Atypical Signs and Symptoms of Giant Cell Arteritis: A Systematic Review.

BACKGROUND: Giant cell arteritis can present with atypical manifestations that delay treatment and risk severe complications. OBJECTIVES: To comprehensively describe all atypical signs/symptoms of giant cell arteritis. DESIGN: In this systematic review, we searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to October 2022. Primary research articles that included at least one participant with an atypical sign/symptom of biopsy-proven giant cell arteritis were included. Study screening and data extraction were performed in duplicate. The primary outcome was the proportion of participants with atypical giant cell arteritis features. Time to treatment was compared between participants with atypical giant features only and participants with both typical and atypical features. RESULTS: Of 21,828 screened records, 429 studies corresponding to 746 individuals (median [IQR] age 72 [IQR, 66-78] years, 63% female) with at least one atypical feature of GCA were included. Eighty-two percent had both atypical and at least one concurrent typical giant cell arteritis feature, whereas 18% of patients with atypical signs and symptoms only presented with atypical features. Patients with atypical symptoms presented to clinicians earlier than patients with typical features (p < 0.001). There was no difference between groups in proportion to elevated ESR and CRP (82.3% vs. 83.35%, p = 0.91) or mortality rate (8.2% vs. 10.8%, p = 0.42). Patients with atypical features only experienced greater delay in treatment initiation (p < 0.001). The most commonly reported atypical signs/symptoms were vertigo (11.9%), scalp necrosis/ulceration (7.9%), and dry cough (5.8%). CONCLUSIONS: Eighteen percent of biopsy-proven giant cell arteritis cases with at least one atypical feature have only atypical features and are more likely to experience delays in treatment. Clinicians should be aware of atypical signs/symptoms of giant cell arteritis and order inflammatory markers early to prevent giant cell arteritis-associated morbidity.

Use of the frontal branch of the superficial temporal artery and the postauricular vein to overcome anatomic variations of superficial temporal vessels in scalp reconstruction with free tissue transfer: a case report.

The superficial temporal artery (STA) bifurcates into frontal and parietal branches. The parietal branch is used as a recipient vessel for scalp reconstruction, but it is absent in approximately 16.3% of individuals. In this case, a 72-year-old woman with an occipital scalp defect lacked both the parietal branch of the STA and the superficial temporal vein. To address this anatomic variation, we used the frontal branch of the STA and the posterior auricular vein as alternative recipient vessels for anterolateral thigh free flap reconstruction. The surgical procedure involved end-to-end microvascular anastomosis of one artery and one vein. Partial flap necrosis occurred postoperatively, but eventually resolved with debridement. The frontal branch of the STA and the posterior auricular vein can serve as reliable alternatives in the absence of the parietal branch. Reconstructive surgeons should be aware of anatomic variations of the STA and adapt their surgical approach accordingly.

A pilot study of agreement between noninvasive thermometers and the core temperature of postoperative cardiothoracic surgical patients.

OBJECTIVE: Reliable and accurate temperature assessment is fundamental for clinical monitoring; noninvasive thermometers of various designs are widely used in intensive care units, sometimes without a specific assessment of their suitability and interchangeability. This study evaluated agreement of four noninvasive thermometers with a pulmonary artery catheter temperature. METHODS: This prospective method comparison study was conducted in an Australian adult intensive care unit. One hundred postoperative adult cardiothoracic surgery patients who had a pulmonary artery catheter (Edwards Lifescience) in situ were identified. The temperature reading from the pulmonary artery catheter was compared to contemporaneous measurements returned by four different thermometers-temporal Artery (TA, Technimed), Per Axilla (Axilla, Welch Allyn), Tympanic (Tymp, Covidien), and the NexTemp® (NEXT, Medical Indicators [used per axilla]). The time required to obtain each noninvasive temperature measurement was recorded. RESULTS: Agreements between each noninvasive temperature and the pulmonary artery catheter standard were assessed using summary statistics and the Bland-Altman method comparison approach. A clinically acceptable maximum difference from the standard was defined as ±0.5 °C. Temperature agreement with the pulmonary artery standard (mean difference °C [95% limits of agreement °C]) was greatest for Tymp (-0.20 [-0.92 to 0.52]), intermediate for AXILLA (-0.37 [-1.3 to 0.59]) and NEXT (-0.71 [-1.7 to 0.27]), and least for TA (-0.60 [-2.0 to 0.81]). The proportion of measurements within ±0.5 °C of the standard were TYMP (81%), AXILLA (63%), TA (45%), and NEXT (30%). The time to obtain measurements varied, with the Tymp and TA estimates immediate, the AXILLA a mean of 40 s (standard deviation = 11 s), while NEXT results were at the manufacturer-recommended 3-min point. CONCLUSIONS: Tympanic thermometers showed closest agreement with the pulmonary artery standard. Deviations by more than 0.5 °C from that standard were relatively common with all noninvasive devices.

