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Zhonghua Kou Qiang Yi Xue Za Zhi =... Apr 2024In view of the surgical complexity of parapharyngeal space tumors involved, this paper summarized the disease data of patients with parapharyngeal space tumors involved...
In view of the surgical complexity of parapharyngeal space tumors involved, this paper summarized the disease data of patients with parapharyngeal space tumors involved in the Department of Oral and Maxillofacial Surgery, the First Hospital of Shanxi Medical University from January 2015 to January 2021. It also summarized the surgical approach and mandibular management, so as to explore surgical strategies for different characteristics of parapharyngeal space tumors involved. A total of 49 patients, including 28 males and 21 females, median age 52 years (range 24-72 years). They were treated with four surgical approaches for tumor resection, 25 cervical approach, 5 cheek and neck approach, 3 transoral approach, and 16 cervical-maxillary approach. Among the patients treated with cervical-maxillary approach, 3 patients were treated with mandible square resection, and 6 patients were treated with temporary mandible dissection. Seven cases were treated with tumor resection and partial mandibular resection. There are various surgical approaches and mandibular management methods involving tumors in the parapharyngeal space, and clinical decisions should be made based on tumor diameter, location, boundary, blood supply and pathological types.
Topics: Male; Female; Humans; Young Adult; Adult; Middle Aged; Aged; Pharyngeal Neoplasms; Parapharyngeal Space; Mandible; Head; Retrospective Studies
PubMed: 38548594
DOI: 10.3760/cma.j.cn112144-20240215-00073 -
Auris, Nasus, Larynx Jun 2024Transoral surgery is a minimally invasive treatment but may cause severe dysphagia at a lower rate than chemoradiotherapy.
OBJECTIVE
Transoral surgery is a minimally invasive treatment but may cause severe dysphagia at a lower rate than chemoradiotherapy.
METHODS
We compared clinical information, surgical complications, and swallowing function in patients who underwent transoral nonrobotic surgery for laryngo-pharyngeal squamous cell carcinoma between 2015 and 2021 in a multicenter retrospective study.
RESULTS
Six hundred and forty patients were included. Postoperative bleeding was observed in 20 cases (3.1%), and the risk factor was advanced T category. Postoperative laryngeal edema was observed in 13 cases (2.0%), and the risk factors were prior radiotherapy, advanced T stage, and concurrent neck dissection in patients with resected HPC. Dysphagia requiring nutritional support was observed in 29 cases (4.5%) at 1 month postoperatively and in 19 cases (3.0%) at 1 year postoperatively, respectively. The risk factors for long-term dysphagia were prior radiotherapy and advanced T category. Short-term risk factors for dysphagia were prior radiotherapy, advanced T category, and concurrent neck dissection, while long-term risk factors for dysphagia were only prior radiotherapy and advanced T category.
CONCLUSION
Prior radiotherapy, advanced T stage, and concurrent neck dissection increased the incidence of postoperative laryngeal edema and short-term dysphagia, but concurrent neck dissection did not affect long-term dysphagia. Such features should be considered when considering the indication for transoral surgery and postoperative management.
Topics: Humans; Male; Retrospective Studies; Deglutition Disorders; Female; Laryngeal Neoplasms; Middle Aged; Aged; Postoperative Complications; Neck Dissection; Pharyngeal Neoplasms; Risk Factors; Squamous Cell Carcinoma of Head and Neck; Neoplasm Staging; Adult; Laryngeal Edema; Carcinoma, Squamous Cell; Postoperative Hemorrhage; Aged, 80 and over; Natural Orifice Endoscopic Surgery
PubMed: 38547566
DOI: 10.1016/j.anl.2024.03.005 -
Sexually Transmitted Diseases Apr 2024In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to...
BACKGROUND
In South Africa, extragenital etiological sexually transmitted infection (STI) screening among men who have sex with men (MSM) is not routinely available. We aimed to determine the prevalence of STI pathogens at rectal and pharyngeal sites, syphilis seroprevalence, and associated risk factors among a selection of high-risk MSM without symptomatic urethritis attending a men's health clinic in Johannesburg, South Africa.
METHODS
A cross-sectional study was conducted in 2022. Enrolled clients self-reported demographic, sexual behavioral risks, and clinical information. Client or clinician-collected rectal and pharyngeal swabs were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. C. trachomatis-positive rectal samples were reflex tested for lymphogranuloma venereum. Blood specimens were screened for syphilis. Univariate and multivariate regression models were used to determine factors independently associated with the presence of an extragenital STI or syphilis.
RESULTS
Among the 97 participants (median age, 29 years), 24.7% had an extragenital STI and 9.4% had high nontreponemal antibody titers (rapid plasma reagin ≥1:16). Rectal STIs were detected in 26.4% participants: N. gonorrhoeae (14.3%), C. trachomatis (9.9%), and M. genitalium (5.5%). Pharyngeal STIs were less prevalent (4.1%). Overall, the prevalence of any STI was 41%. Sex under the influence of drugs (adjusted odds ratio, 4.94; 95% confidence interval, 1.56-15.69) and engaging in condomless receptive anal intercourse with a casual partner (adjusted odds ratio, 8.36; 95% confidence interval, 1.73-40.28) were independent risk factors for having an extragenital STI.
