Angioleiomyoma of the inferior turbinate: a rare cause of isolated facial pain

We present the case of a 33-year-old man with right-sided facial pain. Clinical examination revealed an isolated mass attached to the right inferior turbinate. This was confirmed with computed tomography. Excision was achieved endoscopically and histology revealed an angioleiomyoma. Full symptomatic relief was achieved after surgical excision. Less than 1% of angioleiomyoma lesions are found within the sinonasal cavity. We describe the first documented presentation of angioleiomyoma as a cause of isolated, unilateral facial pain; a very common presentation to the otorhinolaryngology clinic. We promote consideration of angioleiomyoma as a different diagnosis in the presence of facial pain and a unilateral sinonasal lesion. Endoscopic resection provides complete symptomatic resolution.

Nasal obstruction secondary to an inverted midline supernumerary tooth

We present the case of a 36-year-old man who presented with left-sided nasal obstruction and facial pain. Clinical examination and computed tomography revealed an inverted midline supernumerary tooth buckling and deviating the nasal septum to the left. Full surgical resection of the tooth was achieved through a minimally invasive endoscopic septoplasty with full resolution of symptoms. There is little precedent within the literature to guide our management in this case and therefore we offer a successful surgical treatment strategy.

Lagrangian models of reactive transport in heterogeneous porous media with uncertain properties

We consider multi-component reactive transport in heterogeneous porous media with uncertain hydraulic and chemical properties. This parametric uncertainty is quantified by treating relevant flow and transport parameters as random fields, which renders the governing equations stochastic. We adopt a stochastic Lagrangian framework to replace a three-dimensional advection–reaction transport equation with a one-dimensional equation for solute travel times. We derive approximate expressions for breakthrough curves and their temporal moments. To illustrate our general theory, we consider advective transport of dissolved species undergoing an irreversible bimolecular reaction.

Adherence to anemia treatment guidelines in U.S. community oncology practices

19525

Background: Adherence to anemia guidelines may improve patient outcomes including health-related quality of life. This analysis presents baseline guideline adherence among community-based oncology practices prior to an educational intervention targeted to health care providers to improve adherence to anemia guidelines. Methods: Medical records of a sequential sample of adult cancer patients receiving chemotherapy from 47 participating sites during the year prior to site randomization to an educational intervention were abstracted. Each chart was analyzed to determine (1) whether or not the patient met the criteria for anemia treatment with an erythropoiesis- stimulating agent (ESA) or a blood transfusion, and (2) whether the patient received anemia treatment. A complex algorithm was developed to evaluate whether treatment adhered to guideline recommendations. Results: This baseline analysis included 2463 patient charts. Most patients were female (66%); with a mean duration of cancer of 14.5 months and a mean age of 61.8 years. According to guidelines, 523 patients (21%) met the criteria for anemia treatment and of these, 286 (55%) received an ESA or transfusion. In 1103 patients (45%), guidelines suggested that anemia treatment may be inappropriate. However, 216 (20%) of the 1103 patients for whom guidelines recommend against treatment received an ESA or transfusion. For 837 patients (34%), the guidelines did not provide a definitive recommendation and 242 (29%) of such patients received an ESA or transfusion. Conclusions: Baseline assessment found that many patients did not receive treatment consistent with anemia guidelines. This study will evaluate whether a year long educational intervention can improve clinician adherence to guideline recommendations, thereby improving patient outcomes.

No significant financial relationships to disclose.

Prophylaxis of chemotherapy-induced neutropenia: Patterns of care in U.S. community oncology practices

9123

Background: Adherence to neutropenia guidelines may improve patient outcomes and decrease costs associated with febrile neutropenia (FN). This analysis presents baseline data on patterns of colony-stimulating factor (CSF) use among community-based oncology practices prior to an educational intervention targeted to health care providers to improve adherence to CSF guidelines from the National Oncology Alliance (NOA). Methods: Medical records were identified from 47 participating sites. Abstractors collected data from a sequential sample of adult cancer patients receiving chemotherapy during the year prior to site randomization to an educational intervention (June and August 2006). A complex algorithm was developed to identify patients for whom the NOA guidelines recommend primary prophylaxis with a CSF including (1) patients receiving a chemotherapy regimen with a >20% expected risk of FN and (2) patients receiving chemotherapy with a 10–20% risk of FN and who have one of the following risk factors present: diminished performance status or non-Hodgkin's lymphoma with low serum albumin or high serum LDH or spread to bone marrow. Results: 2594 patients were evaluated for this analysis. Most were female (66%) and the mean age was 61.7 years (± 13.1). During this period (2005–06), 423 (16%) patients received chemotherapy regimens with an FN risk >20% and 143 (6%) received chemotherapy regimens with an FN risk of 10–20% and had a risk factor. Of patients receiving chemotherapy with a >20% risk of FN, 176 (42%) received CSF primary prophylaxis. Of patients receiving chemotherapy with a 10–20% risk FN with a risk factor present, 40 (28%) received CSF primary prophylaxis. Conclusions: Many patients for whom guidelines recommend treatment did not receive CSF primary prophylaxis. After the year-long educational intervention, we will re-evaluate CSF patterns of care and assess whether adherence to guidelines improved patient outcomes.

