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Journal of Maxillofacial and Oral... Jun 2022Head and neck cancer represents 5-10% of all malignancies. Squamous cell carcinoma (SCC) of the oral cavity represents about 2% of overall malignant neoplasms and 47% of...
The Interrelation Among Triad of Depth of Invasion, Perineural Invasion and Tumor Size in Squamous Cell Carcinoma of Tongue and Floor of the Mouth: An Analytical Appraisal.
BACKGROUND
Head and neck cancer represents 5-10% of all malignancies. Squamous cell carcinoma (SCC) of the oral cavity represents about 2% of overall malignant neoplasms and 47% of the head and neck region Squamous cell carcinoma of tongue has a peculiar behavior of occult and skips metastasis to regional lymph nodes. It occasionally occurs along with floor of the mouth. The purpose of this study is to evaluate the significance of correlation between, depth of invasion of the primary tumor, its proximity with the neurovascular bundle and subsequent perineural invasion and cervical lymph node metastasis in squamous cell carcinoma tongue and floor of the mouth and the sites involving both.
MATERIALS AND METHODS
A total of 108 patients with carcinoma tongue (59), floor of the mouth (20) and involving both together (29) who underwent treatment during January 2015 to June 2017 that were followed up until December 2019 were assessed. Out of 108 patients that were included in the study, 71 patients underwent primary surgery and 37 patients were inoperable (tongue-17, floor of the mouth-9 and involving both together-11).
RESULTS
Perineural invasion was seen in 15 cases of pT1-2 where depth of invasion was less than 1 cm and in 28 cases of pT3-4 where depth of invasion was more than 1cm (-0.075). Skip metastasis was accounted for 61.9% overall.
CONCLUSION
The triad of perineural invasion, depth of invasion and tumor size is interrelated and was responsible for cervical lymph node metastasis and prognosis of the disease. Obtaining clear deep margins of the tumor from the mucosal margin and removal of lympho-fatty tissue at the floor of the mouth is an important aspect which gives the indication about prognostic factors like depth of invasion, tumor size, cervical nodal metastasis and recurrence of the disease. High-grade tumors (T3-4), depth of invasion of tumor at 1 cm or > 1 cm, increase the propensity of perineural invasion highly.
PubMed: 35712423
DOI: 10.1007/s12663-022-01685-7 -
British Journal of Anaesthesia Aug 2020Liposomal bupivacaine (Exparel®) is a sustained-release formulation of bupivacaine for use in surgical infiltration anaesthesia. We analysed the histological nerve...
BACKGROUND
Liposomal bupivacaine (Exparel®) is a sustained-release formulation of bupivacaine for use in surgical infiltration anaesthesia. We analysed the histological nerve toxicity and clinical effectiveness of perineural Exparel® alone or with added dexamethasone in a mouse model.
METHODS
We assigned 98 mice receiving a perineural sciatic nerve injection into seven groups: sham (n=14, perineural saline), B (n=14, perineural bupivacaine), BDIP (n=14, perineural bupivacaine + intraperitoneal dexamethasone), BDPN (n=14, perineural bupivacaine + perineural dexamethasone), E (n=14, perineural Exparel®), EDIP (n=14, perineural Exparel® + intraperitoneal dexamethasone), and EDPN (n=14, perineural Exparel® + perineural dexamethasone). The duration of thermoalgesic and motor block was evaluated in 49 mice (seven mice randomly selected by group) every 30 min until recovery. Mice were killed for sciatic nerve histological assessment at 14 or 28 days.
RESULTS
The median duration of motor block was 90, 120, 120, 120, 180, and 180 min and the duration of thermoalgesic block was 240, 300, 360, 360, 360, and 420 min for groups B, BDIP, BDPN, E, EDIP, and EDPN, respectively. The B group mice showed mild neural inflammation at 14 days and the E group mice showed mild neural inflammation at 28 days. Addition (intraperitoneal or perineural) of dexamethasone reduced neural inflammation induced by bupivacaine, whereas only perineural dexamethasone reduced neural inflammation induced by Exparel®.
CONCLUSIONS
Perineural or systemic dexamethasone had a protective effect against the neural inflammation induced by bupivacaine, and perineural dexamethasone attenuated delayed inflammation induced by perineural Exparel®.
