver were lowered (P<0.05 or P<0.01). Treatment with L-rg could effectively inhibit TLR2/4 mRNA expression [3 h: (3.510+/-1.528)x10(-4), (13.500+/-2.231)x10(-2); 6 h: (21.000+/-5.346)x10(-4), (18.700+/-2.685)x10(-2); 12 h: (26.200+/-2.076)x10(-4), 1.959+/-0.270, P<0.05 or P<0.01] and alleviate hepatic injuries. The levels of serum amylase, ALT and AST lowered, and the levels of TNF-alpha in the liver were lowered and the levels of NO were markedly increased (P<0.05 or P<0.01).

CONCLUSION

These findings suggest that the expression of TLR2/4 mRNA is increased in the liver in AHNP, and the hepatic injuries are aggravated. NO could markedly inhibit TLR 2/4 mRNA gene expression in the liver in AHNP.

Animal models for intestinal tissue engineering

Although total parenteral nutrition prevents patients with short bowel syndrome from dying of starvation, having short bowel remains a severely debilitating condition. The best current treatment for inadequate absorptive surface area is through intestinal transplantation. However, this therapy is associated with significant morbidity and patients suffer from consequences of long-term immunosuppression. Additionally, the numbers of organs are limited. A new frontier in medicine is the field of tissue engineering. We will review the progress of intestinal bioengineering with a focus on the use of animal models. Investigators initially used autologous tissue as a patch to study intestinal regeneration. Subsequent studies focused on the use of absorbable biomaterials as a patch for tissue ingrowth. The most novel methodology consists of seeding a resorbable scaffold and implanting this construct to observe the regeneration of neointestine. Successful creation of esophagus, stomach, small bowel and colon has been demonstrated. Although these studies are preliminary, the results suggest that tissue-engineered intestine will become a real therapeutic option in the not too distant future for patients with inadequate intestinal tissue.

Primary tumour volume delineation in nasopharyngeal carcinoma and correlation with 1997 AJCC tumour stage classification

OBJECTIVE

To investigate the variability in primary tumour volume in nasopharyngeal carcinoma and compare it with the tumour staging of the 1997 American Joint Committee on Cancer.

DESIGN

Prospective study.

SETTING

Tertiary care centre.

METHOD

A series of 33 newly diagnosed patients who were treated with high-dose radiotherapy participated in the study.

MAIN OUTCOME MEASURES

Using computed tomographic scans, primary tumour volumes were measured using the summation-of-areas technique, and the variability in tumour volume was determined. The Mann-Whitney test was used for statistical analysis.

RESULTS

A large variation in primary tumour volume was observed, especially in advanced-stage cases.

CONCLUSIONS

Nasopharyngeal carcinoma shows considerable variability in primary tumour volume. Incorporation of primary tumour volume may lead to further refinement of the 1997 tumour staging system.

Small bowel tissue engineering using small intestinal submucosa as a scaffold

BACKGROUND

Small intestinal submucosa (SIS) is an extracellular matrix used in tissue engineering studies to create de novo abdominal wall, urinary bladder, tendons, blood vessels, and dura mater. The purpose of this study is to evaluate the feasibility of using SIS as a scaffold for small bowel regeneration in an in situ xenograft model.

MATERIALS AND METHODS

Twenty-three dogs had a partial defect created on the small bowel wall which was repaired with a SIS patch. Four dogs underwent small bowel resection with placement of an interposed tube of SIS. The animals were followed 2 weeks to 1 year.

RESULTS

Three of the 23 dogs with SIS placed as a patch died shortly after surgery due to leakage from the site. The other 20 dogs survived up to time of elective necropsy with no evidence of intestinal dysfunction. At necropsy, the bowel circumference in the patched area had no stenosis. Histological evaluation showed the presence of a mucosal epithelial layer, varying amount of smooth muscle, sheets of collagen, and a serosal covering. Architecturally, the layers were not well organized in the submucosal region. An abundance of inflammatory cells was present in the early postoperative period but receded with time. All 4 dogs with a tubular segment of SIS interposed had significant problems. One had partial obstruction at 1 month, and 3 died in the early postoperative period due to leakage.

