The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

Rhinology. 2015 Oct 25;

Authors: Ivanchenko OA, Karpishchenko SA, Kozlov RS, Krechikova OI, Otvagin IV, Sopko ON, Piskunov GZ, Lopatin AS

Abstract
AIM: This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.
METHODOLOGY: 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture.
RESULTS: A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively.
CONCLUSIONS: The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

PMID: 26501135 [PubMed - as supplied by publisher]

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Common airborne fungi induce species-specific effects on upper airway inflammatory and remodelling responses.

Common airborne fungi induce species-specific effects on upper airway inflammatory and remodelling responses.

Rhinology. 2015 Oct 25;

Authors: Sproson EL, Thomas KM, Lau LC, Harries PG, Howarth PH, Salib RJ

Abstract
OBJECTIVE: Whilst the exact cause of chronic rhinosinusitis (CRS) remains elusive, it is clear that both inflammation and remodelling are key disease processes. Environmental fungi have been linked to airway inflammation in CRS; however, their role in the pathogenesis of this condition remains controversial. The current consensus suggests that whilst fungi may not be directly causative, it is likely that CRS patients have deficits in their innate and potentially acquired immunity, which in turn may modify their ability to react to fungi. This study used a nasal polyp explant tissue stimulation model to study the inflammatory and remodelling responses related to challenge with common airborne fungal species.
METHODS: Ex vivo nasal polyp tissue from six well phenotyped CRSwNP patients undergoing functional endoscopic sinus surgery was stimulated with 1, 10 and 100 μg/ml of Alternaria alternata, Aspergillus niger, Cladosporium sphaerospermum and Penicillium notatum and compared with unchallenged polyp tissue as control. Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of pro-inflammatory cytokines interleukin-6 (IL-6), granulocyte macrophage colony stimulating factor (GM-CSF) and tumour necrosis factor-α (TNF-α); and pro-remodelling cytokines transforming growth factor-b1 (TGF-b1), and basic fibroblast growth factor (bFGF) in the polyp supernatant.
RESULTS: Aspergillus niger stimulation increased pro-inflammatory cytokines TNF-α, GM-CSF and IL-6 whilst having little effect on the remodelling cytokines bFGF and TGF-b1. In contrast, stimulation with Cladosporium sphaerospermum, Alternaria alternata and Penicillium notatum reduced pro-inflammatory cytokines TNF-α and IL-6, but induced a dose-dependent increase in remodelling cytokines TGF-b1 and bFGF.
CONCLUSIONS: This study shows that common airborne fungi induce species-specific effects on the upper airway inflammatory and remodelling responses. These findings provide further immunological evidence of a disease-modifying role for fungi in CRS.

PMID: 26501134 [PubMed - as supplied by publisher]

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Radiobiological evaluation of intensity modulated radiation therapy treatments of patients with head and neck cancer: A dual-institutional study.

Radiobiological evaluation of intensity modulated radiation therapy treatments of patients with head and neck cancer: A dual-institutional study.

J Med Phys. 2015 Jul-Sep;40(3):165-169

Authors: Narayanasamy G, Pyakuryal AP, Pandit S, Vincent J, Lee C, Mavroidis P, Papanikolaou N, Kudrimoti M, Sio TT

Abstract
In clinical practice, evaluation of clinical efficacy of treatment planning stems from the radiation oncologist's experience in accurately targeting tumors, while keeping minimal toxicity to various organs at risk (OAR) involved. A more objective, quantitative method may be raised by using radiobiological models. The purpose of this work is to evaluate the potential correlation of OAR-related toxicities to its radiobiologically estimated parameters in simultaneously integrated boost (SIB) intensity modulated radiation therapy (IMRT) plans of patients with head and neck tumors at two institutions. Lyman model for normal tissue complication probability (NTCP) and the Poisson model for tumor control probability (TCP) models were used in the Histogram Analysis in Radiation Therapy (HART) analysis. In this study, 33 patients with oropharyngeal primaries in the head and neck region were used to establish the correlation between NTCP values of (a) bilateral parotids with clinically observed rates of xerostomia, (b) esophagus with dysphagia, and (c) larynx with dysphagia. The results of the study indicated a strong correlation between the severity of xerostomia and dysphagia with Lyman NTCP of bilateral parotids and esophagus, respectively, but not with the larynx. In patients without complications, NTCP values of these organs were negligible. Using appropriate radiobiological models, the presence of a moderate to strong correlation between the severities of complications with NTCP of selected OARs suggested that the clinical outcome could be estimated prior to treatment.

