Improvement of nutritional status after parathyroidectomy in patients receiving maintenance hemodialysis.

Aims/Introduction: Parathyroidectomy is associated with improved survival in patients with end-stage kidney disease. Protein-energy wasting (PEW) is common in patients with kidney failure and predicts poor outcomes. Recent clinical trials have linked hyperparathyroidism to PEW. The present retrospective cohort study examined whether parathyroidectomy was associated with improvement in nutritional status in maintenance hemodialysis patients. Materials and methods: One hundred twenty-nine maintenance hemodialysis patients who had successful parathyroidectomy during 2012-2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1,000 pg./mL (non-PTX control group) and 187 patients with PTH levels >1,000 pg./mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional parameters associated with PEW were compared over the 12-month study period. Results: In cohort 1, substantially lower serum albumin and serum creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low albumin) and serum Cr/BSA ≤380 µmol/L/m2 (low Cr/BSA) were observed in the PTX group. These parameters improved significantly after parathyroidectomy. Total lymphocyte count (TLC) was comparable at baseline but the percentage of patients with TLC <800 cells/mm3 (low TLC) decreased substantially after parathyroidectomy. At follow-up, serum albumin, serum Cr/BSA and proportions of patients with low albumin and Cr/BSA became comparable with the non-PTX control group. The percentage of patients with low TLC became lower in the PTX group. Mixed-models analysis confirmed significant differences in the changes in serum albumin, serum Cr/BSA, and proportions of patients with low albumin and TLC between the two groups. In cohort 2, nutritional parameters were comparable at baseline. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index ≤18.5 kg/m2, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. A substantial reduction in blood pressure was also observed in the PTX group. Conclusion: Severe hyperparathyroidism was associated with nutritional impairment which improved considerably after parathyroidectomy.

Clinicopathologic Findings and Treatment Outcome of Laryngectomized Patients with Laryngeal Cancer and Hypopharyngeal Cancer: An Experience in Thailand

Objective: To evaluate the clinicopathologic findings and treatment outcome in laryngectomized patients with laryngeal cancer and hypopharyngeal cancer. Materials and Methods: The authors retrospectively reviewed the medical records of 212 patients who had been newly diagnosed and treated with laryngectomy between January 2000 and December 2010. The age, gender, clinical manifestations, associated predisposing condition, tumor WHO grade, AJCC tumor stage, maximum tumor size, anatomical involvement, type of surgery, postoperative sequelae, treatment and therapeutic outcome were analyzed. Results: The present study included laryngeal cancer (n = 155) and hypopharyngeal cancer (n = 57). The patients' age ranged from 38 to 84 years, with the mean age of 62.08±9.67 years. The common clinical presentations were hoarseness (73.6%), cervical lymphadenopathy (35.8%), sorethroat (22.2%), and odynophagia (14.6%). The laryngeal cancer commonly involves true vocal cord (86.5%), anterior commissure (65.8%), false vocal cord (56.8%), laryngeal ventricle (53.5%), subglottis (47.1%), and paraglotic space (35.5%), respectively. Fifty-three percent of cases had stage IV cancer. The most common postoperative surgical sequela was hypothyroidism (77.8%). The overall 5-year survivals for laryngeal cancer and hypopharyngeal cancer were 55% and 9%, respectively. The 5-year survival for node-negative cases was 61.8% versus 17% for node-positive cases (p< 0.001). AJCC stage of laryngeal cancer and hypopharyngeal cancer was a significant predictor of 5-year survival (p< 0.001 and p = 0.004, respectively). Conclusions: The advanced AJCC stage, advanced T stage, advanced N stage, extracapsular tumor spread, and tumor invasion of false vocal cord, epiglottis, preepiglottic space, paraglottic space, thyroid cartilage, cricothyroid membrane were found to significantly augment the decrease of 5-year survival in laryngeal cancer. Only advanced AJCC stage was significantly associated with 5-year survival rate in hypopharyngeal cancer.

Polymorphous low-grade adenocarcinoma of the epiglottis: A case report.

Polymorphous low-grade adenocarcinoma is an uncommon malignant tumor derived from the terminal duct cells of the salivary glands. The present study described a rare case of polymorphous low-grade adenocarcinoma, T2N0M0 stage 2, in a 65-year-old man, who presented with a sore throat and painful dysphagia. Computed tomography revealed an infiltrative heterogenous enhancing mass involving the left aryepiglottic fold. He underwent a tumor removal with frozen section for evaluating the surgical margin. Subsequent supraglottic laryngectomy was performed. Polymorphous low-grade adenocarcinoma was diagnosed histologically, characterized by cytologic uniformly, morphologic diversity and an infiltrative growth pattern. Epiglottic cartilaginous invasion by the tumor is demonstrated. Clinical, radiological, endoscopic and pathological features with briefly reviewed relevant literatures are discussed. This is the first reported description in the literature, to the best of our knowledge, of an epiglottic polymorphous low-grade adenocarcinoma receiving successful supraglottic laryngectomy with 7 year disease free survival.

