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Izuka, Edna Namiko, Murilo Fernando Neuppmann Feres, and Shirley Shizue Nagata Pignatari. "Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers." Dental Press Journal of Orthodontics 20, no. 3 (2015): 43–49. http://dx.doi.org/10.1590/2176-9451.20.3.043-049.oar.
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OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia.
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Teguh, David N., Peter C. Levendag, Inge Noever, et al. "Treatment Techniques and Site Considerations Regarding Dysphagia-Related Quality of Life in Cancer of the Oropharynx and Nasopharynx." International Journal of Radiation Oncology*Biology*Physics 72, no. 4 (2008): 1119–27. http://dx.doi.org/10.1016/j.ijrobp.2008.02.061.
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Atasever Akkas, Ebru, Birsen Yucel, Saadettin Kilickap, et al. "Assessment of the life quality in head and neck cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (2012): e16005-e16005. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16005.
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e16005 Background: In this study, we aimed to investigate the effect of radiotherapy on the life quality in head and neck cancer patients. Methods: Between 2007 and 2010 years, 82 head and neck cancer patients who had taken radiotherapy at Cumhuriyet University Department of Radiation Oncology were assessed at the beginning, midline of the treatment and 1 and 6 months after radiotherapy with European Organization for Reseach and Treatment of Cancer Ouality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35). Wilcoxon sign test were used in the statistical analysis in SPSS version 15.0. Results: Seventy two (%88) men, 10 (%12) women; were analyzed. The median age of the patients was 57 (20-80). Squamous cell carcinoma was the most frequently seen case in 69 (%84) patients. The distribution of the patients according to the localization: larynx carcinoma in 37 (%45) patients, oral cavity tumor in 21 (%26) patients, nasopharynx carcinoma in 14 (%17) patients, paraphypopharynx in 8 (%10) patients and primary unknown in 2 (%2) patients were present. All the symptom scores were affected negatively at the midline, the end, 1 mount after radiotherapy than before the radiotherapy. Pain, swallowing, speech, social eating, social contact, less sexuality, feeling ill, weight loss, weight gain of the symptoms scale scores showed significant improvement at 6 months after the radiotherapy (p<0,05). However it was seen that senses, teeth problems, dry mouth, sticky saliva were affected negatively in the 6th month of radiotherapy than the beginning. Conclusions: In radiotherapy, the life quality of the patients has significantly degraded during the treatment and 1 month after the treatment. However after six months, all the symptom scales were measured as in the beginning. [Table: see text]
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Bugari, Radmila Anca, Sorin Bașchir, Ciprian Mihali, et al. "BACTERIAL BIOFILM IN CHILDREN WITH CHRONIC RHINOSINUSITIS AND CHRONIC ADENOIDITIS." Romanian Medical Journal 68, no. 2 (2021): 256–61. http://dx.doi.org/10.37897/rmj.2021.2.19.
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Chronic rhinosinusitis with chronic adenoiditis in children represents a global public health issue, seriously affecting the quality of parents and children life, because of its irritating symptoms like intermittent snoring, mouth breathing, dry mouth, nasal obstruction, headaches increased irritability and focus disorders on children. Bacterial biofilms are highly associated with the chronic infectious processes in children. Correct therapeutical management of this diagnostic combination is mandatory to improve the quality of one’s life. Objectives. The aim of the study is: to observe the ratio of adenoid mucosa covered with bacterial biofilm extracted from the nasopharynx of 50 paediatric patients suffering of chronic rhinosinusitis (RSC) and chronic adenoiditis (CA); and to point the fact that the adenoids contaminated with bacterial biofilm are a generator for chronic upper airway infections in children. Material and methods. We have measured using an image analysis program the bacterial biofilm covering the entire surface of the extracted adenoids mases, from 28 girls and 22 boys aged between 5 and 12 years diagnosed with CRS and CA. Control visits were performed to verify symptom improvement at 1, 3 and 6 months. Outcomes. Adenoids extracted from paediatric patients diagnosed with CRS and CA presented bacterial biofilms coverage on almost the entire mucosa (86.75%). Conclusions. Adenoid mases removed from paediatric patients with CSR and CA have most of their mucosal covered with bacterial biofilm. In the nasopharynx of paediatric patients with CSR and CA, bacterial biofilm can play the role of a constant fountain of infection. Adenoid mass removal explains the symptomatic improvement observed post operatory in the CRS with CA paediatric patients that do not respond to antibiotic therapy.
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Sherry, Alexander D., Dario Pasalic, G. Brandon Gunn, et al. "Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life." International Journal of Particle Therapy 8, no. 1 (2021): 234–47. http://dx.doi.org/10.14338/ijpt-20-00034.1.
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Abstract Purpose Proton radiation therapy (PRT) may offer dosimetric and clinical benefit in the treatment of head and neck carcinoma of unknown primary (HNCUP). We sought to describe toxicity and quality of life (QOL) in patients with HNCUP treated with PRT. Patients and Methods Toxicity and QOL were prospectively tracked in patients with HNCUP from 2011 to 2019 after institutional review board approval. Patients received PRT to the mucosa of the nasopharynx, oropharynx, and bilateral cervical lymph nodes with sparing of the larynx and hypopharynx. Patient-reported outcomes were tracked with the MD Anderson Symptom Inventory–Head and Neck Module, the Functional Assessment of Cancer Therapy–Head and Neck, the MD Anderson Dysphagia Inventory, and the Xerostomia-Related QOL Scale. Primary study endpoints were the incidence of grade ≥ 3 (G3) toxicity and QOL patterns. Results Fourteen patients (median follow-up, 2 years) were evaluated. Most patients presented with human papillomavirus–positive disease (n = 12, 86%). Rates of G3 oral mucositis, xerostomia, and dermatitis were 7% (n = 1), 21% (n = 3), and 36% (n = 5), respectively. None required a gastrostomy. During PRT, QOL was reduced relative to baseline and recovered shortly after PRT. At 2 years after PRT, the local regional control, disease-free survival, and overall survival were 100% (among 7 patients at risk), 79% (among 6 patients at risk), and 90% (among 7 patients at risk), respectively. Conclusion Therefore, PRT for HNCUP was associated with highly favorable dosimetric and clinical outcomes, including minimal oral mucositis, xerostomia, and dysphagia. Toxicity and QOL may be superior with PRT compared with conventional radiation therapy and PRT maintains equivalent oncologic control. Further prospective studies are needed to evaluate late effects and cost-effectiveness.
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Ovchinnikov, A. Yu, N. A. Miroshnichenko, and Yu O. Nikolaeva. "Effective and safe treatment for the inflammatory diseases of the nose and nasopharynx." Russian Medical Inquiry 4, no. 4 (2020): 238–42. http://dx.doi.org/10.32364/2587-6821-2020-4-4-238-242.
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Inflammatory diseases of the nasal cavity and paranasal sinuses are identified as the leading cause of upper respiratory disorders. Nose breathing is of crucial importance to provide the entry for air to get into the respiratory system. In addition to oxygen saturation, nose breathing provides the exchange of air in the paranasal sinuses. This process is required to maintain normal microflora of the nasal cavity. In contrast, mouth breathing occurring during the inflammatory diseases of the nasal cavity is associated with discomfort and poor health-related quality of life and results in inflammation. Viral inflammatory disorders often exacerbate a patient’s condition and provoke bacterial inflammation. Recent widespread occurrence of antimicrobial resistance forced to change the paradigm in the treatment of inflammatory disorders and to refocus on time-proved topical therapies. Systemic antibiotics are now used only for strict indications. Other treatment options are widely applied. Thus, silver preparations characterized by antiseptic and bactericidal properties allow to avoid complications and to aid the recovery. They are the best choice of topical agents for treating acute rhinosinusitis. KEYWORDS: acute rhinitis, acute rhinosinusitis, acute respiratory viral infections, antibacterial drugs, topical treatment, argentum proteinate. FOR CITATION: Ovchinnikov A.Yu., Miroshnichenko N.A., Nikolaeva Yu.O. Effective and safe treatment for the inflammatory diseases of the nose and nasopharynx. Russian Medical Inquiry. 2020;4(4):238–242. DOI: 10.32364/2587-6821-2020-4-4-238-242.