Topics: Anesthetics, Local; Animals; Anti-Inflammatory Agents; Bupivacaine; Dexamethasone; Disease Models, Animal; Drug Interactions; Inflammation; Male; Mice; Mice, Inbred C57BL; Time
PubMed: 32593455
DOI: 10.1016/j.bja.2020.04.091 -
Molecular and Clinical Oncology Sep 2016Perineural invasion (PNI) has been investigated as a new prognostic factor in a number of carcinomas. However, studies on PNI in cervical cancer are limited, and...
Perineural invasion (PNI) has been investigated as a new prognostic factor in a number of carcinomas. However, studies on PNI in cervical cancer are limited, and inconsistent conclusions have been reported by different groups. The aim of the present study was to analyze the relationship between perineural invasion (PNI) and clinical and histopathological features of cervical cancer, and to evaluate the clinical significance of PNI of cervical cancer. Retrospective review identified 206 patients with cervical cancer who underwent radical hysterectomy plus pelvic lymphadenectomy between December 2012 and August 2014. The association between PNI and clinical and histopathological features of cervical cancer and post-operative radiotherapy was evaluated based on univariate and multivariate analyses. PNI of cervical cancer was identified in 33 of 206 (16%) cervical cancer patients. Univariate analysis demonstrated that PNI was associated with clinical stage, tumor grade, tumor size, depth of invasion, lymphovascular space invasion (LVSI), and lymph node metastasis (P<0.05), but not associated with age and histopathological types (P>0.05). Multivariate analysis suggests that LVSI and lymph node metastasis were associated with PNI of cervical cancer (P<0.05). In addition, post-operative radiotherapy was significantly more recommended for patients with PNI than those without PNI (P<0.001). In conclusion, PNI of cervical cancer is associated with LVSI and lymph node metastasis and can be used as an index for the determination of post-operative radiotherapy for cervical cancer patients.
PubMed: 27588197
DOI: 10.3892/mco.2016.941 -
The British Journal of Radiology Oct 2023Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and... (Review)
Review
Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is compression of the median nerve deep to transverse carpal ligament at wrist. Ultrasonography and electrophysiological study are complementary in the diagnosis and grading of CTS in appropriate clinical settings. The initial management of patients with CTS is conservative with medical therapy and splinting. However, surgical interventions are indicated in patients in whom medical management has failed. With evolution of the concept of safe zone on ultrasonography and identification of the sonoanatomical landmarks of carpal tunnel in greater detail, Ultrasonography-guided interventions are safer and preferred over surgical management in CTS. The primary ultrasonography-guided interventions include perineural injection, perineural hydrodissection and ultrasonography-guided release of transverse carpal ligament. This review article presents the principles of ultrasonography-guided perineural injection, perineural hydrodissection in CTS, the merits and demerits of injectant used in perineural injection/ hydrodissection, and percutaneous ultrasonography-guided thread release of transverse carpal ligament utilizing the concept of safe zone of the ultrasonography-guided interventions for CTS.
Topics: Humans; Carpal Tunnel Syndrome; Ultrasonography, Interventional; Median Nerve; Ultrasonography; Wrist Joint
PubMed: 37660684
DOI: 10.1259/bjr.20230552 -
Annals of Translational Medicine May 2019Perineural invasion (PNI) in early-stage cervical cancer, is associated with multiple high-risk factors and represents a poor outcome in the patients. For nerve-sparing... (Review)
Review
Perineural invasion (PNI) in early-stage cervical cancer, is associated with multiple high-risk factors and represents a poor outcome in the patients. For nerve-sparing radical hysterectomy (NSRH) to become a standard and widely used treatment for cervical cancer, we need to define its oncological safety, and to establish standardized surgical procedures and indications of NSRH. Here, we review the definition and mechanisms, and clinical significance of PNI in cervical cancer, and discuss the indications of NSRH. PNI should be regarded as one of the main pathological features of cervical cancer and a factor affecting prognosis. A deeper understanding of PNI in cervical cancer, hopefully, will provide clear indications of NSRH.
PubMed: 31205921
DOI: 10.21037/atm.2019.04.35 -
Virchows Archiv : An International... Apr 2020In this retrospective study, we analyzed the association between tumor budding and perineural invasion as well as their prognostic role in pancreatic ductal...