CONCLUSIONS

This preliminary study suggests that SIS patches can be used for small bowel regeneration. Tubular segmental replacement is not feasible at this time.

Expression and characterization of monocot rice cytosolic CuZnSOD protein in dicot Arabidopsis

Cytosolic CuZnSOD removes deleterious superoxides from plant cells. In order to understand its function better, we sought to express a monocot CuZnSOD gene in transgenic Arabidopsis. We constructed a transgene using the CaMV 35S promoter to express a rice cytosolic CuZnSOD gene in Arabidopsis and generated over 200 transformants. A 16 kD polypeptide, the same size as the native rice CuZnSOD polypeptide, was detected in the transgenic Arabidopsis. Interestingly, two forms of rice CuZnSOD, rSODI and rSODII, having the same dimeric size, were detected in the transgenic plants. rSODII protein was relatively abundant but had low specific activity. In contrast, rSODI protein was relatively rare and had high specific activity. Inter-conversion of rSODI and rSODII could be achieved by the addition and removal of copper ions into the purified recombinant SOD and to the leaf extract of transgenic plants. Our analysis indicates that rSODI most likely corresponds to native rice CuZnSOD that has incorporated the Cu and Zn ions required for full activity, whereas the less active rSODII form may not have properly incorporated the necessary copper ions.

VEGF is upregulated in a neuroblastoma and hepatocyte coculture model

BACKGROUND

We hypothesize that angiogenic factors are altered by the interaction between neuroblastoma cells and host tissues.

MATERIALS AND METHODS

Human Chang hepatocytes and human neuroblastoma cells are cultured separately and in a noncontact, coculture system. Immunostaining for VEGF is performed on the cells. ELISA is used to detect vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and interleukin-8 in the conditioned media. Human umbilical vein endothelial cells (HUVEC) are cultured with standard medium (control) and hepatocyte, neuroblastoma, and coculture conditioned media. After 48 and 72 h, cells are counted to determine proliferation. Finally, VEGF-blocking antibody is added to the HUVEC cultures with the conditioned media.

RESULTS

VEGF is markedly elevated in the coculture medium compared to the media from hepatocytes or neuroblastoma grown alone [412.2 +/- 52 vs 235 +/- 35 or 74.5 +/- 28.5 (pg/10(6) cells), P < 0.05]. Other growth factors are almost undetectable in any of the media. Immunostaining for VEGF in the cocultured hepatocytes is decreased by almost 50%, but VEGF immunostaining is increased fourfold in the cocultured neuroblastoma cells. A significant increase in cell proliferation is seen at both 48 and 72 h when HUVEC are cultured with the coculture media. Cell proliferation is blocked with the addition of anti-VEGF antibody.

CONCLUSION

The interaction of neuroblastoma with hepatocytes results in an increased production of VEGF. It stimulates endothelial cell proliferation and may enhance the tumor's metastatic potential in an autocrine fashion.

Floral spray transformation can efficiently generate Arabidopsis transgenic plants

In this study, floral spray and floral dip were used to replace the vacuum step in the Agrobacterium-mediated transformation of a superoxide dismutase (SOD) gene into Arabidopsis. The transgene was constructed by using a CaMV 35S promoter to drive a rice cytosolic CuZnSOD coding sequence in Arabidopsis. The transgene construct was developed in binary vectors and mobilized into Agrobacterium. When Arabidopsis plants started to initiate flower buds, the primary inflorescence shoots were removed and then transformed by floral spray or floral dip. More than 300 transgenic plants were generated to assess the feasibility of floral spray used in the in planta transformation. The result indicates that the floral spray method of Agrobacterium can achieve rates of in planta transformation comparable to the vacuum-infiltration and floral dip methods. The floral spray method opens up the possibility of in planta transformation of plant species which are too large for dipping or vacuum infiltration.

