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BACKGROUND: Effective nasal reconstruction requires skin and soft tissue cover, cartilage or bone structure, and mucosal lining. Ideal lining is thin, pliable and vascularised, making reconstruction challenging. This paper presents the first case series with long-term outcomes of pericranial flaps used as inner lining for nasal reconstruction. METHODS: Patients undergoing paramedial forehead flaps from 2007 to 2019 were identified using second-stage nasal reconstruction billing codes. Patients with pericranial flaps for lining, for whom there were data on resulting outcomes and complications, were identified. RESULTS: Sixty-six patients underwent second-stage nasal reconstruction. Eighteen patients had paramedian forehead and pericranial flaps for inner lining reconstruction. The flap lining had no immediate post-operative complications. Three patients suffered partial to major reconstructive failure post radiotherapy. Other complications included nasal stenosis and orocutaneous fistula. CONCLUSION: Combined with paramedian forehead flaps, the pericranial flap is reliable as inner lining for nasal reconstruction. It is easily accessible and useful in resections with limited mucosal options.
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Neoplasias Nasais , Rinoplastia , Humanos , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Estudos Retrospectivos , Neoplasias Nasais/cirurgia , Retalhos Cirúrgicos , Nariz/cirurgiaRESUMO
OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.
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Dissecação/efeitos adversos , Nervo Facial/cirurgia , Hemostasia Cirúrgica/instrumentação , Glândula Parótida/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Drenagem/tendências , Eletrocoagulação/efeitos adversos , Paralisia Facial/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Instrumentos Cirúrgicos/efeitos adversosRESUMO
OBJECTIVE: Evaluate the oncologic outcomes and cost analysis of transitioning to a specimen oriented intraoperative margin assessment protocol from a tumour bed sampling protocol in oral cavity (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN: Retrospective case series and subsequent prospective cohort study SETTING: Tertiary care academic teaching hospital SUBJECTS AND METHODS: Retrospective case series of all institutional T1-T2 OCSCC or OPSCC treated with primary surgery between January 1st 2009 - December 31st 2014. Kaplan-Meier survival estimates with log rank tests were used to compare patients based on final margin status. Cost analysis was performed for escalation of therapy due to positive final margins. Following introduction of a specimen derived margin protocol, successive prospective cohort study of T1-T4 OCSCC or OPSCC treated with primary surgery from January 1st 2017 - December 31st 2018. Analysis and comparison of both protocols included review of intraoperative margins, final pathology and treatment cost. RESULTS: Analysis of our intra-operative tumour bed frozen section protocol revealed 15 of 116 (12.9%) patients had positive final pathology margins, resulting in post-operative escalation of therapy for 14/15 patients in the form of re-resection (7/14), radiation therapy (6/14) and chemoradiotherapy (1/14). One other patient with positive final margins received escalated therapy for additional negative prognostic factors. Recurrence free survival at 3 years was 88.4 and 50.7% for negative and positive final margins respectively (p = 0.048). Implementation of a specimen oriented frozen section protocol resulted in 1 of 111 patients (0.9%) having positive final pathology margins, a statistically significant decrease (p < 0.001). Utilizing our specimen oriented protocol, there was an absolute risk reduction for having a final positive margin of 12.0% and relative risk reduction of 93.0%. Estimated cost avoidance applying the specimen oriented protocol to our previous cohort was $412,052.812017 CAD. CONCLUSION: Implementation of a specimen oriented intraoperative margin protocol provides a statistically significant decrease in final positive margins. This change in protocol leads to decreased patient morbidity by avoiding therapy escalation attributable only to positive margins, and avoids the economic costs of these treatments.
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Carcinoma de Células Escamosas/cirurgia , Margens de Excisão , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/mortalidade , Nova Escócia/epidemiologia , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/mortalidade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida/tendênciasRESUMO
BACKGROUND: Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures. METHOD: A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018. RESULTS: Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373). CONCLUSION: Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.
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BACKGROUND: Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs. METHOD: Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices. RESULTS: The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis. CONCLUSION: This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.