CONCLUSIONS
The high burden of extragenital STIs and active syphilis in asymptomatic MSM underscores the importance of routine etiological screening in this key population, as the syndromic approach would not enable detection or treatment of these infections.
Topics: Male; Humans; Adult; Homosexuality, Male; Syphilis; Gonorrhea; South Africa; Cross-Sectional Studies; Seroepidemiologic Studies; Chlamydia Infections; Sexual and Gender Minorities; Sexually Transmitted Diseases; Neisseria gonorrhoeae; Chlamydia trachomatis; Prevalence; HIV Infections
PubMed: 38534082
DOI: 10.1097/OLQ.0000000000001927 -
Zhonghua Er Ke Za Zhi = Chinese Journal... Mar 2024To explore potential predictors of refractory pneumonia (RMPP) in early stage. The prospective multicenter study was conducted in Zhejiang, China from May 1, 2019 to...
To explore potential predictors of refractory pneumonia (RMPP) in early stage. The prospective multicenter study was conducted in Zhejiang, China from May 1, 2019 to January 31, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; DNA in pharyngeal swab specimens was detected. Patients with positive DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) 39.2 (38.9, 39.7) ℃, 333 (279, 392) 311 (259, 359) U/L, both <0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% 0.593-0.771, <0.01). In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.
Topics: Child; Male; Female; Humans; Mycoplasma pneumoniae; Prospective Studies; Pneumonia, Mycoplasma; C-Reactive Protein; L-Lactate Dehydrogenase; Fever; DNA; Retrospective Studies
PubMed: 38527501
DOI: 10.3760/cma.j.cn112140-20231121-00383 -
Journal of the Neurological Sciences Apr 2024The epidemiology and etiology of facial onset sensory and motor neuronopathy (FOSMN), a rare syndrome that initiates with facial sensory disturbances followed by bulbar...
The epidemiology and etiology of facial onset sensory and motor neuronopathy (FOSMN), a rare syndrome that initiates with facial sensory disturbances followed by bulbar symptoms, remain unknown. To estimate the prevalence of FOSMN in Japan and establish the characteristics of this disease, we conducted a nationwide epidemiological survey. In the primary survey, we received answers from 604 facilities (49.8%), leading to an estimated number of 35.8 (95% confidential interval: 21.5-50.2) FOSMN cases in Japan. The secondary survey collected detailed clinical and laboratory data from 21 cases. Decreased or absent corneal and pharyngeal reflexes were present in over 85% of the cases. Electrophysiological analyses detected blink reflex test abnormalities in 94.1% of the examined cases. Immunotherapy was administered in 81% of cases and all patients received intravenous immunoglobulin. Among them, 35.3% were judged to have temporary beneficial effects evaluated by the physicians in charge. Immunotherapy tended to be effective in the early stage of disease. The spreading pattern of motor and sensory symptoms differed between cases and the characteristics of the motor-dominant and sensory-dominant cases were distinct. Cases with motor-dominant progression appeared to mimic amyotrophic lateral sclerosis. This is the first nationwide epidemiological survey of FOSMN in Japan. The clinical course of FOSMN is highly variable and motor-dominant cases developed a more severe condition than other types of cases. Because clinical interventions tend to be effective in the early phase of the disease, an early diagnosis is desirable.
Topics: Humans; Japan; Amyotrophic Lateral Sclerosis; Neurologic Examination; Face
PubMed: 38520939
DOI: 10.1016/j.jns.2024.122957 -
Trials Mar 2024Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head...
The effects of Phoniatric PREhabilitation in Head and Neck Cancer patients on Aspiration and Preservation of Swallowing (PREHAPS): study protocol of a monocentric prospective randomized interventional outcome-blinded trial.
BACKGROUND
Dysphagia, with its negative impact on life expectancy and quality of life, is a major side effect of head and neck squamous cell carcinoma (HNSCC). In a typical Head and Neck Cancer Center, more than half of patients are affected. Improving treatment, and ideally prevention respectively prehabilitation, therefore seems more than desirable.
METHODS
The study is planned as a monocentric, prospective, outcome-blinded, randomized interventional study comparing an advanced phoniatric-logopedic prehabilitation with a control (standard of care). Seventy patients (30 control group, 30 intervention group, 10 drop-out rate of 15%) with an initial diagnosis of invasive HNSCC and curative treatment intention will be included over a period of 17 months. In addition to the previous standard, both groups will undergo both detailed subjective assessment of swallowing function and quality of life by means of various questionnaires and objective analyses by bioelectrical impedance measurements and phoniatric endoscopic swallowing examinations. In the intervention group, risk-related nutritional counseling (face-to-face) and phoniatric-logopedic prehabilitation are provided: detailed counseling with video demonstration and exercises to strengthen and improve the range of motion of the oral, pharyngeal, and laryngeal muscles (guided by exercise diary). Controls are performed at 6 weeks, 3 and 6 months, and 9 or 12 months after the end of therapy during the regular tumor follow-up. Primary study endpoints are swallowing function and emotional distress at 6 weeks of control visit.