5-Fluorouracil combined with cisplatin via arterial induction for advanced T-stage nasopharyngeal carcinoma: A 10-year outcome of a phase I/II study.

Background and Purpose: Currently, there is no optimal dose recommendation for a 120-h continuous infusion of 5-fluorouracil via arterial cannulation for advanced T-stage nasopharyngeal carcinoma (NPC). Thus, the aim of this study was to determine the maximum tolerated dose (MDT), along with the efficacy, late adverse events, and 10-year survival outcome of 5-fluorouracil administered continuously for 120 h combined with cisplatin via the superficial temporal artery in patients with advanced T-stage NPC. Materials and Methods: Fifty-one patients with histologically confirmed advanced T-stage NPC were eligible for inclusion in this clinical trial. The patients received induction chemotherapy consisting of cisplatin (20 mg/m2/d for 1-5 d) and 5-fluorouracil, administered continuously for 120 h at different dose gradients via a superficial temporal artery. To identify the MTD of 5-fluorouracil infused arterially, we employed a 3 + 3 design during study phase I. The initial dose administered was 200 mg/m2/d, which then was gradually escalated by 50 mg/m2/d until the MTD was reached. Following two cycles of induction chemotherapy, current radical chemoradiotherapy commenced. We assessed the efficacy, survival, toxicity, and quality of life of patients following treatment. Results: The overall response (complete response + partial response) rates following induction chemotherapy in the primary mass and lymph nodes were 100% and 100%, respectively. All 51 (100%) patients achieved T-category down-staging after intra-arterial chemotherapy. The MTD was 450 mg/m2/d for 120 h. No late neurological toxicities, such as brain stem injury, temporal lobe necrosis, and spinal cord injury, were observed. The 5- and 10-year overall survival (OS) rates were 78.0% and 71.7%, respectively, with a median OS of 131 months. Conclusion: Continuous infusion of 5-fluorouracil combined with cisplatin via the superficial temporal artery showed promising survival benefits and few toxicities in patients with advanced T-stage NPC.

Pseudoaneurysm of the superficial temporal artery after blunt trauma: case report and literature review.

An 88-year-old man presented with a left temporal pulsatile mass that developed after blunt trauma. Based on suspicion of hematoma, needle aspiration was performed with the removal of approximately 15 mL of blood. No evident improvement was noted, and active arterial bleeding was observed at the needle puncture site. Doppler ultrasonography revealed a "yin-yang" sign, and the mass was diagnosed as a pseudoaneurysm of the left superficial temporal artery. Under general anesthesia, the superficial temporal artery was ligated and the pseudoaneurysm was removed. Superficial temporal artery pseudoaneurysm is a rare facial tumor that generally occurs after blunt trauma. Due to its rarity, pseudoaneurysms are often misdiagnosed as hematoma. The treatment of choice is excision, although endovascular intervention is a potential treatment option. However, when a pseudoaneurysm is small, conservative treatment can be used.