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Burkey, Brian B., and Robert H. Ossoff. "Endoscopy of Nasopharyngeal Cancer." Diagnostic and Therapeutic Endoscopy 1, no. 2 (1994): 63–68. http://dx.doi.org/10.1155/dte.1.63.
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Nasopharyngeal cancer (NPC) is a unique disease with increasing interest for many physicians due to its unusual etiology, histology, and epidemiology. The recent era of fiberoptic endoscopy now provides the clinician with better tools for the screening, diagnosis, staging, and follow-up of NPC. The use of high resolution flexible and rigid nasopharyngoscopy gives the physician an opportunity for a more sensitive examination in a higher proportion of patients. Ultimately, this will allow for earlier diagnosis of NPC, and improved prognosis and better quality of life for the patients with this disease. Also, by allowing the clinician to perform directed biopsies of the nasopharynx under local anesthesia, fiberoptic nasopharyngoscopy allows a less morbid and more cost-effective approach towards this disease, including screening protocols in certain high risk regions of the world.
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Waliyanti, Ema, and Harumi Iring Primastuti. "Family Support: A Caregiver Experience in Caring for Nasopharynx Cancer Patients in Yogyakarta." Open Access Macedonian Journal of Medical Sciences 9, T4 (2021): 245–52. http://dx.doi.org/10.3889/oamjms.2021.5772.
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BACKGROUND: Increasing the incidence of nasopharyngeal cancer causes an increase mortality in sufferers. Family support is an important aspect of the treatment of patients that very helpful to strengthen psychologically and make patients more enthusiastic about undergoing treatment. Patients who have high enthusiasm will improve their quality of life so that family support is needed in treating patients. AIM: This study aims to explore family experiences in providing support in the care of nasopharyngeal cancer patients in Yogyakarta. METHODS: This research uses qualitative method with phenomenological approach. Data collected through in-depth interviews. Informants in this study amounted to 12 people consisting of patients and families determined by purposive sampling. This research was conducted in Sleman Regency from January to April 2019. Data validity uses source triangulation, member checking, and peer debriefing. Analysis of the data in this study using the help of OpenCode 4.02 software. RESULTS: The results showed that the treatment of patients with nasopharyngeal cancer was influenced by several factors, namely, family perceptions in caring for patients, family knowledge about the disease, and family information sources. These factors will affect the family process in providing care to patients including family support, family communication, and medication that have been undertaken. Family support is provided in the care of nasopharyngeal cancer patients in the form of emotional, informational, instrumental, appreciation, and spiritual support. In addition, in carrying out patient care, there are several obstacles, namely, transportation, administrative, and financial obstacles. CONCLUSION: The family is expected to always provide support to patients in the form of emotional support, informational, instrumental, and appreciation as well as spiritual support for the success of treatment of the patient.
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Svajdova, Michaela, Marian Sicak, Pavol Dubinsky, Marek Slavik, Pavel Slampa, and Tomas Kazda. "Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic." Cancers 12, no. 12 (2020): 3510. http://dx.doi.org/10.3390/cancers12123510.
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Recurrent nasopharyngeal carcinoma represents an extremely challenging therapeutic situation. Given the vulnerability of the already pretreated neurological structures surrounding the nasopharynx, any potential salvage retreatment option bears a significant risk of severe complications that result in high treatment-related morbidity, quality of life deterioration, and even mortality. Yet, with careful patient selection, long-term survival may be achieved after local retreatment in a subgroup of patients with local or regional relapse of nasopharyngeal cancer. Early detection of the recurrence represents the key to therapeutic success, and in the case of early stage disease, several curative treatment options can be offered to the patient, albeit with minimal support in prospective clinical data. In this article, an up-to-date review of published evidence on modern surgical and radiation therapy treatment options is summarized, including currently recommended treatment modifications of both therapeutic approaches during the coronavirus disease 2019 pandemic.
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Aldandan, Ahmed, Ali . Almomen, Abdulrahman Alkhatib, and Ghaleb Alazzeh. "Pediatrics Ewing’s Sarcoma of the Sinonasal Tract: A Case Report and Literature Review." Case Reports in Pathology 2019 (January 2, 2019): 1–3. http://dx.doi.org/10.1155/2019/8201674.
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Ewing’s sarcoma (ES) is a highly malignant, small, round cell tumor that originates from the primitive neuroectodermal cells. Primary ES commonly occurs in early childhood or adolescence. It may present with skeletal and extraskeletal forms. The extraskeletal form is rarely encountered in the head and neck region and is extremely rare in the sinonasal tract. This is a case report of sinonasal ES in a 13-year-old female patient who presented with a 7-month history of right nasal obstruction, anosmia, intermittent epistaxis, snoring, and hearing loss. Clinical examination revealed a right nasal mass pushing the septum to the left side and extending to the nasopharynx. Endoscopic biopsy and histopathological analysis showed a small blue cell tumor suggestive of ES. The patient was treated with surgery, radiotherapy, and chemotherapy. After a follow-up of 5 years, the patient remains recurrence-free with excellent functional status and quality of life.
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Budu, Vlad, Mihail Tusaliu, Alexandru Coman, and Ioan Bulescu. "Squamous cell carcinoma of the pterygopalatine fossa - A case report." Romanian Journal of Rhinology 6, no. 23 (2016): 173–76. http://dx.doi.org/10.1515/rjr-2016-0020.
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Abstract The pterygopalatine fossa is an inverted pyramid-shaped space of the viscerocranium, protected by bony structures. Surgical access to this anatomical space is difficult, especially for tumor resection. There are numerous open surgical techniques for accessing this space, but nowadays, minimally-invasive endoscopic approaches are preferred in order to increase postoperative quality of life and reduce postoperative morbidities.The tumors of the pterygopalatine fossa can be benign or malignant, and can occur primarily in the fossa or as secondary extensions from the surrounding regions through the multiple canals and foramina in its walls. Squamous cell carcinomas of this space have been described to appear as extensions from the nasopharynx, the paranasal sinuses or through perineural extension from the cutaneous branches of the maxillary nerve.In this paper the authors present a rare case of squamous cell carcinoma of the pterygopalatine fossa, which was excised in an endoscopic transnasal approach after preoperative selective embolization.
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Kang, Yung Jee, Sang Duk Hong, and Man Ki Chung. "A Case of Free Flap Reconstruction after Endoscopic Debridemnt for Recalcitrant Nasopharyngeal Osteoradionecrosis Without Facial Incision." Journal of Rhinology 28, no. 2 (2021): 120–24. http://dx.doi.org/10.18787/jr.2021.00353.
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High-dose radiation therapy is the treatment of choice for nasopharyngeal cancer, and clinical outcomes have improved in recent decades. A certain proportion of patients, however, suffer from post-radiation nasopharyngeal necrosis (PRNN). Patients with PRNN complain of headache, foul odor, or symptoms of cranial nerve palsies. Clinically, intracranial infection or bleeding from carotid artery damage may lead to sudden death or severe deterioration in quality of life. Although the prognosis of PRNN was poor, endoscopic debridement with local vascularized flap recently showed favorable outcomes, and many centers are using this technique with a nasoseptal flap. However, if the flap fails or does not fully cover necrotized tissues, necrosis inevitably reoccurs. In this situation, free flap transfer with a facial incision using a transmaxillary approach is used, but some drawbacks exist. In this report, we propose a new resurfacing technique for recurrent PRNN using a transoral-cervical free flap tunneling approach into the nasopharynx without a facial incision after endoscopic debridement.
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Bektaş-Kayhan, K., CD Özbek, O. Yazıcıoğlu, et al. "Long Term Maxillofacial Effects of Radiotherapy in Young Nasopharyngeal Carcinoma Patients: Report of 3 Cases." Journal of Clinical Pediatric Dentistry 37, no. 4 (2013): 407–10. http://dx.doi.org/10.17796/jcpd.37.4.h6343u6378428n26.
