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Head and neck soft tissue sarcoma is uncommon. It is both histologically and clinically heterogeneous, ranging from an indolent, locally destructive tumour, to a locally aggressive neoplasm with metastatic potential.
A retrospective review was conducted of all adult head and neck soft tissue sarcomas, including cases of malignant soft tissue sarcoma and all intermediate type tumours, diagnosed between 1997 and 2012.
Sixty-eight cases were identified in this series from the sarcoma multidisciplinary team. Seventeen different histological subtypes of sarcoma were identified. Neither age, gender nor tumour size were significant prognostic indicators for survival in this series.
Prognosis is dependent on histological subtype, underscoring the importance of histological classification. Some histological subtypes occur only once or twice in a decade, even within a large regional referral centre. An accumulation of evidence from relatively small case series is key in the long-term development of treatment strategies.
Measurement error in self-reported total sugars intake may obscure associations between sugars consumption and health outcomes, and the sum of 24 h urinary sucrose and fructose may serve as a predictive biomarker of total sugars intake.
The Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS) was an ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) cohort. Doubly labelled water and 24 h urinary sucrose and fructose were used as biomarkers of energy and sugars intake, respectively. Participants’ diets were assessed by up to three 24 h recalls (88 % had two or more recalls). Procedures were repeated approximately 6 months after the initial visit among a subset of ninety-six participants.
Four centres (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) across the USA.
Men and women (n 477) aged 18–74 years.
The geometric mean of total sugars was 167·5 (95 % CI 154·4, 181·7) g/d for the biomarker-predicted and 90·6 (95 % CI 87·6, 93·6) g/d for the self-reported total sugars intake. Self-reported total sugars intake was not correlated with biomarker-predicted sugars intake (r=−0·06, P=0·20, n 450). Among the reliability sample (n 90), the reproducibility coefficient was 0·59 for biomarker-predicted and 0·20 for self-reported total sugars intake.
Possible explanations for the lack of association between biomarker-predicted and self-reported sugars intake include measurement error in self-reported diet, high intra-individual variability in sugars intake, and/or urinary sucrose and fructose may not be a suitable proxy for total sugars intake in this study population.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the aetiology and risk factors for head and neck cancer and the recommended interventions appropriate for each risk factor.
• Recent evidence synthesis from National Institute for Health and Care Excellence suggests that the following brief interventions for smoking cessation work should be used:
○ Ask smokers how interested they are in quitting (R)
○ If they want to stop, refer them to an intensive support service such as National Health Service Stop Smoking Services (R)
○ If they are unwilling or unable to accept a referral, offer a stop smoking aid, e.g. pharmacotherapy. (R)
• Brief interventions are effective for hazardous and harmful drinking. (R)
• Specialist interventions are effective in people with alcohol dependence. (R)
• Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment. (R)
• Management of leukoplakia is not informed by high-level evidence but consensus supports targeted use of biopsy and histopathological assessment. (R)
• The management of biopsy proven dysplastic lesions favours:
○ advice to reduce known environmental carcinogens such as tobacco and alcohol (R)
○ surgical excision when the size of the lesions and the patient's function allows (R)
○ long-term surveillance. (R)
• Fanconi anaemia patients should:
○ be followed up in a multidisciplinary specialist Fanconi anaemia clinic (G)
○ have quarterly screening for head and neck squamous cell carcinoma and an aggressive biopsy policy (G)
○ receive prophylactic vaccination against high risk human papilloma virus (G)
○ receive treatment for head and neck squamous cell carcinoma with surgery alone where possible. (G)
This study aimed to examine the performance of head and neck cytology at Nottingham University Hospitals between 2009 and 2010.
Cases were extracted from the Winpath pathology reporting system and correlations were investigated between results and the histological and clinical outcomes. Specimen adequacy and the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the cytology tests were calculated.
In all, 19.7 per cent of aspirates were judged to be inadequate. The absolute and relative sensitivities of head and neck cytology were 87.0 per cent and 89.0 per cent, respectively, and the absolute and relative specificities were 99.0 per cent and 97.0 per cent, respectively. The positive predictive values were 99.0 per cent and 96.0 per cent and the negative predictive values were 92.0 per cent and 92.0 per cent for a diagnostic accuracy of 94.5 per cent and 93.0 per cent. The performance was consistent with previous reports and superior to that of a recent UK series. The high rate of inadequate samples is, however, a concern.
Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.
We present SEDs for single-age, single-metallicity stellar populations (SSPs) covering the full optical spectral range at resolution (FWHM = 2.3Å). These SEDs can be regarded as our base models, as we combine scaled-solar isochrones with an empirical stellar spectral library (MILES), which follows the chemical evolution pattern of the solar neighbourhood. The models rely as much as possible on empirical ingredients as also employ extensive photometric libraries. Thanks to the unprecedented parameter coverage of the MILES library we synthesize SSP SEDs from intermediate- to very-old age regimes, and the metallicity from super-solar to [M/H] = −2.3, all for a suite of IMF shapes and slopes. We propose a new Line Index System (LIS), based on flux-calibrated spectra, to avoid the intrinsic uncertainties associated with the Lick/IDS system and provide more appropriate, uniform, spectral resolution.
To review the management, causative organisms, morbidity and mortality of intracranial abscesses secondary to sinus and ear disease.