No significant financial relationships to disclose.

Development of the functional capacity screening tool (FCST): A brief instrument to identify functional capacity deficits in anemic cancer patients

8593

Background: Existing fatigue measures are long and often difficult to incorporate in practice. The objective of this study was to develop a short tool (Functional Capacity Screening Tool [FCST]) to identify functional capacity deficits related to fatigue in anemic cancer patients (pts) using self-report and performance-based measures of functional capacity. Methods: Data were obtained from a multicenter, open-label, single-arm study of darbepoetin alfa therapy (3.0 μg/kg every 2 weeks) in cancer pts (n=1558) who were ≥ 18 years of age with nonmyeloid malignancies receiving cyclic chemotherapy and anemia (hemoglobin [Hb] ≤ 11 g/dL). The Modified Harvard Step Test (MHST) was used as a performance-based measure of functional capacity to assess adjusted VO2max. Pts who contributed data for the development of FCST completed the following: MHST, baseline and ≥ 1 follow-up Hb measurement, baseline and ≥ 1 follow-up Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and fatigue assessed within 3 days of MHST. Items from FACT-F, Brief Fatigue Inventory (BFI), Fatigue Symptom Inventory (FSI) and Medical Outcomes Study physical functioning scale were tested for inclusion in the FCST. Individual item scores were transformed to a 100-point scale. Item selection was based on identifying best predictors of adjusted VO2max, Hb, and global FACT-F scores using linear regression and the r-square selection method. FCST scores were calculated by summating item scores and dividing by number of items. Results: Data from401 pts contributed to the development of the FCST. Eight items were identified for the FCST with a Cronbach’s coefficient alpha of 0.92. Construct validity was supported by correlations of FCST with FSI (r = 0.80, P < .0001) and BFI (r = 0.86, P < .0001). Correlations between FCST and energy (r = 0.75, P < .0001), productivity (r = 0.72, P < .0001), and Hb (r = 0.24, P < .0001) further supported construct validity. Conclusions: FCST holds promise as a short screening tool for identifying functional capacity deficits in cancer pts. This new instrument was reliable, easy to score, and completed quickly by pts, making it suitable for incorporation in clinical practice. Further validation is required in different cancer populations.

[Table: see text]

Ultrasound guidance improves the adequacy of our preoperative thyroid cytology but not its accuracy

AIMS

Our thyroid cytology audit results of 1990-1995 showed an unsatisfactory rate of 43.1% and prediction of neoplasia with a sensitivity of 86.8%. Increasingly, ultrasound scan (USS)-guided core sampling for cytology is proving a valuable tool instead of freehand fine needle aspiration (FNA) or following unsatisfactory freehand FNA. We present the results of freehand FNA and USS-guided core samples for cytology in two separate patient groups in our centre.

METHODS

Patients who had a thyroid resection and preoperative thyroid cytology in our institution between 1996 and 2002 were included. The histological diagnoses were correlated with the preceding cytology results.

RESULTS

A total of 450 FNAs were performed on 394 patients. Freehand FNAs were performed for 348 (77.3%) samples and USS-guided core for 102 (22.7%) samples; 121 (26.8%) were repeat aspirates performed on 45 patients. Using aspiration cytology (AC) grading, freehand FNA was cytologically inadequate (AC0 or AC1) in 34.8% cases whereas USS-guided core was inadequate in 17.6% cases (P = 0.001). Freehand FNA (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 83.2%, specificity of 46.6%, accuracy of 63.0%, positive predictive value of 56.0% and negative predictive value of 77.1%. USS-guided core sample for cytology (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 93.5%, specificity of 26.0%, accuracy of 51.9%, positive predictive value of 43.9% and negative predictive value of 86.7%.

CONCLUSIONS

Although USS-guided core provides more satisfactory specimens than freehand FNA, in our centre it does not provide increased accuracy.

Alcohol--the neglected risk factor in head and neck cancer

Alcohol remains second only to cigarette smoking as a risk factor for head and neck cancer worldwide. The increase in incidence in head and neck cancer in a number of countries appears linked at least in part to contemporaneous rises in alcohol consumption. The relative increase in risk in women may also relate to increasing alcohol consumption. Women may be particularly sensitive to alcohol-induced tumours in the oral/oropharyngeal sites. The risk is dose related, but with a non-linear increase for heavy drinkers (>100 g i.e. 12 units/day). The type of alcoholic beverage consumed seems less important. Potential mechanisms include local toxic cellular proliferation; carcinogenic action of metabolites e.g. acetaldehyde or impurities; induction of enzymes which activate procarcinogens; reduction of the protective retinoic acid; genetic polymorphism may play a part in certain geographic locations. Alcohol is also linked to stage at presentation, risk of second primary and the occurrence of comorbidity. Public awareness of the risks of alcohol remains disappointingly low. Those in identifiable high-risk groups should perhaps be targeted specifically for counselling.