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This study aimed to determine the relationship between quality of life and satisfaction with care among cancer patients in palliative care in Saudi Arabia.
A total of 130 palliative cancer patients were invited to participate in our cross-sectional study. Patients were recruited from a large tertiary hospital within the Ministry of Health in Saudi Arabia. All eligible participants answered a three-part questionnaire that included demographic data and the validated European Organization for Research and Treatment of Cancer (EORTC QLQ–C15–PAL) and (EORTC IN-PATSAT32) questionnaires.
Participants were mostly female (103/130, 79%) and married (93/130, 71%), and more than half had breast cancer (69/130, 53%). They were between 17 and 86 years of age (mean = 46.7, SD = 16.50). The correlation test showed that the relationship with physical function was weak, while emotional function and global health status had a moderate relationship with general satisfaction (r = 0.21, p < 0.01; r = 0.32, p < 0.001; r = 0.26, p < 0.01, respectively). Our results suggest that emotional function is the more important factor in predicting satisfaction with care among palliative cancer patients. An increase in emotional function leads to increased general satisfaction.
Significance of results:
The emotional function of palliative cancer patients was more closely associated with overall satisfaction with care than physical function or global health status. All palliative care team members are thus required to provide adequate psychosocial support. It is recommended that interdisciplinary and collaborative approaches be integrated in palliative care of cancer patients.
The present study was conducted to determine the rate of level IV lymph node involvement among node-negative (N0) necks in patients with squamous cell carcinoma of the tongue.
The study comprised 32 patients with squamous cell carcinoma of the tongue, with tumour–node–metastasis staging of T1–3N0M0, who were admitted to the Otolaryngology Department at Tehran University of Medical Sciences from March 2012 to March 2014. After a complete diagnostic evaluation, wide primary tumour excision (with 1.5–2 cm margins) and extended supraomohyoid neck dissection (levels I–IV) were accomplished.
Occult metastasis was found in 28 per cent of the patients. Level I, II and III metastases were the most common (18.75, 18.75 and 15.62 per cent, respectively). Level IV metastasis was found in 6.25 per cent of patients.
Supraomohyoid neck dissection appears to be an appropriate treatment for N0 tongue squamous cell carcinoma and there is no need for level IV lymph node dissection in a N0 patient.
To evaluate the characteristics of post-laryngectomy patients, including nasal endoscopy findings, that affect subjective smell improvement in the post-surgical period.
Thirty patients who had undergone total laryngectomy participated in at least three sessions of a smell rehabilitation programme involving the nasal airflow-inducing manoeuvre, under the supervision of a speech-language pathologist. Patient characteristics and nasal endoscopy findings were evaluated.
Participants experienced a mean improvement in sense of smell of 61 per cent (p < 0.001) and a significant improvement in appetite (p = 0.002). Male patients and patients with a nasal discharge had a significantly better outcome.
The nasal airflow-inducing manoeuvre is an effective method for improving smell perception and appetite in laryngectomy patients. There was no relationship between nasal endoscopy findings and outcome of the nasal airflow-inducing manoeuvre rehabilitation programme in our case series.
Sinonasal malignancies are rare tumours, which can be resected using an open or endoscopic approach. The current study evaluated the outcome of both approaches.
A total of 160 patients with malignant nasal tumours were evaluated in an academic tertiary care hospital. The patients were allocated to ‘open’ or ‘endoscopic’ surgery groups, based on the surgical approach employed. The following data were evaluated and compared: patient and tumour characteristics; oncological treatments; and oncological outcomes, including complications, surgical margin, recurrence, overall survival and disease-free survival.
The maxillary sinus was the most common tumour location and squamous cell carcinoma was the most common histopathology-based diagnosis. Younger patients had lower grades of tumour. Higher survival rates were significantly related to lower tumour stages in both surgery groups. There were no differences between the two relatively similar groups in terms of surgical margin, the need for adjunctive therapy, and recurrence and survival rates. In addition, multivariate logistical regression analysis indicated no correlations between the type of surgical approach employed and the rates of recurrence and complications.
Endoscopic surgery for sinonasal malignancies is comparable to the conventional open approach in carefully selected patients.
To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.
Study design and method:
One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund–Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.
Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).
Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.
To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis.
Subjects and methods:
This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented.
There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable).
This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.
Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.
Subjects and methods:
Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.
The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.
Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.
To determine the effect of embolisation on endoscopic resection of angiofibroma.
Subjects and method:
A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.
There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.
Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.
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