Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis.

OBJECTIVES: To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. DESIGN: A prospective cohort study and qualitative systematic review. SETTING: Multi-cancer networks in the South West of England, Hampshire and the Isle of White. PARTICIPANTS: One hundred and seventy-two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty-one patients had radiologically inserted gastrostomy (RIG). Twenty-seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. MAIN OUTCOME MEASURES: Post-procedure mortality, major and minor complications. RESULTS: In the present series, mortality rates were 1.0% (1/121) for PEG and 3.9% (2/51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4/121) and 15.6% (9/51) respectively. In our systematic review and meta-analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014-0.034) following PEG and 1.8% (95% CI 0.010-0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9-9.3%) and 8.9% (95% CI 7.0-11.2%) after RIG. CONCLUSIONS: Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.

Intranodal neurilemmoma presenting as parotid mass.

OBJECTIVE: We report a case of benign intranodal neurilemmoma, an extremely rare tumour arising from a nerve sheath within a lymph node. CASE REPORT: A 67-year-old woman underwent surgery for a left-sided parotid mass. Histopathological analysis revealed a tumour arising from a lymph node within the superficial lobe of the parotid gland. The tumour demonstrated histological features of an intranodal neurilemmoma. CONCLUSIONS: This case represents the first report of an intranodal neurilemmoma arising within a parotid lymph node, and supports the proposal that intranodal neurilemmoma be recognised as a distinct histological entity.

Pre-treatment anaemia alters outcome in early squamous cell carcinoma of the larynx treated by radical radiotherapy.

The purpose of this study was to examine the effect of pre-treatment anaemia on tumour recurrence and survival in patients treated with primary radiotherapy for early squamous cell carcinoma of the larynx. A retrospective analysis of 117 patients with previously untreated T1N0M0 and T2N0M0 squamous cell carcinoma of the larynx was carried out. Patients were considered anaemic if their pre-treatment haemoglobin levels were below 13 g/dl in males and 11.5 g/dl in females. The influence of pre-treatment haemoglobin levels on local control and survival were evaluated using Cox proportional hazards regression models. Two- and five-year local-regional control estimates for anaemic patients were 58 per cent and 53 per cent respectively while patients with normal haemoglobin levels had two and five-year local-regional control rates of 90 per cent and 81 per cent respectively (p = 0.002). Multivariate Cox regression analysis showed pre-treatment haemoglobin significantly influencing recurrence-free survival (p = 0.0094). Patients with a low haemoglobin level prior to radiation therapy suffered higher levels of local-regional failure.

Frontal sinolith.

We report on a case of an endogenous frontal sinolith and a literature review of classification and use of the terms rhinolith, and sinolith.

Automated analysis of wide-field specular photomicrographs.

This report describes computerized image enhancement and analysis from the digitized image of a wide-field specular micrograph to produce an output of frequency distribution of cell areas. The steps involved including image smoothing and averaging, followed by automated scanning to detect individual cell boundaries, and cell area calculation. The limitations of this method include the requirement for expensive interactive display hardware and a 10% misinterpretation of cell boundaries by the algorithm.