PMID: 26500403 [PubMed - as supplied by publisher]

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Role of miR-138 in the regulation of larynx carcinoma cell metastases.

Role of miR-138 in the regulation of larynx carcinoma cell metastases.

Tumour Biol. 2015 Oct 24;

Authors: Gao S, Wang J, Xie J, Zhang T, Dong P

Abstract
The cases of larynx carcinoma (LC) with poor prognosis largely result from the distal metastases of the primary tumor. Since microRNAs (miRNAs) play critical roles during cancer metastases, determination of the involved miRNAs in the regulation of the LC metastases may provide novel therapeutic targets for LC treatment. Here, we studied the LC specimens from the patients and found that the levels of miR-138 were significantly decreased and the levels of ZEB2, a critical factor that regulates cancer cell invasiveness, were significantly increased in LC, compared to the paired normal larynx tissue. Metastatic LC appeared to contained lower levels of miR-138. Moreover, miR-138 and ZEB2 inversely correlated in LC specimens. Bioinformatics analyses showed that miR-138 targeted the 3'-untranslated region (3'-UTR) of ZEB2 mRNA to inhibit its translation, which was confirmed in a luciferase reporter assay. Further, miR-138 overexpression inhibited ZEB2-mediated cell invasiveness, while miR-138 depletion increased ZEB2-mediated cell invasiveness in LC cells. Together, our data suggest that miR-138 suppression in LC cells may promote ZEB2-mediated cancer metastases. Thus, miR-138 appears to be an intriguing therapeutic target to prevent metastases of LC.

PMID: 26499780 [PubMed - as supplied by publisher]

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Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis.

Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis.

Auris Nasus Larynx. 2015 Oct 20;

Authors: Yonezaki M, Akiyama K, Karaki M, Goto R, Inamoto R, Samukawa Y, Kobayashi R, Kobayashi E, Hoshikawa H

Abstract
OBJECTIVE: Intranasal corticosteroid sprays (INCSs) are commonly used for therapy of allergic rhinitis (AR). Adherence to regular use of INCSs is influenced by patient perception and preferences of products. The study objective was to compare perceived sensory attributes of fluticasone furoate nasal spray (FFNS) and mometasone furoate nasal spray (MFNS) in AR patients.
METHODS: In a multicenter, randomized, crossover, prospective study, 40 seasonal AR patients were administered both FFNS and MFNS for 2 weeks each in a crossover fashion, for a total of 4 weeks. Patients completed questionnaires for each product regarding perceived sensory attributes at the end of each two-week period of product administration.
RESULTS: FFNS was significantly preferred over MFNS. Significantly, fewer subjects perceived a bitter taste (p=0.01), medication running down their throat (p=0.033), and medication running out of their nose (p=0.002) with FFNS. MFNS was more frequently reported to induce nasal irritation (p=0.012), sneezing (p=0.017), and rhinorrhea (p=0.007) compared to FFNS. Interestingly, these findings were markedly observed in females. Medicine dripping out of the nose and nasal shooting were the most common problems reported for MFNS with a higher proportion of subjects who felt moderate-to-severe discomfort. Overall, 52.5% of patients expressed a preference for FFNS compared with 22.5% for MFNS.
CONCLUSION: Several perceived sensory attributes of FFNS were rated significantly superior to MFNS. FFNS may contribute to enhanced treatment outcomes in AR patients due to improved treatment adherence.

PMID: 26498699 [PubMed - as supplied by publisher]

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Optimizing hereditary angioedema management through tailored treatment approaches.

Optimizing hereditary angioedema management through tailored treatment approaches.

