Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postopera...Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postoperative period can be used to predict the development of hypocalcaemia. The optimal time point to measure serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels were measured on the day before the operation and at 1 hour, 4 hours, and 24 hours after the operation. S.calcium levels were measured on the day before the operation and 1<sup>st</sup> postoperative day. All the data were compiled and sorted properly and were analyzed statistically. Results: Postoperative hypocalcaemia developed in 18 cases, with an incidence of 26.9%. Pearson correlation showed a significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with 1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean AUC found 93.9%, 94.4%, ≤14.0, 0.988;95.9%, 94.4%, ≤09.5, 0.993 and 91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more sensitivity and specificity for a cut-off value near the laboratory reference range.展开更多
Objective:Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)are commonly employed in pre-operative evaluation for cochlear implant surgery.However,with a decrease in the age of implantation,even minor radiatio...Objective:Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)are commonly employed in pre-operative evaluation for cochlear implant surgery.However,with a decrease in the age of implantation,even minor radiation exposure can cause detrimental effects on children over their lifetime.The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation.Methods:A longitudinal observational study was conducted on 94 ears/47 children,employing CT and MRI scans.The CT and MRI scan measurements include,A value,B value,Cochlear duct length(CDL),twoturn cochlear length,alpha and beta angles to look for cochlear orientation.Cochlear nerve diameter was measured using MRI.The values were compared.Results:The mean difference between measurements from CT and MRI scans for A value,B value,CDL,and two-turn cochlear length values was 0.567±0.413 mm,0.406±0.368 mm,2.365±1.675 mm,and 2.063±1.477 mm respectively without any significant difference.The alpha and beta angle measures were comparable,with no statistically significant difference.Conclusion:The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population.There is no significant difference between the measurements obtained from CT and MRI scans.However,observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery.This aspect must be addressed to ensure positive outcomes for patients.展开更多
BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients...BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients.METHODS Assessment was done to 185 patients(adults=150,age:31.41±8.63 years;children=35;age:15.66±1.63 years).Otolaryngology and neuropsychiatric evaluations were done.Measurements included:A clinical questionnaire(for smell and taste);sniffin'odor,taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements(sQOD-NS).RESULTS Duration of disorders was 11.53±3.97 ms(6-24 ms).Parosmia(n=119;64.32%)was developed months after anosmia(3.05±1.87 ms).Objective testing showed anosmia in all,ageusia and flavor loss in 20%(n=37)and loss of nasal and oral trigeminal sensations in 18%(n=33)and 20%(n=37),respectively.Patients had low scoring of sQOD-NS(11.41±3.66).There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults.CONCLUSION The course of small and taste disorders are supportive of the nasal and oral neuronal compromises.Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders.Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders.There were no demographics,clinical variables at onset or specific profile of these disorders in children compared to adults.展开更多
Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bon...Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.展开更多
Objective: Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and diffi...Objective: Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and Methods: In a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. Results: The study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. Conclusion: An objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.展开更多
Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoreti...Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.展开更多
Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) sh...Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section(IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.展开更多
