The role of separate margins sampling in endoscopic laser surgery for early glottic cancer.

The role of separate margins sampling in endoscopic laser surgery for early glottic cancer.

Acta Otolaryngol. 2016 Jan 27;:1-6

Authors: Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D

Abstract
Conclusions Sampling surgical margins in trans-oral laser microsurgery for early glottic squamous cell carcinoma (SCC) may allow for increased local control rate, although with no difference in local control by endoscopic treatment alone. Objective To further delineate the role of routinely sampling separate surgical margins, in patients with early glottic SCC undergoing endoscopic laser resection. Methods A retrospective case control study. One hundres and two early glottic cancer patients staged Tis-T2 underwent endoscopic laser surgery with curative intent as the primary treatment. Separate margins from the surgical bed were sampled following complete tumor resection in 64 patients; in 38 patients no margins were sampled. Results Margin sampling showed a tendency towards reduced risk for local recurrence, adjusted HR = 0.439 (p-value = 0.096). However, there was no difference in local control by endoscopic treatment alone. The patients with sampled margins were further divided based on margins' status: 39 (61%) had negative margins, and 25 (39%) had positive margins. Compared with negative margins, patients with positive margins showed increased risk for recurrence, adjusted HR = 8.492 (p = 0.008). When margins were not sampled the risk for local recurrence was increased compared to negative margins (adjusted HR = 7.875, p-value = 0.008), and relatively comparable to what was observed when sampled margins were positive (adjusted HR = 0.927, p-value = 0.88).

PMID: 26817681 [PubMed - as supplied by publisher]

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Analysis on correlation between SP and NK-1R and intranasal mucosal contact point headache.

Analysis on correlation between SP and NK-1R and intranasal mucosal contact point headache.

Acta Otolaryngol. 2016 Jan 27;:1-6

Authors: Zhao G, Yin J, Peng H, Wang J

Abstract
Conclusion Distribution of SP and NK-1R, especially NK-1R, in nasal mucosal tissue at contact point was higher compared with non-contact point. It was suggested that SP and NK-1R were associated with mucosal contact point headache. Objectives To observe difference of substance P (SP) and NK-1 receptor (NK-1R) expression in tissues at contact point and non-contact point among the patients with intranasal mucosal contact point headache and speculate the role of SP and NK-1R in mucosal contact point headache. Methods SP and NK-1R in tissues of contact point and non-contact point among 40 patients with intranasal mucosal contact point headache were stained histologically by immunohistochemistry, and the mRNA level was detected by RT-PCR. Results SP was located in cytoplasm of acini epithelial cells, distributed in nasal mucosa tissues at both contact point and non-contact point. However, stain intensity was significantly increased at contact point (Z = -2.554, p < 0.05). NK-1R was located in the cytoplasm of acinar epithelial cells, inflammatory cells, and nerve fibers of contact point; only in cytoplasm of acinar epithelial cells and nerve fibers of non-contact point. Tinctorial rate of NK-1R increased significantly at contact point (χ(2) = 40.438, p < 0.01). mRNA level of SP and NK-1R was up-regulated in nasal mucosa at contact point compared with non-contact point.

PMID: 26817501 [PubMed - as supplied by publisher]

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[Lymphatic malformations in the head and neck area].

[Lymphatic malformations in the head and neck area].

HNO. 2016 Jan 28;

Authors: Wiegand S, Werner JA

Abstract
Lymphatic malformations are congenital malformations of the lymphatic system. They are mainly located in the head and neck area, and grow proportional to the patients' body growth. Depending on the morphology, it can be distinguished between macrocystic, microcystic and mixed lymphatic malformations. Due to their infiltrative growth, microcystic lymphatic malformations are particularly difficult to treat. Therapeutic approaches include conventional surgical resection, laser therapy, sclerotherapy and systemic drug therapies.

PMID: 26820157 [PubMed - as supplied by publisher]

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The role of separate margins sampling in endoscopic laser surgery for early glottic cancer.

The role of separate margins sampling in endoscopic laser surgery for early glottic cancer.