Arteritis de células gigantes: ¿Cómo debutan pacientes chilenos? Análisis de casos y revisión de la literatura / Giant cell arteritis. Experience in 32 patients

BACKGROUND: Giant cell Arteritis (GCA) is the most common systemic vasculitis in patients over 50 years. Diagnosis is based on clinical, laboratory, imaging and biopsy. Temporal artery biopsy (TAB) may be inconclusive in up to 40% of patients. AIM: To describe disease features of patients diagnosed with GCA. MATERIAL AND METHODS: Review of pathology reports of giant cell arteritis and clinical records of patients seen with the diagnosis between 2000 and 2019. Demographic, clinical, laboratory, histopathology, imaging, treatment and follow-up variables were analyzed. RESULTS: We fetched 32 patients with a median age at diagnosis of 70.5 years (range 57-90), 81% women. Twenty eight percent had polymyalgia. 72% had only cranial symptoms, 12% had extracranial involvement and 13% exclusive extracranial involvement. The median time from onset of symptoms to diagnosis was two months (range 0.5-8). All had elevated erythrocyte sedimentation rate and c reactive protein. A TAB was performed in 27 patients and in 17 (65.4%) it confirmed the diagnosis. Transmural inflam- mation was the most frequent finding. All patients received steroids. Follow-up information was available from 25 patients and 92% received a steroid-spa- ring agent, usually methotrexate (74%). Ninety two percent achieved clinical remission in the first year and 59% had minor relapses during steroid tapering. CONCLUSIONS: Our patients showed frequent extracranial involvement and TAB was a useful diagnostic tool.

Utilization of the Revised American College of Rheumatology (rACR) Scoring to Avoid Unnecessary Temporal Artery Biopsies-A Case Series.

Introduction: The American College of Rheumatology (ACR) criteria, and more recently the revised ACR criteria (rACR), are a scoring system developed to aid in the diagnosis of giant cell arteritis (GCA). Our aim was to investigate the value of the non-biopsy criteria of the original ACR criteria and rACR criteria to predict GCA, and investigate the utilization of such scores to avoid biopsy when a very high or very low likelihood of a positive temporal artery biopsy TAB was predicted. Method: We conducted a retrospective cohort study of 59 patients undergoing TAB from 2013 to 2017 in Beaumont Hospital, a tertiary referral centre in Dublin, Ireland. Demographic data, biochemical results, presenting features, and histology results were collected and collated. Results: Data were analysed from 53 patients and ACR scores were compiled. Seventeen scored < 3 and thirty-six scored 3−5. All 11 positive biopsies were in the 3−5 score range. Forty-five patients were analysed with rACR scores. Eight were excluded due to not meeting the inclusion criteria. Of the 11 positive biopsies, 2 were in the 3−4 score range, and 9 were in the ≥5 score range. In the ACR method, 36% of all biopsies scored as low-risk pre-biopsy. In the rACR method, 84.4% of all biopsies scored in the low- and intermediate-risk group pre-biopsy and 15.6% of all biopsies scored in the high-risk group pre-biopsy. Conclusions: This study illustrates the potential value of the rACR scoring system as a useful tool to categorize patients according to risk with a view to avoiding unnecessary TAB. The data suggest that a TAB has a helpful role in low- and intermediate-risk groups but is of minimal benefit in the high-risk group.

Acetazolamide-Challenged Arterial Spin Labeling Detects Augmented Cerebrovascular Reserve After Surgery for Moyamoya.

BACKGROUND: Cerebrovascular reserve (CVR) inversely correlates with stroke risk in children with Moyamoya disease and may be improved by revascularization surgery. We hypothesized that acetazolamide-challenged arterial spin labeling MR perfusion quantifies augmentation of CVR achieved by revascularization and correlates with currently accepted angiographic scoring criteria. METHODS: We retrospectively identified pediatric patients with Moyamoya disease or syndrome who received cerebral revascularization at ≤18 years of age between 2012 and 2019 at our institution. Using acetazolamide-challenged arterial spin labeling, we compared postoperative CVR to corresponding preoperative values and to postoperative perfusion outcomes classified by Matsushima grading. RESULTS: In this cohort, 32 patients (17 males) with Moyamoya underwent 29 direct and 16 indirect extracranial-intracranial bypasses at a median 9.7 years of age (interquartile range, 7.6-15.7). Following revascularization, median CVR increased within the ipsilateral middle cerebral artery territory (6.9 mL/100 g per minute preoperatively versus 16.5 mL/100 g per minute postoperatively, P<0.01). No differences were observed in the ipsilateral anterior cerebral artery (P=0.13) and posterior cerebral artery (P=0.48) territories. Postoperative CVR was higher in the ipsilateral middle cerebral artery territories of patients who achieved Matsushima grade A perfusion, in comparison to those with grades B or C (25.8 versus 17.5 mL, P=0.02). The method of bypass (direct or indirect) did not alter relative increases in CVR (8 versus 3.8 mL/100 g per minute, P=0.7). CONCLUSIONS: Acetazolamide-challenged arterial spin labeling noninvasively quantifies augmentation of CVR following surgery for Moyamoya disease and syndrome.

