Cancer-related hypercalcemia in oral cancer.

Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death. The total incidence of CRH was 6.95‰ per year. A total of 91 patients were enrolled; their median survival time was 28 days. The patients were divided into two groups by survival time, with a cut-off point of 30 days. Reduced serum albumin, leucocytosis, and clodronate use had a statistically significant effect on survival in the univariate analysis (all P<0.05). Forty-five patients (49.5%) had recurrence of CRH, of whom nine died within 30days. These nine patients had a shorter interval to the first episode of CRH recurrence (median 13 days) than those who survived ≥30days (median 28 days) (P<0.001). It was observed that a short interval to the first episode of CRH recurrence is a poor prognostic factor.

Airway pH monitoring in patients with suspected obstructive sleep apnoea using the Dx-pH oropharyngeal probe: preliminary report of a prospective cohort study.

OBJECTIVES: To investigate the laryngopharyngeal reflux (LPR) episodes and pH values in patients with suspected obstructive sleep apnoea (OSA) using the Dx-pH oropharyngeal probe. DESIGN: Prospective cohort study. SETTING: Tertiary medical centre. PARTICIPANTS: Forty patients with complaint of snoring or suspected OSA were prospectively enrolled to receive full nocturnal polysomnography (PSG). The patients were divided into 2 groups: a simple snorers group if the Respiratory Disturbance Index (RDI) was < 5 and an OSA group if the RDI was ≥ 5. MAIN OUTCOME MEASURES: The patients simultaneously received Dx-pH oropharyngeal probe monitoring for 12 h from about 6 pm to 6 am of the next day. The number of LPR events was recorded if the nadir of rapid pH drops was below pH 5.0 and 5.5. The difference of LPR events between the two groups and the difference of LPR events between awake and sleep periods in each group were analysed, respectively. RESULTS: There were 18 (45%) patients diagnosed as OSA with a mean RDI of 28.7, and 22 patients (55%) diagnosed as simple snorers. Between 2 groups, there were no significant differences in the LPR events and pH values during the awake period, sleep period or overall recording period. Comparison of the LPR events and minimum pH values between the awake period and the sleep period revealed there were no significant differences in either group. CONCLUSION: Using the new sensitive Dx-pH oropharyngeal probe with PSG, we found that OSA does not correlate with a higher incidence of LPR episodes.

Methodologic assessment after functional endoscopic sinus surgery.

OBJECTIVES: Functional endoscopic sinus surgery (FESS) has become the procedure of choice to treat chronic rhinosinusitis. However, no standard method has been suggested to measure FESS outcome. In this study, we used different methods to measure FESS outcome, to determine which method was the most accurate. METHODS: Forty-nine patients with chronic rhinosinusitis who underwent FESS were enrolled in this study. Nasal polyps were present in 27 patients. On the day before FESS and 12 weeks after the procedure, all patients filled out a Chinese-language version of the 31-item Rhinosinusitis Outcome Measure (CRSOM-31) and received acoustic rhinometry to measure the second minimal cross-sectional area (MCA2) of the nasal cavity, as well as an endoscopic examination and a computed tomography (CT) scan. RESULTS: When CRSOM-31, MCA2, endoscopy, and CT scores were analyzed, a good correlation was observed between preoperative endoscopy and CT scores in patients with or without nasal polyposis (r = 0.459, p = 0.016; r = 0.578, p = 0.005, respectively). Postoperatively, a good correlation was observed between CRSOM-31 and CT scores in patients with nasal polyposis (r = 0.405, p = 0.036), as well as between CRSOM-31 and endoscopy scores in patients without nasal polyposis (r = 0.64, p = 0.001). CONCLUSIONS: Our results showed that it is difficult to choose a method with which to measure FESS outcome accurately. However, a longer follow-up time and more patients are needed to justify these short-term postoperative results.

Continuous feeding of antimicrobial growth promoters to commercial swine during the growing/finishing phase does not modify faecal community erythromycin resistance or community structure.