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Bactérias/crescimento & desenvolvimento , Contaminação de Equipamentos , Iluminação/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Equipamentos Cirúrgicos/microbiologia , HumanosRESUMO
OBJECTIVES: Transoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10. METHODS: Primary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments. RESULTS: Voice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression. CONCLUSION: Age and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.
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Glote/patologia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/efeitos adversos , Microcirurgia/efeitos adversos , Distúrbios da Voz/diagnóstico , Fatores Etários , Idoso , Feminino , Glote/fisiopatologia , Glote/cirurgia , Humanos , Neoplasias Laríngeas/patologia , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Qualidade de Vida , Autorrelato , Resultado do Tratamento , Distúrbios da Voz/etiologia , Qualidade da VozRESUMO
BACKGROUND: The laryngeal framework provides a natural barrier preventing tumour spread to extralaryngeal structures. Transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (SCC) may violate these boundaries, altering the pathways of tumor spread for potential recurrences. Our project objective is to describe laryngeal SCC recurrence patterns and overall survival in patients requiring total laryngectomy (TL) after TLM. METHODS: Patients undergoing TLM for laryngeal SCC requiring salvage TL were identified from a prospective CO2 laser database containing all patients undergoing TLM for head and neck malignancies at the QEII Health Sciences Center in Halifax, Nova Scotia between March 2002 - May 2014. Surgical pathology reports were analyzed for tumor characteristics, extent of recurrence and invasion of local structures. Kaplan-Meier analyses were performed to evaluate overall survival, disease specific survival (DSS) and locoregional control. RESULTS: Fifteen patients were identified from the database as receiving salvage TL for recurrent disease after initial TLM resection for laryngeal SCC. Final pathology reports demonstrated that 67% (10/15) of patients had thyroid cartilage involvement while 53% (9/15) of patients had cricoid cartilage involvement on salvage TL pathology. 33% (5/15) of patients had perineural invasion and 27% (4/15) had lymphovascular invasion. Mean and median follow-up times were 36.7 months and 26.8 months respectively (range 3.9-112.6). The Kaplan-Meier estimate for overall survival at 36 months was 40% post TL with a standard error (SE) of 13.6%. DSS was 47% (SE 14.2%), and locoregional control was 55% (SE 14.5%) post TL. CONCLUSIONS: Laryngeal recurrence sites following TLM seem to be consistent with historical data at known laryngeal sites of vulnerability. Treatment with TLM does not predispose patients to a lower rate of locoregional control and overall survival after total laryngectomy and salvage outcomes are consistent with literature values.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Biópsia por Agulha , Canadá , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Laringectomia/métodos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Boca/cirurgia , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Terapia de Salvação/métodos , Análise de SobrevidaRESUMO
Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predominantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase 'paradigm shift' in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and colleagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the management of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples' dogma makes his contribution truly a genuine paradigm shift.
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Neoplasias Laríngeas/cirurgia , Terapia a Laser , Humanos , Guias de Prática Clínica como Assunto , Prega Vocal/cirurgiaRESUMO
OBJECTIVE: This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1b stage glottic cancer patients. METHODS: A prospective cohort study in a tertiary care head and neck cancer centre included tumour-node-metastasis stage T1bN0M0 glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan-Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded. RESULTS: Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan-Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years. CONCLUSION: Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1b glottic cancer.
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Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Microcirurgia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Idoso , Intervalo Livre de Doença , Glote/patologia , Glote/cirurgia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Resultado do Tratamento , Qualidade da VozRESUMO
Differences in the reproductive biology of both the Australian weasel shark Hemigaleus australiensis and the Australian sharpnose shark Rhizoprionodon taylori were apparent between individuals from the southern-most extent of their range in eastern Australia (Moreton Bay) and those from northern Australia. For H. australiensis from Moreton Bay the total length (LT ) at which 50% of individuals were mature (LT50 ) was 759 mm for females and 756 mm for males, values that were respectively 17-26% larger than reported for the species in northern Australia. The relatively low percentage (63%) of pregnant mature females and presence of small, similar-sized, embryos in utero in both May and November suggested a semi-synchronous, annual reproductive cycle in Moreton Bay, whereas a synchronous, biannual reproductive cycle occurred in northern Australia. It is likely that H. australiensis has a resting phase between gestation cycles at the southern-most extent of its range. For R. taylori from Moreton Bay the LT50 s were 588 and 579 mm for females and males, respectively, values 2-3% larger than for individuals from the mid-Queensland coast and 31-35% larger than for individuals from northern Australia. The length at which 50% of the females were maternal (611 mm LT ) in Moreton Bay was greater than the LT50 , indicating that not all sharks mate immediately after maturing. Rhizoprionodon taylori in the south had an annual reproductive cycle incorporating a 7-8 month embryonic diapause, with pups probably born in February. A mean fecundity of 7·5 was almost double that reported from northern Australia. Regional variations in the reproductive characteristics of H. australiensis and R. taylori may influence their resilience to fishing and other anthropogenic pressures. The substantial differences reported here highlight the importance of region-specific life-history parameters to successful management and conservation.