Objective:To study the potential role of subjective visual vertical(SVV)as a prognostic marker for canalith repositioning maneuver(CRM)in patients with posterior canal benign paroxysmal positional vertigo(PC-BPPV)for ...Objective:To study the potential role of subjective visual vertical(SVV)as a prognostic marker for canalith repositioning maneuver(CRM)in patients with posterior canal benign paroxysmal positional vertigo(PC-BPPV)for the Indian population.Methods:SVV was examined in 30 patients with PC-BPPV before and after canalith repositioning maneuver and after complete resolution of PC-BPPV.Study parameters included the mean of 10 angular tilt readings and direction of deviation,which were compared before and after CRM and following complete resolution of PC-BPPV.Results:The angle of SVV tilt was greater and deviated towards the affected ear before CRM in all patients,which decreased significantly shortly after CRM and continued to decrease after complete resolution of PC-BPPV(p<0.0001).Conclusions:SVV can be used to test utricular dysfunction in PC-BPPV.The angle of tilt improves in response to CRM,which may be used as a prognostic marker in patients with PC-BPPV receiving CRM.展开更多
This prospective study was done at the Southern Railway Headquarters Hospital, Ayanavaram, Chennai to measure the intraoperative blood loss during adenotonsillectomy and to assess the factors affecting it. Since blood...This prospective study was done at the Southern Railway Headquarters Hospital, Ayanavaram, Chennai to measure the intraoperative blood loss during adenotonsillectomy and to assess the factors affecting it. Since blood volume in children is low, even a small loss will result in dreaded complications, so blood loss measurement in paediatric surgery is important. Adenotonsillectomy is the most common surgery performed in the field of otolaryngology, so blood loss measurement is essential in this surgery. In the study, 50 children who underwent adenotonsillectomy, by conventional dissection and snare method for tonsillectomy and curette method for adenoidectomy, were evaluated for operative blood loss. This study was conducted over a 1 year period, from June 2013 to June 2014. Both gravimetric method and blood volume studies were used to measure the operative blood loss. The estimated blood loss by gravimetric method was 94.35 ml, whereas the actual blood loss by blood volume studies was 90.57 ml and the average blood loss was 92.46 ml. The youngest child who was operated was 4 years old and the oldest child was 15 years old. The minimum blood loss was 40.30 ml and the maximum was 278.46 ml. In our series, operative blood loss was dependent on fibrosis of tonsil and the grade of the tonsil. There was no significant correlation between age and sex of the patient and the surgical skills.展开更多
Background: Coblation based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Cobl...Background: Coblation based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Coblation technology provides ablation, resection, coagulation of soft tissue and hemostasis of blood vessels in one convenient surgical device. Coblation technology can be used in the larynx and trachea for removing or debulking sessile polyps, lesions or tumors. Minimally invasive coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalization. Aim: This case study aims to explore the advantages of coblation combined with microscopy to treat benign laryngeal lesions. Case report: We report the case of laryngeal papilloma treated with minimally invasive coblation resection. Fiberoptic laryngoscopy was done pre-operatively and that showed papillomatous mass at anterior half of right vocal cord involving inferior surface and also extending upto anterior commissure. Mobility of both vocal cords was normal. On the basis of the above findings with normal vocal cords mobility, the microlaryngeal surgery with coblation was planned. After complete pre-op work up, the patient underwent trans-oral microscopic coblation excision of mass under general anaesthesia. Power level was set to 7 for ablation and 3 for coagulation. The PROcise<sup>TM</sup> LW Plasma Wand system was chosen such that it was malleable to reach the papillomatous mass without obstructing the vision. It was totally excised and sent for histopathology examination. Post-operatively after four hours, he was able to take normal diet comfortably. He was followed up after 10 days. Histopathological report confirmed the diagnosis of papilloma. Check laryngoscopy was performed after 3 weeks. Laryngeal examination was absolutely normal with almost normal vocal cords and normal voice post-operatively. Conclusion: Microscopic surgery with coblation has the advantages of less bleeding, short procedure duration, increased completion rate and few complications.展开更多
Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materia...Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.展开更多
Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locall...Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locally aggressive, capable of extensive bone destruction. The disease has aggressive behavior and a high incidence of recurrence (40% - 60%). Case report: A 35 years old male presented with history of unilateral hearing loss and otalgia of six month duration. On examination, there was a soft bulge in the superior wall of external auditory canal. Contrast enhanced CT scan showed soft tissue density occupying the right external auditory canal and bulging into the middle ear cavity, displacing the intact ossicular chain medially with evidence of destruction of the posterior wall of the external auditory canal, glenoid fossa, mastoid bone and the scutum. The squamous part of the right temporal bone showed evidence of lateral bowing with discontinuity. Surgical resection was done through post aural approach. Histopathological examination revealed pigmented villonodular tenosynovitis which stained positive for CD 68. Post operatively patient was evaluated clinically and with radiological modalities which showed healthy mastoid cavity and no increase in post operative granulations on magnetic resonance imaging. Conclusion: Pigmented villonodular tenosynovitis of temporomandibular joint is a rare entity. Due to the aggressive behavior of the lesion, radical or aggressive surgical resection should be done. Long term follow up with radiological modality should be done due to the high recurrence rate.展开更多
Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively.Their role at present is more as adjunct to microscope which still remains the work-horse ...Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively.Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy.However,as endoscopy and endoscopic instruments are increasingly getting refined,role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies.This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends.An extensive review of literature on this theme was performed.Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included.Intra-operatively,in 267(15.82%)cases,residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope.On follow-up,recidivism was identified in 108 cases(6.4%)in second look procedures.Common sites of recurrence were hidden areas like sinus tympani.This review while acknowledging the value of microscope,highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.展开更多
Although otitis media poses a serious health risk in developing countries,being a frequent occurrence in children below five years of age,parental awareness and practices about otitis media have not been adequately re...Although otitis media poses a serious health risk in developing countries,being a frequent occurrence in children below five years of age,parental awareness and practices about otitis media have not been adequately researched.Present cross-sectional study was undertaken in Navi Mumbai schools,from October 2019 to December 2019,wherein parents with children<5 years of age answered a questionnaire which gathered data on their knowledge,attitude and practices about otitis media in their wards.Chi-square tests,Cramer’s V were used to study association between gender,age-group and education of parents with their knowledge,practice and attitude about otitis media.Out of 425 valid responses,overall most parents displayed adequate knowledge(77%),positive attitude(61%)and good care-seeking practices(70%).There was a positive correlation of knowledge and practice with level of education.This study shows acceptable levels of knowledge,attitude and practices in parents about otitis media.Parents who did not seek treatment from health centre attributed the behaviour to poverty,ignorance and lack of health insurance.The positive correlation of knowledge and practices with level of education highlights the importance of role of education in modifying parental awareness and care seeking behaviour.Our findings call for a need to further strengthen community-based healthcare and improve parental confidence in healthcare services for early detection and adequate treatment of otitis media.展开更多
To investigate the enhancement of immunological activity of CpG ODN by chitosan gene carrier in mice, the effect of lymphocyte proliferation was detected in mice by using MTT, the levels of IgG and cytokines (IL-2 and...To investigate the enhancement of immunological activity of CpG ODN by chitosan gene carrier in mice, the effect of lymphocyte proliferation was detected in mice by using MTT, the levels of IgG and cytokines (IL-2 and IL-12) in serum were measured by ELISA and peripheral blood T lymphocyte subsets CD4+, CD8+ were analyzed by flow cytometry. Our results showed that spleen lymphocytes isolated from the CS-CpG ODN group of mice showed the strongest proliferation (SI =1.551), and the levels of IgG, IL-2 and IL-12 in serum were higher than those of other groups. Com- pared with the immunization with CpG ODN, the immunization with CS-CpG ODN gene carrier was more efficient in up-regulating the percentage of CD4+ T cells and the ratio of CD4+/CD8+ of mice. It was concluded that CS gene carrier of CpG ODN was much more effective in improving immunity of CpG ODN in mice.展开更多
Objective:To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hyp...Objective:To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are < 30 yrs of age, 53% are between 30-60 yrs of age and 52% are > 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.展开更多