AIMS: To investigate the effect of continuous feeding of antimicrobial growth promoters (tylosin or virginiamycin) on the swine faecal community. METHODS AND RESULTS: The study consisted of two separate on-farm feeding trials. Swine were fed rations containing tylosin (44 or 88 mg kg(-1) of feed) or virginiamycin (11 or 22 mg kg(-1) of feed) continuously over the growing/finishing phases. The temporal impact of continuous antimicrobial feeding on the faecal community was assessed and compared to nondosed control animals through anaerobic cultivation, the analysis of community 16S rRNA gene libraries and faecal volatile fatty acid content. Feeding either antimicrobial had no detectable effect on the faecal community. CONCLUSIONS: Erythromycin methylase genes encoding resistance to the macrolide-lincosamide-streptogramin B (MLS(B) ) antimicrobials are present at a high level within the faecal community of intensively raised swine. Continuous antimicrobial feeding over the entire growing/finishing phase had no effect on community erm-methylase gene copy numbers or faecal community structure. SIGNIFICANCE AND IMPACT OF THE STUDY: Antimicrobial growth promoters are believed to function by altering gut bacterial communities. However, widespread MLS(B) resistance within the faecal community of intensively raised swine likely negates any potential effects that these antimicrobials might have on altering the faecal community. These findings suggest that if AGP-mediated alterations to gut communities are an important mechanism for growth promotion, it is unlikely that these would be associated with the colonic community.

Antibacterial effect of electrolysed acid water on the nasal discharge from patients with chronic rhinosinusitis.

This study was conducted to determine whether electrolysed acid water (EAW) increased the antibacterial effect of irrigating solution used in the management of chronic rhinosinusitis (CRS). One hundred CRS patients were recruited from April 2008 to February 2009. Four swab specimens were taken from the ipsilateral middle meatus of each patient and one was placed in a Thanswab tube, while the other three were each placed randomly in one of three glass tubes containing either 5 ml of EAW, distilled water or 70% alcohol. They were immediately sent to the laboratory for aerobic and anaerobic cultures. Bacteria grew from 36 specimens when they were placed in a Thanswab tube, from four when placed in a tube with EAW, 30 when placed in distilled water and two when placed in alcohol. The culture rate was significantly lower when the specimens were placed in a tube with EAW as compared with distilled water or in a Thanswab tube, but was not different compared with alcohol. The bacteria that grew from four specimens after first being processed by EAW were all anaerobes. This study showed that EAW exhibited an increased antibacterial effect on bacteria grown from the nasal discharge of CRS patients.

Ethmoid sinus mycology of chronic rhinosinusitis.

This goal of this study was to demonstrate whether fungi were present in the ethmoid sinus in patients with chronic rhinosinusitis. Before surgery, swab specimens were collected from the middle meatus for conventional fungal cultures, and lavaged fluid was collected from the nasal cavity for fungal cultures by Ponikau's method. During surgery, tissue specimens were taken from the inferior turbinate and the anterior ethmoid sinus for conventional fungal cultures and detection of fungal DNA by polymerase chain reaction. The ethmoid sinus mucosa with coating mucus was also collected for fungal cultures by Ponikau's method. Among 53 specimens, three middle meatal specimens and 27 lavaged specimens (50.9%) grew fungi. Inferior turbinal mucosa did not grow fungi, but three ethmoid sinus specimens grew fungi by the conventional fungal culture method and by Ponikau's method. Alternaria DNA was detected in 42 inferior turbinal specimens (79.3%) and in 39 ethmoid sinus specimens (73.6%). Our study showed that although fungi were rarely cultured from the ethmoid sinus Alternaria DNA was detected in most of the ethmoid sinus mucosa.

Bacteriology of endoscopically normal maxillary sinuses.

The bacteriology of maxillary sinuses with normal endoscopic findings is reported in this study. When transantral sinoscopy was used to examine the maxillary sinuses, the whole maxillary sinus was inspected with different-angle endoscopes. If no lesion was seen over the whole maxillary sinus mucosa, no secretion existed in the maxillary sinus cavity, and the maxillary sinus ostium was wide open, the maxillary sinus was considered endoscopically normal. The bacteriology of these endoscopically normal maxillary sinuses was studied by passing cotton-tipped sticks through the cannula to collect swab specimens. In some cases, a biopsy forceps was also passed to obtain mucosal specimens. The specimens were sent to the laboratory for aerobic and anaerobic cultures. Between July 1990 and May 1998, 83 swab and 31 mucosal specimens were collected from 69 patients who had not taken any antibiotic within 10 days before endoscopy. The culture rates were 62.3 per cent (35/53) from swab specimens and 57.1 per cent (eight out of 14) from mucosal specimens in patients with the diagnosis of chronic paranasal sinusitis, and were 46.7 per cent (14/30) from swab specimens and 41.2 per cent (seven out of 17) from mucosal specimens in patients without this diagnosis. This study shows that endoscopically normal maxillary sinuses are not sterile.