Multidisciplinary treatment of olfactory neuroblastoma: Patterns of failure and management of recurrence.

PURPOSE: Esthesioneuroblastoma is an uncommon malignancy of the head and neck for which there is no defined treatment protocol. The purpose of this study is to report our experience with the treatment and patterns of failure of this disease. METHODS AND MATERIALS: From 1994 to 2012, 37 previously unreported patients with esthesioneuroblastoma were evaluated, and 32 eventually treated for cure at 2 academic medical centers. All patients were staged with Kadish criteria. The mean and median follow-ups were 96.1 and 76.5 months respectively (range 6-240 months). RESULTS: The Kadish stage was A in 6 patients, B in 13 patients, and C in 13 patients. Four patients were initially treated with concurrent chemo-radiation therapy. Twenty-eight patients were treated with primary surgery. Two (2) underwent open medial maxillectomy and 26 underwent craniofacial resection (open - 17, endoscopic - 9). Three patients received curative surgical resection only. Seven patients failed either within the cranial axis or distantly, 6 of the 7 are dead of disease, 10-194 months following initial treatment. Six patients had isolated neck recurrences, 4/6 were salvaged with neck dissection and additional chemo-radiation and remain alive 30-194 months following initial treatment. Estimated overall survival rate at 10 years was 78% based on Kadish and T stages. CONCLUSION: In this retrospective analysis of 32 patients, Kadish stage C and stage T3/T4 tumors were associated with worse outcome. Total radiation dose of 60 Gy, margin status, patient age, were not found to have significant prognostic value.

Sodium cromoglicate: an ineffective drug or meta-analysis misused?

Sodium cromoglicate (SCG) has been available since around 1970 for the treatment of asthma and other allergic disorders in both adults and children. It has been approved for use around the world. Over the period of its development, a number of different formulations were introduced. In 1999, a systematic review of SCG use in childhood asthma was carried out and reported initially as a poster. Further systematic reviews and papers followed from the same authors and finally a Cochrane Collaboration review was published in 2003. All concluded that SCG was ineffective in paediatric asthma. Both the British Thoracic Society Guidelines for the treatment of paediatric asthma and the Model List of Essential Drugs of the WHO now reflect these conclusions. This paper looks carefully at the conclusions of these systematic reviews and raises concerns about the interpretation of the results. These failed to take adequate account of the changes with time in both the formulations used and the age groups examined, and also failed to take adequate note of the totality of information available over all end-points. One primary end-point was based on only four out of the 24 studies included in the review. Rather than having no effect, it is demonstrated that a considerable body of evidence favours SCG compared to placebo and, far from being ineffective, the drug appears to be effective particularly in older children. This article replaces a previously published version. DOI: 10.1002/pst.258.

Retracted and replaced: Sodium cromoglicate: an ineffective drug or meta-analysis misused?

The following article from Pharmaceutical Statistics, Sodium cromoglicate: an ineffective drug or meta-analysis misused? by M. T. Stevens, A. M. Edwards, J. B. L. Howell published online on 15 March 2007 in Wiley InterScience (www.interscience.wiley.com), has been retracted by agreement between the author, the journal Editor in Chief, Steven Julious, and John Wiley & Sons, Ltd. The retraction has been agreed because the article is not yet ready for publication and an early version without revisions was published in error. Replacement article pending. Copyright (c) 2007 John Wiley & Sons, Ltd.

The potential peril from caliber-persistent arteries of the lips.

The arteries supplying the lips are very tortuous so they can accommodate the movements of the mouth. Labial arteries taper only slightly and are usually caliber-persistent vessels. On rare occasions, older adults have a tumor-like lesion form on the vermilion of the upper or lower lip or have an ulcer of the lower lip. Cancer is the concern of the person and his or her physician and dentist. In surgical excision of this tumor-like lesion or removal of a specimen for biopsy, the treatment team needs to prepare for the possibility of brisk arterial bleeding and have proper materials to ligate the labial artery in the event it is inadvertently transected. It is also important to remember that both ends of a transected artery should be ligated. Could the tumor-like lesion or lip ulcer be a mucosal sign of a caliber-persistent artery of another area of the gastrointestinal tract? This question has not received adequate investigation. The relationship is unlikely but deserves consideration.

