ABSTRACT
Obstructive sialadenitis is the most common cause of non-malignant salivary gland disorders, with salivary gland strictures being responsible for approximately 23% of all benign obstructive disease. Significant advances in minimally invasive techniques, including radiologically-guided balloon sialoplasty, offer the potential for successful treatment with reduced complications. At present there is a paucity of follow-up data regarding patient outcomes and repeat interventions in those undergoing the procedure. Patients with parotid or submandibular gland sialadenitis secondary to gland stricture were identified and underwent radiologically-guided balloon sialoplasty at Queen Alexandra Hospital, Portsmouth, UK between 2015 and 2022. Patient outcomes, complications and reintervention rates were recorded prospectively over the seven-year period and analysed retrospectively. A total of 44 patients underwent radiologically-guided balloon sialoplasty. Forty (89%) underwent sialoplasty for parotid gland disease, with a minority (n = 5) receiving an intervention for submandibular gland strictures. A total of 37 (84%) had their obstruction successfully treated (82% of parotid gland obstructions and 100% of submandibular gland obstructions). Five patients (11%) required a repeat intervention. Seventeen successfully treated patients (85%) who attended follow-up clinic appointments described complete resolution of their symptoms, with the remaining three (15%) describing a partial response. Radiologically-guided balloon sialoplasty for the treatment of benign obstructive sialadenitis secondary to a gland stricture is a safe and effective method of eliminating the obstruction and relieving patients' symptoms. Most patients were symptom free at short-term follow up, with a minority requiring a second sialoplastic intervention.
Subject(s)
Salivary Gland Diseases , Sialadenitis , Humans , Constriction, Pathologic/surgery , Constriction, Pathologic/complications , Constriction, Pathologic/pathology , Salivary Ducts/surgery , Salivary Ducts/pathology , Retrospective Studies , Salivary Gland Diseases/diagnostic imaging , Salivary Gland Diseases/surgery , Sialadenitis/surgery , Sialadenitis/etiology , United Kingdom , Endoscopy/methodsABSTRACT
Head and neck ultrasonography with fine-needle aspiration cytology (FNAC) is recommended by the National Institute for Health and Care Excellence (NICE) and the British Association of Head and Neck Oncologists (BAHNO) for investigating neck masses. Finite specialist radiologists and increased demands on services have increased waiting lists and breached targets. Many patients are on a two-week cancer pathway and accurate investigation cannot be delayed. The implementation of a sonographer trained in neck ultrasound-guided FNAC was analysed together with its impact on the service. Over a 21-month period we have demonstrated a fall in waiting lists from 310 to 28 patients, without compromise to diagnostic accuracy. Additionally, a cost-saving of £60,000 was made. Improvements in efficiency and waiting lists can be achieved through targeted specialist training for allied health professionals, liberating specialists for other duties.
Subject(s)
Head and Neck Neoplasms , Humans , Biopsy, Fine-Needle , Head and Neck Neoplasms/diagnostic imaging , Waiting Lists , Neck/diagnostic imaging , Ultrasonography , Sensitivity and SpecificityABSTRACT
A 68-year-old man presented with an intraconal lesion on the right side, which increased in size after a CT-scan in prone position. This phenomenon is diagnostic for an orbital varix.
Subject(s)
Orbit/blood supply , Varicose Veins/diagnosis , Aged , Humans , Male , Orbit/diagnostic imaging , Prone Position , Tomography, X-Ray Computed , Watchful WaitingABSTRACT
BACKGROUND: Early hepatic artery thrombosis (eHAT) after liver transplantation occurs in 3% of adults and 8% of children and often results in retransplantation. eHAT is initially asymptomatic and arterial patency is monitored with percutaneous Doppler ultrasound screening (pDUS). The aim of the study is to analyze the diagnostic accuracy of "continuous" Doppler registration (CONDOR) using an implantable miniature Doppler. METHODS: This prospective observational study was conducted in 102 liver transplant recipients. Hepatic arterial signal is checked by CONDOR at least six times per day for the first 10 days after transplantation with comparison of diagnostic accuracy of CONDOR versus pDUS. RESULTS: Extra investigations were performed after 48 (11%) regular pDUS where arterial patency was questioned: 32 extra pDUS, 14 computed tomography (CT) angiographies, and 2 reoperations. CT scan confirmed eHAT in 4 cases. In 10 cases of pDUS-suspected eHAT, where subsequent CT showed an open artery, the CONDOR signal was clearly pulsatile. In 2 of 4 patients with five eHATs, a weak arterial signal was inadvertently interpreted as an open artery (sensitivity of 60%). The accuracy for detection of eHAT increased from 93% (pDUS) to 99% (CONDOR). Using CONDOR, additional CT angiographies may be prevented in 10% of cases. CONCLUSION: CONDOR is a useful adjunct to pDUS because it reduces the false-positive rate of pDUS. Further development of the technique and analysis of the signal generated by CONDOR are needed to improve the sensitivity before CONDOR can replace pDUS as a reliable screening method for detection of eHAT.
