Malignant salivary gland tumours of the larynx: a single institution review.

Malignant salivary gland tumours of the larynx are very rare, with limited reports of clinical outcomes. We present the decade-long experience of a single institution. A 10-year retrospective chart review of a tertiary head and neck cancer centre was performed. Index patients were identified from a review of a pathology database, and reviewed by a head and neck pathologist. Patient demographics, presenting signs and symptoms, treatment modalities and clinical outcomes were extracted from electronic medical records. Six patients were included, with an age range of 44 to 69. All six had malignant laryngeal salivary gland tumours. Pathologies included: three adenoid cystic carcinoma (2 supraglottic, 1 subglottic), one mucoepidermoid carcinoma (supraglottic), one epithelial-myoepithelial carcinoma (supraglottic) and one adenocarcinoma (transglottic). All were treated with surgery (2 endolaryngeal, 4 open) and five of six with the addition of adjuvant therapy (4 radiotherapy, 1 concurrent chemoradiation). One patient had smoking history; no patients had significant alcohol history. With 4.5 years of median follow-up, none of the patients has had recurrence or local/distant metastasis. Salivary gland tumours of the larynx present in mid to late-age, and can be successfully managed with a multi-modality approach, resulting in excellent local and regional control rates.

Non-epithelial tumors of the larynx: a single institution review.

AIM: Non-epithelial tumors of the larynx are rare and encompass a wide range of pathology. We present the decade-long experience of a single institution to define clinical presentations and outcomes. MATERIAL AND METHODS: This is a ten year retrospective chart review of a tertiary head and neck cancer center. Index patients were identified from a review of a pathology database, and patient demographics, presenting signs and symptoms, treatment modalities, and clinical outcomes were extracted from electronic medical records. Epithelial tumors (squamous cell carcinoma, spindle cell carcinoma, and salivary tumors), granulomas, sarcoidosis, papilloma, and amyloidosis were all excluded. RESULTS: Twenty-four patients with ages ranging from 2months-old to 84years were identified. Malignant lesions (11) included chondrosarcoma (6), Kaposi's sarcoma (2), metastatic melanoma, synovial cell sarcoma, and T cell neoplasm. Six were operated upon endolaryngeally, but four required either upfront or salvage total laryngectomy. Two received adjuvant therapy. Benign lesions (13) included hemangioma (4), granular cell tumor (3), myofibroblastic tumor (2), schwannoma (2), chondroma, and ossifying fibromyxoid tumor. Nine underwent endolaryngeal operations, and four were managed medically or with observation. None have required aggressive open resection or total laryngectomy. CONCLUSION: Treatment approach of non-epithelial tumors of the larynx depends on the site and extent of the tumor, histology, and sensitivity of adjuvant therapy. Benign tumors can be managed without need for aggressive resection thereby sparing laryngeal function.

Modelling harmonic generation measurements in solids.

Harmonic generation measurements typically make use of the plane wave result when extracting values for the nonlinearity parameter, ß, from experimental measurements. This approach, however, ignores the effects of diffraction, attenuation, and receiver integration which are common features in a typical experiment. Our aim is to determine the importance of these effects when making measurements of ß over different sample dimensions, or using different input frequencies. We describe a three-dimensional numerical model designed to accurately predict the results of a typical experiment, based on a quasi-linear assumption. An experiment is designed to measure the axial variation of the fundamental and second harmonic amplitude components in an ultrasonic beam, and the results are compared with those predicted by the model. The absolute ß values are then extracted from the experimental data using both the simulation and the standard plane wave result. A difference is observed between the values returned by the two methods, which varies with axial range and input frequency.

Fluvoxamine and sleep disturbances in posttraumatic stress disorder.

This study assesses the efficacy of fluvoxamine treatment on different domains of subjective sleep quality in Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD). Medically healthy male Vietnam theater combat veterans (N = 21) completed a 10-week open label trial. Fluvoxamine treatment led to improvements in PTSD symptoms and all domains of subjective sleep quality. The largest effect was for dreams linked to the traumatic experience in combat. In contrast, generic unpleasant dreams showed only a modest response to treatment. Sleep maintenance insomnia and the item "troubled sleep" showed a large treatment response, whereas sleep onset insomnia improved less substantially. These therapeutic benefits contrast with published reports that have found activating effects of Selective Serotonin Reuptake Inhibitors on the sleep electroencephalogram.

