Comparison of upper gastrointestinal fluoroscopy versus computed tomography for evaluation of post-operative leak in a bariatric surgery patient.

Bariatric surgery patients commonly undergo post-operative fluoroscopic evaluation for complications, including leaks, in order to progress with oral intake and recovery. As one of the most severe and potentially life-threatening complications, leaks occur in as many as 5% of bariatric surgery patients. Several characteristics of these patients complicate the detection of leaks, including large body habitus and limited mobility. The early detection of leaks can lead to significant reductions in morbidity and mortality in bariatric surgery patients. In a retrospective case series of 619 patients, of whom 20 had experienced a leak, CT scan had a sensitivity of 95% and specificity of 100%, while upper gastrointestinal (UGI) evaluation had an inferior sensitivity of 79% and specificity of 95%. In addition to greater sensitivity and specificity, CT scan can identify other complications, such as abscesses and bowel obstructions. Also, UGI evaluation is notably more dependent on patient and technologist compliance, resulting in suboptimal examinations. UGI, on the other hand, may help further define the size and more precise location of the leak, but typically cannot be performed until the following day if the patient becomes symptomatic at night. We propose that CT evaluation, used in combination with UGI, may increase the overall sensitivity of detecting a leak, thereby improving patient outcomes and decreasing hospital utilization.

Neutrophil-to-lymphocyte ratio: Prognostic indicator for head and neck squamous cell carcinoma.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) has prognostic significance for many cancers, with higher values correlating with poor outcomes. The purpose of this study was to determine the prognostic significance of this inflammatory marker for patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Univariate logistic regression and multivariate Cox regression analyses were performed on a retrospective cohort of 123 patients treated with primary chemoradiotherapy. RESULTS: The NLR is an indicator of both recurrence-free and overall survival, but the NLR does not have independent prognostic significance when the favorable prognostic influence of human papillomavirus (HPV) status is incorporated into multivariate models. CONCLUSION: The interaction between NLR and HPV status suggests that HPV status may be a determining factor in the favorable prognosis associated with a decreased NLR in HNSCC; these findings also suggest that HPV status may interact with the prognostic associations of indicators of systemic inflammation in HNSCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 662-667, 2017.