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Nasopharyngeal carcinoma (NPC) is a rare and distinct malignancy that arises from the epithelium of the nasopharynx. It accounts almost 1 % of all pediatric malignancies. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on salivary glands, oral mucosa, bone, dentition, masticatory musculature, and temporomandibular joints. Here we present 3 male NPC patients 13, 14 and 15 years old. One of them had stage III and the others stage IV diseases. Administered dose of radiation was 66 Gy for case I, 70 Gy for case II and 68 Gy for case III. The follow-up period was more than 12 months except for case III and all of them were disease free in their last visit. All attended dental clinics for dental and TMJ problems. Dentitions were severely affected, trismus and severe xerostomia. Long term effects of radiotherapy which has a great impact on patients’ quality of life and the role of supportive care and minimizing the late effects of ionizing radiation are discussed.
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Rasulov, Alexey, and Saifutdin Arifov. "Comparative analysis of the quality of life of patients with some methods of surgical treatment of vasomotor rhinitis." OTORHINOLARYNGOLOGY, no. 2(1) 2018 (June 11, 2018): 32–38. http://dx.doi.org/10.37219/2528-8253-2018-2-32.
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Quality of life (abbr. – QOL) is a category with which it characterizes the essential circumstances of the life of the population, determining the degree of dignity and freedom of the personality of each person and a subjective indicator when evaluating the results of treatment of chronic diseases. To determine the quality of life of patients with cavity problems and SNPs, such as rhinitis and sinusitis, special questionnaires have been created, translated into Russian and adapted. The purpose of this study is to examine in a comparative aspect the indicators of the quality of life of patients with vasomotor rhinitis with various treatment methods. Materials and Methods: The study was conducted in the clinic of the Department of Otorhinolaryngology of the Tashkent institute of postgraduate medical education on 43 patients with vasomotor rhinitis in age from 20 to 46 years, average age 28±1.3 years. All patients with BP included in our study, after collecting complaints and anamnesis, underwent an endoscopic examination of the nasal cavity and nasopharynx, a computerized tomogram of the nose and paranasal sinuses, standard laboratory tests and microscopy of a smear from the nasal cavity on eosinophils. Evaluation of QOL was performed according to a special questionnaire Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Results: Studies have shown the highest efficiency of laser coagulation with vasomotor rhinitis. After laser surgery, a rapid improvement in QOL was observed, and there was no adverse effect on the mucous membrane of the nasal cavity. Given the well-tolerated laser coagulation, the lack of the need for observation and care of the nasal cavity in the postoperative period, the possibility of outpatient treatment, allows us to recommend this type of exposure as the method of choice in the surgical treatment of patients with vasomotor rhinitis. However, the need for special equipment and the availability of trained personnel who have access to work with laser systems somewhat limits the widespread use of this method. The simplicity of submucosal vasotomy, the availability of tools for carrying out, the rather rapid restoration of QOL, puts it on a par with the laser effect on efficiency. The need to use nasal tampons after surgery, hospital stay and patient monitoring in the early postoperative period reduces the patients' QL and makes this operation strictly inpatient. In our study, electrocautery demonstrated the lowest rate of improvement in QOL than during laser irradiation and submucous vasotomy. The most slow and incomplete restoration of QOL in this method of treatment emphasizes the disadvantage of this method from the point of view of the patient's QOL. Conclusion: Evaluation of the long-term results of surgical treatment of QL and clinical manifestations of BP makes it possible to recommend laser coagulation as the most optimal method providing a long-lasting effect in treating patients with BP. An alternative is to take a submucous vasotomy of the inferior nasal concha.
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Yonts, Alexandra B., Nada Harik, Alyssa Doslea, et al. "170. Acute Flaccid Myelitis: Patient Characteristics and Prospective Follow-up Study at Children’s National Hospital, 2013–2019." Open Forum Infectious Diseases 7, Supplement_1 (2020): S214. http://dx.doi.org/10.1093/ofid/ofaa439.480.
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Abstract Background Acute Flaccid Myelitis (AFM), diagnosed almost exclusively in children, is characterized by sudden onset flaccid weakness in one or more extremities with distinct gray matter spinal cord lesions on magnetic resonance imaging (MRI), with or without cerebrospinal fluid (CSF) pleocytosis. Outbreaks of AFM have occurred biennially since 2014. Although the definitive causative agent(s) remain unknown, current data support an association with Enteroviruses D68 and A71. Treatment is supportive and long-term prognosis is variable, with many children having persistent motor deficits. Methods In this prospective cohort study, we identified patients with clinical and radiographic presentation consistent with AFM at Children’s National Hospital (CNH) from 2013–2019. Medical records and MRIs of identified patients were then reviewed by members of the multidisciplinary CNH AFM Task Force to identify those meeting diagnostic criteria for AFM. Identified patients had follow-up arranged in the multidisciplinary AFM clinic for exam, functional motor assessment and quality of life questionnaires (Peds QL, PROMIS and NeuroQoL). Results Since 2013, we identified 22 patients meeting criteria for AFM at CNH. The average age of our patients was 7.25 years (range 6 months to 16 years); almost 2/3 of patients had CSF pleocytosis. Half of patients presented with initial neurologic complaint of single limb weakness. Other presenting neurological symptoms included ataxia, bilateral lower extremity weakness and ophthalmoplegia. A potential infectious cause was identified in the CSF, blood, nasopharynx or stool of 9 patients. As of November 2019, 7 of 21 patients have had follow-up evaluation; 1 had no improvement, 4 had partial improvement but with persistent motor deficits, and 2 had complete resolution. Two patients/families have completed quality of life questionnaires to date. CNH AFM Patient Characteristics and Results Conclusion Similar to other centers, the majority of CNH AFM patients with follow-up to date have persistent and significant long term motor deficits. Assessment of quality of life is an important aspect that has not yet been formally assessed in other studies and will provide useful information regarding the experience of these patients and help identify goals for optimizing care in the future. Disclosures All Authors: No reported disclosures
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Bai, Yichun, Yang Liu, Zhenlei Su, et al. "Gene editing as a promising approach for respiratory diseases." Journal of Medical Genetics 55, no. 3 (2018): 143–49. http://dx.doi.org/10.1136/jmedgenet-2017-104960.
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Respiratory diseases, which are leading causes of mortality and morbidity in the world, are dysfunctions of the nasopharynx, the trachea, the bronchus, the lung and the pleural cavity. Symptoms of chronic respiratory diseases, such as cough, sneezing and difficulty breathing, may seriously affect the productivity, sleep quality and physical and mental well-being of patients, and patients with acute respiratory diseases may have difficulty breathing, anoxia and even life-threatening respiratory failure. Respiratory diseases are generally heterogeneous, with multifaceted causes including smoking, ageing, air pollution, infection and gene mutations. Clinically, a single pulmonary disease can exhibit more than one phenotype or coexist with multiple organ disorders. To correct abnormal function or repair injured respiratory tissues, one of the most promising techniques is to correct mutated genes by gene editing, as some gene mutations have been clearly demonstrated to be associated with genetic or heterogeneous respiratory diseases. Zinc finger nucleases (ZFN), transcription activator-like effector nucleases (TALEN) and clustered regulatory interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) systems are three innovative gene editing technologies developed recently. In this short review, we have summarised the structure and operating principles of the ZFNs, TALENs and CRISPR/Cas9 systems and their preclinical and clinical applications in respiratory diseases.
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Lapidot, Rotem, Tyler Faits, Ismail Arshad, et al. "2628. Nasopharyngeal Microbiome in the First Weeks of Life Distinguishes Infants Who Subsequently Develop Lower Respiratory Tract Infections." Open Forum Infectious Diseases 6, Supplement_2 (2019): S917. http://dx.doi.org/10.1093/ofid/ofz360.2306.