Expert Rev Clin Immunol. 2015 Oct 23;:1-13

Authors: Nasr IH, Manson AL, Al Wahshi HA, Longhurst HJ

Abstract
Hereditary angioedema (HAE) is a rare but serious and potentially life threatening autosomal dominant condition caused by low or dysfunctional C1 esterase inhibitor (C1-INH) or uncontrolled contact pathway activation. Symptoms are characterized by spontaneous, recurrent attacks of subcutaneous or submucosal swellings typically involving the face, tongue, larynx, extremities, genitalia or bowel. The prevalence of HAE is estimated to be 1:50,000 without known racial differences. It causes psychological stress as well as significant socioeconomic burden. Early treatment and prevention of attacks are associated with better patient outcome and lower socioeconomic burden. New treatments and a better evidence base for management are emerging which, together with a move from hospital-centered to patient-centered care, will enable individualized, tailored treatment approaches.

PMID: 26496459 [PubMed - as supplied by publisher]

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Imaging Acute Airway Obstruction in Infants and Children.

Imaging Acute Airway Obstruction in Infants and Children.

Radiographics. 2015 Oct 23;:150096

Authors: Darras KE, Roston AT, Yewchuk LK

Abstract
Acute airway obstruction is much more common in infants and children than in adults because of their unique anatomic and physiologic features. Even in young patients with partial airway occlusion, symptoms can be severe and potentially life-threatening. Factors that predispose children to airway compromise include the orientation of their larynx, the narrow caliber of their trachea, and their weak intercostal muscles. Because the clinical manifestations of acute airway obstruction are often nonspecific, clinicians often rely on the findings at imaging to establish a diagnosis. Several key anatomic features of the pediatric airway make it particularly susceptible to respiratory distress, and the imaging recommendations for children suspected of having acute airway obstruction are presented. Although cross-sectional imaging may be helpful, the diagnosis can often be established by using radiographs alone. Radiographs of the chest and upper airway should be routinely acquired; however, for the child who is in severe distress, a single lateral radiographic view may be all that is necessary. The purpose of this article is to provide an imaging approach to acquired causes of acute airway obstruction in children, including (a) abnormalities affecting the upper portion of the airway, such as croup, acute epiglottitis, retropharyngeal infection, and foreign bodies, and (b) abnormalities affecting the lower portion of the airway, such as asthma, bronchiolitis, and foreign bodies. It is essential that the radiologist recognize key imaging findings and understand the pathophysiologic features of acute airway obstruction because in most cases, when the cause is identified, the condition responds well to prompt management. (©)RSNA, 2015.

PMID: 26495798 [PubMed - as supplied by publisher]

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[Laryngeal Tube Position Shift after Chest Compression: Comparison of Fixation Methods Using Durapore Tape, Multipore Tape, or a Neck Tape].

Related Articles

[Laryngeal Tube Position Shift after Chest Compression: Comparison of Fixation Methods Using Durapore Tape, Multipore Tape, or a Neck Tape].

Masui. 2015 May;64(5):566-8

Authors: Seno H, Komasawa N, Fujiwara S, Miyazaki S, Tatsumi S, Minami T

Abstract
BACKGROUND: The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem.
METHODS: We investigated the effectiveness of three fixation methods of LT using a manikin and automated chest compressor.
RESULTS: After 10-minute chest compression, LT without fixation was shifted by 0.4 ± 0.1 cm, which was greater than with Durapore tape (0.2 ± 0.1 cm), Multipore tape (0.2 ± 0.1 cm), or a neck tape (0.1 ± 0.1 cm). The shift of the position was smaller with neck tape fixation compared to Durapore or Multipore tape fixation.
CONCLUSIONS: A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.

PMID: 26422972 [PubMed - indexed for MEDLINE]

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[Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery without Endotracheal Intubation].

Related Articles

[Spontaneous Respiration Technique for Pediatric Microlaryngeal Surgery without Endotracheal Intubation].