Objective:To compare effect of midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,ra...Objective:To compare effect of midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,randomized,double-blind,clinical trial focused on a pediatric population aged 2-7 years(n=153)with the American Society of AnesthesiologistsⅠ-Ⅱwho required elective surgery.The patients were stratified into three intervention groups:midazolam,ketamine,and dexmedetomidine.Hemodynamic parameters(blood pressure,heart rate,and oxygen saturation)every 5 min until induction of anesthesia along with non-hemodynamic factors,comprised of sedation score before the administration and at the time of being separated from the parents,as well as parental separation anxiety scale,acceptance of anesthesia induction,and side effects were recorded and compared.Results:No statistically significant difference in oxygen saturation,heart rate,blood pressure,duration of surgery,time to achieve an Aldrete score of 9-10,or sedation score was noted in the study groups.More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group(P=0.001).Moreover,fewer patients accept anesthesia induction(P=0.001)and more had side effects in the ketamine group(P=0.047).Conclusions:Our findings indicate that compared to the ketamine group,dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects.Dexmedetomidine and midazolam may be considered better choices.However,the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference.Clinical registarion:This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.展开更多
Objective Nasal-type natural killer/T-cell lymphoma of Waldeyer's ring(WR-NK/TL) has different clinicopathological characteristics from those of other subtypes of NK/T lymphoma; thus, the optimal treatment remains...Objective Nasal-type natural killer/T-cell lymphoma of Waldeyer's ring(WR-NK/TL) has different clinicopathological characteristics from those of other subtypes of NK/T lymphoma; thus, the optimal treatment remains unclear. To find a more effective treatment model for WR-NK/TL, we conducted a single-center study of concurrent radiochemotherapy.Methods Forty-five patients with newly diagnosed stage IE to IIE WR-NKTL were randomly divided into two groups. The 23 cases in the concurrent radiochemotherapy group were treated with three-dimensional conformal radiotherapy(48–52 Gy) and 2 courses of DICE(dexamethasone, ifosfamide, cisplatin, and etoposide) synchronous chemotherapy. The 22 cases in the radiotherapy group only received three-dimensional conformal radiotherapy(50–54 Gy). The primary end points were overall survival(OS), progressionfree survival(PFS), and toxicity.Results The 1-, 3-, and 4-year OS and PFS rates were 95.5%, 65.6%, and 45.9%, and 86.4%, 56.0%, and 46.7% in the radiotherapy group, and 100%, 88.5%, and 88.5%, and 100%, 82.0%, and 73.8% in the concurrent radiochemotherapy group, respectively. The OS(P = 0.0477) and PFS rates(P = 0.0488) were higher in the concurrent radiochemotherapy group than in the radiotherapy group. The overall response rate was 100% in both the radiotherapy group [complete response(CR), 18 cases] and concurrent radiochemotherapy group(CR, 22 cases). The concurrent radiochemotherapy group had more severe side effects, especially grade 3 + 4 events, such as leukopenia, anorexia, and stomatitis. However, side effects benefiting from excellent oral care were endurable.Conclusion Radiotherapy plus concurrent DICE chemotherapy may be an effective and safe comprehensive treatment for patients with WR-NKTL.展开更多
Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual p...Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.展开更多
Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient.A frequent question they ask to coordinating doctors is:Are you sure he w...Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient.A frequent question they ask to coordinating doctors is:Are you sure he will not feel anything?Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli,it is recommended to use a curarization and an analgesic agent(most often morphine).The doses of opioids are less important than during usual anaesthesia,whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain.But what assures us that absolutely no more sensibility exists at this precise moment?Should the use of full analgesic dose of opioids not be continued anyway?Could this make the levies more"ethical"?展开更多
文摘Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postoperative period can be used to predict the development of hypocalcaemia. The optimal time point to measure serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels were measured on the day before the operation and at 1 hour, 4 hours, and 24 hours after the operation. S.calcium levels were measured on the day before the operation and 1<sup>st</sup> postoperative day. All the data were compiled and sorted properly and were analyzed statistically. Results: Postoperative hypocalcaemia developed in 18 cases, with an incidence of 26.9%. Pearson correlation showed a significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with 1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean AUC found 93.9%, 94.4%, ≤14.0, 0.988;95.9%, 94.4%, ≤09.5, 0.993 and 91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more sensitivity and specificity for a cut-off value near the laboratory reference range.
