Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

Abstract
BACKGROUND: Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
OBJECTIVES: This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
METHODS: Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.
RESULTS: The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
CONCLUSION: Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

PMID: 27476336 [PubMed - as supplied by publisher]

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Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.

Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.

Clin Pract. 2016 Apr 26;6(2):824

Authors: Heymanns V, Oseni AW, Alyeldien A, Maslehaty H, Parvin R, Scholz M, Petridis AK

Abstract
Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

PMID: 27478578 [PubMed]

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The Rhoton Collection.

The Rhoton Collection.

J Neurol Surg B Skull Base. 2016 Aug;77(4):294-6

Authors: Sorenson J

PMID: 27478757 [PubMed]

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Dr. Al Rhoton, Jr.: Friend, Mentor, and Colleague.

Dr. Al Rhoton, Jr.: Friend, Mentor, and Colleague.

J Neurol Surg B Skull Base. 2016 Aug;77(4):291-3

Authors: Robertson JH

PMID: 27478756 [PubMed]

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Prof. Rhoton: Master and Mentor.

Prof. Rhoton: Master and Mentor.

J Neurol Surg B Skull Base. 2016 Aug;77(4):288-90

Authors: Fernandez-Miranda JC

PMID: 27478755 [PubMed]

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Albert L. Rhoton, Jr., M.D., 1932-2016.

Albert L. Rhoton, Jr., M.D., 1932-2016.

J Neurol Surg B Skull Base. 2016 Aug;77(4):283-5

Authors: Link MJ, Graffeo CS

PMID: 27478754 [PubMed]

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Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma.

Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma.

Intern Med. 2016;55(15):2105-8

Authors: Sokabe A, Mizooka M, Sakemi R, Kobayashi T, Kishikawa N, Yokobayashi K, Kanno K, Tazuma S

Abstract
Jugular paraganlioma is a benign, slow-growing tumor originating from the paraganglion cells and it is associated with catecholamine secretion. Paragangliomas can secrete Interleukin-6 (IL-6) and present as a systemic inflammatory syndrome; these characteristics have not been previously associated with jugular paragangliomas. A 63-year-old man with a jugular tumor in the skull base was referred to our hospital for an evaluation of pyrexia, back pain, and acute inflammation. His serum IL-6 level was elevated on admission and it decreased after radiotherapy. This is the first known case of a jugular paraganglioma exhibiting systemic inflammatory syndrome.

PMID: 27477424 [PubMed - in process]

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[The Base of the Skull. Rudolf Virchow between Pathology and Anthropology].

[The Base of the Skull. Rudolf Virchow between Pathology and Anthropology].

Medizinhist J. 2016;51(2):92-123

Authors: Seemann S

Abstract
Throughout his scientific career, the pathologist and anthropologist Rudolf Virchow (1821-1902) examined countless skulls, gradually changing his perspective on this object of research. Initially, he was mainly concerned with pathologically deformed skulls. From the 1850s onwards, he gradually developed a more anthropological approach, and anthropology increasingly came to dominate his scientific interest. This article shows how different influences became central for the establishment of his specific and dynamic model of the human skull development and its successful application in anthropology. Crucial for this process were Virchow's collaboration with his teacher Robert Froriep (1804-1861) in the department of pathology of the Charité, his research on cretinism and rickets, as well as his description of the base of the skull as the center of skull development. His research work was attended by and showed a reciprocal interaction with the buildup of large skull collections. This article uses Virchow's original publications on skull pathology as well as his still preserved skull specimens from the collection of the Berlin Museum of Medical History at the Charité for an integrated text and object based analysis.

PMID: 27476256 [PubMed - in process]

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Discovery and characterization of a peptide that enhances endosomal escape of delivered proteins in vitro and in vivo.

Related Articles

Discovery and characterization of a peptide that enhances endosomal escape of delivered proteins in vitro and in vivo.

J Am Chem Soc. 2015 Nov 11;137(44):14084-93

Authors: Li M, Tao Y, Shu Y, LaRochelle JR, Steinauer A, Thompson D, Schepartz A, Chen ZY, Liu DR

Abstract
The inefficient delivery of proteins into mammalian cells remains a major barrier to realizing the therapeutic potential of many proteins. We and others have previously shown that superpositively charged proteins are efficiently endocytosed and can bring associated proteins and nucleic acids into cells. The vast majority of cargo delivered in this manner, however, remains in endosomes and does not reach the cytosol. In this study we designed and implemented a screen to discover peptides that enhance the endosomal escape of proteins fused to superpositively charged GFP (+36 GFP). From a screen of peptides previously reported to disrupt microbial membranes without known mammalian cell toxicity, we discovered a 13-residue peptide, aurein 1.2, that substantially increases cytosolic protein delivery by up to ∼5-fold in a cytosolic fractionation assay in cultured cells. Four additional independent assays for nonendosomal protein delivery collectively suggest that aurein 1.2 enhances endosomal escape of associated endocytosed protein cargo. Structure-function studies clarified peptide sequence and protein conjugation requirements for endosomal escape activity. When applied to the in vivo delivery of +36 GFP-Cre recombinase fusions into the inner ear of live mice, fusion with aurein 1.2 dramatically increased nonendosomal Cre recombinase delivery potency, resulting in up to 100% recombined inner hair cells and 96% recombined outer hair cells, compared to 0-4% recombined hair cells from +36-GFP-Cre without aurein 1.2. Collectively, these findings describe a genetically encodable, endosome escape-enhancing peptide that can substantially increase the cytoplasmic delivery of cationic proteins in vitro and in vivo.