Neutrophil extracellular traps in giant cell arteritis biopsies: presentation, localization and co-expression with inflammatory cytokines.

OBJECTIVES: To explore the presence of neutrophil extracellular traps (NETs) in inflamed temporal artery biopsies (TABs) of patients with GCA. METHODS: Ten patients with GCA [five with limited and five with associated generalized vascular involvement, as defined by 18F-fluorodeoxyglucose PET with CT (PET/CT)] and eight with PMR were studied. The presence, location, quantitation and decoration of NETs with IL-6, IL-1ß and IL-17A were assessed in TABs at the time of disease diagnosis by tissue immunofluorescence and confocal microscopy. Paired serum levels of IL-6 and IL-17A were also evaluated in all patients. RESULTS: All temporal artery biopsies from GCA, but not PMR, patients had NETs located mainly in the adventitia, adjacent to the vasa vasorum. NETs decorated with IL-6 were present in 8/10 TABs of GCA patients, of whom 5 were PET/CT(+) and 3 PET/CT(-) patients. IL-17A(+) NETs were observed in all GCA patients. IL-1ß(+) NETs were not detected in any GCA patient. No relation was found between serum IL-6 and IL-17A levels and NETs containing IL-6 and/or IL-17A. CONCLUSIONS: NETs bearing pro-inflammatory cytokines are present in inflamed GCA-TABs. Future studies with a larger number of patients from different centres will show whether the findings regarding neutrophils/NETs in the TAB are consistent and disclose their clinical impact.

Colour Doppler ultrasound and the giant cell arteritis probability score for the diagnosis of giant cell arteritis: a Canadian single-centre experience.

OBJECTIVES: The aim was to compare the accuracy of colour Doppler ultrasonography (CDUS) and temporal artery biopsy (TAB) to establish the final diagnosis of GCA and to determine how the GCA probability score (GCAPS) performs as a risk stratification tool. METHODS: Descriptive statistics were performed on a retrospective cohort of patients referred to our vasculitis referral centre between 1 July 2017 and 1 October 2020 for suspected GCA. CDUS, TAB, centre-specific TAB (vasculitis centre vs referring hospitals) and GCAPS were compared against the final diagnosis of GCA as determined by a GCA expert; CDUS was also compared with TAB results. RESULTS: Data from 198 patients were included: 60 patients with GCA and 138 patients without GCA. Sixty-two patients had a TAB. Using the final diagnosis by a GCA expert as a reference, the sensitivity, specificity, positive predictive value and negative predictive value were 93.3%, 98.5%, 96.6% and 97.1% for CDUS and 69.2%, 100%, 100% and 81.8% for TAB, respectively. The false-negative rate was 6.7% for CDUS and 30.8% for TAB. False-negative TAB mostly occurred when performed in referring hospitals (57.1%) as opposed to our vasculitis centre (21.1%). With a cut-off at 9.5 points, sensitivity for GCAPS was 98.3% and specificity 74.3%. CONCLUSION: CDUS of the temporal and axillary arteries showed a high sensitivity and specificity and helped to diagnose GCA in patients with negative TAB. We validated that GCAPS is a useful clinical tool, with a score of <9.5 making the diagnosis of GCA improbable.

Clinical and technical determinants of positive temporal artery biopsy: a retrospective cohort study.