文摘Objective:Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)are commonly employed in pre-operative evaluation for cochlear implant surgery.However,with a decrease in the age of implantation,even minor radiation exposure can cause detrimental effects on children over their lifetime.The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation.Methods:A longitudinal observational study was conducted on 94 ears/47 children,employing CT and MRI scans.The CT and MRI scan measurements include,A value,B value,Cochlear duct length(CDL),twoturn cochlear length,alpha and beta angles to look for cochlear orientation.Cochlear nerve diameter was measured using MRI.The values were compared.Results:The mean difference between measurements from CT and MRI scans for A value,B value,CDL,and two-turn cochlear length values was 0.567±0.413 mm,0.406±0.368 mm,2.365±1.675 mm,and 2.063±1.477 mm respectively without any significant difference.The alpha and beta angle measures were comparable,with no statistically significant difference.Conclusion:The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population.There is no significant difference between the measurements obtained from CT and MRI scans.However,observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery.This aspect must be addressed to ensure positive outcomes for patients.
文摘BACKGROUND Smell disorders are the most frequent persistent coronavirus disease 2019(COVID-19)complications.AIM To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients.METHODS Assessment was done to 185 patients(adults=150,age:31.41±8.63 years;children=35;age:15.66±1.63 years).Otolaryngology and neuropsychiatric evaluations were done.Measurements included:A clinical questionnaire(for smell and taste);sniffin'odor,taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements(sQOD-NS).RESULTS Duration of disorders was 11.53±3.97 ms(6-24 ms).Parosmia(n=119;64.32%)was developed months after anosmia(3.05±1.87 ms).Objective testing showed anosmia in all,ageusia and flavor loss in 20%(n=37)and loss of nasal and oral trigeminal sensations in 18%(n=33)and 20%(n=37),respectively.Patients had low scoring of sQOD-NS(11.41±3.66).There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults.CONCLUSION The course of small and taste disorders are supportive of the nasal and oral neuronal compromises.Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders.Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders.There were no demographics,clinical variables at onset or specific profile of these disorders in children compared to adults.
文摘Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.
文摘Objective: Clinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and Methods: In a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. Results: The study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. Conclusion: An objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.
文摘Background:Patients with bilateral chronic otitis media-mucosal type have been conventionally treated with sequential tympanoplasty.Bilateral simultaneous tympanoplasty is usually not preferred because of the theoretical risk of iatrogenic sensorineural hearing loss.With the advent of modern surgical instruments and surgical techniques,the risk is expected to be lower.This study compares the clinical outcomes in typeⅠtympanoplasty performed simultaneously and sequentially.Materials&methods:This randomized prospective study was carried out in a tertiary care hospital between August 2015 and July 2017.A total of 30 patients were divided into two groups of 15 each.This study analyzed the graft uptake,pure tone audiogram findings pre-and post-operatively,duration of surgery and number of hospital visit for each patient and the outco mes were co mpared between both the groups.Result:Patients undergoing bilateral simultaneous tympanoplasty had significantly lesser mean duration of surgery and number of hospital visits than the patients undergoing sequential tympanoplasty.Graft uptake and postoperative wound infections were similar in both the groups.Postoperative hearing improvement was significantly better in the bilateral simultaneous tympanoplasty group.However,further studies are needed to authenticate this observation.None of the patients had a postoperative deterioration of hearing or sensorineural hearing loss.Conclusion:Bilateral simultaneous tympanoplasty is not only feasible but also better than sequential tympanoplasty,especially in terms of operating time,follow-up and overall financial implications on the patient.
文摘Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section(IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.
文摘Objective:To study the potential role of subjective visual vertical(SVV)as a prognostic marker for canalith repositioning maneuver(CRM)in patients with posterior canal benign paroxysmal positional vertigo(PC-BPPV)for the Indian population.Methods:SVV was examined in 30 patients with PC-BPPV before and after canalith repositioning maneuver and after complete resolution of PC-BPPV.Study parameters included the mean of 10 angular tilt readings and direction of deviation,which were compared before and after CRM and following complete resolution of PC-BPPV.Results:The angle of SVV tilt was greater and deviated towards the affected ear before CRM in all patients,which decreased significantly shortly after CRM and continued to decrease after complete resolution of PC-BPPV(p<0.0001).Conclusions:SVV can be used to test utricular dysfunction in PC-BPPV.The angle of tilt improves in response to CRM,which may be used as a prognostic marker in patients with PC-BPPV receiving CRM.