Canal-wall-down tympanoplasty with mastoidectomy for advanced cholesteatoma

OBJECTIVE

The objective of this study was to review 8.5 years of the senior author's experience with canal-wall-down mastoid surgery for extensive cholesteatoma with high-grade atelectasis and severely destructed ossicles.

DESIGN

A retrospective review was conducted.

SETTING

The setting was a tertiary care medical centre.

METHODS

Available records consulted included 104 canal-wall-down mastoidectomy for advanced-stage cholesteatomas between July 1984 and December 1992.

MAIN OUTCOME MEASURES

Recurrence, hearing results, and dry ear rate were analyzed.

RESULTS

The recurrence rate was 4 of 104 (3.8%), and 9.6% of subjects suffered from recurrent otorrhea. Thirty-seven of 104 (35.6%) achieved the closure of air-bone gap within 20 dB. The availability of stapes suprastructure influenced the postoperative hearing level significantly (p < .001).

CONCLUSION

Even in treating advanced cholesteatoma, canal-wall-down mastoidectomy provides a low recurrence rate, establishes a high dry ear rate, and preserves adequate hearing when the stapes suprastructure is available for reconstruction.

Free fluid on abdominal computed tomography scan after blunt trauma does not mandate exploratory laparotomy in children

BACKGROUND/PURPOSE

The isolated finding of free intraperitoneal fluid on abdominal computed tomography (CT) scan after blunt trauma in adults is considered an indication for laparotomy by many trauma surgeons. The authors wished to determine if these guidelines are applicable to children.

METHODS

A retrospective chart review was conducted. The authors included all children (< or =12 years of age) sustaining blunt abdominal trauma who were admitted to our institution between January 1, 1994 and November 1, 1998.

RESULTS

There were 814 children admitted, and 437 had abdominal CT scans. Thirty-four studies showed free fluid associated with solid organ injuries, spine or pelvic fractures, or pneumoperitoneum, and were excluded. Thirty-two children had free fluid without associated injuries and formed the basis for the study. Five of these children underwent laparotomy based on the CT finding alone. The remaining 27 were observed with serial abdominal examinations and did not require surgical intervention. Only 1 of the 5 children who underwent surgery for the finding of isolated free fluid had a therapeutic laparotomy. In comparison, during the same period, 38 children underwent laparotomy after blunt injury based only on physical examination findings with a therapeutic laparotomy rate of 68%. The therapeutic laparotomy rate was significantly higher when the procedure was based solely on clinical examination as compared with the isolated finding or free fluid on the abdominal CT (26 of 38 v 1 of 5, P < .05).

CONCLUSION

In contrast to adults, finding isolated free fluid on abdominal CT scans in children after blunt trauma does not dictate immediate surgical exploration.

Neuroblastoma and hepatocyte coculture conditioned media alter apoptosis

BACKGROUND

Neuroblastoma is a childhood tumor that often displays unusual biological behavior. The tumor may present with widespread metastases that are unresponsive to aggressive treatment. At other times, both the metastases and the primary tumor may spontaneously regress without treatment. Apoptosis, or programmed cell death, is thought to play a role in the dichotomous behavior of neuroblastoma. We hypothesize that neuroblastoma cells will interact with host tissues to release mediators that affect apoptosis.

MATERIALS AND METHODS

Human neuroblastoma cells and human Chang hepatocytes are grown in a noncontact, coculture system. After incubation for 4 days, the medium from the coculture system is collected. Neuroblastoma cells and Chang hepatocytes are then plated separately with the conditioned medium and their own standard growth medium as controls. After 4 days, these cells are harvested and cytospins made for immunostaining. Tumor necrosis factor alpha (TNF-alpha), Fas ligand, and Bcl-2, are measured with immunohistochemistry. Apoptosis is detected with the TUNEL method. Immunostaining data are interpreted with computer image analysis and reported as stain index. TUNEL data are reported as percentage apoptotic cells. All data are reported as means +/- SEM. Statistical analysis is performed and P < 0.05 considered significant.

