Workplace violence in medical radiation science: A systematic review.

INTRODUCTION: According to World Health Organization (WHO), workplace violence (WPV) is a significant issue in healthcare. However, no systematic review on WPV in medical radiation science (MRS) has been published yet. The purpose of this paper is to systematically review prevalence of WPV in MRS and its risk factors. METHODS: Electronic scholarly publication databases, namely EBSCOhost/Cumulative Index of Nursing and Allied Health Literature Ultimate, PubMed/Medline, ScienceDirect, Scopus, and Wiley Online Library were used for literature search to identify articles about WPV in MRS published over last 10 years as per preferred reporting items for systematic reviews and meta-analyses guidelines. To facilitate comparisons of the WPV prevalence and relative importance of individual risk factors across the included studies, their reported absolute figures of findings were used to synthesize respective percentages (if not stated). RESULTS: Twelve papers met the selection criteria and were included. This review shows that the WPV prevalence were 69.2-100 % (whole career) and 46.1-83.0 % (last 12 months) in diagnostic radiography, 63.0-84.0 % (whole career) in radiation therapy, 57.6 % in medical sonography (last 12 months), and 46.8 % (last 6 months) in nuclear medicine. The identified WPV risk factors included intoxicated patients, staff stress, feeling of inadequacy resulting in self-protection, more vulnerable practitioners (female, <40 years old and <5-year experience), working in radiation therapy treatment room, emergency department, examination room, general radiography, public hospital, and non-examination and waiting areas, long patient waiting time, night shift, overcrowding environment, unable to meet patients'/family members' expectations, miscommunication, patient handling, inadequate staff and security measures, interaction with colleagues, and lone working. CONCLUSION: The WPV risk in diagnostic radiography and radiation therapy appears extremely high as a result of the aforementioned risk factors. Nevertheless, these study findings should be used with caution due to potential non-response bias. IMPLICATIONS FOR PRACTICE: A WPV policy should be developed in every clinical workplace. Even if such policy is available, its enforcement including policy awareness boosting, and encouraging incident reporting and support seeking will be essential for reducing WPV. More survey studies based on WHO WPV questionnaire should be conducted for strengthening evidence base.

Complete spontaneous regression of a metastatic melanoma of the mandible: a case report and follow-up recommendations.

Regression of metastatic melanoma is very rare and occurs in only 0.23% of cases. Metastasis to the oral cavity is particularly uncommon and accounts for only 1-3% of all oral malignancies. This report presents a case of spontaneous and complete regression of a metastatic melanoma in the mandibular ramus. The patient remains asymptomatic more than 2 years after diagnosis. The patient was followed up regularly. It is recommended that further surveillance imaging be performed in asymptomatic patients following discussion with the surgical and oncological teams. This type of surveillance, together with new systemic treatments, is advocated due to its potential to increase long-term survival even after relapse.

Saliva testing for human papilloma virus in oropharyngeal squamous cell carcinoma: A diagnostic accuracy study.

BACKGROUND: New cases of oropharyngeal squamous cell carcinoma (OPSCC) are routinely tested for HPV. HPV in saliva can be detected with PCR, but its clinical applicability in the context of OPSCC remains unknown. METHODS: Forty-six consecutive patients diagnosed with OPSCC had pre-treatment saliva specimens collected. PCR for HPV on saliva was compared to p16 IHC and HPV DNA in situ hybridisation (ISH) on surgical biopsies. RESULTS: The sensitivity and specificity of saliva testing when compared to the reference test of p16 IHC and HPV DNA ISH were 72.2% and 90%, and positive and negative predictive values were 96.3% and 47.4%. There were no adverse events. Time from last meal, smoking, alcohol drinking and physical exercise did not impact on results. CONCLUSIONS: Saliva testing is a promising test to detect HPV in patients with OPSCC. A positive result could avoid the need for surgical biopsies, thereby reducing costs, patient morbidity and expedite treatment.

Long-term survival outcomes in patients with surgically treated oropharyngeal cancer and defined human papilloma virus status.