Skin self-examination for melanoma--another golden rule.

Melanoma is likely to become the most important cancer of the 21st century. Health education can improve the prognosis of this cancer. The goal of melanoma education is to reduce the rising incidence and mortality from melanoma. Skin self-examination is an important means of promoting awareness. Marketing the excellent health habit of inspecting our pigmented lesions on Melanoma Monday and several times annually requires teaching the public who is at increased risk, the signs of in situ and early melanoma, and the action to be taken if a suspicious spot is found. A skin scan for melanoma is a splendid health habit for every American.

Melanoma awareness and self-examination practices: results of a United States survey.

BACKGROUND: Skin cancers are common and there has been a dramatic increase in their incidence, particularly melanoma. However, little is known about awareness of melanoma and early detection practices in the general U.S. population. OBJECTIVE: In 1995, the American Academy of Dermatology increased their efforts to promote awareness of melanoma. This study was conducted to document current knowledge of melanoma and self-examination practices. METHODS: In February 1995, a telephone survey was conducted in a nationally representative sample of 1001 persons at least 18 years of age (3% margin of error) that included questions on knowledge, attitudes, and practices regarding early detection of melanoma. RESULTS: Almost 42% of those surveyed were unaware of melanoma, and only 26% of those who were aware could identify its specific signs. Most recognized at least one common risk factor for melanoma (e.g., sun exposure, fair skin). However, many did not distinguish melanoma from other skin cancers in terms of risk factors, signs of early disease, and body site distribution. The lowest measures of melanoma knowledge and attitudes were found among those who are male, nonwhite, and parents, and those with the lowest level of education and income. More than half (54%) did not conduct a self-examination. This practice was most frequently reported by women, white persons, and the elderly, as well as those with a greater knowledge of melanoma. CONCLUSION: Our research documents deficiencies in knowledge and practices related to early detection of melanoma in the general U.S. population and supports the need for public education about melanoma.

Think melanoma.

Every physician's office should be a melanoma detection station. Identification and surgical excision of early melanoma is today's best answer to reducing the death rate from this treacherous disease. Public awareness of melanoma is gaining momentum. Melanoma education for physicians is vital if the battle against melanoma is to be successful. This presentation is a challenge to all physicians and students of medicine to identify patients at risk for melanoma and to follow up with a skin scan to search for suspicious spots on all patients with risk factors for melanoma as a part of their physical examination. We need to teach individuals at risk to do self-examination, to report immediately any recent growth changes in an existing mole or any recently acquired pigmented lesion, and to practice the rules of safe sun exposure. Because securing a suitable specimen of tissue for biopsy and proper interpretation of sections are paramount in patient management and understanding prognosis, we present guidelines for performing a proper biopsy.

How common is increased airway reactivity amongst the elderly?

A random sample of subjects over 65 years of age who had replied to a postal questionnaire on respiratory symptoms was asked to attend for lung function studies and, if fit, an inhaled methacholine bronchial challenge. Of 283 subjects, 180 (63.6%) agreed to attend. Most (98%) subjects performed reproducible spirometry, with no evidence of fatigue on repeated testing. However, 20 subjects were found to be unsuitable for challenge (forced expiratory volume in 1 s, (FEV1) < 1 litre or unable to perform spirometry reproducibly). The dose of methacholine producing a 20% fall in FEV1 was termed the PD20. A positive challenge with PD20 < 6.13 mumol methacholine was found in 69 of 160 (43%) subjects studied, with highly reactive airways (PD20 < 1.0 mumol methacholine) in 19 of 160 (12%). Bronchial hyperreactivity, which is closely associated with clinical asthma, was found to be far more common amongst the elderly than previously recognised. Low initial FEV1 (1-1.5 litres) predisposed to both a positive challenge (p < 0.01) and also to highly reactive airways (p < 0.01), generally associated with respiratory symptoms. Subjects with low (1-1.5 litres) baseline FEV1 were five times more likely to have highly reactive airways than those with FEV1 > 1.5 litres, confirming a relationship between baseline airway calibre and bronchial reactivity. Early detection of subjects with low FEV1, who are therefore more likely to have increased airway reactivity, may help to reduce respiratory morbidity in the elderly with considerable benefit both to patients and to the Health Service.