Temporal artery biopsy (TAB) is one of the diagnostic tools to confirm the diagnosis of giant cell arteritis (GCA). We aim to evaluate the clinical and technical determinants of a positive biopsy. Demographics, clinical, technical, and laboratory data of all TAB's performed between 2007 and 2019 at a single academic medical center. 107 biopsies performed for 103 patients were included; 72.9% were female, and 27.1% were male. The mean age at the time of biopsy was 67.1 ± 9.3 years. One biopsy was excluded for lack of arterial tissue content. Of the remaining 106, 19.6% were positive. The length of the biopsy and the number of arterial cross-sections were not significantly associated with its result. A positive biopsy was seen more in patients with low albumin (p = 0.010) and hypothyroidism (p = 0.017) but less in those with prior glucocorticoids treatment (p = 0.028). Predictors of a positive biopsy included male gender [OR 4.029, 95% CI (1.330-12.209), p = 0.014]; elevated ESR [OR 3.998, 95% CI (1.908-6.787), p = 0.023]; polymyalgia rheumatica (PMR) symptoms [OR 5.121, 95% CI (2.094-9.872), p = 0.001]; and advancing in age (6.5% per every additional year), [OR 1.065, 95% CI (1.005-1.130), p = 0.033]. 53.7% of the patients were eventually diagnosed with GCA; 39.2% of them were based on positive biopsy. In conclusion, old age, male gender, elevated ESR, and PMR symptoms increase the odds of positive TAB. Technical factors, such as biopsy length and the number of cross-sections, did not influence eventual biopsy results, highlighting the pivotal role of the clinical presentation of the patients in selecting patients for TAB.

Is the intima-media thickness of temporal and axillary arteries influenced by cardiovascular risk?

OBJECTIVES: To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT. METHODS: Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10-22 MHz and 6-18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm. RESULTS: A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002] . The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk. CONCLUSION: Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.

Anatomy and external landmarks of the superficial temporal artery using 3-dimensional computed tomography.

PURPOSE: The purpose of this study was to analyze the anatomical variability of the superficial temporal artery (STA) and to provide an easy visual landmark to find the STA and its branches to facilitate its surgical access. METHODS: A retrospective study was conducted on 57 patients who underwent a head and neck computed tomography with contrast injection. A visual landmark running from the tragus to the corner of the eye was used: the "eye-tragus-line" (ETL). On the ETL, the distance between the tragus and the STA was measured. The length of the STA main branch, its parietal and frontal branch and the angle of the STA and its branches with the ETL were measured. The division of the STA was studied as above/at the same level/below the zygomatic arch (ZA) and the ETL. RESULTS: The STA division was located above the ZA in 61.54% of cases, at the same level in 26.92% of cases and below in 11.54% of cases. Regarding the ETL, 93.27% of the STA divisions were located above the ETL, 5.77% at the same level and 0.96% below. On the ETL, the STA was located 15.55 ± 4.5 mm in front of the tragus. CONCLUSION: This study allowed to define an easy visual landmark: the ETL running from the tragus to the corner of the eye. The STA main branch was located 15.55 ± 4.5 mm of front of the tragus on the ETL. The STA division was nearly always located above the ETL (99.04%). Furthermore, this study provides a statistical representation of the anatomy of the STA and its branches.

Temporal Artery Ultrasound to Diagnose Giant Cell Arteritis: A Practical Guide.

The diagnostic modalities for giant cell arteritis (GCA) have evolved significantly in recent years. Among the different diagnostic tools developed, Doppler ultrasound of the temporal arteries, with a sensitivity and specificity reaching 69% and 82%, respectively, is now recognized as superior and, therefore, is a first-line diagnostic tool in GCA. Moreover, with the increasing development of new ultrasound technologies, the accuracy of Doppler ultrasound in GCA seems to be constantly improving. In this article, we describe in detail the scanning technique to perform while realizing Doppler ultrasound of temporal arteries to assess GCA, as well as the diagnostic performance of this tool according to current literature.

Early variation of ultrasound halo sign with treatment and relation with clinical features in patients with giant cell arteritis.