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Ecossistema , Reprodução , Tubarões/fisiologia , Animais , Austrália , Desenvolvimento Embrionário , Feminino , Fertilidade , Peixes , Masculino , Queensland , Maturidade SexualRESUMO
BACKGROUND: The purpose of this study was to evaluate the functional and oncological outcomes of patients treated for T3 laryngeal squamous cell carcinoma. Specifically comparing transoral laser microsurgery and radiotherapy/chemoradiotherapy treatment modalities. METHOD: A retrospective review of patients treated for T3 laryngeal SCC between 2002 and 2010 was undertaken. RESULTS: Forty-nine patients were included. 15 cases were glottic, (9 treated with TLM, 6 with RT/CRT), 33 supraglottic (6 treated with TLM, 27 with RT/CRT) and 1 subglottic subsite (treated with RT/CRT). There was no statistical difference between treatment groups for 24 month locoregional control (72.3 %), overall survival (glottis 86.7 %, supraglottic 70.4 %) and disease specific survival (glottic 93.3 % and supraglottic 74.1 %). Overall laryngeal preservation (84.9 %) was also similar in both groups. CONCLUSION: Our institution is expanding the application of TLM to selected patients with T3 laryngeal carcinoma. Oncological outcomes have not been jeopardized by this approach and the treatment is well tolerated by patients with few complications.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/terapia , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Good quality data on Aboriginal and Torres Strait Islander peoples are needed to assess the effectiveness of programs and interventions, and to evaluate policies that are designed to improve the status of, and service delivery to, Aboriginal and Torres Strait Islander peoples. Due to the lack of longitudinal data it is difficult to gain knowledge on the specific causes or consequences of changes in indigenous outcomes. Variables such as name, date of birth and address for Aboriginal and Torres Strait Islanders may be subject to more variation and be less consistently reported than other Australians. Improving the collection and management of key identifying variables for Aboriginal and Torres Strait Islanders are key to providing more quality information on this population group.
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OBJECTIVE: To prospectively identify factors promoting healthy self-management of gestational and type 2 diabetes mellitus among underserved pregnant women. STUDY DESIGN: Twenty-nine in-depth, semi-structured interviews were performed over the course of pregnancy for 10 women with diabetes. Interviews on factors promoting diabetes self-management used cognitive load theory to frame questions. Qualitative analysis of longitudinal interview data applied grounded theory techniques to generate themes. RESULT: Half this cohort of minority, low-income, public aid-supported women had type 2 diabetes. Four themes, comprised of both internal self-driven motivators and external sources of support, were identified. These themes were: (1) disease familiarity and diabetes self-efficacy; (2) external motivation (for health of fetus and responsibilities to older children); (3) supportive social and physical environment; and (4) self-regulatory behavior, including goal responsiveness and long-term goal-setting. CONCLUSION: Low-income women used multiple internal and external resources to promote health during a pregnancy complicated by diabetes. Successful behavior modification and achievement of diabetes care goals require leveraging these resources.
