Analysis of exhaled breath for diagnosing head and neck squamous cell carcinoma: a feasibility study.

BACKGROUND: Squamous cell carcinoma of the head and neck (HNSCC) are wide-spread cancers that often lead to disfigurement and loss of important functions such as speech and ingestion. To date, HNSCC has no adequate method for early detection and screening. METHODS: Exhaled breath samples were collected from 87 volunteers; 62 well-defined breath samples from 22 HNSCC patients (larynx and pharynx), 21 patients with benign tumours (larynx and pharynx) and 19 healthy controls were analysed in a dual approach: (i) chemical analysis using gas chromatography/mass spectrometry (GC-MS) and (ii) breath-print analysis using an array of nanomaterial-based sensors, combined with a statistical algorithm. RESULTS: Gas chromatography/mass spectrometry identified ethanol, 2-propenenitrile and undecane as potential markers for HNSCC and/or benign tumours of the head and neck. The sensor-array-based breath-prints could clearly distinguish HNSCC both from benign tumours and from healthy states. Within the HNSCC group, patients could be classified according to tumour site and stage. CONCLUSIONS: We have demonstrated the feasibility of a breath test for a specific, clinically interesting application: distinguishing HNSCC from tumour-free or benign tumour states, as well as for staging and locating HNSCC. The sensor array used here could form the basis for the development of an urgently needed non-invasive, cost-effective, fast and reliable point-of-care diagnostic/screening tool for HNSCC.

Assessment of seasonal pattern of idiopathic sudden sensorineural hearing loss: a retrospective cross-sectional study.

BACKGROUND: A seasonal trend of patients with idiopathic sudden sensorineural hearing loss may direct research into possible aetiology. METHODS: This study reviewed data from the medical records of patients who presented from 2004 to 2019 and who were diagnosed with new-onset idiopathic sudden sensorineural hearing loss. Seasonal pattern was assessed using chi-square and Rayleigh tests, and further confirmed by Monte Carlo simulation. RESULTS: The study included 740 patients with a mean age of 48.3 years and a median age of 49 years. There was no statistical evidence for a difference in the distribution of sensorineural hearing loss cases for the four seasons of each year or with the cumulative data. New-onset idiopathic sudden sensorineural hearing loss cases averaged around 11 per month; there was no statistical evidence for a seasonal difference, as determined either by the Rayleigh test or with Monte Carlo simulation. CONCLUSION: There was no evidence to support the claim that idiopathic sudden sensorineural hearing loss incidence displays a seasonal pattern. More research is necessary to explore potential external factors such as climate or infection.

Direct maxillary irrigation therapy in non-operated chronic sinusitis: a prospective randomised controlled trial.

OBJECTIVE: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. METHODS: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund-MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. RESULTS: Post-treatment Lund-Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. CONCLUSION: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone.

Inferior turbinate reduction: comparing post-operative bleeding between different surgical techniques.

OBJECTIVE: Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty. METHODS: Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up. RESULTS: Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02-10.43). CONCLUSION: Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.

Prevalence of rhinosinusitis among atypical cystic fibrosis patients.

The objective of this paper is to study the correlation between sinonasal involvement and type of cystic fibrosis (CF) in Israeli's CF patients. The comparative study includes 70 CF patients: 40 typical and 30 atypical CF patients. History and physical examination data were recorded, including endoscopic nasal examination as well as sinus computer tomography scan. The data collected from the two groups were statistically analyzed. Twenty-seven percent of atypical CF patients compared with 2.5% of typical CF patients had CF presenting symptoms of chronic rhinosinusitis (CRS) or obstructive nasal polyps (p < 0.001). Although severe CRS was found slightly more often in patient with atypical CF (43 vs. 32.5%), this difference did not reach statistical significance. Nine patients with severe CRS underwent endoscopic sinus surgery. Among these patients, six (66.6%) had atypical CF and only three (33.3%) had typical CF (p = 0.09). In conclusion, severe CRS is a common diagnosis among patients with typical and atypical CF disease. In the current study, no significant difference in the frequency of CRS was found between the two groups. High awareness toward the diagnosis of atypical CF, careful medical history focusing on sinonasal involvement and physical examination, including nasal endoscopy, for all CF patients (typical and atypical CF) may contribute to an early detection and treatment of significant sinonasal involvement, and may improve the quality of life of the patients.

A novel technique for protecting staff during microlaryngoscopy procedures.

OBJECTIVE: Microlaryngoscopy is an aerosol-generating procedure. This paper presents a novel approach for better protecting staff during microlaryngoscopy. METHODS: A clear plastic microscope drape is attached to the objective lens. Instead of using the drape to cover the microscope, it is pulled down to cover the patient's head and torso. The holes designated for the binoculars of the microscope are used for the surgeon hands, forming protective clear plastic sleeves. CONCLUSION: The proposed technique, which is simple, relatively inexpensive and technically feasible for any hospital to perform during microlaryngoscopy procedures, can increase safety and minimise droplet and aerosol exposure in the operating theatre.

The effect of bleeding on children's haemodynamic indices: an analysis of previous post-tonsillectomy bleeding cases.