Acta Otolaryngol. 2016 Jan 27;:1-6

Authors: Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D

Abstract
Conclusions Sampling surgical margins in trans-oral laser microsurgery for early glottic squamous cell carcinoma (SCC) may allow for increased local control rate, although with no difference in local control by endoscopic treatment alone. Objective To further delineate the role of routinely sampling separate surgical margins, in patients with early glottic SCC undergoing endoscopic laser resection. Methods A retrospective case control study. One hundres and two early glottic cancer patients staged Tis-T2 underwent endoscopic laser surgery with curative intent as the primary treatment. Separate margins from the surgical bed were sampled following complete tumor resection in 64 patients; in 38 patients no margins were sampled. Results Margin sampling showed a tendency towards reduced risk for local recurrence, adjusted HR = 0.439 (p-value = 0.096). However, there was no difference in local control by endoscopic treatment alone. The patients with sampled margins were further divided based on margins' status: 39 (61%) had negative margins, and 25 (39%) had positive margins. Compared with negative margins, patients with positive margins showed increased risk for recurrence, adjusted HR = 8.492 (p = 0.008). When margins were not sampled the risk for local recurrence was increased compared to negative margins (adjusted HR = 7.875, p-value = 0.008), and relatively comparable to what was observed when sampled margins were positive (adjusted HR = 0.927, p-value = 0.88).

PMID: 26817681 [PubMed - as supplied by publisher]

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Analysis on correlation between SP and NK-1R and intranasal mucosal contact point headache.

Analysis on correlation between SP and NK-1R and intranasal mucosal contact point headache.

Acta Otolaryngol. 2016 Jan 27;:1-6

Authors: Zhao G, Yin J, Peng H, Wang J

Abstract
Conclusion Distribution of SP and NK-1R, especially NK-1R, in nasal mucosal tissue at contact point was higher compared with non-contact point. It was suggested that SP and NK-1R were associated with mucosal contact point headache. Objectives To observe difference of substance P (SP) and NK-1 receptor (NK-1R) expression in tissues at contact point and non-contact point among the patients with intranasal mucosal contact point headache and speculate the role of SP and NK-1R in mucosal contact point headache. Methods SP and NK-1R in tissues of contact point and non-contact point among 40 patients with intranasal mucosal contact point headache were stained histologically by immunohistochemistry, and the mRNA level was detected by RT-PCR. Results SP was located in cytoplasm of acini epithelial cells, distributed in nasal mucosa tissues at both contact point and non-contact point. However, stain intensity was significantly increased at contact point (Z = -2.554, p < 0.05). NK-1R was located in the cytoplasm of acinar epithelial cells, inflammatory cells, and nerve fibers of contact point; only in cytoplasm of acinar epithelial cells and nerve fibers of non-contact point. Tinctorial rate of NK-1R increased significantly at contact point (χ(2) = 40.438, p < 0.01). mRNA level of SP and NK-1R was up-regulated in nasal mucosa at contact point compared with non-contact point.

PMID: 26817501 [PubMed - as supplied by publisher]

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Ocular vestibular evoked myogenic potentials to vertex low frequency vibration as a diagnostic test for superior canal dehiscence.

Ocular vestibular evoked myogenic potentials to vertex low frequency vibration as a diagnostic test for superior canal dehiscence.

Clin Neurophysiol. 2016 Jan 12;

Authors: Verrecchia L, Westin M, Duan M, Brantberg K

Abstract
OBJECTIVE: To explore ocular vestibular evoked myogenic potentials (oVEMP) to low-frequency vertex vibration (125Hz) as a diagnostic test for superior canal dehiscence (SCD) syndrome.
METHODS: The oVEMP using 125Hz single cycle bone-conducted vertex vibration were tested in 15 patients with unilateral superior canal dehiscence (SCD) syndrome, 15 healthy controls and in 20 patients with unilateral vestibular loss due to vestibular neuritis. Amplitude, amplitude asymmetry ratio, latency and interaural latency difference were parameters of interest.
RESULTS: The oVEMP amplitude was significantly larger in SCD patients when affected sides (53μVolts) were compared to non-affected (17.2μVolts) or compared to healthy controls (13.6μVolts). Amplitude larger than 33.8μVolts separates effectively the SCD ears from the healthy ones with sensitivity of 87% and specificity of 93%. The other three parameters showed an overlap between affected SCD ears and non-affected as well as between SCD ears and those in the two control groups.
CONCLUSIONS: oVEMP amplitude distinguishes SCD ears from healthy ones using low-frequency vibration stimuli at vertex.
SIGNIFICANCE: Amplitude analysis of oVEMP evoked by low-frequency vertex bone vibration stimulation is an additional indicator of SCD syndrome and might serve for diagnosing SCD patients with coexistent conductive middle ear problems.