DISCUSSION
Prehabilitation measures have already proven successful in other patient groups, e.g., transplant patients. In the field of head and neck oncology, interest in such concepts has increased significantly in recent years. However, usually, only subgroups, e.g., patients with swallowing problems after radiochemotherapy alone, are in focus. Our study aims to investigate the general benefit of prehabilitation with regard to swallowing function, which is so important for protection of aspiration and quality of life.
TRIAL REGISTRATION
German Clinical Trials Register DRKS00029676 . International Clinical Trials Registry Platform DRKS00029676 . Registered on 19 July 2022.
Topics: Humans; Deglutition; Squamous Cell Carcinoma of Head and Neck; Preoperative Exercise; Quality of Life; Prospective Studies; Head and Neck Neoplasms; Deglutition Disorders; Randomized Controlled Trials as Topic
PubMed: 38519961
DOI: 10.1186/s13063-024-08010-2 -
Ear, Nose, & Throat Journal Mar 2024We describe a case of lymphatic malformation (LM) with snoring as the primary symptom. The patient, an 11-year-old boy, sought medical attention due to "snoring that had...
We describe a case of lymphatic malformation (LM) with snoring as the primary symptom. The patient, an 11-year-old boy, sought medical attention due to "snoring that had worsened over 3 years, accompanied by shortness of breath for 1 month." The preoperative examination showed that the apnea-hypopnea index during sleep was 33.4. The average overnight blood oxygen saturation was 95.3%, reaching a lowest level of 79.9%. Magnetic resonance imaging identified a space-occupying lesion in the postpharyngeal space, leading to significant compression and narrowing of the pharyngeal cavity. This suggested the possibility of a vascular malformation, with a higher proportion of vascular components. The patient underwent resection of the pharyngeal mass and temporary tracheostomy under general anesthesia, and intraoperative freeze and postoperative pathological diagnoses confirmed LM. Postoperative prognosis was favorable.
PubMed: 38515221
DOI: 10.1177/01455613241233747 -
Molecular & Cellular Proteomics : MCP May 2024Spatial tissue proteomics integrating whole-slide imaging, laser microdissection, and ultrasensitive mass spectrometry is a powerful approach to link cellular phenotypes...
Spatial tissue proteomics integrating whole-slide imaging, laser microdissection, and ultrasensitive mass spectrometry is a powerful approach to link cellular phenotypes to functional proteome states in (patho)physiology. To be applicable to large patient cohorts and low sample input amounts, including single-cell applications, loss-minimized and streamlined end-to-end workflows are key. We here introduce an automated sample preparation protocol for laser microdissected samples utilizing the cellenONE robotic system, which has the capacity to process 192 samples in 3 h. Following laser microdissection collection directly into the proteoCHIP LF 48 or EVO 96 chip, our optimized protocol facilitates lysis, formalin de-crosslinking, and tryptic digest of low-input archival tissue samples. The seamless integration with the Evosep ONE LC system by centrifugation allows 'on-the-fly' sample clean-up, particularly pertinent for laser microdissection workflows. We validate our method in human tonsil archival tissue, where we profile proteomes of spatially-defined B-cell, T-cell, and epithelial microregions of 4000 μm to a depth of ∼2000 proteins and with high cell type specificity. We finally provide detailed equipment templates and experimental guidelines for broad accessibility.
Topics: Humans; Proteomics; Laser Capture Microdissection; Workflow; Palatine Tonsil; Automation; Proteome; B-Lymphocytes; Mass Spectrometry; T-Lymphocytes
PubMed: 38513891
DOI: 10.1016/j.mcpro.2024.100750 -
The Journal of Obstetrics and... Jun 2024Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD...
Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD during pregnancy, which was difficult to diagnose. A 37-year-old pregnant female (gestational week [GW] 7) was admitted to our hospital because of hyperemesis gravidarum. On the eighth day of hospitalization (GW 8), she suddenly developed a fever (38.0°C) with skin rash and posterior pharynx redness. Blood tests showed pancytopenia and abnormal liver function. The patient was misdiagnosed with severe Epstein-Barr virus infection and administered with prednisolone. Subsequently, cervical lymphadenopathy was observed, and biopsy results led to the diagnosis of KFD. Thereafter, her symptoms improved, and she was discharged at GW 13. KFD must be included as a differential diagnosis for patients with fever, abnormal liver function, and pancytopenia during pregnancy.
Topics: Humans; Female; Histiocytic Necrotizing Lymphadenitis; Pregnancy; Adult; Pregnancy Complications; Hyperemesis Gravidarum
PubMed: 38511280
DOI: 10.1111/jog.15928 -
Otolaryngologic Clinics of North America Jun 2024While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual...
While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty.
Topics: Child; Humans; Adenoidectomy; Endoscopy; Nasal Septum; Nasopharynx; Nose; Palate; Sleep Apnea, Obstructive; Tonsillectomy; Turbinates
PubMed: 38508883
DOI: 10.1016/j.otc.2024.02.008