Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer / Papel diagnóstico da elastografia ultrassonográfica nas metástases de linfonodos em pacientes com câncer de cabeça e pescoço

Abstract Introduction: Ultrasonography is the easiest non-invasive method to diagnose lymph node metastases in patients with head and neck cancer. However, since CT scans are often preferred in the evaluation of primary tumours of these patients, information about lymphatic metastases may also available in these patients. Therefore, ultrasound is not routinely employed in the evaluation of these patients. However, elastography technique, a recent development in ultrasound technology, could make use of ultrasonography in these patients even more widespread, even though it is still not widely used today. Objectives: The aim of this study was to evaluate the role of sonographic elastography in the diagnosis of lymph node metastasis of head and neck cancer. Methods: Twenty-three patients diagnosed with head and neck cancer and scheduled for surgical treatment including neck dissection were included in the study. All patients underwent neck examination by palpation, ultrasound elastography and computerized tomography with contrast. To compare the diagnostic performance of palpation, ultrasound elastography and computerized tomography, the findings of each examination method were compared with the histopathological examination results of neck specimens. Results: 15 (65.2%) patients had a primary tumour in the larynx; 7 (30.4%) in the oral cavity; and 1 (4.3%) in the parotid. 7 (30.4%) out of 23 patients underwent bilateral neck dissection. In total, 30 neck dissections were hereby taken into account during study. Ultrasound elastography showed higher accuracy (83.3%) and higher sensitivity (82.4%) than palpation and computerized tomography, but the specificity of ultrasound elastography was lower (84.6%) than palpation and computerized tomography. Conclusions: Ultrasound elastography is helpful for the diagnosis of lymph node metastases in patients with head and neck cancer. Due to its non-invasive character, it can be used safety in combination with other radiological techniques to support or improve their diagnostic performance.

Resumo Introdução: A ultrassonografia é o método mais fácil e não invasivo para diagnosticar metástases em linfonodos em pacientes com câncer de cabeça e pescoço. No entanto, como as tomografias computadorizadas são frequentemente preferidas na avaliação de tumores primários desses pacientes, as informações sobre metástases linfáticas também se tornam disponíveis. Portanto, a ultrassonografia não faz parte da avaliação de rotina desses pacientes. Entretanto, a técnica de elastografia, um desenvolvimento mais recente na tecnologia de ultrassom, poderia tornar o uso da ultrassonografia mais difundido nesses pacientes, embora atualmente ainda não seja amplamente usado. Objetivo: Avaliar o papel da elastografia ultrassonográfica no diagnóstico de metástases em linfonodos em casos de câncer de cabeça e pescoço. Método: Foram incluídos no estudo 23 pacientes diagnosticados com câncer de cabeça e pescoço e com tratamento cirúrgico programado, inclusive esvaziamento cervical. Todos os pacientes foram submetidos a exame cervical por palpação, elastografia ultrassonográfica e tomografia computadorizada com contraste. Para comparar o desempenho diagnóstico da palpação, elastografia ultrassonográfica e tomografia computadorizada, os achados de cada método de exame foram comparados com os resultados do exame histopatológico de amostras obtidas do pescoço. Resultados: Dos pacientes, 15 (65,2%) apresentaram tumor primário na laringe; sete (30,4%) na cavidade oral; e um (4,3%) na parótida. Sete (30,4%) dos 23 pacientes foram submetidos a esvaziamento cervical bilateral. Foram considerados durante o estudo 30 pescoços. A elastografia ultrassonográfica mostrou maior acurácia (83,3%) e maior sensibilidade (82,4%) do que a palpação e a tomografia computadorizada, mas a especificidade da elastografia ultrassonográfica foi menor (84,6%) do que a palpação e a tomografia computadorizada. Conclusões: A elastografia ultrassonográfica é útil para o diagnóstico de metástases de linfonodos em pacientes com câncer de cabeça e pescoço. Graças ao seu caráter não invasivo, pode ser usada com segurança em combinação com outras técnicas radiológicas para apoiar ou melhorar o desempenho diagnóstico.

Will it be a Survivor to Add Clavulanic Acid to Cephalosporins in Order to Overcome Resistance Problem?.