In this retrospective study, we analyzed the association between tumor budding and perineural invasion as well as their prognostic role in pancreatic ductal adenocarcinoma. A total of N = 119 patients resected for pancreatic ductal carcinoma from 1996 to 2015 were included. Clinical and standard histopathological parameters were retrieved from the patient's records. One representative hematoxylin and eosin section from the tumor region was examined for perineural invasion and tumor budding using light microscopy. Tumor budding was assessed independently using two different methods: in the first approach, the number of buds was counted over three fields of 0.237 mm at 40-fold magnification; in the second approach, tumor budding was quantified according to the recommendation of the International Tumor Budding Consensus Conference (ITBCC) over a field of 0.785 mm at 20-fold magnification. Linear and logistic regression was applied to delineate association between perineural invasion, tumor budding, and other parameters; Kaplan-Meier and Cox regression were used in the survival analysis. Regardless of the quantification approach, high tumor budding was a significant negative prognostic factor in the univariable Cox regression (> 5 buds/0.237 mm, hazard ratio (HR) 1.66, 95% confidence interval (CI) 1.06-2.61, p = 0.027; ≥ 10 buds/0.785 mm, HR 1.68, 95% CI 1.07-2.64, p = 0.024). In the multivariable model adjusting for stage and standard histopathological parameters, lymph vessel invasion (HR = 2.43, 95% CI 1.47-4.03, p = 0.001) and tumor budding > 5 buds/0.237 mm (HR = 1.70, 95% CI 1.07-2.7, p = 0.026) were independent negative prognostic factors, while adjuvant therapy was a positive prognostic factor (HR = 0.54, 95% CI 0.33-0.86, p = 0.009). No significant prognostic value could be delineated for perineural invasion. In conclusion, tumor budding is an independent negative prognostic factor in pancreatic ductal adenocarcinoma associated with lymph node metastasis. The prognostic role of perineural invasion remains uncertain.
Topics: Carcinoma, Pancreatic Ductal; Female; Humans; Lymphatic Metastasis; Male; Pancreatic Neoplasms; Prognosis; Proportional Hazards Models; Survival Analysis
PubMed: 31786688
DOI: 10.1007/s00428-019-02719-1 -
Techniques in Coloproctology Feb 2021In recent years, there has been growing concern about the potential association of stent placement as a bridge to surgery in malignant colon obstruction and some... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In recent years, there has been growing concern about the potential association of stent placement as a bridge to surgery in malignant colon obstruction and some anatomopathological findings that could lead to worsening long-term cancer outcomes, such as perineural, vascular and lymphatic invasion. The aim of the present review was to assess the pathological changes found in surgical specimens after stent placement for obstructing colon cancer vs. emergency surgery, and the impact of perineural invasion on survival rates METHODS: MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed four meta-analyses to estimate the pooled effect sizes using a random effect model. The outcomes were perineural, vascular and lymphatic invasion rates, and 5-year overall survival rate in patients with obstructive colon cancer, depending on the presence or absence of perineural invasion.
RESULTS
Ten studies with a total of 1273 patients were included in the meta-analysis. We found that patients in the stent group had a significantly higher risk of perineural (OR 1.98, 95% CI 1.22-3.21; p = 0.006) and lymphatic invasion (OR 1.45, 95% CI 1.10-1.90; p = 0.008). Furthermore, patients with positive perineural invasion had almost twice the risk of dying compared to those with no perineural invasion (HR 1.92, 95% CI 1.22-3.02; p = 0.005).
CONCLUSIONS
Stent placement as a bridge to surgery in colorectal cancer patients modifies the pathological characteristics such as perineural and lymphatic invasion, and this may worsen the long-term prognosis of patients. The presence of perineural infiltration in obstructed colon cancer decreases the long-term survival of patients.
Topics: Colonic Neoplasms; Colorectal Neoplasms; Humans; Intestinal Obstruction; Stents
PubMed: 33200308
DOI: 10.1007/s10151-020-02350-2 -
American Journal of Veterinary Research Jun 2021To evaluate the effects of using ropivacaine combined with dexmedetomidine for sciatic and saphenous nerve blocks in dogs.
Effects of perineural administration of ropivacaine combined with perineural or intravenous administration of dexmedetomidine for sciatic and saphenous nerve blocks in dogs.
OBJECTIVE
To evaluate the effects of using ropivacaine combined with dexmedetomidine for sciatic and saphenous nerve blocks in dogs.
ANIMALS
7 healthy adult Beagles.