RESULTS

Chang hepatocytes grown in the coculture conditioned media have an increase in TNF-alpha and Fas ligand. The neuroblastoma cells have a significant decrease in Fas ligand. There is a significant increase in the number of apoptotic hepatocytes when they are cultured in the conditioned media. In contrast, the neuroblastoma cells grown in the coculture conditioned media show no increase in apoptosis. Finally, Bcl-2 is significantly increased in the neuroblastoma cells cultured in the conditioned media.

CONCLUSIONS

Neuroblastoma cells grown in coculture conditioned media show increased expression of Bcl-2 and decreased Fas ligand levels. These changes should diminish apoptosis activity in the tumor cells. In contrast, the conditioned media induce elevated levels of proapoptotic mediators in the Chang hepatocytes. A tumor's ability to successfully metastasize may be dependent on mediators generated in the tumor-host interaction, and may not be just an independent characteristic of the tumor itself.

Deep neck infections in diabetic patients

PURPOSE

Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management.

PATIENTS AND METHODS

A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus.

RESULTS

Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients.

CONCLUSIONS

In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

Effects of radiotherapy for nasopharyngeal carcinoma on the paranasal sinuses: study based on computed tomography scanning

OBJECTIVE

The purpose of this study was to determine if radiotherapy for nasopharyngeal carcinoma causes mucosal disease of the paranasal sinuses.

DESIGN

This study was a retrospective study.

SETTING

This study was conducted at a tertiary care centre.

METHOD

A series of 69 newly diagnosed patients, without pre-existing sinus disease, who were treated with high-dose radiotherapy participated.

MAIN OUTCOME MEASURES

The prevalence, severity, and time course of mucosal abnormalities were analyzed, as judged by consecutive computed tomographies (CTs).

RESULTS

The CT study revealed that 58.8% of the postirradiation scans had mucosal disease of the sinuses. The maxillary sinus had the highest prevalence (42.3%) without statistical significance (p = .10). The difference by McNemar test for two follow-up scans was not significant (p = .48) and by Kappa test was significant (p = .04). The relationship between the prevalence and the time course post radiotherapy revealed that it remained a high prevalence until after the 4-year follow-up scans.

CONCLUSIONS

The results of this study confirm that chronic sinus disease is a common late complication of radiotherapy and it persists for years. Thus, aggressive treatment is indicated.

Prospective surveillance of children with invasive Haemophilus influenzae disease in Taiwan

During the 16 months from January 1, 1996 through April 30, 1997, forty-three cases of invasive Haemophilus influenzae disease were identified in residents younger than 14 years of age in Taiwan. H. influenzae serotyping was performed on all isolated specimens. There were 33 (76.7%) cases of type b disease; three (7.0%), non-type b, and seven (16.3%), nontypeable cases. Among these H. influenzae type b cases, there were 18 (54.5%) male patients and 15 (45.5%) female patients. With regard to age-distribution, nine (27.3%) patients were aged 2 to 5 years; nine (27.3%), between 1 to 2 years; fifteen (45.5%), younger than 1; and none were younger than 3 months old. Demographical study indicated that 13 patients (39.4%) located in northern Taiwan; 5 (15.2%), central Taiwan; 12 (36.4%), southern Taiwan; 3 (9.0%) from eastern Taiwan. Among the 33 H. influenzae type b cases, twenty-five (75.8%) patients had meningitis and 8 patients had other disease entities, i.e. pneumonia in 4 patients, bacteremia in 3, and cellulitis in 1. In terms of prognosis, three (9.1%) patients died, all of whom having meningitis or sepsis; 7 (21.2%) developed hydrocephalus; 2 (6.1%) had seizure disorder without hydrocephalus and 21 (63.6%) patients recovered completely without sequelae.