Head and neck cancer surgery in elderly patients: the role of frailty assessment.

OBJECTIVES: To study whether any risk model, frailty index, patients' comorbidities, or demographic characteristics correlate with postoperative morbidity in elderly patients who underwent surgery for head and neck cancer (HNC). A secondary objective was to compare between frailty indexes that are used at our medical center. METHODS: A retrospective analysis of head and neck cancer patients operated between 2007 and 2021 was performed. RESULTS: One hundred and fifteen patients were included and divided into three age groups: 50-69 years, 70-79 years and ≥ 80 years. Although most elderly patients had a significantly higher rate of comorbidities and lower Norton scores, no statistically significant difference was found between the groups in postoperative morbidity rates, intensive care unit (ICU) or internal medicine department admissions, re-hospitalization in 1-3 months, and in falling risk (MFS-Morse Fall Scale). On multivariate analysis there was a positive correlation between preoperative cerebrovascular accident (CVA), dementia, and cardiac arrhythmias, and the probability for developing postoperative complication. The latter findings were not related to the patients' age. CONCLUSIONS: In this study, we did not find higher postoperative morbidity rates among elderly population in comparison to younger age groups, and therefore, our current evaluation system could not assist in identifying elderly at risk. However, prediction of operative risk based on physiologic reserve or frailty is an important tool in the evaluation of elderly head and neck cancer patients. Future studies are needed to assess the role of frailty index in the elderly head and neck cancer population.

Severity of pneumococcal versus non-pneumococcal acute otitis media in children.

BACKGROUND: Pneumococcal acute otitis media (AOM) has been previously considered as a more severe disease than that caused by other otopathogens, based on clinical and/or otologic scores. We sought to test this hypothesis in the pneumococcal conjugated vaccine (PCV) era. METHODS: Children <6 years who presented with 'severe' AOM episodes with middle ear fluid (MEF) cultures during 2008-2013 were retrospectively identified. 'Severe' AOM episodes were considered if tympanocentesis was required or if spontaneous otorrhea was present. Data were extracted for demographics, clinical and laboratory tests. Children were categorised according to their PCV status as 'unimmunised' or 'PCV7/PCV13 immunised' and according to their MEF culture results into the 'pneumococcal' or the 'non-pneumococcal' group. Leukocytosis was defined as white blood cells (WBC) count >15 000/µL, and elevated C-reactive protein (CRP) level was considered as >50 mg/L. RESULTS: Of 295 eligible AOM episodes, 106 (36%) were culture positive. Children in the pneumococcal group (65, 61%) had a significantly higher WBC counts and higher CRP levels, were more often <2 years old and were more prone to complicate with acute mastoiditis (AM), compared to children in the non-pneumococcal group, P = 0.03, P = 0.02, P = 0.04 and P = 0.03, respectively. In the pneumococcal group, unimmunised children had higher WBC counts when compared with PCV13-immunised children (P = 0.04), but there were no appreciable differences in CRP levels between unimmunised and PCV7/PCV13-immunised children. CONCLUSION: Pneumococcal AOM is associated with higher leukocytosis and CRP levels than non-pneumococcal AOM. Circulating Streptococcus pneumoniae strains causing 'severe' AOM in PCV13-immunised children yielded lower inflammatory responses when compared with unimmunised children.

Traumatic quadriceps muscle tears among Israeli Special Forces Soldiers.

INTRODUCTION: Quadriceps muscle tear, secondary to direct trauma, is an uncommon injury in a military setting. Signs and symptoms of this injury are usually non-specific and may resemble other, more common and benign overuse injuries. PATIENTS AND METHODS: Five Israeli Defense Forces Special Forces soldiers who were diagnosed with partial quadriceps muscle tears, following a "low-kick" exercise, aimed to the thigh, during "hand-to-hand combat" training. Diagnosis and follow-up were made using thigh sonography. RESULTS: Symptoms duration before diagnosis was 20.6 +/- 9.41 days (mean +/- SD, range: 7-35). Two of the soldiers were found to have myositis ossificans at the affected site, a known complication of muscle trauma. Treatment regime included a long rest and intensive physiotherapy, with a gradual return to active service. Downtime from diagnosis was 55.8 +/- 17.3 days (mean +/- SD, range: 24-73). All patients eventually fully recovered and returned to active service. CONCLUSION: Quadriceps muscle tear is a rare injury with a delayed presentation and diagnosis in highly motivated soldiers. Sonography facilitates diagnosis and monitoring of healing. Early diagnosis may decrease morbidity and allow earlier return to work.

Natural course of insulin edema.

Generalized edema due to water retention is a very rare complication of insulin therapy. It affects mainly patients with newly diagnosed diabetes or patients with chronic hyperglycemia following initiation of insulin therapy. When it occurs, it is treated effectively with diuretics. This case report describes a female patient, who developed severe insulin edema following initiation of insulin. Diuretics were not given due to severe side effects, thus the natural outcome of insulin edema was observed. Edema was gradually replaced by fat tissue with persistent weight gain. Physicians treating diabetic patients should be aware of "insulin edema" in the differential diagnosis of weight gain in patients treated with insulin.