OBJECTIVE: This study investigated long-term survival outcomes in surgically treated oropharyngeal cancer patients with known human papilloma virus status. METHODS: A case note review was performed of all patients undergoing primary surgery for oropharyngeal cancer in a single centre over a 10-year period. Human papilloma virus status was determined via dual modality testing. Associations between clinicopathological variables and survival were identified using a log-rank test. RESULTS: Of the 107 cases in the study, 40 per cent (n = 41) were human papilloma virus positive. The positive and negative predictive values of p16 immunohistochemistry for human papilloma virus status were 57 per cent and 100 per cent, respectively. At a mean follow up of 59.5 months, 5-year overall and disease-specific survival estimates were 78 per cent and 69 per cent, respectively. Human papilloma virus status (p = 0.014), smoking status (p = 0.021) and tumour stage (p = 0.03) were significant prognostic indicators. CONCLUSION: The long-term survival rates in surgically treated oropharyngeal cancer patients were comparable to other studies. Variables including human papilloma virus status and tumour stage were associated with survival in patients treated with primary surgery; however, nodal stage and presence of extracapsular spread were non-prognostic.

Magnetic resonance diffusion metrics indexing high focal cellularity and sharp transition at the tumour boundary predict poor outcome in glioblastoma multiforme.

AIM: To investigate the prognostic power of intra-tumoural and gradient magnetic resonance imaging (MRI) diffusion metrics in patients with glioblastoma multiforme (GBM). MATERIALS AND METHODS: Forty-six consecutive patients with histologically confirmed GBM who had undergone preoperative diffusion tensor imaging at 3 T were included. Mean diffusivity (MD) and MD gradient maps were computed. Regions of interest were analysed to determine the minimum MD within the enhancing tumour (minMD). MD gradients were calculated along the enhancing tumour boundary and subjected to histogram analysis. Overall survival (OS) and time to progression (TTP) were derived and survival analysis was undertaken. RESULTS: There were 31 deaths and 37 patients progressed during the study period. Multivariate survival analysis, controlling for treatment and gender, showed that minMD values<6.1×10(-4) mm(2)/s predicted shorter OS (hazard ratio [HR]=2.82, 1.25-6.34; p=0.012) and TTP (HR=5.43, 1.96-15.05; p=0.001). Higher MD gradient values of the tumour boundary predicted shorter survival: MD gradient values >4.7×10(-5) mm(2)/s (10(th) centile) had a significantly shorter OS with a HR of 0.43 (0.19-0.96; p=0.04). Similarly, a value above 1.4×10(-4) mm(2)/s (75(th) centile) was a significant predictor for shorter OS (HR=0.39, 0.17-0.89; p=0.03). CONCLUSIONS: Lower minMD and higher MD gradient values for the 10(th) and 75(th) percentile of the tumour boundary demonstrated prognostic value in preoperative GBM. This suggests that MRI diffusion metrics indicative of higher focal cellularity and steeper transition from high cellular tumour edge to low cellular oedema define more aggressive glioblastoma subtypes with a poorer prognosis.

WITHDRAWN: Can depth of invasion of pT1 carcinoma of the oral tongue predict occult metastases in the neck? A retrospective study.

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Immunoglobulin G4 related chronic sclerosing sialadenitis.

BACKGROUND: ENT surgeons may be the first specialists to encounter and diagnose patients with salivary gland disease. A new entity involving the salivary glands has recently been described of which ENT surgeons need to be aware: immunoglobulin G4 related chronic sclerosing sialadenitis. METHOD: A literature search of Medline, Embase and Cochrane Library databases was performed, using the search terms 'IgG4', 'hyperIgG4 syndrome' and 'IgG4 related chronic sclerosing sialadenitis'. RESULTS: Knowledge concerning immunoglobulin G4 related chronic sclerosing sialadenitis is rapidly increasing. This new entity is part of a fibro-inflammatory corticosteroid-responsive systemic disease (immunoglobulin G4 related disease) and has been described in almost every organ. Biopsy of the submandibular gland can be diagnostic. However, the diagnosis can easily be overlooked if: clinical suspicion is not high, one is unaware of the classical morphology and/or immunoglobulin G4 staining is not performed. This paper presents a summary of the current understanding of the disease and its management. CONCLUSION: ENT surgeons should be aware of this new disease entity. Patients with systemic disease should be managed under a multidisciplinary team, with input from clinicians who have an interest in such diseases (such as gastroenterologists and rheumatologists), and input from histopathologists and radiologists.

