Rates of neutropenia in adults with influenza A or B: a retrospective analysis of hospitalised patients in South East Queensland during 2015.

Neutropenia in adult patients is often attributed to intercurrent viral infections; however, there are limited data describing the frequency or natural history of this phenomenon. We examined all patients presenting to three large hospitals in the Metro South region of South East Queensland with laboratory-confirmed influenza A or B throughout the 2015 influenza season (January-October). Four hundred and thirty-six patients were studied and 15.3% of this cohort were neutropenic (absolute neutrophil count <2.0 × 109 /L) with no identifiable cause other than the influenza. Importantly, the majority of cases were mild, with absolute neutrophil count remaining >1.0 × 109 /L. The incidence of neutropenia was significantly higher in association with influenza B than influenza A (18.3% vs 10.3%). We conclude that mild, transient neutropenia is common among patients with influenza infection and advise that it should not cause alarm or invite specific investigation unless severe or prolonged.

When should iron chelation therapy be considered in patients with myelodysplasia and other bone marrow failure syndromes with iron overload?

Despite the absence of a robust evidence base, there is growing consensus that effective treatment of iron overload leads to decreased morbidity and premature mortality in patients with good prognosis myelodysplastic syndromes (MDSs). Furthermore, new treatment modalities, including disease-modifying therapies (lenalidamide and azacytidine) and reduced intensity conditioning therapies for allogeneic blood stem cell transplants, are offering the prospect of longer survival for patients with traditionally less favourable prognosis MDS, who might also benefit from iron chelation. This article proposes assessment of patients with MDS and related bone marrow failure syndromes to determine suitability for iron chelation. Iron chelation therapy options and monitoring are discussed.

Complications associated with free jejunal graft reconstruction of the pharyngoesophagus--a multiinstitutional experience with 52 cases.

Fifty-two patients who underwent reconstruction of the pharynx and esophagus using the free jejunal graft were retrospectively reviewed. The complications were categorized into those associated with the resection, those associated with the harvesting of the graft, and those related to the reconstruction per se. In this series, the graft failure rate was 7.6% with an overall success rate of 90.3%. Graft necrosis was found to be the most serious complication occurring in four patients. Methods of detection of graft necrosis and management of these complications are discussed.

Predicting the blood pressure response to atenolol.

The fall in blood pressure in response to atenolol 50 mg per day has been estimated using ambulatory BP and heart rate monitoring during the day in 35 mild to moderate hypertensive patients. The fall in pressure for the group averaged 18.2 +/- 11.3/11.5 +/- 8.3 mmHg. The 95% confidence internals were 14.5-22.0 mmHg systolic and 8.8-14.3 mmHg diastolic with the individual responses in diastolic pressure being related to the pretreatment variability of diastolic pressure (r = 0.65 P less than 0.001) and to the initial heart rate (r = 0.35 P less than 0.05). With atenolol treatment the BP fall is greater in patients with a more unstable BP. Blood pressure reduction is achieved by reducing the level of cardiac activity.

Partial vs total esophagectomy for advanced carcinoma of the hypopharynx.

Cancer of the hypopharynx is an aggressive disease with a poor prognosis irrespective of the therapeutic regimen instituted. Controversy centers around the extent of surgery required to adequately ablate the advanced cancers, particularly related to the role of esophagectomy. A literature review and analysis of 43 cases of advanced hypopharyngeal cancer treated with total laryngopharyngectomy and partial esophagectomy support the argument that in carefully selected situations, a partial esophagectomy is oncologically an adequate operation.

On the shapes of leaves.

The properties of a function G(x, y) of 2-dimensional Cartesian coordinates x, y can be used to obtain complex shapes through a nonlinear iterative procedure. It is conjectured that at least some biological shapes are determined by this procedure, and those of leaves are considered as a test of the hypothesis. It is shown that this procedure will generate the shapes of even very complicated leaves such as those of the holly tree to a considerable degree of accuracy. Certain issues of evolutionary biology appear in our view in a clearer light according to this procedure, and these are discussed towards the end of the paper. © 1994 Wiley-Liss, Inc.

Longterm effects of heavy irradiation to the neck.

The longterm effects of heavy irradiation to the neck are now well known. The literature contains reports of major skin contractures, hypothyroidism, laryngeal and tracheal stenosis, major vessel stenosis, and hypoplastic development of cervical vertebrae, but very rarely are all these complications seen in a single patient. Two patients have undergone extensive treatment at the Toronto General Hospital during the past decade for complications of neck irradiation in childhood and their stories should serve as yet another reminder that irradiation, although a major ally in oncological therapy when carefully applied, can be a tool of great destruction when used in excess.

Fibromatosis presenting as vocal cord palsy.

For many years, pathologists have sought to create some order in the classification of non-metastasizing fibrous tissue disorders ranging from the benign keloid at one end of the scale to the "non-metastasizing fibrosarcoma" at the other. It is now generally accepted that these fibrous anomalies are members of the same family and the entire range from the most benign to the most bizarre is encompassed by the term "fibromatosis". Unfortunately, some of these lesions behave in a most aggressive manner and there appears to be little correlation between the histological appearance of the tumor and its clinical aggression. Some, particularly if occurring in the head and neck may pursue a relentless course and, defying all forms of therapy, result in death of the patient. Recently a young man presented with fibromatosis in the supraclavicular region. Despite a short history, the lesion was quite advanced and was considered surgically unresectable. Radiotherapy was thus considered to be the treatment of choice.

Nape of neck flap.

Great advances in the field of reconstructive head and neck surgery have been made in the last 20 years, and although the nape of neck flap has not been used as frequently as the deltopectoral flap or the forehead flap, its contribution in this field has been significant. This paper discusses the flap's history, anatomical basis, and clinical applications. Advantages, disadvantages, and complications are discussed and the flap's role in modern head and neck reconstructive surgery is examined.

Computerized tomography in head and neck tumor diagnosis.

Computerized tomography has revolutionized the investigation of head and neck tumors and so rapid are the advances in this field, reviews are often outdated at time of publication. Several cases are presented to demonstrate the value of computerized tomography in investigation of lesions involving the paranasal sinuses, nasopharynx, and soft tissues of the neck.

Multiple tumors of the parotid gland.

Multiple tumors in a single major salivary gland are rare. Recently a patient with an acinic cell carcinoma and a Warthin's tumor in the same parotid gland was surgically treated at the Toronto General Hospital. A review of the world literature failed to reveal any report of this combination of tumors in the same gland.