PMID: 26465072 [PubMed - indexed for MEDLINE]

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Secondary oesophageal or gastric cancer in patients treated for head and neck squamous cell carcinoma.

Secondary oesophageal or gastric cancer in patients treated for head and neck squamous cell carcinoma.

Dan Med J. 2016 Aug;63(8)

Authors: Andersen AR, Bjerring OS, Godballe C, Detlefsen S, Mortensen MB

Abstract
INTRODUCTION: Patients with head and neck squamous cell carcinoma (HNSCC) are at an elevated risk of developing second primary malignancies (SPM). Our objectives were to estimate the excess risk of oesophageal and gastric SPMs in patients with malignancies of the pharynx or larynx and, additionally, to examine possible risk factors of developing SPMs.
METHODS: Data on all patients treated for HNSCC with curative intent in the Region of Southern Denmark in the period between 1 January 2000 and 31 December 2010 were reviewed. A total of 1,172 patients were identified. The combined data from the DAHANCA database, the Danish National Pathology Registry and the patient charts were analysed.
RESULTS: A total of 27 patients developed an SPM in the oesophagus or stomach corresponding to a standardised incidence ratio of 9.5 (95% confidence interval (CI): 6.5-13.9). Supraglottic (odds ratio (OR) = 6.9; p < 0.004) and hypopharyngeal (OR = 3.9; p < 0.049) index tumour sites were significant risk factors for developing SPM. The median survival of patients with SPM was 3.6 years (95% CI: 1.6-5.1; range: 0.7-12.4) from diagnosis of the index cancer compared with 3.4 years (95% CI: 3.1-4.3; range: 0.04-13.7) for patients without SPM.
CONCLUSION: In this study, we confirm that there is an elevated risk of developing oesophageal and gastric cancer in the Danish population of patients with a cancer in the supraglottic or hypopharyngeal region. Therefore, we recommend close follow-up of these patients and a low threshold for examination of the oesophagus and stomach.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.

PMID: 27477794 [PubMed - in process]

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Optimal use of CT imaging in pediatric congenital cholesteatoma.

Optimal use of CT imaging in pediatric congenital cholesteatoma.

Auris Nasus Larynx. 2016 Jul 28;

Authors: Kim SY, Kim HS, Park MH, Lee JH, Oh SH, Chang SO, Kim CS, Jung AY, Kim YH

Abstract
OBJECTIVE: This study aimed to determine the radiation dose of temporal bone computed tomography (TBCT) to detect pediatric congenital cholesteatoma (CC), and suggests strategy for lowering perioperative radiation dose.
METHODS: Fifty-three CC patients followed up for more than 12 months after surgery. Perioperative clinical findings and the effective radiation dose (ERD) of TBCT were investigated. Patients' mean age at initial TBCT was 60 months; the mean follow-up period was 43 months.
RESULTS: In 33 (62.3%) of 53 patients, only one TBCT was performed postoperatively. Postoperative CT imaging was performed to evaluate before second-stage ossiculoplasty, due to suspicion of CC recurrence on examinations, or as part of follow-up. When TBCT was performed on more than two occasions after surgery as a part of follow-up, there was no difference in the distribution of stage or type of CC compared to patients subjected to TBCT on less than three occasions (p=0.093 and p=0.744, respectively). During the most-recent follow-up of these 53 cases, there was no CC recurrence. The mean ERD of a single TBCT was 1.2mSv, and the mean cumulative ERD of TBCT was 2mSv per patient.
CONCLUSION: Mean and cumulative ERD of TBCT performed in CC cases was not too high to consider radiation hazard. However, efforts to minimize the number of CT scans should be taken basically.

PMID: 27477570 [PubMed - as supplied by publisher]

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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

Abstract
BACKGROUND: Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
OBJECTIVES: This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
METHODS: Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.
RESULTS: The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
CONCLUSION: Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

PMID: 27476336 [PubMed - as supplied by publisher]

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Comprehensive, Population-Based Sensitivity Analysis of a Two-Mass Vocal Fold Model.

Related Articles

Comprehensive, Population-Based Sensitivity Analysis of a Two-Mass Vocal Fold Model.