PROCEDURES
In phase 1, dogs received each of the following 3 treatments in random order: perineural sciatic and saphenous nerve injections of 0.5% ropivacaine (0.4 mL/kg) mixed with saline (0.9% NaCl) solution (0.04 mL/kg; DEX0PN), 0.5% ropivacaine mixed with dexmedetomidine (1 μg/kg; DEX1PN), and 0.5% ropivacaine mixed with dexmedetomidine (2 μg/kg; DEX2PN). In phase 2, dogs received perineural sciatic and saphenous nerve injections of 0.5% ropivacaine and an IV injection of diluted dexmedetomidine (1 μg/kg; DEX1IV). For perineural injections, the dose was divided equally between the 2 sites. Duration of sensory blockade was evaluated, and plasma dexmedetomidine concentrations were measured.
RESULTS
Duration of sensory blockade was significantly longer with DEX1PN and DEX2PN, compared with DEX0PN; DEX1IV did not prolong duration of sensory blockade, compared with DEX0PN. Peak plasma dexmedetomidine concentrations were reached after 15 minutes with DEX1PN (mean ± SD, 348 ± 200 pg/mL) and after 30 minutes DEX2PN (816 ± 607 pg/mL), and bioavailability was 54 ± 40% and 73 ± 43%, respectively. The highest plasma dexmedetomidine concentration was measured with DEX1IV (1,032 ± 415 pg/mL) 5 minutes after injection.
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested that perineural injection of 0.5% ropivacaine in combination with dexmedetomidine (1 μg/kg) for locoregional anesthesia in dogs seemed to balance the benefit of prolonging sensory nerve blockade while minimizing adverse effects.
Topics: Administration, Intravenous; Anesthetics, Local; Animals; Dexmedetomidine; Dogs; Nerve Block; Ropivacaine; Sciatic Nerve
PubMed: 34032477
DOI: 10.2460/ajvr.82.6.449 -
Acta Neurochirurgica Dec 2020Perineural spread (PNS) is an emerging mechanism for progressive, non-traumatic brachial plexopathy. We aim to summarize the pathologies (tumor and infection) shown to... (Review)
Review
BACKGROUND
Perineural spread (PNS) is an emerging mechanism for progressive, non-traumatic brachial plexopathy. We aim to summarize the pathologies (tumor and infection) shown to have spread along or to the brachial plexus, and identify the proposed mechanisms of perineural spread.
METHODS
A focused review of the literature was performed pertaining to pathologies with identified perineural spread to the brachial plexus.
RESULTS
We summarized pathologies currently reported to have PNS in the brachial plexus and offer a structure for understanding and describing these pathologies with respect to their interaction with the peripheral nervous system.
CONCLUSIONS
Perineural spread is an underrepresented entity in the literature, especially regarding the brachial plexus. It can occur via a primary or secondary mechanism based on the anatomy, and understanding this mechanism helps to support biopsies of sacrificial nerve contributions, leading to more effective and timely treatment plans for patients.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Leprosy; Magnetic Resonance Imaging; Neoplasms; Tuberculosis
PubMed: 32632655
DOI: 10.1007/s00701-020-04466-8 -
Journal of Equine Veterinary Science Jun 2021This study aimed to examine how short-term loss of proprioception in the equine foot influences the individual COP path during the stance phase of the trot in sound... (Review)
Review
This study aimed to examine how short-term loss of proprioception in the equine foot influences the individual COP path during the stance phase of the trot in sound horses. Ten horses were evaluated to be objectively non-lame using the 'Equinosis Q System and subsequently examined using a portable pressure measuring system with pressure foils fixed directly underneath both front hooves prior to and after perineural anesthesia of the palmar digital nerves. The individual COP paths of both forelimbs was assessed prior to and after unilateral and bilateral abaxial sesamoid nerve blocks. COP from initial contact to mid stance and breakover as well as the inter-stride variability were descriptively evaluated for each horse and limb. The individual COP path for each horse and limb during stance was shown to be highly repeatable without significant inter-stride variability. Location of initial contact, COP during midstance and breakover are not affected by unilateral or bilateral short-term loss of sensory feedback from the foot after perineural anesthesia. Anesthesia of the foot with an abaxial sesamoid nerve block does not affect the foot's COP during stance at a trot, therefore, sudden changes in gait pattern after perineural anesthesia should be interpreted with caution and warrant further clinical investigation.
Topics: Animals; Foot; Forelimb; Gait; Hoof and Claw; Horses; Nerve Block
PubMed: 33993942
DOI: 10.1016/j.jevs.2021.103429