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Diabetes Mellitus Tipo 2/etnologia , Diabetes Gestacional/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Complicações na Gravidez/etnologia , Autocuidado/normas , Apoio Social , Adulto , Feminino , Humanos , Entrevistas como Assunto , Grupos Minoritários , Motivação , Pobreza , Gravidez , Estudos Prospectivos , Pesquisa QualitativaRESUMO
The goal of this project was to determine the pharmacokinetics of voriconazole and its concentration in cerebrospinal fluid (CSF), aqueous humor, and synovial fluid in five healthy dogs following once daily oral dose of 6 mg/kg for 2 weeks. Body fluid and plasma drug concentrations were determined by high-performance liquid chromatography (HPLC). Mild to moderate gastrointestinal adverse effects were seen. The mean AUC0-24 : minimum inhibitory concentration (MIC) ratio was 15.23 for a chosen MIC of 1 µg/mL, which is lower than the recommended target of 20-25 and also lower than previously reported in dogs, perhaps reflecting induction of metabolizing enzymes by multiple dosing. Voriconazole concentrations in the CSF, aqueous humor, and synovial fluid were only 13-30% the concurrent plasma concentration, which is lower than previously reported in other species. Results of this study suggest that twice daily, administration may be necessary to maintain therapeutic plasma concentrations in dogs but further studies are warranted.
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Antifúngicos/farmacocinética , Voriconazol/farmacocinética , Administração Oral , Animais , Antifúngicos/administração & dosagem , Antifúngicos/análise , Antifúngicos/sangue , Antifúngicos/líquido cefalorraquidiano , Humor Aquoso/química , Cromatografia Líquida de Alta Pressão/veterinária , Cães , Feminino , Masculino , Testes de Sensibilidade Microbiana/veterinária , Líquido Sinovial/química , Voriconazol/administração & dosagem , Voriconazol/análise , Voriconazol/sangue , Voriconazol/líquido cefalorraquidianoRESUMO
BACKGROUND: Seven male Labrador Retriever puppies from 3 different litters, born to clinically normal dams and sires, were evaluated for progressive weakness and muscle atrophy. Muscle biopsies identified a congenital myopathy with pathologic features consistent with myotubular myopathy. Further investigations identified a pathogenic mutation in the myotubularin gene, confirming that these puppies had X-linked myotubular myopathy (XLMTM). OBJECTIVE: To review the clinical phenotype, electrodiagnostic and laboratory features of XLMTM in this cohort of Labrador Retrievers. RESULTS: Male puppies with XLMTM were small and thin compared with their normal littermates. Generalized weakness and muscle atrophy were present by 7 weeks of age in some puppies and evident to most owners by 14 weeks of age. Affected puppies stood with an arched spine and low head carriage, and walked with a short, choppy stride. Muscle atrophy was severe and progressive. Patellar reflexes were absent. Laryngeal and esophageal dysfunction, and weakness of the masticatory muscles occurred in puppies surviving beyond 4 months of age. Serum creatine kinase activity was normal or only mildly increased. EMG findings were nonspecific and included positive sharp waves and fibrillation potentials. Clinical signs progressed rapidly, with most affected puppies unable to walk within 3-4 weeks after clinical signs were first noticed. CONCLUSIONS AND CLINICAL IMPORTANCE: Although initial clinical signs of XLMTM are similar to the phenotypically milder centronuclear myopathy in Labrador Retrievers, XLMTM is a rapidly progressive and fatal myopathy. Clinicians should be aware of these 2 distinct myopathies with similar clinical presentations in the Labrador retriever breed.
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Doenças do Cão/genética , Miopatias Congênitas Estruturais/veterinária , Animais , Biópsia , Tamanho Corporal , Doenças do Cão/patologia , Cães , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/patologia , Miopatias Congênitas Estruturais/genética , Miopatias Congênitas Estruturais/patologia , Linhagem , Nervos Periféricos/patologiaRESUMO
We conducted a systematic review summarizing data on incidence of high- and low-grade lesions in women with normal baseline cervical cytology, stratified by age (<30 and ⩾30 years), and baseline human papillomavirus (HPV) infection. Incidence of high- and low-grade lesions in women aged ⩾30 years with a baseline HPV infection increased over follow-up time (5-127 months), although incidence generally remained <10%. Without baseline HPV infection, incidence of high-grade lesions remained low over follow-up time (<5% over 5-122 months). Incidence of high-grade lesions in women aged ⩾30 years with baseline HPV infection appeared similar to that in women aged <30 years. In some women aged <30 years, high-grade lesions can develop relatively shortly after initial HPV infection. We observed an increase in low-grade lesions over time in women aged ⩾30 years with baseline HPV infection, potentially indicative of an HPV infection that is potentially progressing to higher grade lesions.