OBJECTIVES: To compare the ultrasound characteristics with clinical features, final diagnosis and outcome; and to evaluate the halo size following glucocorticoid treatment in patients with newly diagnosed GCA. METHODS: Patients with suspected GCA, recruited from an international cohort, had an ultrasound of temporal (TA) and axillary (AX) arteries performed within 7 days of commencing glucocorticoids. We compared differences in clinical features at disease presentation, after 2 weeks and after 6 months, according to the presence or absence of halo sign. We undertook a cross-sectional analysis of the differences in halo thickness using Pearson's correlation coefficient (r) and Analysis of Variance (ANOVA). RESULTS: A total of 345 patients with 6 months follow-up data were included; 226 (65.5%) had a diagnosis of GCA. Jaw claudication and visual symptoms were more frequent in patients with halo sign (P =0.018 and P =0.003, respectively). Physical examination abnormalities were significantly associated with the presence of ipsilateral halo (P <0.05). Stenosis or occlusion on ultrasound failed to contribute to the diagnosis of GCA. During 7 days of glucocorticoid treatment, there was a consistent reduction in halo size in the TA (maximum halo size per patient: r=-0.30, P =0.001; and all halos r=-0.23, P <0.001), but not in the AX (P >0.05). However, the presence of halo at baseline failed to predict future ischaemic events occurring during follow-up. CONCLUSION: In newly diagnosed GCA, TA halo is associated with the presence of ischaemic features and its size decreases following glucocorticoid treatment, supporting its early use as a marker of disease activity, in addition to its diagnostic role.

Assessment of the Most Optimal Control Tissue for Intracranial Aneurysm Gene Expression Studies.

Background and Purpose- Finding adequate control tissue for intracranial aneurysm (IA) pathophysiological studies, including gene expression studies, can be challenging. We compared gene expression profiles of superficial temporal, cortical, and circle of Willis (CoW) arteries and IA in search of the most optimal control tissue for future experiments. Methods- We compared RNA-sequencing data of IA samples and of superficial temporal, cortical, and CoW artery samples using Pearson correlation, Euclidean distance, and principal component analysis. We used the Mann-Whitney U test for comparison of Pearson correlation coefficients and Euclidean distances, to assess which control tissue is most similar to IA in terms of gene expression. Other unrelated tissues were used as negative controls. Results- The cortical and the CoW arteries were more similar to IA in terms of gene expression than the superficial temporal artery. This was based on Pearson correlation (+0.023 [90% CI, 0.017/0.029; P=1.9E-09] for the cortical artery and +0.034 [90% CI, 0.028/0.040; P=6.0E-15] for the CoW artery compared with the superficial temporal artery), Euclidean distance (-25.71 [90% CI, -31.54/-20.02; P=1.9E-11] for the cortical artery and -38.09 [90% CI, -44.08/-32.19; P<2.2E-16] for the CoW artery compared with the superficial temporal artery) and principal component analysis. In all analyses, the unrelated tissues formed separate groups compared with IA and the 3 control arteries. Conclusions- The cortical arteries and the CoW arteries are better controls for gene expression studies on IA than the superficial temporal artery. This probably relates to differences in anatomy of these tissues, such as the presence of an external elastic lamina in the extracranial vasculature and absence in the intracranial vasculature, because IAs, cortical arteries, and CoW arteries are all intracranial while the superficial temporal artery is extracranial. Since CoW arteries can only be obtained postmortem, cortical arteries are preferred over CoW arteries.

Therapeutic efficacy of regional and systemic chemotherapy in advanced maxillary sinus cancer.

BACKGROUND: To compare the efficacy of regional chemotherapy through the superficial temporal artery and systemic chemotherapy in patients with advanced maxillary sinus cancer. METHODS: Nine of 22 patients with over TNM stage III maxillary sinus cancer received regional chemotherapy and 13 received systemically. The change of tumor volume, the degree of response according to the tumor location, and side effects after chemotherapy were analyzed. RESULTS: Tumor volume reduction was significantly higher in the regional than systemic chemotherapy. Tumor response to chemotherapy was greater in regional than systemic chemotherapy in most maxillary sinus wall. The tumor response in anterior, posterior, and lateral wall of maxillary sinus was greater more than two times in the regional than systemic chemotherapy. There were no severe side effects related to regional chemotherapy. CONCLUSION: Regional chemotherapy was superior to systemic chemotherapy regarding tumor volume reduction, especially located in the anterior, posterior, and lateral wall of maxillary sinus.