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Abstract Background Colonization of the nasopharynx (NP) is the initial event in the pathogenesis of lower respiratory tract infections (LRTI). Evidence is accumulating that the NP microbiome influences host immune responses and whether colonization progresses to disease or not. We hypothesized that infants who experience LRTI early in life display distinct NP microbiome characteristics prior to infection, and potentially as early as the newborn period. Methods As part of the “Southern Africa Mother Infant Pertussis Study” in Zambia, NP samples were prospectively collected approximately every 2 weeks beginning at birth, through 3 months of age, in conjunction with clinical data. Samples were also collected when an infant experienced respiratory symptoms. We identified infants from the cohort with LRTI and matched with asymptomatic controls. We performed 16S ribosomal DNA amplicon sequencing on DNA extracted from the NP samples using Illumina MiSeq, and analyzed the data using Qiime2 and PathoScope2. We described the NP microbiome characteristics of asymptomatic infants and infants with LRTI and their changes over time and compared between the two populations at each 2-week interval using the R package DESeq2. Results Ten infants who had LRTI during the study period were matched with 17 healthy asymptomatic controls, together contributing 183 samples with high-quality reads. In asymptomatic infants, Dolosigranulum, Haemophilus and Moraxella’s relative abundance increased over the first 3 months of life, while Corynebacterium and Staphylococcus relative abundance decreased in the NP microbiome (Figure 1). In contrast, infants who developed LRTI had increased abundance of Staphylococcus, Anaerobacillus, and Bacillus, and decreased relative abundance of Dolosigranulum and Moraxella compared with asymptomatic controls (Figure 2). These differences were already present at the time of first sample collection (age 1 week). Conclusion Infants who develop LRTI early in life demonstrate altered NP microbial composition as early as the first week of life. These differences could potentially lead to early identification of at-risk infants. If confirmed, interventions to prevent LRTI in infancy could be evaluated to reduce respiratory mortality and morbidity. Disclosures All authors: No reported disclosures.
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Santos, Marcos Antonio, Luis Felipe Oliveira e Silva, Hugo Fontan Kohler, et al. "Impact of systemic treatment associated to radiotherapy on quality of life in locally advanced head and neck cancer patients in Brazil: Prospective real-world data study." Journal of Clinical Oncology 37, no. 15_suppl (2019): e17563-e17563. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17563.
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e17563 Background: the purpose of this study was to compare quality of life (QoL) and overall survival (OS) in patients with locally advanced head and neck cancer treated with radiotherapy only (RT), chemoradiotherapy with cisplatin (CT-RT) or RT with cetuximab (CET-RT). Methods: in this real-world, multi-institutional and prospective study, QoL outcomes were assessed using EORTC QLQ-C30 and QLQ-H&N43 questionnaires. Patients were treated according to each participating institution’s protocol. The Item Response Theory was used to generate a global QoL score, based on the 71 questions of both forms. Questionnaires were completed before treatment and every three months, thereafter. Survival was calculated using the Kaplan-Meyer method, and groups were compared by the log-rank test. The impact of the treatment modalities on QoL was analyzed using multivariate regression analyses. Results: Six hundred and twenty-six patients, with tumors located at the oral cavity (36%), oropharynx (30%), larynx (21%), hypopharynx (9%) and nasopharynx (4%) were included. Median follow up was 10.2 months. RT was delivered to 39% of the patients while 58% received CT-RT and 3% received CET-RT. Patients submitted to surgery were not included. OS was higher when systemic treatment was added to RT (median OS CET-RT: 21.9 months and CT-RT: 24.3 months, versus 14.2 months with RT, p < 0.05). A decrease in QoL during treatment was observed in all patients’ groups, but CT-RT had a statistically significant negative impact on QoL when compared to CET-RT (p = 0.02). An important limitation of the study is the low number of patients that received this last treatment modality, what is, probably, a result of local policies on reimbursement. Other factors that influenced QoL were alcohol consumption (better QoL for patients with no history of chronic alcohol consumption, p = 0.007) and radiotherapy technique (better QoL for patients treated with intensity-modulated RT, when compared to conformal RT, p < 0.001). Conclusions: We observed, as expected, better OS with systemic therapy, when associated to RT. A decrease in QoL was detected, as well, during treatment, but a less pronounced decrease was seen in patients receiving CET-RT, when compared to CT-RT. More studies are needed to confirm the QoL improvement in patients submitted to this last treatment approach.
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Kataria, Tejinder, Saumya R. Mishra, Deepak Gupta, et al. "Modulated radiotherapy for head and neck carcinomas: an outcome study." Journal of Radiotherapy in Practice 17, no. 4 (2018): 384–89. http://dx.doi.org/10.1017/s1460396918000183.
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AbstractBackgroundTo evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).Materials and methodsA total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.ResultsAmong the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.ConclusionsIn our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
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Muhammad, Noor, Muhammad Rafique, Saud Baloch, Syed Hyder Raza, Hina Khan, and Saeed Quresh. "CANCERS." Professional Medical Journal 21, no. 01 (2018): 123–29. http://dx.doi.org/10.29309/tpmj/2014.21.01.1907.
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Objective: To calculate the prevalence of common types of cancer in SINDHbased on Civil Hospital Karachi (CHK) database. Type of Study: Retrospective ObservationalStudy. Place & Duration of Study: Clinical Oncology Department Civil Hospital Karachi, fromJanuary, 2004 to December 2011(8 Years). Methods: All the Patients attending the oncologydepartment CHK were selected for study. After completing data the cancer registry patients werecategorized according to their diagnosis and this data was recorded on Microsoft Excel sheet.Results: During period of January 2004 to December 2011, the total number of patients includedin the study was 5504 out of which 2638 were males and 2866 females. The list of prevalence ofdifferent types of cancer was created and according to the statistical analysis based on CHK database, the increasing trend was seen in breast, oral cavity, lymphoid tissue, blood, colorectal, liver& biliary tract, faciomaxillary, lung, uterus, esophagus, gastrointestinal stromal tumor, larynx,ovary, male genital system, Nasopharynx, urinary system and brain cancers. Conclusions: It isconcluded that the registration of cancer patients is highly beneficial for the evaluation of cancerprevalence and incidence. This registration is also helpful for calculating the comparativeincidence and prevalence of cancers on national and international levels. The recorded data willalso help to improve the quality of life of cancer patients as this data is very much helpful toidentify the etiology and risk factors of cancers which will improve health prevention andmanagement plans by higher authorities.
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Guseva, A. L., and M. L. Derbeneva. "Antihistamines in the treatment of allergic rhinitis." Meditsinskiy sovet = Medical Council, no. 6 (May 27, 2020): 90–96. http://dx.doi.org/10.21518/2079-701x-2020-6-90-96.
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Allergic rhinitis is a common allergic disease that have a substantially negative impact on the patients’ quality of life. Pharmacotherapy is essential to the treatment of allergic rhinitis, including the use of antihistamines, leukotriene receptor antagonists, topical steroids, decongestants, cromones, anticholinergics and their various combinations. Antihistamines are commonly prescribed drugs to treat mild, moderate, and severe disease. The article discusses the mechanisms of action of first- and second-generation antihistamines and compares the potential side effects and drug interactions.First-generation antihistamines differ in their significant sedative and hypnotic effect, mainly due to their pronounced lipophilic properties and ability to transverse the blood–brain barrier and bind to H1-histamine receptors in the central nervous system. Due to low selectivity of the first-generation antihistamines, they may interact with other receptors and develop adverse side effects, including dry mouth, nasopharynx, more rarely pupillary dilation, increased intraocular pressure, tachycardia, and urine retention. Bilastine is a highly selective second-generation antihistamine that has a rapid onset and a prolonged action. This drug does not interact with the P450 cytochrome system or undergo significant metabolism in the human body, and therefore the drug has low potential for drug-drug interactions. Bilastine is excreted almost completely unchanged and therefore does not require dose adjustment in patients with renal or hepatic impairment. Bilastine demonstrated similar efficacy in seasonal allergic rhinitis compared to cetirizine and desloratadine, as well as similar efficacy and safety in long-term treatment of patients with perennial rhinitis compared to cetirizine. Bilastine is well tolerated both at standard and at supratherapeutic doses, appears to have less sedative potential than other second-generation antihistamines, and has no cardiotoxicity.
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Khan, Mohd Rizwan. "Oral Diseases Panorama in Dermatology: An Observational Study." International Journal of Innovative Research in Medical Science 5, no. 10 (2020): 427–35. http://dx.doi.org/10.23958/ijirms/vol05-i10/958.