Alveolar soft-part sarcoma of the tongue: report of a case and review of the literature.

Alveolar soft part sarcoma (ASPS) accounts for less than 1% of all sarcomas. More frequently encountered within the lower limbs, the authors present a 24-year-old male with ASPS presenting as an asymptomatic swelling of the lateral tongue. At 12 months post wide local excision of the lesion, the patient remains well with no evidence of local or regional recurrence. Histological and immunohistochemical features are diagnostic of ASPS. Whilst rare, head and neck surgeons should be aware of ASPS as a potential cause of slow growing lesions, as early surgical resection is vital in view of the propensity for metastatic spread.

Mangifera indica (mango).

Mangifera indica, commonly used herb in ayurvedic medicine. Although review articles on this plant are already published, but this review article is presented to compile all the updated information on its phytochemical and pharmacological activities, which were performed widely by different methods. Studies indicate mango possesses antidiabetic, anti-oxidant, anti-viral, cardiotonic, hypotensive, anti-inflammatory properties. Various effects like antibacterial, anti fungal, anthelmintic, anti parasitic, anti tumor, anti HIV, antibone resorption, antispasmodic, antipyretic, antidiarrhoeal, antiallergic, immunomodulation, hypolipidemic, anti microbial, hepatoprotective, gastroprotective have also been studied. These studies are very encouraging and indicate this herb should be studied more extensively to confirm these results and reveal other potential therapeutic effects. Clinical trials using mango for a variety of conditions should also be conducted.

Effects of clinical service reorganisation on cellular pathology workload.

AIMS: To assess changes in volume and complexity of cellular pathology workload after clinical service reorganisation and alterations in pathology reporting practices, and to identify objective measures of change applicable to all cellular pathology departments. The ear, nose, and throat (ENT), head and neck (HN) specialty was chosen for assessment. METHODS: Cellular pathology workload from the ENT-HN surgical specialty was assessed numerically and the complexity in examination of cancer resection specimens was evaluated. Medical and technical time inputs in the reporting of ENT-HN cancer resections were measured prospectively, and the histological and cytological workload arising from the management of such cases was obtained. RESULTS: The 88.83% increase in ENT-HN specimens contrasted with a 13.53% increase in total surgical workload. Substantial increases in work complexity were found when measured as blocks/slides for each case and number of histochemical/immunohistochemical requests. On average, examination of one ENT-HN cancer case consumed 55% of one pathologist's work session and over one 10th of a technician's working week. On average, each cancer generated 3.3 histological and 1.06 cytological specimens. CONCLUSIONS: Evidence is provided of the increase in cellular pathology workload and in its complexity. This study lists objective measures of complexity applicable to all pathology subspecialties. Given the workforce crisis and expanding clinical needs, realistic workload calculations should include measurement of complexity and not just volumes.

Myxoglobulosis in oral extravasation mucocele: an entity?

AIMS: Myxoglobulosis is a recognized variant of mucocele of the vermiform appendix. Myxoglobulosis has recently been reported in extravasation mucocele of the oral cavity. This morphological study was carried out to identify the prevalence and possible pathogenesis of this unusual feature. MATERIALS AND METHODS: A retrospective review of archival material diagnosed as oral cavity mucocele was undertaken. This covered a period of 32 months and consisted of 76 cases. In accordance with the proposed traumatic origin of extravasation mucocele, histological changes were classified on the basis of mucin extravasation and cyst formation. Globular structures, as described in the reports of myxoglobulosis, were looked for, as were changes that could be ascribed to their formation. CONCLUSIONS: Globular structures were noted in 22 (31%) of 71 cases of extravasation mucocele. They were present within cysts (11 samples) and in extraluminal connective tissue in the rest. They appeared to originate from alterations in connective tissue collagen following mucin extravasation. Their structure is different from that described in appendicial mucocele. When observed, they are best regarded as part of the normal sequence in the formation of oral cavity extravasation mucocele, without attaching special importance to them.

Effects of peroxide on endothelial nitric oxide synthase in coronary arteries.