Masui. 2015 May;64(5):524-9

Authors: Torii N, Tachibana K, Fujita N, Yamashita T, Terada Y, Kinouchi K

Abstract
We report the anesthetic management of microlaryngeal surgery in children using tubeless total intravenous anesthesia (TIVA) without endotracheal intubation under spontaneous breathing. In 9 patients (median age : 4.9 yr. range 1 months-14 years, body weight : 17 kg, range 3-61 kg), 19 procedures were performed with TIVA using propofol and remifentanil. The median time from the start of TIVA to rigid laryngoscope insertion was 11 minutes. Propofol 15.7 mg x kg(-1) x hr(-1) and remifentanil 0.05 μg x kg(-1) x min(-1) was infused in this interval. Laryngospasm was observed in two cases, but it responded to a bolus of propofol (0.5-1.0 mg x kg(-1)) and additional topical anesthesia with 1% lidocaine. Three children were found apneic after a bolus administration of remifentanil or after increasing the rate of remifentanil infusion accompanied with desaturation and their tracheae were intubated. The spontaneous respiration technique using TIVA without intubation provides an excellent view of the operative field while allowing stable anesthesia. Further studies are required to establish the optimal dose of propofol and remifentanil and the timing of rigid laryngoscope insertion.

PMID: 26422960 [PubMed - indexed for MEDLINE]

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A genetic variant of p53 restricts the mucous secretory phenotype by regulating SPDEF and Bcl-2 expression.

Related Articles

A genetic variant of p53 restricts the mucous secretory phenotype by regulating SPDEF and Bcl-2 expression.

Nat Commun. 2014;5:5567

Authors: Chand HS, Montano G, Huang X, Randell SH, Mebratu Y, Petersen H, Tesfaigzi Y

Abstract
Despite implications for carcinogenesis and other chronic diseases, basic mechanisms of p53 and its variants in suppressing Bcl-2 levels are poorly understood. Bcl-2 sustains mucous cell metaplasia, whereas p53(-/-) mice display chronically increased mucous cells. Here we show that p53 decreases bcl-2 mRNA half-life by interacting with the 5' untranslated region (UTR). The p53-bcl-2 mRNA interaction is modified by the substitution of proline by arginine within the p53 proline-rich domain (PRD). Accordingly, more mucous cells are present in primary human airway cultures with p53(Arg) compared with p53(Pro). Also, the p53(Arg) compared with p53(Pro) displays higher affinity to and activates the promoter region of SAM-pointed domain-containing Ets-like factor (SPDEF), a driver of mucous differentiation. On two genetic backgrounds, mice with targeted replacement of prolines in p53 PRD show enhanced expression of SPDEF and Bcl-2 and mucous cell metaplasia. Together, these studies define the PRD of p53 as a determinant for chronic mucous hypersecretion.

PMID: 25429397 [PubMed - indexed for MEDLINE]

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Investigation of the relationship between neutrophil-to-lymphocyte ratio and obstructive sleep apnoea syndrome.

Investigation of the relationship between neutrophil-to-lymphocyte ratio and obstructive sleep apnoea syndrome.

J Laryngol Otol. 2015 Oct 26;:1

Authors: Bakshi SS

PMID: 26498109 [PubMed - as supplied by publisher]

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Changes in the immunohistochemical localization of the glycine receptor in the superior olivary complex of adult circling mice.

Changes in the immunohistochemical localization of the glycine receptor in the superior olivary complex of adult circling mice.

Mol Med Rep. 2015 Oct 13;

Authors: Yoo YB, Maskey D, Kim MJ

Abstract
Circling mice is a mutant model of spontaneous deafness exhibiting degenerated spiral ganglion cells in the cochlea and loss of organ of Corti. The balance between glycinergic inhibition and glutamatergic excitation in the lateral superior olive (LSO) is essential for the detection of interaural level differences. Long term weakening of glycinergic synaptic inhibition in the LSO may lead to the downregulation of synaptic release of glycine in dorsal cochlear nucleus and downregulation of postsynaptic glycine receptor (GlyR) activity in the LSO, which may contribute to hearing loss. The present study utilized an immunohistochemical method to assess changes in GlyR immunoreactivity (IR) and the cell number in the superior olivary complex (SOC) of heterozygote (+/cir) and homozygote (cir/cir) circling mice. A significant decrease in the IR was observed in all nuclei of the SOC of homozygous mice. Loss of GlyR immunoreactive cells and a decrement in cell size was also observed in the homozygotes. A decrease in the GlyR IR in the neurons and neuropils, cell number and size of the cir/cir, may lead to profound changes in inhibitory transmission and the functional properties in the SOC nuclei. Therefore, the functional loss of inhibitory neurotransmitters in the brainstem may result in deafness of adult cir/cir mice.