PMID: 26818880 [PubMed - as supplied by publisher]

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Vestibular Disorders in Children With Congenital Cytomegalovirus Infection.

Related Articles

Vestibular Disorders in Children With Congenital Cytomegalovirus Infection.

Pediatrics. 2015 Oct;136(4):e887-95

Authors: Bernard S, Wiener-Vacher S, Van Den Abbeele T, Teissier N

Abstract
BACKGROUND: Congenital cytomegalovirus (CMV) infection is the leading infectious cause of neurologic disabilities and sensorineural hearing loss in children. Sensorineural hearing loss prevalence in CMV suggests a viral tropism for the inner ear. Vestibular disorders induced by CMV infection are underestimated. This is the largest and most thorough study to assess the incidence of vestibular disorders and their correlation with hearing thresholds in children with CMV.
METHODS: This retrospective study assessed a cohort of 52 children with congenital CMV infection and sensorineural impairment who received a complete hearing and vestibular assessment. Vestibular evaluation included clinical examination, caloric bithermal test, earth vertical axis rotation, off-vertical axis rotation, and vestibular evoked myogenic potential. The prevalence, progression, and clinical impact of vestibular disorders were studied and correlated with hearing thresholds and the severity of congenital CMV infection.
RESULTS: Forty-eight children (92.3%) had hearing loss and vestibular disorders. Of those, vestibular disorders were complete and bilateral in 33.3%, partial and bilateral in 43.7%, and partial and unilateral in 22.9%. Serial testing in 14 children showed stable vestibular function in 50% and deterioration in 50%. Congenital CMV infection has a negative impact on postural development that is correlated with neurologic and vestibular impairment. Vestibular disorders were significantly associated with hearing disorders, but their respective severities showed no concordance.
CONCLUSIONS: Vestibular disorders are frequent and severe in CMV-infected children. Routine screening and appropriate management of vestibular lesions is essential to initiate adapted care.

PMID: 26347442 [PubMed - indexed for MEDLINE]

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Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery.

Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery.

Case Rep Emerg Med. 2015;2015:789076

Authors: Calogero CG, Miller AC, Greenberg MR

Abstract
Inferior thyroid artery (ITA) rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.

PMID: 26819785 [PubMed]

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Cancer Incidence in Appalachia, 2004-2011.

Cancer Incidence in Appalachia, 2004-2011.

Cancer Epidemiol Biomarkers Prev. 2016 Jan 27;

Authors: Wilson RJ, Ryerson AB, Singh SD, King JB

Abstract
BACKGROUND: Limited literature is available about cancer in the Appalachian Region. This is the only known analysis of all cancers for Appalachia and non-Appalachia covering 100% of the US population. Appalachian cancer incidence and trends were evaluated by state, sex, and race and compared with those found in non-Appalachian regions.
METHODS: US counties were identified as Appalachian or non-Appalachian. Age-adjusted cancer incidence rates, standard errors, and confidence intervals were calculated using the most recent data from the United States Cancer Statistics for 2004 to 2011.
RESULTS: Generally, Appalachia carries a higher cancer burden compared with non-Appalachia, particularly for tobacco-related cancers. For all cancer sites combined, Appalachia has higher rates regardless of sex, race, or region. The Appalachia and non-Appalachia cancer incidence gap has narrowed, with the exception of oral cavity and pharynx, larynx, lung and bronchus, and thyroid cancers.
CONCLUSIONS: Higher cancer incidence continues in Appalachia and appears at least in part to reflect high tobacco use and potential differences in socioeconomic status, other risk factors, patient health care utilization, or provider practices. It is important to continue to evaluate this population to monitor results from screening and early detection programs, understand behavioral risk factors related to cancer incidence, increase efforts to reduce tobacco use and increase cancer screening, and identify other areas where effective interventions may mediate disparities.
IMPACT: Surveillance and evaluation of special populations provide means to monitor screening and early detection programs, understand behavioral risk factors, and increase efforts to reduce tobacco use to mediate disparities. Cancer Epidemiol Biomarkers Prev; 25(2); 1-9. ©2016 AACR.