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Background: The oral cavity is a mirror of the body, entry point to food, antigens, and microorganisms. Oral cavity with mastication and speech, also have a role play in immunological defense. The Oral mucous membrane is in link with skin, oropharynx, and nasopharynx. The oral cavity and anterior two-thirds of the tongue are formed by the ectoderm and that is why from a dermatologist's viewpoint, an oral opening is especially imperative and involved in a range of systemic and skin disease, also affect teeth and gums. The body's natural protection is in good quality oral care. Oral problems when associated with skin conditions require oral care as it affects the quality of life and enable dermatologist and dentist in the identification and diagnosing of systemic disease. Oral illness can bring into being from infection, inflammation or neoplastic, immunological, benign, or malignant. Results: The oral cavity is a mirror to a variety of systemic and cutaneous diseases. Interpretation of the symptom and signs of systemic diseases help early diagnosis. However, while not correct oral hygiene, microorganisms will reach levels that may result in oral infections and decay. The health status of our oral cavity can give us a strong signal of the health of our bodies. It proceeds as a premature warning system. That's why the oral cavity should be examined in one piece from the buccal mucosa to the oropharynx. Conclusion: The mouth is a straightforwardly available window of the body. In contemplation with development, composition, and utility oral cavity is only one of its kind. It is a two-way road as systemic skin disease has oral manifestation. Interpretation of the symptom and signs help in identification and early diagnosis of systemic diseases. Oral illness can bring into being from infection, inflammation or neoplastic, immunological, benign, or malignant. That's why the oral cavity should be examined in one piece from buccal mucosa, lips, tongue, gum, teeth, palate to the oropharynx. Knowledge of systemic diseases is vital in day to day clinical practice, often oral manifestation is the most significant or first sign of systemic illness. So dermatologists and dental surgeons are conscious of oral complaints and their association with systemic disease.
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Burtness, Barbara, Jean Bourhis, Jan Baptist Vermorken, et al. "LUX head and neck 2: A randomized, double-blind, placebo-controlled, phase III study of afatinib as adjuvant therapy after chemoradiation in primarily unresected, clinically high-risk, head and neck cancer patients." Journal of Clinical Oncology 30, no. 15_suppl (2012): TPS5599. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.tps5599.
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TPS5599 Background: Locally advanced squamous cell cancer of the head and neck (SCCHN) is treated with curative intent, but recurrence and death are common. SCCHN frequently over-expresses EGFR (ErbB1). Co-expression of other HER family members such as HER2 (ErbB2) may contribute to resistance to EGFR inhibition, which is the only validated targeted therapy in SCCHN. Methods: The trial investigates if adjuvant afatanib, an irreversible ErbB family blocker, which has shown preclinical activity against all ErbB dimers including EGFR and HER2, reduces the risk of recurrence in high-risk patients who have no evidence of disease following platinum-based chemoradiation with or without neck dissection. Patients are eligible who have received definitive chemoradiation to a minimum of 66 Gy, with concurrent cisplatin (≥200 mg/m2) or carboplatin (≥AUC 9), for SCC of the oral cavity, oropharynx, or hypopharynx or larynx. Patients with base of tongue or tonsil cancer and ≤10 pack years of tobacco use, as well as those with nasopharynx, sinus or salivary gland cancer, are excluded. Adequate bone marrow, liver and kidney function is required. Prior therapy with investigational agents or EGFR inhibitors is not permitted. Randomization must take place within 16 weeks of the completion of chemoradiation with or without subsequent neck dissection. Patients are randomized 2:1 to afatinib 40 mg po qd or placebo, and treatment continues for 18 months in the absence of disease recurrence, second primary tumors, or intolerance to the study medication. Dose escalation to 50 mg qd is undertaken in patients with no side effects, and stepwise dose reduction to 30 or 20 mg po qd for diarrhea, skin toxicity or other adverse events is permitted. The primary endpoint is disease-free survival (DFS). The study is planned to accrue approximately 669 patients worldwide, with a 90% power to detect a hazard ratio of 0.72. Secondary endpoints are DFS at 2 years, overall survival, health-related quality of life, and safety.
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Tunkel, David E., Samantha Anne, Spencer C. Payne, et al. "Clinical Practice Guideline: Nosebleed (Epistaxis) Executive Summary." Otolaryngology–Head and Neck Surgery 162, no. 1 (2020): 8–25. http://dx.doi.org/10.1177/0194599819889955.
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Objective Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the great majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. Purpose The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It will focus on nosebleeds that commonly present to clinicians with phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients, patients with hemorrhagic telangiectasia syndrome (HHT) and patients taking medications that inhibit coagulation and/or platelet function, are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the working group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based upon their experience and assessment of individual patients. Action Statements The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include 1 or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome (HHT). (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation about examination of the nasal cavity and nasopharynx using nasal endoscopy was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.
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Tunkel, David E., Samantha Anne, Spencer C. Payne, et al. "Clinical Practice Guideline: Nosebleed (Epistaxis)." Otolaryngology–Head and Neck Surgery 162, no. 1_suppl (2020): S1—S38. http://dx.doi.org/10.1177/0194599819890327.
Full textAbstract:
Objective Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient’s quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. Purpose The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It focuses on nosebleeds that commonly present to clinicians via phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients—patients with hereditary hemorrhagic telangiectasia syndrome and patients taking medications that inhibit coagulation and/or platelet function—are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. Action Statements The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include one or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome. (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation, about examination of the nasal cavity and nasopharynx using nasal endoscopy, was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.
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Izmailova, Elena S., Andrew Cohen, Rafi Kabarriti, Jeremy Eichler, Chengrui Huang, and Nitin Ohri. "Daily step counts to predict hospitalizations during chemoradiotherapy for head and neck cancer." Journal of Clinical Oncology 39, no. 15_suppl (2021): 1571. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.1571.
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1571 Background: Wearable activity trackers could provide useful data for managing cancer patients with respect to treatment selection, toxicity monitoring, and implementation of supportive care measures. Here, we seek to evaluate the association between daily step counts and hospitalizations in a cohort of patients with head and neck cancer (HNC). Methods: This analysis consists of patients enrolled in one of three prospective trials involving activity monitoring (NCT02649569, NCT03115398, NCT03102229) during chemoradiation. Study subjects were asked to wear a commercial fitness tracker continuously during the therapy. ECOG performance status (PS) was assessed at baseline, and quality of life (QoL) EORTC QLQ-C30 questionnaires were completed weekly. Multivariable Cox regression models with time-dependent covariates (average step count over the past 3 days, most recent QoL score) and time-fixed covariates (age, sex, baseline PS, study number, baseline tumor volume, and treatment setting [definitive versus postoperative]) were used to identify predictors of first hospital admission during the chemoradiotherapy course. In addition to the Cox regression models, linear mixed models were fitted with daily step count as the dependent variable to examine its relationship with certain independent variables including age, sex, weekend status, days after treatment initiation, and study number. Results: Sixty-six HNC patients who received chemoradiotherapy between 2015 and 2019 were included in the analysis. Median age was 60 (range: 27-88). 47% of patients had ECOG PS score 0, 47% ECOG score 1, and 6% ECOG score 2. 29% of patients had HPV-positive oropharyngeal tumors, and the most common other tumor subsites were larynx (27%), and nasopharynx (12%). The Cox regression survival model demonstrated a 26% reduction in the short-term hospitalization risk for every 1000 daily steps (averaged over the past 3 days, hazard ratio 0.74; 95% confidence interval (CI) 0.55-0.98, p = 0.0367). Hospitalizations were not significantly associated with most recent QoL or baseline ECOG PS. Additionally, according to the linear mixed model results, daily step count was not associated with age (p = 0.8048). Study subjects moved less on weekends (on average 245 fewer steps on weekends than weekdays, 95% CI 134-357, p < 0.0001). Also, an increase in most recently measured ECOG PS was associated with a decrease in daily step count (167 fewer steps for every increase in ECOG PS, 95% CI -289 to -45, p < 0.0072). Conclusions: Daily step counts are a dynamic predictor of hospitalizations in patients undergoing chemoradiotherapy for head and neck cancer. Interventional studies are needed to demonstrate feasibility of leveraging physical activity data to optimize supportive care during cancer therapy and enhance cancer care quality. Clinical trial information: NCT02649569, NCT03115398, NCT03102229.