OBJECTIVE: Post-surgical bleeding after tonsillectomy occurs in 2-7 per cent of cases. This study examined whether heart rate and haematocrit changes are associated with the amount of bleeding. METHOD: In this retrospective analytical study, data were collected from the medical charts of patients admitted with post-surgical bleeding. RESULTS: Over the course of 10 years, there were 218 cases of post-operative bleeding in children aged under 18 years. There was a significant increase in heart rate after the bleeding had started, and a significant decrease in both haemoglobin and haematocrit levels (p < 0.05). There was no significant correlation between the differences in haemoglobin and haematocrit and changes in heart rate. CONCLUSION: No correlation was found between the differences in haemoglobin and haematocrit levels and the changes in heart rate from before the surgery to after the bleeding had started. The monitoring of paediatric patients' heart rate after tonsillectomy surgery solely for the purpose of predicting acute blood loss is therefore discouraged.

Retrosternal goiter presenting as deep vein thrombosis of the arm.

INTRODUCTION: Deep vein thrombosis of the upper-extremity (ueDVT) is often caused by trauma to the subclavian vein, central venous line and hypercoagulation disorders. CASE REPORT: We present a case of a ueDVT due to retrosternal goiter compressing the right brachiocephalic vein. Low molecular weight heparin was initiated subcutaneously and fluid was aspirated from the thyroid cyst causing an immediate improvement. Cytology detected no malignancy. At eight-month follow-up, the patient showed complete resolution of her symptoms. DISCUSSION: In general, the optimal treatment should include removal of the compressing thyroid. In co-morbid patients and a dominant thyroidal cyst, thyroid aspiration may be sufficient.

A novel rat model for assessment of laryngotracheal injury following transoral intubation.

OBJECTIVE: Laryngotracheal damage is a well-described complication of endotracheal intubation and animal models are essential for studying the underlying cellular injury cascade. This novel rat model is based on transoral intubation and aims to simulate the common clinical scenario of tube-related airway damage. METHODS: Prospective randomized control pilot study. 28 male Sprague-Dawley were randomly assigned into three groups: control, 3-h' intubation and 6-h' intubation. The animals were then euthanized and their laryngotracheal complexes sent for histological analysis. Epithelial damage, mucosal thickness and mucosal gland hypertrophy were reviewed. RESULTS: Total of 13 control animals and 15 intubated animals. 10 intubated animals survived the study protocol. Loss of epithelial surface architecture including damage to the microscopic ciliary mechanism was a common feature amongst all intubated animals. Average mucosal thickness of the larynx (including vocal cords and subglottic area) was 143 ±â€¯88 µm for control rats, 315 ±â€¯101 µm for rats intubated 3 h and 574 ±â€¯174 µm for rats intubated 6 h .This was a statistically significant difference. Average mucosal gland hypertrophy in the laryngeal subsite was 0.41 ±â€¯0.5 in control rats, 1.4 ±â€¯0.5 in rats intubated 3 h and 2.0 ±â€¯0.0 for rats intubated 6 h (statistically significant difference). There was a clear difference between three and 6 h of intubation with poorer mucosal injury parameters for longer intubation. CONCLUSIONS: We describe a novel rat-based animal model for simulating airway mucosal damage following transoral intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria.

BACKGROUND: Chronic sinusitis is one of the most common otolaryngological diagnoses. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis can easily be misdiagnosed and treated as chronic sinusitis, causing continuing harm. AIM: To better identify and characterise these two subgroups of patients, who may suffer from a systemic disease requiring multidisciplinary treatment and prolonged follow up. METHODS: A retrospective, longitudinal study of all patients diagnosed with allergic fungal sinusitis or eosinophilic mucin rhinosinusitis within one otolaryngology department over a 15-year period. RESULTS: Thirty-four patients were identified, 26 with eosinophilic mucin rhinosinusitis and 8 with allergic fungal sinusitis. Orbital involvement at diagnosis was commoner in allergic fungal sinusitis patients (50 per cent) than eosinophilic mucin rhinosinusitis patients (7.7 per cent; p < 0.05). Asthma was diagnosed in 73 per cent of eosinophilic mucin rhinosinusitis patients and 37 per cent of allergic fungal sinusitis patients. CONCLUSION: Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis have the same clinical presentation but different clinical courses. The role of fungus and the ability to confirm its presence are still problematic issues, and additional studies are required.

Chymotrypsin output in the stools in pancreatic and other diseases.

Chymotrypsin output in the stools (u./24 hr.) has been calculated from analysis of single stool samples, using cuprous isothiocyanate as a continuous marker. The values thus calculated agreed favorably with those calculated from three-day stool collections. In 45 controls, with and without steatorrhea, chymotrypsin output was above 10,000 u./24 hr. In six patients with pancreatic insufficiency the values were considerably lower. In 10 patients with pancreatic disease without insufficiency the values were in the normal range. The method was found very useful in the diagnosis of pancreatic insufficiency. It was not sensitive enough to detect lesser degrees of pancreatic damage.