Reactive oxygen species (ROS) are produced in ischemia and reperfusion. Since endothelial nitric oxide synthase (eNOS) is key to the endothelium-dependent vasodilation, we examined the effects of peroxide on this enzyme. We treated cells cultured from pig coronary artery endothelium with different concentrations of hydrogen peroxide, washed them, solubilized them and measured NOS activity by arginine to citrulline conversion. Hydrogen peroxide inhibited the eNOS activity with an IC50 value of 0.85 +/- 0.39 mM. In another experiment, we perfused arteries with solutions containing 0 or 1 mM hydrogen peroxide, washed them, removed the endothelium using a cotton swab, centrifuged and solubilized the endothelium and monitored its NOS activity. Hydrogen peroxide (1 mM) did not affect the NOS activity significantly (p > 0.05) in this assay. We conclude that the inactivation of eNOS by hydrogen peroxide does not play a major role in the ischemia-reperfusion damage because the peroxide concentrations attained during ischemia-perfusion are much lower than those affecting the eNOS activity.

Successful management of spontaneous pneumothorax during general anaesthesia in a patient with eosinophilia.

A 10-year-old male patient posted for left elbow arthrolysis developed pneumothorax during general anaesthesia. He had history of upper respiratory tract infection and high eosinophil count, which remained high in spite of treatment. In such patients, it is advisable to use steroid pre-operatively & intraoperatively to produce transient eosinopenia so that complications of eosinophilia are avoided.

Apoptosis after intestinal ischemia-reperfusion injury: a morphological study.

BACKGROUND: Apoptosis has been identified after ischemia-reperfusion (IR) injury to the brain, heart, kidney, retina, and the adrenals. Intestinal IR injury causes villous and crypt damage, which has so far been attributed to cellular necrosis. This study was undertaken to investigate the possible role of apoptosis after reperfusion of cold-stored small bowel grafts in syngeneic rats. METHODS: Small intestinal grafts were stored at 4 degrees C for 24 hr in saline (n=6) or in modified University of Wisconsin solution (n=6), followed by reperfusion for 1 hr in syngeneic Lewis rats. Small bowel samples were obtained before storage, after preservation and after 1 hr of reperfusion. They were processed for light and electron microscopy and analyzed for cell death, with particular emphasis on apoptosis. RESULTS: Less than one apoptotic event was seen per 10 crypts in normal and stored bowels. An occasional normal and some denuded villous epithelial cells of stored bowels exhibited apoptosis. After isotransplantation and 1 hr of reperfusion, marked increase in apoptosis was seen in the crypts and denuded villous epithelial cells of both saline- and modified University of Wisconsin-stored bowels. Secondary necrosis was seen in apoptotic cells, as were dark cells. Only a few cells showed signs of primary ischemic necrosis. CONCLUSIONS: Apoptosis occurs after intestinal IR injury. Modulation of its genetic regulatory and biochemical effector machinery might alleviate or even prevent IR injury in small bowel transplanted after similar periods of storage.

Intestinal metaplasia subtyping: evaluation of Gomori's aldehyde fuchsin for routine diagnostic use.

AIMS: Intestinal metaplasia (IM) has been implicated in the pathogenesis of gastro-oesophageal carcinoma, but because of its common occurrence, its specificity for use in cancer surveillance is low. IM subtypes characterized by mucin phenotype have been studied to try and improve specificity. METHODS AND RESULTS: On balance, type III IM seems the most promising for use in gastric cancer surveillance. The situation is problematic at the gastro-oesophageal junction where the normal occurrence of acidic mucins raises doubt on the value of subtyping. High iron diamine-Alcian blue combination (HID-AB) is commonly used for IM subtyping, but its potential toxicity and long staining period (up to 24 hours) precludes widespread clinical use. This study has compared the sulphomucin staining ability of Gomori's aldehyde fuchsin-Alcian blue combination (GAF-AB) against HID-AB for identifying and subtyping IM in gastric and oesophageal biopsies. CONCLUSIONS: Compared to HID-AB, a sensitivity of 85%, a specificity of 100% and a staining time of less than 30 minutes, shows this stain to be a simple and effective technique for identifying and subtyping IM in routine laboratories.