Evaluation of the attributable fraction and burden of HPV-related oropharyngeal cancers in Greece-the ORPHEAS study.

BACKGROUND: Herein, we evaluated the attributable fraction (AF) of human papillomavirus (HPV)-mediated (HPV+) oropharyngeal carcinomas (OPCs) in Greece over a recent calendar period. PATIENTS AND METHODS: ORPHEAS, a retrospective, observational, multicenter, cross-sectional study with prospective recruitment, included adult patients with OPC in 2017-2022, each of them with a high-quality, treatment-naïve tumor specimen. The primary endpoint was the HPV-AF, defined as combined positivity for p16INK4a (p16) overexpression and HPV DNA presence by central laboratory testing, among included patients. Other endpoints evaluated the HPV+/HPV- patient/disease characteristics at OPC diagnosis and the HPV subtypes for HPV+ patients. RESULTS: 144/147 patients with available HPV status by central laboratory testing were analyzed [median age: 60.0 years; males: 111 (77.1%)]. The most common tumor anatomical sites were the tonsils (70/147, 48.6%) and the base of the tongue (51, 35.4%), and most patients were at the American Joint Committee on Cancer eighth edition TNM (tumor-node-metastasis) stages III (25, 22.7%) and IV (43, 39.1%). The HPV-AF was 52.1% (75/144; 95% confidence interval 43.6% to 60.5%). Most HPV+ patients were infected by an HPV type targeted by the 9-valent HPV vaccine (72/75, 96.0%), especially HPV16 (70/75, 93.3%). HPV+ compared with HPV- patients were younger (median age 58.0 versus 64.0 years; P = 0.003); more likely to have tumors in the tonsils (65.0% versus 30.4%; P < 0.001); less likely to have tumors in the base of the tongue (25.3% versus 46.4%; P = 0.008); and less frequently at TNM stage IV (20.4% versus 57.1%; overall P < 0.001). CONCLUSIONS: In Greece, we observed a high HPV-AF (52.1%) in OPC, approximating the AFs reported for some Northern European countries. HPV+ versus HPV- patients were younger, more frequently with tonsillar tumors, and less frequently at TNM stage IV. Since most patients were infected by ≥1 HPV type targeted by the 9-valent vaccine, the HPV+ OPC burden could be mitigated through a routine HPV gender-neutral vaccination program.

The use of the subclavian vein for temporary transvenous pacemaker therapy.

Temporary artificial pacing of the heart has been available clinically for the past twenty years. It was introduced as a life saving procedure for the treatment of complete arterioventricular (A-V) block and other symptomatic bradyarrhythmias. Recent developments in the field of cardiac pacemakers have resulted in pacemaker application in a wide variety of patients and the technique chosen may vary considerably with the purpose. It is of value to separate the indications for temporary pacing into urgent, semi-urgent and elective. Application of this mode of therapy requires access to the heart, a pulse generator capable of emitting a controlled electrical stimulus, and a conducting channel. In each of these areas a technology and body of knowledge has been developed. Subclavian venipuncture with catheterization is a practical procedure for the prolonged or continuous intravenous administration of different kinds of fluids. The technique of the insertion of temporary pacing lead and the point of entry vary with the indication for the procedure and the skill and experience of the operation. For the insertion of a temporary pacing electrode, several veins can be utilized; femoral, anticubical, external and interval jugular, and subclavian. Successful electrode insertion can be accomplished with relative ease through each of these veins. Selection of a vein depends upon the clinical (table: see text) situation, the availability of flouroscopic equipment and the familiarity of the operator with a specific approach.

The fate of patients with intraventricular conduction disturbances complicating acute myocardial infarction.

The partial incidence and the early and late mortality were studied in 104 patients with acute myocardial infarction complicated by intraventricular conduction defects. Right bundle branch block and left anterior hemiblock had a greater incidence than the other conduction anomalies, while the hospital mortality was greater for the complete right bundle branch block combined with left anterior or posterior hemiblock, followed in order by complete left bundle branch block. Late morality was higher in cases with complete right bundle branch block combined with left posterior hemiblock and also in cases with focal block or left bundle branch block indicating a poor prognosis for these patients. For the rest sub-groups of patients late mortality was relatively low indicating the possibility of long survival after passing the acute phase. However, longer periods of observation are desirable for further estimation of their ultimate prognosis.

Transient abnormal Q waves during acute myocardial infarction.

A 65 years old woman with an acute myocardial infarction, as it was judged by serial enzyme changes, developed transitory Q waves in V2-V4 and II, III and AVF during the attack of chest pain. These Q waves were not present 12 hours later. It is suggested that these changes represent a focal block in the septal fibers of the left bundle system. This defect could explain the transient right precordial Q waves seen in myocardial infarction or ischemia, as well as the fixed Q waves of many patients without septal infarction at autopsy.