PLoS One. 2016;11(2):e0148309

Authors: Robertson D, Zañartu M, Cook D

Abstract
Previous vocal fold modeling studies have generally focused on generating detailed data regarding a narrow subset of possible model configurations. These studies can be interpreted to be the investigation of a single subject under one or more vocal conditions. In this study, a broad population-based sensitivity analysis is employed to examine the behavior of a virtual population of subjects and to identify trends between virtual individuals as opposed to investigating a single subject or model instance. Four different sensitivity analysis techniques were used in accomplishing this task. Influential relationships between model input parameters and model outputs were identified, and an exploration of the model's parameter space was conducted. Results indicate that the behavior of the selected two-mass model is largely dominated by complex interactions, and that few input-output pairs have a consistent effect on the model. Results from the analysis can be used to increase the efficiency of optimization routines of reduced-order models used to investigate voice abnormalities. Results also demonstrate the types of challenges and difficulties to be expected when applying sensitivity analyses to more complex vocal fold models. Such challenges are discussed and recommendations are made for future studies.

PMID: 26845452 [PubMed - indexed for MEDLINE]

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Immunohistochemical Characterization of the Ectopic Epithelium Devoid of Goblet Cells From a Posttraumatic Iris Cyst Causing Mucogenic Glaucoma.

Related Articles

Immunohistochemical Characterization of the Ectopic Epithelium Devoid of Goblet Cells From a Posttraumatic Iris Cyst Causing Mucogenic Glaucoma.

J Glaucoma. 2016 Mar;25(3):e291-4

Authors: Wakae H, Higashide T, Tsuneyama K, Nakamura T, Takahashi K, Sugiyama K

Abstract
PURPOSE: Mucogenic glaucoma is an unusual form of secondary open-angle glaucoma caused by intracameral ectopic mucus-producing epithelium. To date, only 3 cases have been described in detail. Numerous goblet cells in the specimens indicated a possible conjunctival origin. We immunohistochemically characterized the implanted epithelium from an iris cyst responsible for mucogenic glaucoma.
METHODS: A series of immunostaining analyses were performed on a sector-iridectomy specimen derived from an eye with mucogenic glaucoma and a history of limbal penetrating injury. An iris cyst was present in the inferonasal quadrant of the right eye of a 58-year-old man. The anterior chamber was filled with hazy, translucent material, and the chamber angle was gonioscopically open. The cyst was resected due to medically uncontrollable high intraocular pressure.
RESULTS: The ectopic epithelium was mostly positive for CK19, a corneal and conjunctival epithelial marker. Negative staining for MUC5AC, a secretory mucin, and positive staining for MUC1, a membrane-bound mucin, corroborated the absence of goblet cells. Ectopic epithelial cells were abundantly positive for CK15, a limbal basal cell marker, but there was patchy immunostaining of CK13, a conjunctival epithelial marker, and sparse labeling with CK12, a corneal epithelial marker. Immunostaining patterns of CK15, CK13, and CK12 were nearly mutually exclusive.
CONCLUSIONS: The ectopic epithelium of an iris cyst causing mucogenic glaucoma was most likely to originate from limbal basal cells, which showed dual direction of differentiation toward both the conjunctival and corneal epithelia. The membrane-bound mucin may have caused mucogenic glaucoma in the absence of goblet cells.

PMID: 26550968 [PubMed - indexed for MEDLINE]

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Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial.

Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial.

J Laryngol Otol. 2016 Aug 1;:1-5

Authors: Romsaithong S, Tomanakan K, Tangsawad W, Thanaviratananich S

Abstract
OBJECTIVES: To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis.
METHODS: A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment.
RESULTS: After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable.
CONCLUSION: One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.

PMID: 27477534 [PubMed - as supplied by publisher]

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Nasal airflow and brain activity: is there a link?

Nasal airflow and brain activity: is there a link?

J Laryngol Otol. 2016 Aug 1;:1-6

Authors: Price A, Eccles R

Abstract
BACKGROUND: Over the past few decades, evidence has emerged suggesting that nasal airflow asymmetry and brain asymmetry are linked. The nose exhibits asymmetrical airflow, with the dominant airflow alternating from one nasal passage to the other over a period of hours. Some authors have suggested a correlation between cerebral hemisphere dominance and nostril dominance. Others have proposed an association between rhythmic fluctuations in nasal airflow and corresponding fluctuations in cerebral hemisphere activity. Based on ancient yoga breathing techniques, newer evidence suggests that altering nasal airflow can influence brain activity, with reports of improved cognitive function caused by unilateral forced nostril breathing. It seems that a nasal airflow stimulus may have an activating effect on the brain, as it has also been shown to trigger seizure activity in epileptic patients.
OBJECTIVES: This article explores these theories in detail, reviews the evidence, and presents new models linking nasal airflow and brain activity.

PMID: 27477330 [PubMed - as supplied by publisher]

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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

Abstract
BACKGROUND: Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
OBJECTIVES: This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
METHODS: Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.
RESULTS: The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
CONCLUSION: Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

PMID: 27476336 [PubMed - as supplied by publisher]

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Comment on "Partially Cystic Thyroid Nodules on Ultrasound: Probability of Malignancy and Sonographic Differentiation".

Comment on "Partially Cystic Thyroid Nodules on Ultrasound: Probability of Malignancy and Sonographic Differentiation".

Thyroid. 2016 Jul 31;

Authors: Cui K, Zhang M, Fu C, Ma X, Li J

PMID: 27477239 [PubMed - as supplied by publisher]

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