Management of Non-High-Risk Salivary Gland Carcinomas With Surgery Alone.

Background Risk stratification and appropriate treatment selection are essential for the management of head and neck malignancies, in order to optimize long-term outcomes. Salivary gland carcinomas (SGCs) pose a particular challenge due to their extensive biologic heterogeneity. Primary surgical resection remains the mainstay of treatment; however, outcomes with single modality therapy for 'non-high-risk' lesions are less elucidated in the literature present on the subject. We present our experience with non-high-risk salivary gland malignancies treated by surgery alone.  Methods A retrospective analysis of SGCs from 1998-2011 was completed after receiving Institutional Review Board approval. Patient demographic, tumor, treatment, and outcome data were obtained from chart review. The primary outcomes of interest were overall survival (OS) and recurrence-free survival (RFS). Results Of the 62 patients identified, 49 patients underwent resection of the primary tumor alone, while an ipsilateral selective neck dissection was included for 13 patients. The median follow-up was 5.05 years. Of the tumors, 79% were low-intermediate grade, 3% high grade, and 17% poorly classified. The OS and RFS were 91% and 87% at five years and 80% and 79% at 10 years, respectively. The combined failure rate of local, regional, and distance was 13%. Conclusion Surgery alone is an appropriate treatment strategy for patients with non-high-risk salivary gland malignancy, affording a high likelihood of long-term RFS and OS.

Middle ear barotrauma causing transient facial nerve paralysis after scuba diving.

Middle ear barotrauma is a well known entity with typical injury occurring when diving or ascending in a commercial jetliner. Patients often present with symptoms of acute onset otalgia, hearing loss and sometimes haemotympanum (with or without tympanic membrane perforation). On rare occasions, facial nerve paralysis can occur when the tympanic segment of the facial nerve is dehiscent within the middle ear. We present a case of spontaneously resolving facial nerve palsy associated with middle ear barotrauma following a brief, shallow dive. Prompt and astute diagnosis leads to proper management with simple myringotomy and can prevent unnecessary testing and other misguided treatments.

Outcome of ligation of the inferior vena cava in the modern era.

BACKGROUND: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation. METHODS: The records of patients with injuries to the IVC treated in an urban level I trauma center from 1995 to 2008 were reviewed. Demographics, injury severity, and outcome data were recorded. In addition, outpatient records were reviewed and telephone interviews were conducted to assess for the presence and severity of long-term sequelae. RESULTS: One hundred patients had IVC injuries, and 25 (25%) underwent ligation. Location of injury was infrarenal in 54 patients, suprarenal in 21, retrohepatic in 15, and suprahepatic in 10. Twenty-two of 54 (41%) injuries to the infrarenal IVC and 3 of 21 (14%) injuries to the suprarenal IVC were ligated. Patients who underwent ligation had a significantly higher Injury Severity Score (ISS) (22 vs 15, P < .001), a higher transfusion requirement (26 U vs 12 U, P < .001), a longer hospital length of stay (78 days vs 26 days, P = .02), a longer intensive care unit length of stay (24 days vs 9 days, P < .001), and a higher mortality (59% vs 21%, P < .001). Ten of 13 early survivors of infrarenal IVC ligation received early below knee fasciotomy. Three other patients with normal compartment pressures were treated expectantly without development of a compartment syndrome. The 1 survivor of suprarenal ligation had below knee fasciotomies and had normal renal function by 1 month post injury, despite an initial creatinine elevation from .7 mg/dL to 3.2 mg/dL. Ten (40%) patients with IVC ligation survived to hospital discharge (9 infrarenal, 1 suprarenal), and long-term follow-up data are available in 8 patients (7 infrarenal, 1 suprarenal). At an average of 42 months (11-117 months), no patient has significant lower extremity edema or dysfunction. CONCLUSIONS: (1) Ligation of the infrarenal IVC is an acceptable damage control technique, although it remains associated with a high mortality. Ligation of the suprarenal IVC may be done, if necessary, although few survivors of this technique exist. (2) Early fasciotomy is generally required, but occasional patients may be treated expectantly, based on measurements of compartment pressures. (3) Long-term sequelae in survivors of IVC ligation for trauma are rare.

Apparatus and initial results for pressurized planar electrochromatography.

Pressurized planar electrochromatography (PPEC) is a new planar chromatographic technique in which the mobile phase is driven by electroosmotic flow, while the sorbent layer is pressurized in a manner that allows heat to flow from the layer through an electrically insulating, thermally conducting, sheet of aluminum nitride ceramic. A prototype apparatus for performing PPEC is described. Separation by PPEC is faster than by conventional TLC, and an example is presented of a 24-fold enhancement in the speed of separation. PPEC was performed on both regular and high-performance C18 layers, and the latter yield substantially faster separation. The sorbent layer requires conditioning at elevated temperature before use, and solute migration velocity increases with this temperature. The flow rate increases in a linear manner with increasing voltage and diminishes in a nonlinear manner with increasing pressure. Both electrical current and Joule heating diminish with increasing pressure, and the diminution of flow at high pressure can be compensated by an increase in voltage. PPEC is more efficient than classical TLC. Theoretical plate heights diminish with increasing Rf and are in the range 29-21 and 55-27 microm for the high-performance and regular plates, respectively. PPEC retains the advantages of classical TLC but has the ability to separate a substantially higher number of samples simultaneously. An example is presented on the separation of nine samples in 1 min on a 2.5 cm x 10 cm sorbent layer.

Role of buffer concentration and applied voltage in obtaining a good separation in planar electrochromatography.

Planar electrochromatography is performed by applying an electric field across a thin layer chromatography (TLC) plate. In addition to electroosmotic flow in the axial direction, there is also flow to the surface of the TLC layer, and this can substantially degrade the quality of separation. This effect is offset by Joule heating which causes evaporation of liquid from the layer surface, and which under some conditions causes degradation of separation quality by excessive drying of the layer. It is shown that pH, buffer concentration, and applied voltage control the balance between liquid being driven to the surface and liquid evaporating from the surface due to Joule heating. Conditions are discussed which result in good separation quality, or in separations degraded by either excessive wetting or drying of the layer. The above separations were performed at constant voltage. A chromatogram is presented that shows that a good separation is also obtained at constant power, i.e. under conditions where there is a constant amount of Joule heating.