文摘This prospective study was done at the Southern Railway Headquarters Hospital, Ayanavaram, Chennai to measure the intraoperative blood loss during adenotonsillectomy and to assess the factors affecting it. Since blood volume in children is low, even a small loss will result in dreaded complications, so blood loss measurement in paediatric surgery is important. Adenotonsillectomy is the most common surgery performed in the field of otolaryngology, so blood loss measurement is essential in this surgery. In the study, 50 children who underwent adenotonsillectomy, by conventional dissection and snare method for tonsillectomy and curette method for adenoidectomy, were evaluated for operative blood loss. This study was conducted over a 1 year period, from June 2013 to June 2014. Both gravimetric method and blood volume studies were used to measure the operative blood loss. The estimated blood loss by gravimetric method was 94.35 ml, whereas the actual blood loss by blood volume studies was 90.57 ml and the average blood loss was 92.46 ml. The youngest child who was operated was 4 years old and the oldest child was 15 years old. The minimum blood loss was 40.30 ml and the maximum was 278.46 ml. In our series, operative blood loss was dependent on fibrosis of tonsil and the grade of the tonsil. There was no significant correlation between age and sex of the patient and the surgical skills.
文摘Background: Coblation based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Coblation technology provides ablation, resection, coagulation of soft tissue and hemostasis of blood vessels in one convenient surgical device. Coblation technology can be used in the larynx and trachea for removing or debulking sessile polyps, lesions or tumors. Minimally invasive coblation technology can offer less invasive treatment with quicker recovery and shorter hospitalization. Aim: This case study aims to explore the advantages of coblation combined with microscopy to treat benign laryngeal lesions. Case report: We report the case of laryngeal papilloma treated with minimally invasive coblation resection. Fiberoptic laryngoscopy was done pre-operatively and that showed papillomatous mass at anterior half of right vocal cord involving inferior surface and also extending upto anterior commissure. Mobility of both vocal cords was normal. On the basis of the above findings with normal vocal cords mobility, the microlaryngeal surgery with coblation was planned. After complete pre-op work up, the patient underwent trans-oral microscopic coblation excision of mass under general anaesthesia. Power level was set to 7 for ablation and 3 for coagulation. The PROcise<sup>TM</sup> LW Plasma Wand system was chosen such that it was malleable to reach the papillomatous mass without obstructing the vision. It was totally excised and sent for histopathology examination. Post-operatively after four hours, he was able to take normal diet comfortably. He was followed up after 10 days. Histopathological report confirmed the diagnosis of papilloma. Check laryngoscopy was performed after 3 weeks. Laryngeal examination was absolutely normal with almost normal vocal cords and normal voice post-operatively. Conclusion: Microscopic surgery with coblation has the advantages of less bleeding, short procedure duration, increased completion rate and few complications.
文摘Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.
文摘Background: Pigmented villonodular synovitis is a rare condition typically affecting the major joints and the involvement of the temporomandibular joint is rare. Although, it is histologically benign, it can be locally aggressive, capable of extensive bone destruction. The disease has aggressive behavior and a high incidence of recurrence (40% - 60%). Case report: A 35 years old male presented with history of unilateral hearing loss and otalgia of six month duration. On examination, there was a soft bulge in the superior wall of external auditory canal. Contrast enhanced CT scan showed soft tissue density occupying the right external auditory canal and bulging into the middle ear cavity, displacing the intact ossicular chain medially with evidence of destruction of the posterior wall of the external auditory canal, glenoid fossa, mastoid bone and the scutum. The squamous part of the right temporal bone showed evidence of lateral bowing with discontinuity. Surgical resection was done through post aural approach. Histopathological examination revealed pigmented villonodular tenosynovitis which stained positive for CD 68. Post operatively patient was evaluated clinically and with radiological modalities which showed healthy mastoid cavity and no increase in post operative granulations on magnetic resonance imaging. Conclusion: Pigmented villonodular tenosynovitis of temporomandibular joint is a rare entity. Due to the aggressive behavior of the lesion, radical or aggressive surgical resection should be done. Long term follow up with radiological modality should be done due to the high recurrence rate.