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Haritha, C., and V. Shankar. "Oral morphine gargles: A cost effective approach for pain relief in patients with chemoradiation induced acute oral mucositis in head and neck cancers." Journal of Clinical Oncology 27, no. 15_suppl (2009): e20504-e20504. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20504.
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e20504 Background: Painful oral mucositis is the most significant dose-limiting toxicity in head & neck cancer patients treated with conc. CT-RT protocol. The purpose of this study is to evaluate the efficacy of oral morphine gargles in reducing the severity of chemoradiation induced mucositis pain & thus, its impact on nutrition, quality of life & cost of supportive care, during the treatment period. Methods: 106 consecutive patients, recruited between May 2006 through Dec. 2007, with adv. head and neck cancers (54 oropharynx, 42 hypopharynx & 10 nasopharynx) were included in the study. All patients underwent treatment under conc. CT-RT (Inj.CDDP 40mg/m2 weekly, RT: 66–70gy/33–35# @200cgy/# delivered by 3D- CRT). Patients who had painful mucositis (RTOG Grade 3 or more) not controlled with magic mouthwash, Tab. Acetaminophen 500mg qds or Tab.Tramdol 50–100 mg tds were randomized into 2 groups: morphine group (MOP) -53 patients & Control group (CON) - 53 patients. Patients in both groups received adjusted doses of oral steroids based on the severity of oral mucositis. While CON group patients were given adjusted doses of tramadol, MOP group patients were assigned to 15ml of 2% morphine gargles administered every 4th hourly. Patients were instructed not to swallow the rinses and to hold the solution in the mouth for 3mins duration. All patients underwent weekly recording of (1) response to pain rated on VAS (2) weight (3) morphine systemic side-effects (4) QOL Questionnaire. Mann-Whitney test and ’T’ Test are used for statistical analysis of the data. Results: Patients in the MOP group had significant lower pain intensity scores, better QOL scores & less weight loss compared to patients in the CON group. The duration of the severe pain was atleast 1 week shorter in the MOP group. Systemic side-effects secondary (nausea, vomiting, constipation) to opiod use were significantly lower in the MOP group. The Cost of supportive care for pain management was less in the MOP group, with greater compliance for the treatment. Conclusions: Morphine gargles, in our experience, is an effective approach for pain relief in patients with CT-RT induced acute mucositis in head and neck cancers thus leading to better nutrition & compliance in the treatment. No significant financial relationships to disclose.
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Robles, C., C. Vale, V. Dinh, et al. "Retrospective review of locally advanced head and neck cancer treated with concomitant chemoradiotherapy at the Miami VA Medical Center." Journal of Clinical Oncology 24, no. 18_suppl (2006): 15541. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.15541.
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15541 Management of Stage III or IV Head and Neck (H&N) cancer is debatable. Standard of care is Radical Surgery (Sx) followed by Radiotherapy (XRT). However, cosmetic and functional complications are distressing and result in decreased quality of life. Therefore, organ preservation has become important when deciding best management. The VA larynx study, the EORTC 24891 and the 91–11 US intergroup trial have shown efficacy of organ preserving chemoradiotherapy (Cx+Rx) comparable to Sx and XRT. These studies are limited to laryngeal and hypopharyngeal cancers and whether same principles can be applied to other H&N sites is unknown. We conducted a retrospective study of stage III & IV H&N cancer treated at our Institution between 1996–2004 to evaluate survival, organ preservation and toxicities. 45 males between 47 to 83 years (median 59.6) were studied. 87% were white and 13% black. 82% had history of tobacco and alcohol abuse, 4% tobacco only, 11% alcohol only and 2% never smoked or drank. The sites of disease were: nasopharynx 1 (2%), oropharynx 19 (42%), base of tongue 10 (22%), larynx 6 (13%) and pharynx 9 (20%). 15 patients (33%) where stage III and 30 (67%) stage IV. The treatment was combined Cx+Rx. The mean dose of XRT was 6697 Cgy and mean cycles of chemotherapy (Cx) were 2.2. Of those, 42 patients (93%) received cisplatin and 5FU, 2 (4%) carboplatin and 5FU and 1 (2%) carbo only. 10 patients (22%) received additional Cx and 14 (31%) underwent additional Sx (neck dissection). 19 patients (42%) are alive, 19 (42%) are death and 7 (16%) were lost to f/u. Median survival is 30.6 months. 1 patient was refractory and 6 relapsed in less than a year. Among them, 4 were local relapses, 1 a neck recurrence (no prior dissection) and 1 a distant relapse. The most common acute toxicities were: Anemia 87%, neutropenia 64%, hyperglycemia 82%, transient elevation of BUN 60% and creatinine 36%, hypo/hypernatremia 64%, severe mucositis 71%, weight loss 76%, N/V 47% and severe dysphagia 27%. Cx+Rx appears to be a safe, feasible and comparable alternative to Sx regardless of the anatomical origin in locally advanced H&N cancer, with the advantage of organ preservation. Additional XRT boost, Cx or Sx could decrease relapses. Further studies are warranted to validate these hypotheses. No significant financial relationships to disclose.
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Mishra, Ananya, Kasim Mohamed, Prasanna Kumar, and Sathish Kumar Jayagandhi. "Prosthetic Rehabilitation of Maxillectomy Defects, with Single-Piece Open-Hollow Bulb Definitive Obturator." Journal of Evolution of Medical and Dental Sciences 10, no. 16 (2021): 1169–73. http://dx.doi.org/10.14260/jemds/2021/248.
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Patients who undergo surgical resection of the maxillo-mandibular structures as a result of trauma, infection or malignancy, suffer from psycho-social setbacks which has a profound impact on their over-all quality of life. 1,2 These defects, especially those following maxillectomy, result in oroantral communication, facial deformation, impaired speech and difficulty in deglutition. For the rehabilitation of patients with such defects, surgical and prosthetic treatment options are available. As, not all patients can be successfully rehabilitated with reconstructive surgeries due to postoperative complications like graft rejection, the extent of the surgical defect and high psychological impact factor associated with repeated surgeries, prosthetic rehabilitation proves to be an alternative treatment option. The prosthetic rehabilitation of such patients is challenging as it requires restoration of the lost form, function and aesthetics, under constantly changing state of post-surgical intraoral tissues, with limited mouth opening. The maxillofacial prosthesis designed to close congenital or an acquired tissue opening, primarily of the hard palate, is known as an obturator. 3 The obturator has two functional components, one seals the surgical defect and the other replaces the lost dentoalveolarstructures.4-7 The design of an obturator may vary depending on the extent of the defect, remnant dentoalveolar complex, soft tissue undercuts and existent muscle physiology.8,9 Among the two designs, solid and hollow, hollow obturators are widely used. The bulb portion of the hollow obturator, which accommodates the surgical defect, can be open or closed9,10and its selection depends on the prosthodontist’s clinical decision-making skills and the ease of fabrication. In this article we have discussed the rehabilitated patients with single-piece, openhollow bulb definitive obturator. Patients undergo extensive maxillary surgical resections due to aggressive lesions like malignancies and deep fungal infections. Prosthetic rehabilitation of such patients with an obturator becomes of paramount importance as it separates the oropharynx from the nasopharynx, reduces the risk of recurrent infections, replaces lost dentoalveolar structures, permits intelligible speech, reinstates mastication and deglutition, restores facial contour and patient’s self-esteem. The bulb portion of the obturator extends into the defect and accommodates it, forming a hermetic seal. In this clinical report, we highlight the success of prosthetic rehabilitation of maxillectomy patients using single-piece, open-hollow bulb definitive obturator. The meticulous follow-up carried out reveals the success of the prosthesis and adds practice-based evidence to the maxillectomy rehabilitation outcome.
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Castro, G., A. G. de Lima, D. R. Lopes, et al. "Oral mucositis prevention by low-level laser therapy in head and neck cancer patients submitted to concurrent chemoradiation: A prospective randomized study." Journal of Clinical Oncology 27, no. 15_suppl (2009): 6019. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6019.