PMID: 26498980 [PubMed - as supplied by publisher]

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A 'calcium capacitor' shapes cholinergic inhibition of cochlear hair cells.

Related Articles

A 'calcium capacitor' shapes cholinergic inhibition of cochlear hair cells.

J Physiol. 2014 Aug 15;592(Pt 16):3393-401

Authors: Fuchs PA

Abstract
Efferent cholinergic neurons project from the brainstem to inhibit sensory hair cells of the vertebrate inner ear. This inhibitory synapse combines the activity of an unusual class of ionotropic cholinergic receptor with that of nearby calcium-dependent potassium channels to shunt and hyperpolarize the hair cell. Postsynaptic calcium signalling is constrained by a thin near-membrane cistern that is co-extensive with the efferent terminal contacts. The postsynaptic cistern may play an essential role in calcium homeostasis, serving as sink or source, depending on ongoing activity and the degree of buffer saturation. Release of calcium from postsynaptic stores leads to a process of retrograde facilitation via the synthesis of nitric oxide in the hair cell. Activity-dependent synaptic modification may contribute to changes in hair cell innervation that occur during development, and in the aged or damaged cochlea.

PMID: 24566542 [PubMed - indexed for MEDLINE]

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Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

Sports Health. 2015 Sep;7(5):458-462

Authors: Lee AD, Yu A, Young SB, Battaglia PJ, Ho CJ

Abstract
Omohyoid muscle syndrome is a rare cause of an X-shaped bulging lateral neck mass that occurs on swallowing. This is a diagnostic case report of a 22-year-old mixed martial arts athlete who acquired this condition.

PMID: 26502424 [PubMed - as supplied by publisher]

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High Risk of Lateral Nodal Metastasis in Lateral Solitary Solid Papillary Thyroid Cancer.

High Risk of Lateral Nodal Metastasis in Lateral Solitary Solid Papillary Thyroid Cancer.

Ultrasound Med Biol. 2015 Oct 20;

Authors: Lai XJ, Zhang B, Jiang YX, Li JC, Zhao RN, Yang X, Zhang Q, Zhang XY, Li WB, Zhu SL

Abstract
We explored the relationship between ultrasonic intra-thyroidal location and neck node metastasis pattern in solitary solid papillary thyroid cancer (PTC). Data on 186 patients were retrospectively reviewed. The association between several characteristics and neck node metastasis pattern were analyzed. Among the 186 thyroid nodules, age ≥45 y (p = 0.005), mass size ≥2 cm (p = 0.001), presence of calcifications (p < 0.001) and lateral nodal metastasis (p = 0.001) were significantly related to central nodal metastasis in multivariate analysis. Mass size ≥2 cm (p = 0.046) and central nodal metastasis (p = 0.002) were significantly related to lateral nodal metastasis in multivariate analysis. Location of an intra-thyroidal solitary solid PTC located non-adjacent to the trachea (lateral) was significantly related to lateral nodal metastasis (p = 0.043) compared with location of an intra-thyroidal solitary solid PTC adjacent to the trachea (medial or isthmus). Lateral lesions have a high risk of lateral nodal metastasis in solitary solid PTC.

PMID: 26497768 [PubMed - as supplied by publisher]

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Paranasal sinus opacification at MRI in lower airway disease (the HUNT study-MRI).

Paranasal sinus opacification at MRI in lower airway disease (the HUNT study-MRI).