文摘Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively.Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy.However,as endoscopy and endoscopic instruments are increasingly getting refined,role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies.This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends.An extensive review of literature on this theme was performed.Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included.Intra-operatively,in 267(15.82%)cases,residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope.On follow-up,recidivism was identified in 108 cases(6.4%)in second look procedures.Common sites of recurrence were hidden areas like sinus tympani.This review while acknowledging the value of microscope,highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.
文摘Although otitis media poses a serious health risk in developing countries,being a frequent occurrence in children below five years of age,parental awareness and practices about otitis media have not been adequately researched.Present cross-sectional study was undertaken in Navi Mumbai schools,from October 2019 to December 2019,wherein parents with children<5 years of age answered a questionnaire which gathered data on their knowledge,attitude and practices about otitis media in their wards.Chi-square tests,Cramer’s V were used to study association between gender,age-group and education of parents with their knowledge,practice and attitude about otitis media.Out of 425 valid responses,overall most parents displayed adequate knowledge(77%),positive attitude(61%)and good care-seeking practices(70%).There was a positive correlation of knowledge and practice with level of education.This study shows acceptable levels of knowledge,attitude and practices in parents about otitis media.Parents who did not seek treatment from health centre attributed the behaviour to poverty,ignorance and lack of health insurance.The positive correlation of knowledge and practices with level of education highlights the importance of role of education in modifying parental awareness and care seeking behaviour.Our findings call for a need to further strengthen community-based healthcare and improve parental confidence in healthcare services for early detection and adequate treatment of otitis media.
基金This work was supported by a grant from Natural Science Foundation of Hubei province (No.2006ABA134)National Natural Sciences Foundation (No.30170051)
文摘To investigate the enhancement of immunological activity of CpG ODN by chitosan gene carrier in mice, the effect of lymphocyte proliferation was detected in mice by using MTT, the levels of IgG and cytokines (IL-2 and IL-12) in serum were measured by ELISA and peripheral blood T lymphocyte subsets CD4+, CD8+ were analyzed by flow cytometry. Our results showed that spleen lymphocytes isolated from the CS-CpG ODN group of mice showed the strongest proliferation (SI =1.551), and the levels of IgG, IL-2 and IL-12 in serum were higher than those of other groups. Com- pared with the immunization with CpG ODN, the immunization with CS-CpG ODN gene carrier was more efficient in up-regulating the percentage of CD4+ T cells and the ratio of CD4+/CD8+ of mice. It was concluded that CS gene carrier of CpG ODN was much more effective in improving immunity of CpG ODN in mice.
文摘Objective:To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are < 30 yrs of age, 53% are between 30-60 yrs of age and 52% are > 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.
文摘Objective:To compare effect of midazolam,dexmedetomidine,and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction.Methods:This multicenter,prospective,randomized,double-blind,clinical trial focused on a pediatric population aged 2-7 years(n=153)with the American Society of AnesthesiologistsⅠ-Ⅱwho required elective surgery.The patients were stratified into three intervention groups:midazolam,ketamine,and dexmedetomidine.Hemodynamic parameters(blood pressure,heart rate,and oxygen saturation)every 5 min until induction of anesthesia along with non-hemodynamic factors,comprised of sedation score before the administration and at the time of being separated from the parents,as well as parental separation anxiety scale,acceptance of anesthesia induction,and side effects were recorded and compared.Results:No statistically significant difference in oxygen saturation,heart rate,blood pressure,duration of surgery,time to achieve an Aldrete score of 9-10,or sedation score was noted in the study groups.More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group(P=0.001).Moreover,fewer patients accept anesthesia induction(P=0.001)and more had side effects in the ketamine group(P=0.047).Conclusions:Our findings indicate that compared to the ketamine group,dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects.Dexmedetomidine and midazolam may be considered better choices.However,the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference.Clinical registarion:This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.
