How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group.

PURPOSE: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Bilateral inflammatory pseudotumour of the trigeminal nerve: a diagnostic challenge.

Inflammatory pseudotumour (IPT) is an uncommon disease with undefined pathogenesis. It is often characterized by local aggressiveness with compressive and displacing effects on surrounding structures. It may appear in different regions of the body, rarely involving perineural structures unilaterally. We present a case of a bilateral IPT around trigeminal branches in a patient with a long-term history of periorbital swelling and proptosis.

Duration of viral suppression in patients on stable therapy for HIV-1 infection is predicted by plasma HIV RNA level after 1 month of treatment.

UNLABELLED: The aim of this study was to assess the predictive value of HIV RNA levels after 1 month of therapy on the long-term virologic outcome in an unselected general population of HIV-infected patients. DESIGN: Analysis was conducted retrospectively on an ongoing clinical cohort of HIV-positive patients who were receiving antiretroviral treatment. Data on 575 patients were analyzed. RESULTS: The HIV RNA value at 1 month was significantly correlated with the virologic outcome after 12 and 24 months of therapy (R = 0.258 and R = 0.44, respectively). The predictive value of the 1-month viral load was also statistically significant after stratification for baseline CD4 T-cell counts. Prediction was similar in highly compromised patients (CD4 < or = 100 cells/microl; R = 0.426; p = .001) or in patients with a better immunologic status (R = 0.419; p < .0001). It retained validity in patients who were naive or experienced for antiretroviral therapy. CONCLUSION: HIV RNA level after 1 month of therapy is a useful prognostic marker in HIV-infected patients. It predicts long-term virologic and immunologic outcome. A cutoff level of 5000 copies/ml identifies patients most likely to fail current therapy. In these patients, a more aggressive strategy or specific diagnostic interventions to clarify the relative influence of viral resistance and/or subtherapeutic regimens is advised.

Teicoplanin versus cefamandole in the prevention of infection in total hip replacement.

In a prospective, controlled, single-blind study the efficacy of teicoplanin versus cefamandole in preventing infections in total hip replacement was investigated in 496 consecutive patients. A single intravenous dose of teicoplanin (400 mg) was as effective as two intravenous doses of cefamandole (2 g before and 1 g after surgery). No major complications were observed in either group. Infective wound complications were observed only in the cefamandole group. These infections, although not dangerous for the patients, required supplementary antibiotic treatment in all cases. Teicoplanin is a reasonable choice as a prophylactic agent in orthopaedic surgery when a high risk of infection due to staphylococci is present.

The effect of ciprofloxacin on oral contraceptive steroid treatments.

The effect of ciprofloxacin, a new broad-spectrum quinolone derivative, on concomitant oral contraceptive steroids has been studied in a double-blind cross-over placebo-controlled randomized trial. Ten healthy women using long-term oral contraceptive steroids received either ciprofloxacin 500 mg BID or placebo during two consecutive cycles. Therapy was continued for seven days from the first day of contraceptive treatment. FSH, LH and oestradiol blood levels were repeatedly determined to monitor contraceptive steroid efficacy. A seven-day treatment with ciprofloxacin did not affect steroid treatment outcome and appears to be safe in women using this contraceptive method.

PIP: In Italy, health care personnel at the General Hospital in Busto Arsizio randomly assigned 10 healthy women, 22-33 years old, using combined oral contraceptives (OCs) over a long time to either the group receiving 500 mg oral ciprofloxacin twice a day for 7 days for 2 consecutive cycles or to the placebo group. They monitored the women daily and took blood samples on days 7, 9, 14, and 16 of the 2 consecutive cycles. Researchers wanted to determine the interaction between OCs and ciprofloxacin. The volunteers had not taken any drug, other than OCs, in the month before the study. The various OCs consisted of .02-.04 mg ethinyl estradiol and .05-15 mg levonorgestrel, .15 mg desogestrel, or .075 gestodene. None of the women experienced breakthrough bleeding. Ciprofloxacin did not change serum levels of luteinizing hormone, follicle-stimulating hormone, or estradiol (p .05). In fact, the levels for both the ciprofloxacin group and the placebo group were below those levels which signal ovulation. The researchers could not determine the effect of ciprofloxacin on entero-hepatic recirculation of estradiol. These results suggested that ciprofloxacin does not reduce the contraceptive effect of OCs and, therefore, can be safely used to treat infections in women using OCs.