Eur Arch Otorhinolaryngol. 2015 Oct 26;

Authors: Hansen AG, Helvik AS, Thorstensen WM, Nordgård S, Langhammer A, Bugten V, Stovner LJ, Eggesbø HB

Abstract
The study builds on the concept of united airways, which describes the link between the upper and lower airways. Explorations of this concept have mainly related to asthma and less to chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate paranasal sinus opacification at magnetic resonance imaging (MRI) in COPD, self-reported asthma and respiratory symptoms. In this cross-sectional study, 880 randomly selected participants in the Nord-Trøndelag health survey (HUNT) (mean age 57.7 years, range 50-66 years, 463 women) were investigated using MRI of the paranasal sinuses. Participants were allocated to four mutually exclusive groups: (1) COPD (n = 20), (2) asthma (n = 89), (3) respiratory symptoms (n = 199), and (4) reference group (n = 572). Paranasal sinus opacifications were categorised as mucosal thickening, polyps and retention cysts, and fluid. In each participant, measurements ≥1 mm from all sinuses were summed to give a total for each category of opacities. The sums for these three categories were further added together, and referred to as the total sum. Using the 75th percentile cut-off values, the likelihood of having paranasal sinus opacifications was more than six times higher in participants with COPD and twice as high in participants with asthma than among the reference group. Respiratory symptoms were only associated with mucosal thickening. The present study shows that paranasal sinus opacification is associated not only with asthma, but also with COPD and respiratory symptoms. This is in accordance with the united airways hypothesis, and should be kept in mind when handling patients with these conditions.

PMID: 26499376 [PubMed - as supplied by publisher]

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Minor salivary gland carcinoma: a review of 35 cases.

Minor salivary gland carcinoma: a review of 35 cases.

Eur Arch Otorhinolaryngol. 2015 Oct 23;

Authors: Haymerle G, Schneider S, Harris L, Häupl T, Schopper C, Pammer J, Grasl MC, Erovic BM

Abstract
Minor salivary gland carcinomas represent a heterogeneous group of tumors with broad variation in clinical appearance and histopathology. Clinical data of patients with small salivary gland malignancies were collected from the medical records. Tissue microarray was constructed to determine the expression pattern of 24 proteins in 35 patients with minor salivary gland carcinomas. The choice of markers was based on involvement in neoangiogenesis, cell-to-cell contact, cell-cycle regulation and carcinogenesis. Protein expression data were correlated to patients' clinical data. Overexpression of patched (p = 0.046) and Smo (p = 0.032) was linked to a better overall survival and Glutathione S-transferase π overexpression was linked to prolonged disease-free survival (p = 0.005). Cox-1 (p = 0.035) and VEGFR2 (p = 0.009) were significantly linked to decreased survival for recurrent disease. Bcl-x (84 %), β-catenin (87 %) and Cox-2 (87 %) were significantly overexpressed in minor salivary gland carcinomas. We have shown that Smo resulted in a better overall survival, whereas Gstπ in improved disease-free survival. VEGFR2 was a prognostic factor for survival after recurrence in patients with minor salivary gland carcinomas. Cyclooxygenase inhibitors and anti-Wnt-1 antibodies might be a potential therapeutic option in an adjuvant setting or for patients with unresectable tumors of the minor salivary glands.

PMID: 26498950 [PubMed - as supplied by publisher]

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Intensity modulated perioperative HDR brachytherapy for recurrent and/or advanced head and neck metastases.

Intensity modulated perioperative HDR brachytherapy for recurrent and/or advanced head and neck metastases.

Eur Arch Otorhinolaryngol. 2015 Oct 23;

Authors: Teudt IU, Kovàcs G, Ritter M, Melchert C, Soror T, Wollenberg B, Meyer JE

Abstract
Recurrent neck metastases following surgery and full dose adjuvant radiotherapy of squamous cell head and neck cancer remain a clinical challenge. After revision neck dissection and chemotherapy re-irradiation dosage is often limited and survival prognosis deteriorates. Here, adjuvant high-dose rate intensity modulated perioperative brachytherapy (HDR IMBT) offers a second full radiation dose with a limited volume of normal tissue radiation in the neck. In this retrospective study patients were identified who underwent revision surgery and perioperative HDR IMBT for recurrent neck metastases. Survival rates were estimated and the scarce literature on interstitial brachytherapy of the neck was reviewed. From 2006 to 2014, nine patients were treated for recurrent or palliative neck metastases using salvage surgery and HDR IMBT. Eight patients received previous surgery and external beam radiotherapy with or without chemotherapy. Two and five year overall survival was calculated to be 78 and 67 %, respectively. HDR IMBT is a salvage treatment option for selected cases in the neck following surgical revision or last-line treatment strategies. In the literature and this small cohort radiation toxicity and the risk of "carotid blow-out" seemed to be low.