Background: Bacterial resistance is closely associated with the use of antimicrobial agents. Prolonged therapy with antibiotics can lead to the development of resistance in a microorganism that initially is sensitive to antibiotics, but later it can adapt gradually and develop resistance to antibiotics. Aims: We reviewed whether clavulanic acid plus cephalosporin combinations help to solve the resistance problem. Methods: We evaluated and reviewed this topic via “Antibiotic Resistance”, “Cephalosporin and β-Lactamase Inhibitor Combinations” and our suggestions. Results: Acquired resistance arises from: (1) mutations in cell genes (chromosomal mutation) leading to cross-resistance, (2) gene transfer from one microorganism to other by plasmids (conjugation or transformation), transposons (conjugation), integrons and bacteriophages (transduction). β-Lactamases hydrolyze nearly all β-lactams that have ester and amide bond, e.g., penicillins, cephalosporins, monobactams, andcarbapenems. Serine β-lactamases – cephalosporinases, e.g. AmpC enzyme – are found in Enterobacter spp. and P. aeruginosa and penicillases in S. aureus. Amoxicillin-clavulanate resistance (MIC >16 microg/ml) in Escherichia coli is reported previously. Therefore, development of new drugs or combination is necessary for the antimicrobial resistance. To manage the Cephalosporin resistance, Cephalosporin and β-Lactamase Inhibitor Combinations, such as Ceftolozane/tazobactam or Ceftazidime/avibactam have been used. Conclusion: As resistance to cephalosporins have been increasing, cephalosporin + clavulonate combination will be another choice for managing the antibiotic resistance to the cephalosporins. Our suggestion is based on the success of the clavulonate combination of amoxicillin to manage the antibiotic resistance.

Office-Based Olfaction Assessment.

A simple assessment of olfactory acuity is essential and can play a vital role in patient care and quality-of-life parameters. Any process that interferes with the physiologic environment of the nasal mucosa can be associated with restricted olfaction. Studies have examined how the human sense of smell likely integrates information from complex arrays of odorant chemicals that, individually, would seem to produce conflicting odorous sensations. “Scratch and sniff” format screening tests are readily available and have been standardized for age, gender, and ethnicity. It is important to identify a scent that can be used as in an initial olfactory test If a patient cannot identify this scent, they should take further diagnostic testing. In this review, we give some essential information on office-based olfaction assessment and attempt to cover important aspects of the evaluation, especially from a clinical perspective.

Puesta al día de la terapia con corticoides intranasales / Update on therapy with intranasal corticosteroids

La rinitis alérgica (RA) es una enfermedad crónica del tracto respiratorio superior cuya prevalencia ha aumentado en las últimas décadas; en la actualidad afecta entre el 5% y el 40 % de la población general en muchos países desarrollados. Aunque no se asocia con morbilidad grave o mortalidad, en un número considerable de enfermos la RA afecta sustancialmente la calidad de vida. El tratamiento eficaz incluye el tratamiento de la RA y de las comorbilidades. Los corticoides intranasales (CIN) se utilizan para el tratamiento de la RA desde principios de la década de 1970. En la actualidad, los CIN se consideran los agentes más eficaces y la terapia de primera línea para aliviar los síntomas de la RA. Diversos estudios han demostrado que los CIN y, en especial, los preparados más nuevos, son fármacos seguros,asociados con efectos adversos graves mínimos o nulos. En este trabajo se realizó una actualización de la terapia con CIN...

Evalúan las probables propiedades terapéuticas de la espirulina / Assessment of the probable therapeutic properties of spirulina

La espirulina es un alga verdeazulada (cianobacteria) que ha sido consumida por los seres humanos durante cientos de años en la región Kanem de Chad y en las regiones lacustres de México. Actualmente se comercializa en todo el mundo como alimento terapéutico. Su potencial como tratamiento de varias enfermedades se encuentra en evaluación. El consumo mundial de espirulina ha clarificado tanto sus potenciales efectos adversos como sus acciones beneficiosas. En este artículo se presenta un breve resumen del uso de la espirulina en el área de la salud.