PMID: 26819264 [PubMed - as supplied by publisher]

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Interaction between MLL3 genetic polymorphisms, smoking, and alcohol drinking in laryngeal cancer: a case-control study.

Interaction between MLL3 genetic polymorphisms, smoking, and alcohol drinking in laryngeal cancer: a case-control study.

Cancer Med. 2016 Jan 27;

Authors: Chen D, Gong L, Jiang Q, Wang X, Zhang B

Abstract
A previous study indicated that MLL3 genetic polymorphisms were associated with human cancer. However, whether MLL3 genetic variants are associated with the risk of laryngeal cancer is not clear. This study investigated the association between MLL3 gene polymorphisms and laryngeal cancer in a Chinese population. Four polymorphisms of the MLL3 gene (rs6943984, rs4725443, rs3800836, rs6464211) were genotyped using the TaqMan method in 592 patients with larynx cancer and 602 age- and sex-matched noncancer controls. We found that rs6943984 and rs4725443 of the MLL3 gene were significantly associated with the risk of larynx cancer after Bonferroni correction. The minor allele A for rs6943984 was associated with increased larynx cancer risk (P < 0.001, OR = 1.960, 95% CI = 1.587-2.420). C allele frequency (0.151) for rs4725443 was significantly higher in the case group than the control group (0.072, P < 0.001). Haplotype analyses showed that haplotypes A-T-A-C and G-T-G-C increased the risk of laryngeal cancer (OR = 2.406, 95% CI: 1.820-3.180, P < 0.001; OR = 1.399, 95% CI: 1.180-1.659, respectively), and haplotypes G-T-A-C and G-T-G-T significantly reduced the risk of laryngeal cancer (OR = 0.332, 95% CI: 0.271-0.408, P < 0.001; OR = 0.742, 95% CI: 0.607-0.908, respectively). We also found that MLL3 rs6943984 and rs4725443 polymorphisms had synergistic effects with smoking or alcohol drinking for the risk of laryngeal cancer. This study indicated that MLL3 genetic polymorphisms and haplotypes were associated with larynx cancer in a Chinese population. There was a mutually synergistic effect between smoking, alcohol drinking, and MLL3 gene polymorphisms for laryngeal cancer.

PMID: 26818916 [PubMed - as supplied by publisher]

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Heterozygosity for a Novel Missense Mutation in the ITGB4 Gene Associated With Autosomal Dominant Epidermolysis Bullosa.

Heterozygosity for a Novel Missense Mutation in the ITGB4 Gene Associated With Autosomal Dominant Epidermolysis Bullosa.

JAMA Dermatol. 2016 Jan 27;

Authors: Turcan I, Pasmooij AM, van den Akker PC, Lemmink H, Halmos GB, Sinke RJ, Jonkman MF

Abstract
Importance: Epidermolysis bullosa (EB) is a group of mechanobullous genodermatoses characterized by the fragility of skin and mucous membranes. Mutations in the ITGA6 and ITGB4 genes, encoding the hemidesmosomal protein α6β4-integrin, have been involved in the pathogenesis of EB. To date, the inheritance of these particular genes is known to be exclusively autosomal recessive. Herein, we report a novel heterozygous missense mutation in the ITGB4 gene exerting a dominant negative effect that cosegregates with the EB phenotype in an extended family.
Observations: The clinical phenotype of affected individuals is primarily characterized by nail dystrophy and late onset of mild skin fragility and acral blistering. Some patients developed granulation tissue in the larynx, urethra, lacrimal duct, and external auditory canal. Sequencing the complete set of genes associated with EB revealed a heterozygous missense mutation in exon 5 of ITGB4: c.433G>T, p.Asp145Tyr. The mutation was found in the affected relatives and was not present in unaffected relatives and control DNA samples.
Conclusions and Relevance: This study highlights, for the first time to our knowledge, the possibility of a dominant mode of inheritance for a missense ITGB4 mutation in EB, thus expanding the mutational database and genotype-phenotype correlation for this rare disease.

PMID: 26817667 [PubMed - as supplied by publisher]

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Surgical treatment of a case of adult epiglottic laryngomalacia.

Related Articles

Surgical treatment of a case of adult epiglottic laryngomalacia.

Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Feb;132(1):45-7

Authors: Bartolomeo M, Bigi A, Pelliccia P, Makeieff M

Abstract
INTRODUCTION: Adult laryngomalacia is rare. It may be idiopathic or secondary to trauma or degenerative disease.
CASE REPORT: A 25-year-old man presented with inspiratory dyspnea on effort of several months' evolution. Flexible endoscopy found epiglottic laryngomalacia, managed by CO2 laser V-shaped partial epiglottectomy.
DISCUSSION: Excessive resection of the epiglottis may lead to false passage; insufficient resection risks being ineffective. V-shaped partial epiglottectomy minimizes risk of false passage while ensuring permanent respiratory airflow via the epiglottic V during epiglottic movement.

PMID: 25614370 [PubMed - indexed for MEDLINE]

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GTV delineation in supraglottic laryngeal carcinoma: interobserver agreement of CT versus CT-MR delineation.

Related Articles

GTV delineation in supraglottic laryngeal carcinoma: interobserver agreement of CT versus CT-MR delineation.

Radiat Oncol. 2015;10:26

Authors: Jager EA, Kasperts N, Caldas-Magalhaes J, Philippens ME, Pameijer FA, Terhaard CH, Raaijmakers CP

Abstract
BACKGROUND: GTV delineation is the first crucial step in radiotherapy and requires high accuracy, especially with the growing use of highly conformal and adaptive radiotherapy techniques. If GTV delineations of observers concord, they are considered to be of high accuracy. The aim of the study is to determine the interobserver agreement for GTV delineations of supraglottic laryngeal carcinoma on CT and on CT combined with MR-images and to determine the effect of adding MR images to CT-based delineation on the delineated volume and the interobserver agreement.
METHODS: Twenty patients with biopsy proven T1-T4 supraglottic laryngeal cancer, treated with curative intent were included. For all patients a contrast enhanced planning CT and a 1.5-T MRI with gadolinium were acquired in the same head-and-shoulder mask for fixation as used during treatment. For MRI, a two element surface coil was used as a receiver coil. Three dedicated observers independently delineated the GTV on CT. After an interval of 2 weeks, a set of co-registered CT and MR-images was provided to delineate the GTV on CT. Common volumes (C) and encompassing volumes (E) were calculated and C/E ratios were determined for each pair of observers. The conformity index general (CIgen) was used to quantify the interobserver agreement.
RESULTS: In general, a large variation in interobserver agreement was found for CT (range: 0.29-0.77) as well as for CT-MR delineations (range: 0.17-0.80). The mean CIgen for CT (0.61) was larger compared to CT-MR (0.57) (p = 0.032). Mean GTV volume delineated on CT-MR (6.6 cm(3)) was larger compared to CT (5.6 cm(3)) (p = 0.002).
CONCLUSION: Delineation on CT with co-registered MR-images resulted in a larger mean GTV volume and in a decrease in interobserver agreement compared to CT only delineation for supraglottic laryngeal carcinoma.

PMID: 25612508 [PubMed - indexed for MEDLINE]

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A National Population Study of the Co-Occurrence of Multiple Long-Term Conditions in People With Multimorbidity, Denmark, 2013.

A National Population Study of the Co-Occurrence of Multiple Long-Term Conditions in People With Multimorbidity, Denmark, 2013.

Prev Chronic Dis. 2016;13:E12

Authors: Friis K, Pedersen MH, Larsen FB, Lasgaard M

Abstract
The objective of this study was to describe the prevalence of pairwise combinations of 17 long-term conditions. Data were obtained from a national, representative population-based study including 162,283 Danish citizens aged 16 years or older. We calculated the prevalence of each long-term condition given the presence of another long-term condition. Compared with the general population, people with angina pectoris had more than twice the odds of having 12 of the 16 other long-term conditions, and inversely, people with cancer, tinnitus, or cataracts did not have notably higher odds for any of the other long-term conditions.

PMID: 26820044 [PubMed - as supplied by publisher]

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Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling.

Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling.

Neurosciences (Riyadh). 2016 Jan;21(1):60-3

Authors: Al-Jehani HM, Alwadaani HA, Almolani FM

Abstract
Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature.

PMID: 26818170 [PubMed - in process]

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Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

Related Articles

Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins.

Neurosurg Rev. 2015 Apr;38(2):253-63; discussion 263-4

Authors: Baltsavias G, Parthasarathi V, Aydin E, Al Schameri RA, Roth P, Valavanis A

Abstract
We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.

PMID: 25468011 [PubMed - indexed for MEDLINE]

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