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Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Adulto JovemRESUMO
A predominant theory of the much debated histogenesis of Warthin tumor (WT) is that it arises from heterotopic salivary ductal inclusions (SDI) in parotid lymph nodes (LN). If this were the case, we might expect to see an increased number of SDI in the lymph nodes of patients with WT compared to controls. To test this, we compared the prevalence of SDI in patients with WT versus those with pleomorphic adenoma (PA). Cases of WT and PA were retrieved from the case files of the Department of Pathology at the QEII Health Science Centre, Halifax, NS, Canada. We then compared the prevalence of SDI in parotid LN between patients diagnosed with WT versus PA. 46 WT and 52 PA met our inclusion criteria. WT was significantly associated with an older age at surgery (62.5 years vs 50.2 years, p = 0.001). 71.7 % of WT and 32.7 % of PA had inclusions in any LN. The presence of inclusion is a significant predictor for WT versus PA (p = 0.019). Where smoking status was available, 92.5 % of WT patients were smokers/ex-smokers, versus. 55.1 % of PA (p = 0.034 for current smokers). Among PA, 44 % of smokers had inclusions compared with 22.7 % of non-smokers. SDIs are more frequent in parotid LN from patients with WT than PA. The high proportion of smokers among WT patients is consistent with prior studies. The results support the hypothesis that WT arises from SDIs. Individuals with more SDIs may be predisposed to WT.
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Adenolinfoma/patologia , Corpos de Inclusão/patologia , Linfonodos/patologia , Neoplasias Parotídeas/patologia , Ductos Salivares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/patologiaRESUMO
OBJECTIVE: To report our outcomes with salvage CO2 laser surgery following recurrence of laryngeal and oropharyngeal cancer after radiotherapy. METHOD: This study entailed a prospective review of patients treated with transoral laser microsurgery for recurrent laryngeal and oropharyngeal cancer between 2002 and 2010 at the Queen Elizabeth II Health Science Centre in Canada. RESULTS: Sixteen patients were identified, with a mean follow up of 30.6 months. Five patients died of recurrence. Complications were common in patients with oropharyngeal cancer. The overall survival and disease-free survival rates at an average of 29.8 months follow up were 50 per cent and 68.8 per cent respectively. CONCLUSION: Salvage surgery using transoral laser microsurgery should be considered in the management of patients with recurrent laryngeal and oropharyngeal cancer. This technique offers acceptable salvage rates with less comorbidity than other treatments.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Laríngeas/cirurgia , Terapia a Laser/métodos , Recidiva Local de Neoplasia/cirurgia , Neoplasias Orofaríngeas/cirurgia , Terapia de Salvação , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/radioterapia , Intervalo Livre de Doença , Feminino , Glote/cirurgia , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/radioterapia , Lasers de Gás , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/radioterapia , Estudos Prospectivos , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
OBJECTIVE: To compare the image quality provided by rigid laryngoscopes versus flexible distal-chip laryngoscopes when documenting the same laryngeal pathology. METHODS: This paper reports a prospective single-blind study. Ten early stage glottic cancer cases were selected. Photographs of the pathologies were taken using both rigid and flexible distal-chip laryngoscopes (a total of 20 photographs). Nineteen clinicians were asked to review the laryngoscopic photographs; the clinicians were provided with a worksheet, which included questions regarding the clinical description, photograph quality and overall satisfaction with the images obtained. Clinicians' responses to the worksheet questions were then analysed. RESULTS: The overall accuracy rate for lesion sidedness, anatomical sub-site involvement, anterior commissure involvement and tumour staging were 94.7 per cent, 46.6 per cent, 53.7 per cent and 47.1 per cent respectively. There were no statistically significant differences in terms of the accuracy rates, photograph quality or overall satisfaction with the photographs obtained by either modality. CONCLUSION: There were no statistically significant differences demonstrated in overall clinical accuracy or perceived image quality between the use of the rigid or flexible endoscopes when interpreting images of early glottic cancer.