Métodos de termometria não invasiva em comparação oa método de aferição da temperatura de cateter de artéria pulmonar: um estudo de medidas repetidas / Comparison of noninvasive methods of thermometry and the pulmonary artery, temperature method: a repeated measures study

A aferição da temperatura corporal é uma ferramenta essencial no cuidado de pacientes críticos. Para a identificação da temperatura corporal é necessário o uso de um termômetro preciso e ágil. Quando técnicas invasivas não estão sendo utilizadas, a equipe de enfermagem depende de termômetros não invasivos. Atualmente, na literatura, não há um consenso sobre a acurácia e precisão de métodos como as temperaturas oral, axilar, de membrana timpânica ou de artéria temporal. Ademais evidências acerca dos fatores que podem alterar a confiabilidade desses métodos são escassas. Por isso estudos clínicos devem ser realizados com esses métodos para respaldar o uso dessas técnicas na prática. Objetivo: Comparar a acurácia e precisão de métodos de termometria não invasivas (artéria temporal, membrana timpânica, oral e axilar) em comparação a temperatura de artéria pulmonar. Método: Foram realizados uma revisão sistemática e metanálise e um estudo clínico de medidas repetidas. A metanálise foi realizada com dados de 41 artigos pesquisados na literatura. Os dados do estudo clínico foram coletados em duas Unidades de Terapia Intensiva na cidade de Belo Horizonte. Foram incluídos pacientes adultos em uso do cateter de artéria pulmonar. As cinco temperaturas foram aferidas três vezes de cada paciente. Para análise dos dados foi realizada análise descritiva, gráficos de Bland-Altman e análises de regressão. Resultados: A acurácia e precisão das temperaturas na metanálise foram; temperatura axilar, -0,35 e 0,06; temperatura oral, -0,21 e 0,08; temperatura de membrana timpânica, -0,05 e 0,05; e temperatura de artéria temporal, -0,22 e 0,26. A acurácia e precisão após análise dos dados do estudo clínico foram, respectivamente: temperatura axilar, -0,42 e 0,59; temperatura oral, -0,30 e 0,37; temperatura de membrana timpânica, -0,21 e 0,44; e temperatura de artéria temporal, -0,25 e 0,61. Conclusão: Os termômetros não invasivos mostraram uma boa acurácia e precisão em relação a temperatura de artéria pulmonar, entretanto em pacientes com alterações da temperatura os termômetros não invasivos tornam-se pouco acurados.(AU)

The identification of body temperature is an essential tool in critical care nursing. The use of a reliable and agile thermometer is necessary to identify the real body temperature. When available, invasive thermometer are indicated for its precision. Although, when not available, the nursing staff must rely in noninvasive thermometers. Nowadays, in the literature, there isn´t a consensus about the reliability of noninvasive temperature techniques, such as axillary, oral, tympanic membrane and temporal artery. Furthermore, there is a lack of knowledge about factors that alters the reliability of those thermometers. Clinical studies must be developed to back these techniques in nursing care. Aim: Compare the accuracy and precision of noninvasive techniques (axillary, oral, tympanic membrane and temporal artery) with the pulmonary artery temperature. Methods: An Systematic review/Metanalysis and a Cross-sectional Repeated measure clinical study were developed. The Metanalysis used data from 41 published articles. The data for the clinical study were collected in two intensive care units of two hospitals in Belo Horizonte. Patients with pulmonary artery catheter were included. The five temperatures were measured three times in each patient. Descriptive analyses were made, Bland-Altmann graphics were plotted and a four regression models were developed. Results: The accuracy and precision identified in the Metanalysis were: axillary, -0,35 and 0,06; oral, -0,21 and 0,08; tympanic membrane, -0,05 and 0,05; and temporal artery, -0,22 and 0,26. The accuracy and precision of the noninvasive thermometers and the pulmonary artery temperature identified in the clinical study were: axillary -0,42 and 0,59; oral -0,30 and 0,37; tympanic membrane -0,21 and 0,44; and temporal artery -0,25 and 0,61. Conclusion: The noninvasive thermometers showed a good accuracy and precision when compared with the pulmonary temperature, However, in non-normothermic patients the reliability of the thermometers is poor.(AU)