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6019 Background: Oral mucositis is a major treatment-related complication of concurrent chemoradiation (CRT) in head and neck cancer (HNC) patients (pts), affecting nutrition, pain control, quality of life and adequate treatment delivery. Low level laser (LLL) is a promising preventive therapy. We aimed to evaluate the efficacy of LLL to decrease and delay severe oral mucositis and its impact on RT interruptions. Methods: In this prospective, randomized, double-blind, phase III trial, pts were treated with either daily He-Ne LLL 2.5 J/cm2, or placebo laser, before RT. Eligible pts had to be diagnosed with SCC or undifferentiated carcinoma of oral cavity, pharynx, larynx, or metastatic to the neck with unknown primary site (UPS); age > 18 y; candidates to adjuvant or definitive CRT; signed informed consent. CRT consisted of conventional RT 60–70 Gy (1.8–2.0 Gy/d, 5 times/wk) + concurrent cisplatin 100 mg/m2 every 3 wks. Main endpoints were oral mucositis severity in wks 2, 4 and 6 (CTC-NCI v.2.0); RT interruptions due to mucositis; pain intensity (VAS). To detect a decrease in the incidence of grade 3 or 4 oral mucositis from 80 to 50%, we planned to enroll 74 pts, error I/II 5 and 20%, respectively. Results: 73 pts were included (77% male; mean age 53 y); primary site: oropharynx (31 pts), larynx (15), nasopharynx (10), hypopharynx (8), oral cavity (7 pts), UPS (2); 36 pts received prophylactic LLL. Mean delivered RT dose (Gy) was higher in pts treated with LLL (69.3 vs. 67.8, p = 0.04). The number of treatment fields was the same (6 vs. 6, p = 0.50) and the mean cisplatin dose-intensity was 40.9 and 40.1 mg/m2/wk (p = 0.3) between pts treated with LLL or placebo, respectively. During CRT, the number of pts diagnosed with grade 3 or 4 oral mucositis treated with LLL/placebo was 4/5 (wk 2, p = 1.0); 4/11 (wk 4, p = 0.08); and 8/9 (wk 6, p = 1.0), respectively. More pts treated with placebo had RT interruptions due to mucositis (6 vs. 0, p =0.02). The occurrence of severe pain did not differ between the study arms in wks 2, 4 and 6 (5/5, 8/8 and 8/8, p = 1.0). Conclusions: LLL therapy was effective in reducing grade 3 or 4 oral mucositis and in reducing RT interruptions in these HNC pts treated with concurrent CRT, which may translate into improved CRT efficacy and tolerance. No significant financial relationships to disclose.
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Patil, Vijay M., Amit Joshi, Vanita Noronha, et al. "Palliative chemotherapy in carcinoma nasopharynx." South Asian Journal of Cancer 08, no. 03 (2019): 173–77. http://dx.doi.org/10.4103/sajc.sajc_230_18.
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Abstract Introduction: Nasopharyngeal carcinoma is a rare malignancy. We conducted an audit of systemic therapies received in palliative setting in carcinoma nasopharynx and studied their outcomes. Methods: Patients who underwent first-line palliative systemic chemotherapy between January 2014 and April 2017 for carcinoma nasopharynx at the department of medical oncology at authors' institute were selected for this analysis. Toxicities, responses, progression-free survival (PFS), and overall survival (OS) were analyzed. In addition, a Quality-Adjusted Time without Symptoms or Toxicity analysis with threshold utility analysis was performed. Results: Fifty-one patients were included in this analysis. The indication of palliative chemotherapy was locoregionally recurrent disease in 25 (49.0%) patients and metastatic disease in 26 (51.0%) patients. The overall response rate was 62.0% (n = 33). The median PFS was 225 days (95% confidence interval [CI]: 164–274 days) and median OS was 513 days (95% CI: 286–931 days). The restricted mean TOX state duration was 2.6 days (95% CI: 0.3–4.9), restricted mean TWiST duration was 219.2 days (95% CI: 184.0–254.4), and restricted mean REL duration was 74.3 days (95% CI: 38.1–110.4). Conclusion: Systemic cytotoxic therapy in nasopharyngeal cancers is associated with high response rates and clinically meaningful PFS; with low duration of time spent in adverse events.
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Marcy, P. Y., N. Magné, C. Bailet, G. Poissonnet, R. J. Bensadoun, and F. Demard. "Endovascular Embolization to Control Life-Threatening Epistaxis Due to a Post Radiotherapy Pseudoaneurysm of the Maxillary Artery." Interventional Neuroradiology 8, no. 3 (2002): 317–20. http://dx.doi.org/10.1177/159101990200800313.
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We report an unusual case (never described) of a false aneurysm of the maxillary artery following irradiation and biopsy that ruptured into the nasopharynx in an 34-year-old man who presented with severe epistaxis 15 months after radiation therapy of the nasopharynx (80 Gy). Angiography revealed a fusiform aneurysm of the second portion of the maxillary artery, which was successfully embolized but the patient died from a pseudomonas septicemia three months later. False aneurysms of the maxillary artery following irradiation are exceptional complications. Despite a successful endovascular treatment, the absence of collateral revascularization did not allow to complete healing of the radionecrotic pharyngeal area and led to a lethal septicemia.
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Shaw, A. S., and S. E. J. Connor. "Parasellar epidermoid cyst rupturing into the nasopharynx." Journal of Laryngology & Otology 119, no. 2 (2005): 140–43. http://dx.doi.org/10.1258/0022215053419934.
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Epidermoid tumours are non-neoplastic inclusion cysts representing up to 1.1 per cent of all intracranial tumours, typically presenting with symptoms related to pressure or intracranial rupture in the fourth or fifth decade of life. The authors present a case of a parasellar epidermoid cyst which has ruptured in to the nasopharynx; to the best of their knowledge, this has not been previously reported. The computed tomography (CT) and magnetic resonance imaging (MRI) are presented. The pathology and radiological features of epidermoid tumours are discussed, particularly in relation to extracranial connections. The differential diagnosis of lesions eroding the central skull base is reviewed.
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Roziaty, Putranti Dyahayu, Soehartono Soehartono, and Hendradi Surjotomo. "Hubungan Antara Kadar DNA Plasma Virus Epstein Barr Dengan Stadium Klinis Karsinoma Nasofaring WHO Tipe 3." Oto Rhino Laryngologica Indonesiana 48, no. 2 (2019): 165. http://dx.doi.org/10.32637/orli.v48i2.277.
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Latar Belakang: Karsinoma nasofaring (KNF) merupakan keganasan yang tersering ditemukan, dan berdampak pada penurunan kualitas hidup serta memiliki mortalitas tinggi. Penanganan KNF selama ini terkendala oleh waktu tunggu yang cukup lama dalam menentukan staging KNF terutama untuk antrian pemeriksaan computed tomography scan (CT scan) dan Ultrasonography (USG). Pemeriksaan kadar DNA EBV (Deoxyribonucleic acid Epstein-Barr Virus) pada pasien yang relatif lebih mudah dan terjangkau dapat digunakan untuk memprediksi stadium dan prognosis KNF. Dengan mengetahui prognosis KNF lebih dini, maka diharapkan penanganan terhadap KNF dapat segera dilakukan. Tujuan: Mengetahui apakah kadar DNA EBV dapat dipakai untuk memprediksi stadium dan prognosis KNF dengan cara mencari hubungan antara kadar DNA EBV dengan stadium KNF. Metode: Penelitian cross sectional melibatkan 15 subjek penelitian yang terdiagnosis KNF WHO tipe 3 kemudian dilakukan staging dengan CT scan, USG abdomen, dan foto toraks, serta diambil sampel darah untuk diukur kadar DNA EBV. Hasil: Seluruh subjek penelitian mengalami peningkatan kadar DNA EBV sesuai dengan peningkatan stadium KNF. Peningkatan stadium KNF berhubungan signifikan dengan peningkatan kadar DNA EBV (p=0,001). Ukuran tumor (T) berhubungan signifikan dengan kadar DNA EBV (p=0,023), ukuran nodul (N) berhubungan signifikan dengan kadar DNA EBV (p=0,005), ada tidaknya metastasis tidak berhubungan signifikan dengan kadar DNA EBV (p=0,398). Nilai cut off kadar DNA EBV sebesar 952 kopi/ml. Kesimpulan: Terdapat hubungan yang signifikan antara kadar DNA EBV dengan stadium klinis, dengan demikian kadar DNA EBV dapat dipertimbangkan untuk digunakan sebagai prediktor stadium dan prognosis KNF. Background: Nasopharyngeal carcinoma (NPC) is the predominant tumor type arising in the nasopharynx, with a high mortality and affecting quality of life. NPC treatment management is hindered by long queues of Computed Tomography Scan (CT scan) and Ultrasonography (USG) examinations to ascertain the NPC staging. The examination of Epstein-Barr Virus (EBV) DNA level is relatively simpler and inexpensive to predict the NPC staging and prognosis, thus, it can speed up NPC treatment. Objective: To determine whether EBV DNA level can be used to predict the NPC stage and prognosis by finding a correlation between EBV DNA level and NPC stage. Method: This was a cross-sectional study involving 15 respondents who were diagnosed as WHO type 3 NPC, and examined by CT scan, abdominal ultrasound, chest X-ray, and blood test for measuring the levels of EBV DNA to determine the stage. Results: All respondents had elevated levels of EBV DNA in accordance with NPC stage elevation. Increased NPC stages were significantly correlated with elevated levels of EBV DNA (p=0.001). The size of tumor (T) was significantly correlated with EBV DNA (p=0.023), the size of nodule (N) was significantly correlated with EBV DNA (p=0.005). The presence or absence of metastasis did not significantly correlate with EBV DNA (p=0.398). The EBV DNA cut off value was 952 copies/ml. Conclusions: There was a significant correlation between EBV DNA levels and clinical stages, hence EBV DNA can be considered to be used as NPC staging and prognosis predictor.