Audiological outcomes of cochlear implantation in Ramathibodi Hospital.

OBJECTIVE: To evaluate the outcomes of the patients at 1-year post cochlear implantation emphasized on audiological outcomes. MATERIALS AND METHOD: Retrospective study of hearing response follow in three, six, and 12 months of 143 ears undergoing cochlear implantation between 1995 and 2009. Only 77 ears were found to have the completed data for analysis. Deaf patients were categorized into five groups in which they were operated by four different cochlear implant devices. The two parameters used to evaluate the outcomes included the aided response (AR), assessing the hearing threshold of cochlear implant user; and the Categories of Auditory Performance (CAP) which assess their auditory receptive abilities. RESULTS: Demographic data showed male:female ratio was 4:3. Age ranged from 2 to 68 years. Although the aided hearing threshold among five groups of deafness showed improvement without statistical difference, the auditory ability showed significance higher score in post-lingual than pre-lingual deaf patients (p < 0.05). Patients with aural communication prior to surgery also showed higher auditory ability than those without aural communication (p < 0.05). The outcomes of CAP were analyzed among patients operated with different cochlear implant devices. Users with Pulsar CI 100 Opus 2, HiRes 90K Auria, and HiRes 90 K Harmony showed better auditory ability than with Combi 40+ Tempo+. Both mean scores of AR and CAP were higher at six and 12 months than at three months. At 12 months the scores were higher than at six months (p < 0.05). CONCLUSIONS: Cochlear implant surgery resulted in good hearing, however the improvement of speech understanding need more time to practice. Patients using cochlear implant at 12 months showed more improvement of hearing and performance than those using for less than 12 months.

Fourteen-years experience with cochlear implantation in Ramathibodi Hospital.

OBJECTIVE: To review the cochlear implant program in Ramathibodi Hospital and share experience of cochlear implantation emphasized on clinical and surgical outcomes. MATERIAL AND METHOD: Retrospective review of 143 ears (140 patients) operated with cochlear implant between 1995 and 2009. The demographic data including etiology of deafness and findings from temporal bone CTscans were reviewed. The authors' experience with cochlear implant surgery in terms of patient selection, patient advisory clinic, necessary equipment, pre- and postoperative evaluations, surgical techniques and complications were discussed. RESULTS: Most congenital origin was unknown etiology and congenital rubella was the most common known cause. From the CT scans of congenital deafness, vestibular aqueduct dilatation was the most common and found in 29.31% while Mondini malformation was shown to be 16.37%. The authors' surgical technique of using the pocket method and designed bony ridge at cortical mastoid rim had helped stabilizing the implant and electrode fancoil. During the last two years, no complication or revision surgery was detected. CONCLUSION: Cochlear implant surgery in both children and adults can result in good surgical outcome and fewer complications under experienced surgeons and a good team.

Expression of hormonal receptor in patients with metastasizing pleomorphic adenoma of the major salivary gland; a clinicopathological report of three cases.

BACKGROUND: Metastasizing pleomorphic adenoma is an uncommon malignant tumor of the salivary gland demonstrating benign epithelial and modified myoepithelial elements intermingling with tissue of mucoid, myxoid, or chondroid appearance that inexplicably manifests local or distant metastasis. OBJECTIVE: To determine the expression of hormonal receptor in the patients with metastasizing pleomorphic adenoma of the major salivary gland. MATERIAL AND METHOD: Medical records, clinical and pathologic findings of three patients who were diagnosed as metastasizing pleomorphic adenoma were reviewed. The immunohistochemical stains for estrogen receptor, progesterone receptor, and Ki-67 were performed. RESULTS: Three cases of metastasizing pleomorphic adenoma, clinically presenting as painless, gradually enlarged cervical lymph nodes were reported. The pathologic examinations of the cervical lymph nodes are morphologically and immunohistologically identical to the sialoadenectomy specimen. Immunohistochemical stains show positive reactivity to progesterone receptor but negative reactivity to estrogen receptor in both mesenchymal and epithelial components of pleomorphic adenoma. CONCLUSION: These are the first reported cases of metastasizing pleomorphic adenoma of the major salivary glands associated with expression of progesterone receptor in both specimens of sialoadenectomy and lymph node biopsy. This finding supports the pathogenesis of benign metastasis of tumor. However, the role of hormonal receptor in the pathogenesis and treatment of salivary metastasizing pleomorphic adenoma should be further investigated.

Parapharyngeal [corrected] salivary duct carcinoma involving the cavernous sinus.

Salivary duct carcinoma (SDC) is a relatively uncommon malignant tumor of the salivary gland derived from the excretory duct reserve cells of the salivary glands. The authors report a case of SDC in a 34-year-old man who presented with trismus and left sided headache, radiologically by a left parapharyngeal mass involving into the left cavernous sinus and histologically by intraductal growth pattern with a cribriform appearance and comedonecrosis. Perineural invasion of the mandibular branch of trigeminal nerve is demonstrated. Clinical and pathologic features with relevant literatures are reviewed.