PMID: 26498949 [PubMed - as supplied by publisher]

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Reconstructive approach to hostile cranioplasty: A review of the University of Chicago experience.

Related Articles

Reconstructive approach to hostile cranioplasty: A review of the University of Chicago experience.

J Plast Reconstr Aesthet Surg. 2015 Aug;68(8):1036-43

Authors: Fong AJ, Lemelman BT, Lam S, Kleiber GM, Reid RR, Gottlieb LJ

Abstract
BACKGROUND: Hostile sites for cranioplasty occur in patients with a history of radiation, infection, failed cranioplasty, CSF leak or acute infection. We review our series of autologous cranioplasties and present an approach to decision-making for reconstructing these complex defects.
METHODS: Patients with cranioplasty of a hostile cranial site at the University of Chicago between 2003 and 2012 were identified. They were stratified into three groups: chimeric free flap with vascularized bone (the vascular group), non-vascularized bone with local coverage (the non-vascular group) and non-vascularized bone with free flap (the mixed group). The primary outcome measure was a major complication in the year following cranioplasty, identified by flap or bone graft failure.
RESULTS: We reviewed 33 cases; 14 "vascular", 13 "non-vascular", and 8 "mixed". There was no difference in flap or bone graft failure rates, which were 7% (1/14) for the vascular group, 8% (1/13) for the non-vascular group, and 0% for the mixed group (p = NS). Overall complication rate was statistically different between the three groups (p = 0.01). The non-vascular group had the lowest complication rate (31%). Based on our data we developed an assessment score (The University of Chicago CRAnial Severity Score of Hostility, CRASSH) for patient and treatment stratification.
CONCLUSIONS: Vascularized, non-vascularized and mixed reconstructive methods can be used successfully in these challenging situations. We offer the CRASSH to aid in aligning patients with the most appropriate autologous reconstruction method for their hostile cranial sites.

PMID: 25971417 [PubMed - indexed for MEDLINE]

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Cochlear implantation for hearing rehabilitation in single-sided deafness after translabyrinthine vestibular schwannoma surgery.

Cochlear implantation for hearing rehabilitation in single-sided deafness after translabyrinthine vestibular schwannoma surgery.

Eur Arch Otorhinolaryngol. 2015 Oct 23;

Authors: Hassepass F, Arndt S, Aschendorff A, Laszig R, Wesarg T

Abstract
The aim of the study was to investigate the option of cochlear implantation (CI) in resultant single-sided deafness associated with unilateral translabyrinthine resection of sporadic vestibular schwannoma (VS). This is a retrospective study performed at Tertiary Care Academic Centre. Following extensive counselling regarding the potential for delayed CI, translabyrinthine VS resection was performed and an intracochlear placeholder was inserted to allow later CI in 11 patients who showed intraoperative microscopic confirmation of preserved cochlear nerve anatomy. Follow-up magnetic resonance imaging (MRI) and promontory testing were performed 1 year after surgery to confirm the absence of VS recurrence and viable cochlea. Confirmed CI candidates underwent a second procedure where the placeholder was removed and the CI inserted (4/11). Preimplant unaided and CI-aided evaluations at 12 and 24 months were performed for subjective and objective hearing outcomes. Tinnitus suppression was also measured for implant on and off effects. Available audiological data for three patients demonstrated significant hearing benefits for 'speech from deaf/implanted side, noise from the normal-hearing side' in all three patients and localisation ability improved for 2/3 patients. Subjective findings presented similar results. For the two patients with preimplant tinnitus, complete suppression occurred during active CI. CI is beneficial for hearing rehabilitation and tinnitus reduction in SSD patients with remaining viable cochlear nerve after translabyrinthine VS surgery. Counselling on the risks of intracochlear placeholder insertion and the inherent limitations for ongoing MRI investigations of VS recurrence is essential.

PMID: 26498948 [PubMed - as supplied by publisher]

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