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Koch, Tom. "Life quality vs the ‘quality of life’:." Social Science & Medicine 51, no. 3 (2000): 419–27. http://dx.doi.org/10.1016/s0277-9536(99)00474-8.
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Jagannadham, Rajendra Prasad, Lakshmi Latchupatula, Sravani Ponnada, Neelima Lalam, Raghunadhababu Gudipudi, and Bhagyalakshmi Atla. "Histopathological Study of Lesions of the Nasal Cavity, Paranasal Sinuses and Nasopharynx in a Tertiary Care Centre, Visakhapatnam over a Period of 2 Years." Journal of Evidence Based Medicine and Healthcare 8, no. 33 (2021): 3054–59. http://dx.doi.org/10.18410/jebmh/2021/557.
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BACKGROUND A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination
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Tickell, Crispin. "The quality of life: What quality? Whose life?" Environmental Values 1, no. 1 (1992): 65–76. http://dx.doi.org/10.3197/096327192776680197.
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Tickell, Crispin. "The Quality of Life: What Quality? Whose Life?" Interdisciplinary Science Reviews 17, no. 1 (1992): 19–25. http://dx.doi.org/10.1179/isr.1992.17.1.19.
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Heller, Debra S., Margaret S. Brandwein, Michael J. Klein, and Hugh Biller. "“Hairy Polyp” of Infancy—Pathology, Embryology, and Differential Diagnosis." American Journal of Rhinology 3, no. 1 (1989): 5–8. http://dx.doi.org/10.2500/105065889782024438.
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“Hairy polyp,” or dermoid polyp, of the nasopharynx is a rare tumor of early life composed of ectodermal and mesodermal derivatives. We present a case, consider its embryological origins, and discuss the differential diagnosis of nasopharyngeal polypoid masses in infancy.
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Mahmood, Ashraf Nabeel, Rashid Sheikh, Hamad Al Saey, Sarah Ashkanani, and Shanmugam Ganesan. "Angiofibroma Originating outside the Nasopharynx: A Management Dilemma." Case Reports in Otolaryngology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/3065657.
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Background. Angiofibroma is a benign tumor, consisting of fibrous tissue with varying degrees of vascularity, characterized by proliferation of stellate and spindle cells around the blood vessels. It most commonly arises from the nasopharynx, although it may rarely arise in extranasopharyngeal sites. Case Report. A 46-year-old male presented with left side nasal obstruction and epistaxis for one month. Clinical nasal examination revealed left sided polypoidal mass arising from the vestibular region of the lateral nasal wall. Results. CT scan and MRI showed highly vascular soft tissue mass occupying the anterior part of the left nostril. Preoperative selective embolization followed by transnasal excision was performed. Histopathological examination confirmed the diagnoses of nasal vestibular angiofibroma. Conclusion. Extranasopharyngeal angiofibroma is a very rare pathology. It should be kept in mind as a differential diagnosis with any unilateral nasal vestibular mass causing nasal obstruction and epistaxis. A biopsy without further investigation can cause life threatening bleeding in the patient.
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Goel, Alexander N., Andrey Filimonov, Julie Teruya-Feldstein, et al. "Burkitt lymphoma of the nasopharynx causing life-threatening airway obstruction: A case report." American Journal of Otolaryngology 42, no. 4 (2021): 102977. http://dx.doi.org/10.1016/j.amjoto.2021.102977.
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Johan Fürst, Carl. "Quality of Life." Acta Oncologica 35, sup7 (1996): 141–48. http://dx.doi.org/10.3109/02841869609101675.
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Zhao, Jialing. "Quality and Life." Dialogue and Universalism 29, no. 3 (2019): 171–76. http://dx.doi.org/10.5840/du201929346.
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With the swift development of technology, the distance among people’s hearts surprisingly becomes further and further. Residents living in the congested cities feel more lonely than those who inhabit countryside. The mass media makes them consider ever ything at hand stereotyped. They parrot their designated work again and again, without passion or enthusiasm. Hence facing these social predicaments and interior struggle, Robert M. Pirsig embarks on a trip to cross America by motorcycle, in order to gain spiritual epiphany and freedom. Therefore, he finds quality is the panacea that may solve the present problems. Quality has a long history, which is closely analogous to Plato’s goodness. Quality is one, just as the supreme spirit in the Buddhist Upanishad whose universe and ego are identical. However, modern technology lacks of oneness, so that each time touching it, people only feel cruel and ugly since both the creator and the owner do not have the sense of identity for their innovative or possessive things. The injection of quality into technology may break through the difficulties resulting from the traditional method of dichotomy for the reason that quality spurs technology to melt nature and human’s soul, creating something that exceeds the two. This thesis aims to probe the meaning of quality and the account of modern crisis caused by the absence of quality. The last part points out how to reconcile the conflict between human’s value and technological needs, so as to achieve the ultimate goal that enhances people’s happiness.
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Surozhskij, A. "Quality of life." Консультативная психология и психотерапия 23, no. 5 (2015): 5–10. http://dx.doi.org/10.17759/cpp.2015230501.
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Metropolitan Anthony was frequently invited to speak by medical institutions, particularly by those caring for terminally ill or dying. In his talk he approaches the notion of the quality of life from an unexpected angle. He suggests that the quality of life is inseparable from the notions of human dignity, the aim and the purpose of life. Metropolitan Anthony compares the condition of a terminally ill patient with the situation of people who — often willingly — survive or die in other extreme conditions.
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Wortis, Joseph. "Quality of life." Biological Psychiatry 23, no. 6 (1988): 541–42. http://dx.doi.org/10.1016/0006-3223(88)90001-7.
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Mercier, M., S. Schraub, and P. Bourgeois. "QUALITY OF LIFE." Lancet 330, no. 8551 (1987): 161–62. http://dx.doi.org/10.1016/s0140-6736(87)92363-4.
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Heath, Hazel. "Quality of life." Nursing Older People 22, no. 8 (2010): 8. http://dx.doi.org/10.7748/nop.22.8.8.s11.
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Khaira, H. S. "Quality of life." European Journal of Vascular and Endovascular Surgery 10, no. 4 (1995): 510. http://dx.doi.org/10.1016/s1078-5884(05)80184-4.
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Perkins, J. M. T., and T. S. O'Brien. "Quality of life." European Journal of Vascular and Endovascular Surgery 10, no. 4 (1995): 511. http://dx.doi.org/10.1016/s1078-5884(05)80186-8.
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Hickey, N. C. "Quality of life." European Journal of Vascular and Endovascular Surgery 12, no. 1 (1996): 127. http://dx.doi.org/10.1016/s1078-5884(96)80298-x.
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