Study design and setting:
Retrospective, case note review of suppurative intracranial complications of ear and sinus disease in patients admitted to a regional neurosurgical centre between 1980 and 2004. These data were compared with published material from the same region from 1950–1979.
There was a marked reduction in the mortality rate and the number of intracranial abscesses secondary to chronic ear disease, comparing the two time periods. However, there was little change in the percentage of sinus-related abscesses treated and in their symptoms, signs, abscess location and long term morbidity. Microbiology results showed that streptococcal species predominated as causative organisms, with a high percentage of anaerobic bacteria in otogenic abscesses.
Despite improved outcomes, a high index of suspicion for intracranial complications of ear or sinus disease should be maintained in the presence of appropriate signs and symptoms.
To present a significant complication of pharyngolaryngeal reconstruction, which resulted in diagnostic confusion as it mimicked a second primary tumour of the head and neck.
Case report and review of the world literature.
A 61-year-old man developed a granulomatous foreign body reaction, mimicking a second primary tumour, at the distal end of a salivary bypass tube, following pharyngolaryngectomy and reconstruction using a tubed anterolateral thigh flap. Clinically and radiologically, this was felt to represent a second primary tumour of the oesophagus, but biopsies revealed full thickness inflammation of the mucosa and granulation tissue. Repeat oesophagoscopy two weeks after removal of the tube showed complete resolution.
No record of an oesophageal foreign body reaction to a Montgomery salivary bypass tube has previously been reported in the world literature. This report highlights the potential for such a lesion to cause diagnostic confusion with a second primary tumour.
The need for research that is applicable to the most common health problems is well recognized. Some of this research will be in the area of primary care, and family doctors must contribute to the research for it to be effective in improving care. Using a sample of key informants from 10 different countries, this paper explores the extent to which family doctors are involved in research in the various regions of the globe. We find great variability in the level of research being conducted by family doctors at academic institutions and in the development of the community research structures, such as practice based research networks. Despite the problems, family doctors are involved in research in every region assessed, and there is room for optimism that this role will be substantially expanded.
Parapharyngeal abscess secondary to quinsy is a well understood complication; however, its incidence has significantly declined following early use of effective antibiotics. Tracking of infection from the parapharyngeal space through the anatomical planes to cause mediastinitis has a significant mortality rate and requires early detection and aggressive management. A case of quinsy leading to mediastinitis, pericarditis and pleural effusions is presented. It highlights the potentially life-threatening complications of a commonly encountered ENT problem.
Twenty-two consecutive VLBI images of supernova 1993J in the galaxy M81 taken over 7 years show, in unprecedented detail, the dynamic evolution of the expanding radio shell of an exploded star. High precision astrometry using phase-referencing shows that the supernova expands isotropically, and that its geometric center has a formal proper motion of 190±110 km s−1 w.r.t. the core of M81. Systematic changes in the images most likely reflect a pattern of inhomogeneities in the medium left over from the progenitor star, or possibly instabilities in the expanding shell. As the shockfront sweeps up the medium, it is progressively decelerated, and after 7 years it has slowed to less than 1/2 its original expansion velocity. SN1993J is likely now entering the early stages of the adiabatic phase common in much older supernova remnants.
Twenty consecutive VLBI images of supernova 1993J in M81 from the time of explosion to the present show the dynamic evolution of the expanding radio shell of an exploded star. No clear sign of a pulsar nebula, expected to have a spectral luminosity 10 to 1,000 times larger than that of the Crab, has yet been seen. The upper limit on the brightness at 8.4 GHz in the center of the shell in one of the latest images is 0.15 mJy per beam of 0.4 mas2, corresponding to a spectral luminosity of that of the Crab. Any nebula that may have formed in the center is probably still obscured by the surrounding thermal matter with no substantial filamentation having yet occurred in the latter.
We describe a patient with trigeminal neunnoma whose main presenting symptom was trismus. This has not previously been reported in the literature. We review the previously described symptoms and signs of trigeminal neurinoma.
Tardive dyskinesia is important in the side-effect profile of antipsychotic medication.
The development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.
Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.
The relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).
Our results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.
In this paper we report the first results of the 327 MHz VLBI survey which has been carried out in the last two years to select potential candidate sources for the future SVLBI missions and to search for directions of small scattering-“holes” in the interstellar scattering medium. During the three VLBI sessions conducted so far, we observed about 80 sources. Preliminary data analyzed from the first part of the survey shows that at least 17 out of 50 sources have compact components with a size smaller than 30 mas.
M81 has been shown to have a compact flat-spectrum core with a possible steep-spectrum jet. We report on position determinations of the brightness peak of the nucleus relative to the position of the early supernova 1993J with uncertainties as low as 0.08 mas. At early epochs, the supernova was largely pointlike at any frequency and therefore an ideal phase reference. We describe how VLBI astrometry at several frequencies could be used to support a model with a core and a one-sided jet for the nucleus of M81.
Four cases of serious MRSA wound infection following head and neck surgery have been identified. One patient died. At post mortem a mediastinal abscess containing MRSA was found to have eroded into the innominate artery causing fatal haemorrhage. The other three suffered serious wound infections, two requiring further surgery. Once MRSA hadbeen identified they were treated with intravenous teicoplanin and all made a full recovery.