The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2.

OBJECTIVE: Meeting criterion A2 for the diagnosis of posttraumatic stress disorder (PTSD) in DSM-IV requires that an individual have high levels of distress during or after the traumatic event. Because of the paucity of valid and reliable instruments for assessing such responses, the authors developed a 13-item self-report measure, the Peritraumatic Distress Inventory, to obtain a quantitative measure of the level of distress experienced during and immediately after a traumatic event. METHOD: The cross-sectional study group comprised 702 police officers and 301 matched nonpolice comparison subjects varying in ethnicity and gender who were exposed to a wide range of critical incidents. RESULTS: The Peritraumatic Distress Inventory was found to be internally consistent, with good test-retest reliability and good convergent and divergent validity. Even after controlling for peritraumatic dissociation and for general psychopathology, the authors found that Peritraumatic Distress Inventory scores correlated with two measures of posttraumatic stress symptoms. CONCLUSIONS: The Peritraumatic Distress Inventory holds promise as a measure of PTSD criterion A2. Future studies should prospectively examine the ability of the Peritraumatic Distress Inventory to predict PTSD and its associated biological and cognitive correlates in other trauma-exposed groups.

Effects of gender and ethnicity on duty-related posttraumatic stress symptoms among urban police officers.

We studied 655 urban police officers (21% female, 48% white, 24% black, and 28% Hispanic) to assess ethnic and gender differences in duty-related symptoms of posttraumatic stress disorder (PTSD). We obtained self-report measures of: a) PTSD symptoms, b) peritraumatic dissociation, c) exposure to duty-related critical incidents, d) general psychiatric symptoms, e) response bias due to social desirability, and f) demographic variables. We found that self-identified Hispanic-American officers evidenced greater PTSD symptoms than both self-identified European-American and self-identified African-American officers. These effects were small in size but they persisted even after controlling for differences in other relevant variables. Contrary to expectation, we found no gender differences in PTSD symptoms. Our findings are of note because: a) they replicate a previous finding of greater PTSD among Hispanic-American military personnel and b) they fail to replicate the well-established finding of greater PTSD symptoms among civilian women.

An overview of the Peritraumatic Distress Scale.

Posttraumatic stress disorder (PTSD) occurs when significant intrusion, avoidance, and hyperarousal symptoms are manifest for at least 1 month following exposure to a traumatic event, with at least 1 month following exposure to a traumatic event, with at least 1 month elapsed betwenn the event and the diagnossis (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994 [DSM-IV]).(1) However, such symptoms are not necessarily manifest in the immediate aftermath of the trauman,(2) nor does their intial presence strongly predict who will develop PTSD.(3) One immediate response to trauma which has been convicingly linked to PTSD symptoms is peritraumatic dissociation.(4) In this poster, we briefly introduce a new scale assessing immediate responses distinct from peritraumatic dissociation, and we examine its power to predict PTSD symptoms.

Longitudinal course and predictors of continuing distress following critical incident exposure in emergency services personnel.

This study examines the longitudinal course and predictors of stress-specific and general symptomatic distress in emergency services personnel. A three-group quasi-experimental design was used to determine the responses of 322 rescue workers to the Loma Prieta earthquake Interstate 880 Freeway collapse and to unrelated control critical incidents. Self-report questionnaires, including measures of incident exposure, peritraumatic dissociation and emotional distress, and current symptoms, were administered 1.9 years (initial) and 3.5 years (follow-up) after the freeway collapse. Despite modest symptom improvement at follow-up, rescue workers were at risk for chronic symptomatic distress after critical incident exposure. Peritraumatic dissociation accounted for significant increments in current posttraumatic stress disorder symptoms, over and above exposure, adjustment, years of experience, locus of control, social support, and general dissociative tendencies. The results suggest that rescue workers, particularly those with more catastrophic exposure and those prone to dissociate at the time of the critical incident, are at risk for chronic symptomatic distress.