基金Supported by grants from the Health Department Foundation of Sichuan Province,China(No.090156)the Science and Technology Bureau Foundation of Nanchong City from China(No.2060402)
文摘Objective Nasal-type natural killer/T-cell lymphoma of Waldeyer's ring(WR-NK/TL) has different clinicopathological characteristics from those of other subtypes of NK/T lymphoma; thus, the optimal treatment remains unclear. To find a more effective treatment model for WR-NK/TL, we conducted a single-center study of concurrent radiochemotherapy.Methods Forty-five patients with newly diagnosed stage IE to IIE WR-NKTL were randomly divided into two groups. The 23 cases in the concurrent radiochemotherapy group were treated with three-dimensional conformal radiotherapy(48–52 Gy) and 2 courses of DICE(dexamethasone, ifosfamide, cisplatin, and etoposide) synchronous chemotherapy. The 22 cases in the radiotherapy group only received three-dimensional conformal radiotherapy(50–54 Gy). The primary end points were overall survival(OS), progressionfree survival(PFS), and toxicity.Results The 1-, 3-, and 4-year OS and PFS rates were 95.5%, 65.6%, and 45.9%, and 86.4%, 56.0%, and 46.7% in the radiotherapy group, and 100%, 88.5%, and 88.5%, and 100%, 82.0%, and 73.8% in the concurrent radiochemotherapy group, respectively. The OS(P = 0.0477) and PFS rates(P = 0.0488) were higher in the concurrent radiochemotherapy group than in the radiotherapy group. The overall response rate was 100% in both the radiotherapy group [complete response(CR), 18 cases] and concurrent radiochemotherapy group(CR, 22 cases). The concurrent radiochemotherapy group had more severe side effects, especially grade 3 + 4 events, such as leukopenia, anorexia, and stomatitis. However, side effects benefiting from excellent oral care were endurable.Conclusion Radiotherapy plus concurrent DICE chemotherapy may be an effective and safe comprehensive treatment for patients with WR-NKTL.
文摘Objectives: We report two types of anatomical variations of the recurrent laryngeal nerve in two patients. Through these two patients we wanted to highlight our surgical approach of the recurrent nerve in an unusual position and to describe the surgical implication of these almost rare variations. Case report: patient aged 28 and 58 admitted for goiter. They underwent a right lobisthmectomy. Both recurrences were approached retrograde. The anatomical variations of the nerve concerned the non-recurrent laryngeal nerve in the first patient. In the second patient there were three anatomical variations, namely an extra laryngeal bifurcation of the nerve, a pre-vascular position of the nerve and a branch connecting the vagus nerve and the recurrent nerve. No recurrence nerve injury was noted. Conclusion: The anatomical variations of the nerve are numerous. A careful dissection is a guarantee of a good prognosis.
文摘Families facing the growing demand for organ removal from their loved ones are questioning the possible suffering of the brainstem dead patient.A frequent question they ask to coordinating doctors is:Are you sure he will not feel anything?Currently due to the risk of exacerbation of spinal reflexes and abnormal movements following surgical stimuli,it is recommended to use a curarization and an analgesic agent(most often morphine).The doses of opioids are less important than during usual anaesthesia,whereas the person is considered brainstem dead and there is no longer any cerebral integration of the pain.But what assures us that absolutely no more sensibility exists at this precise moment?Should the use of full analgesic dose of opioids not be continued anyway?Could this make the levies more"ethical"?
