Galectin-1 is associated with poor prognosis in patients with cutaneous head and neck cancer with perineural spread.

Spread of head and neck cancer along the cranial nerves is often a lethal complication of this tumour. Current treatment options include surgical resection and/or radiotherapy, but recurrence is a frequent event suggesting that our understanding of this tumour and its microenvironment is incomplete. In this study, we have analysed the nature of the perineural tumour microenvironment by immunohistochemistry with particular focus on immune cells and molecules, which might impair anti-tumour immunity. Moderate to marked lymphocyte infiltrates were present in 58.8% of the patient cohort including T cells, B cells and FoxP3-expressing T cells. While human leukocyte antigen (HLA) class I and more variably HLA class II were expressed on the tumour cells, this did not associate with patient survival or recurrence. In contrast, galectin-1 staining within lymphocyte areas of the tumour was significantly associated with a poorer patient outcome. Given the known role of galectin-1 in immune suppression, the data suggest that galectin inhibitors might improve the prognosis of patients with perineural spread of cancer.

The impact of ear disease and hearing impairment on the lives of Nepali patients in Pokhara: a qualitative study.

BACKGROUND: Ear disease in Nepal is a common problem which, left untreated, can cause serious complications such as hearing impairment (HI). Evidence shows that HI is associated with educational difficulties, employment problems and social isolation. Currently, there is little qualitative literature investigating the long-term impact of ear disease, and none specifically reporting on Nepali populations. This qualitative study explored the experiences of individuals affected by ear disease, with a view to informing hospital services and educational programmes. METHODS: A quota sampling technique was used, with 21 face-to-face semi-structured interviews conducted in Pokhara, Nepal during February-March 2014. Interviews were audiotaped, and verbatim transcripts were analysed using a conventional content analysis approach. RESULTS: Three overarching themes were identified: stigma, non-disclosure and barriers as a result of HI, stigma and non-disclosure. Stigma was both experienced and feared by participants throughout their lives, and as a result, they would not disclose their problem to friends, teachers and employers. Participants faced barriers in their education and work but did not receive the support they required because people were unaware of their condition. CONCLUSIONS: This research suggests that a 'stigma cycle' has developed and that participants are being trapped within it. This impacts adversely upon individuals' personal, social and economic development, limiting the human capital available to Nepal.

Systematic review of outcome of cochlear implantation in superficial siderosis.

BACKGROUND: Superficial siderosis is a progressive disease of the central nervous system associated with chronic subarachnoid hemorrhage. Sensorineural hearing loss occurs early in the disease typically progressing to a profound hearing loss during several years and ultimately affecting 95% of patients. OBJECTIVE: There are published reports of variable outcomes regarding auditory performance for cochlear implantation in cases of superficial siderosis: the objective of this article was to systematically review this evidence. DATA SOURCES: A systematic search of NHS Evidence electronic journal databases AMED (1985 to present), BNI (1985 to present), CINAHL (1981 to present), EMBASE (1980 to present), HEALTH BUSINESS ELITE, HMIC, MEDLINE (1950 to present), and PsycINFO (1806 to present) was performed. Further research using personal communication, Google Scholar, hand searching Otology & Neurotology (2008-2011), and assessment of reference lists identified in other relevant articles yielded additional articles. STUDY SELECTION: A total of 24 articles were short-listed based on relevance; no studies were excluded on a basis of quality. Of these 24 articles, 11 were excluded. DATA EXTRACTION AND SYNTHESIS: The 13 articles included in this review report 15 cases of cochlear implantation in superficial siderosis. Of these 15 individual cases, 7 (47%) showed clear sustained benefit from cochlear implantation, 6 showed limited/no benefit from the onset, and the remaining 2 patients' initial benefit was not maintained. CONCLUSION: Outcomes will depend on the site of lesion and the degree of cochlear nerve functionality, as well as ongoing neural deterioration. Comprehensive assessment of the auditory pathway including electrical auditory brainstem response and magnetic resonance imaging as well as pre/postimplantation counseling is indicated, but these preoperative measures are imperfect predictors of outcomes. There are indications that, where the underlying disease is stable, cochlear implant performance may be sustained, and where there is disease progression (specifically regarding involvement of auditory brainstem nuclei), cochlear implant performance may deteriorate. Further data are needed in this regard; however, results suggest that earlier implantation would provide benefit for a longer period and increase cost-effectiveness.

Hearing impairment in otitis media with effusion: a cross-sectional study based in Pokhara, Nepal.

OBJECTIVE: Otitis media with effusion (OME) is a major cause of childhood hearing impairment (HI) in the developing world, but its prevalence has never been quantified in Nepal. This study therefore set out to determine the proportion of cases of OME complicated by HI and to identify associated factors. METHODS: This was a cross-sectional prevalence survey carried out in rural, urban and Tibetan schools in and around Pokhara, Nepal. HI was the primary outcome, and was defined as a middle-frequency pure tone average >25 dB on audiological testing. The study population was defined as children aged four years and older, attending primary school and with a diagnosis of OME. RESULTS: One hundred and eleven schoolchildren with a combined total of 172 ears affected by OME underwent audiometric assessment. HI was most prevalent in the rural Nepali population; 27% (95%CIs 18-38%) had HI, with a mean hearing loss of 22 dB (15-25 dB). In the Tibetan population, 16% (8-29%) had HI, with a mean loss of 17 dB (12-22 dB). The urban Nepali population had the least HI; 4% (1-13%) were affected, with a mean loss of 16 dB (15-19 dB). The difference in prevalence between the urban and rural Nepali populations was statistically significant (p>0.05). Logistic regression analysis did not identify any associated factors. CONCLUSIONS: HI is a common complication of OME in Nepal. There is hitherto-unreported variation between populations in the number of cases of OME complicated by HI. This study identified higher rates of morbidity amongst rural populations but was unable to identify associated factors.

A protocol for the conservative management of vestibular schwannomas.

OBJECTIVES: To devise a protocol for the safe surveillance of vestibular schwannomas. STUDY DESIGN: Retrospective review of case records. SETTING: Tertiary referral neurotology clinic. PATIENTS: Three hundred twenty patients have been managed conservatively with a mean follow-up of 43 months since 1997. Two hundred seventy-six patients with at least 1 follow-up scan have been included in the study. INTERVENTION: Review of case records and radiologic data to devise management protocol. MAIN OUTCOMES MEASURED: Tumor growth rates, timing of detection of growth in growing tumors, and timing of detection of growth in tumors growing at different rates. RESULTS: Of 276 patients, 62 (22%) demonstrated growth. The mean growth rate for growing tumors was 4 mm annually (range, 0.5-17 mm/yr). Of the growing tumors, 65% grew slowly (0.5-5 mm/yr) and 35% grew more rapidly (>5-17 mm/yr). Four tumors displayed genuine nonlinear growth. Of the rapidly growing tumors, 16 of 19 were detected at the first follow-up magnetic resonance imaging (6 mo). Of all growing tumors, 90% were detected within 3 years. The remaining 10% were detected within a further 3 years. CONCLUSION: Growth is usually manifest in the first 3 years after presentation. We recommend an initial magnetic resonance imaging scan at 6 months, with scans to take place at annual intervals for 2 years. A further scan 2 years later will identify any patient with indolent tumors. Thereafter, follow-up should be lifelong every 5 years. Cystic tumors represent a particular threat to patients and should only be treated conservatively with caution.