Primary transoral robotic surgery +/- adjuvant therapy for oropharyngeal squamous cell carcinoma-A large observational single-centre series from the United Kingdom.

OBJECTIVES: To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). DESIGN: Observational case series. SETTING: Tertiary centre; first TORS practice to commence in the UK. PARTICIPANTS: All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. MAIN OUTCOME MEASURES: Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease-Specific, Progression-Free and Locoregional control. RESULTS: The cohort comprised of 120 patients undergoing TORS with minimum 12-month follow-up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV-related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins <2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78-92), disease-specific 90% (85-96), progression-free 86% (79-92) and locoregional control 90% (84-96). The equivalent survival figures for the HPV-related cases alone were as follows: overall 88% (82-94), disease-specific 93% (87-98), progression-free 88% (81-95) and locoregional control 92% (87-98). CONCLUSIONS: Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality.

An unusual case of cavitating pulmonary nodules: Lemierre's syndrome with isolated involvement of the external jugular vein.

A 65-year-old female presented with symptoms of tonsillitis and sepsis. Despite initial treatment with i.v. fluid and antibiotics, her condition deteriorated and she became hypoxaemic. CT pulmonary angiography showed no filling defects in the pulmonary arteries, but there were multiple cavitating lung nodules, initially thought to represent metastases. A subsequent contrast-enhanced CT of the neck and thorax demonstrated thrombosis of the left external jugular vein (EJV), leading to a revised diagnosis of Lemierre's syndrome (i.e. septic embolization from jugular thrombophlebitis). Noteworthy aspects of the case include the initial misdiagnosis of the cavitating lung nodules by the reporting radiologist and the isolated involvement of the EJV-Lemierre's syndrome usually involves the internal jugular vein. The case highlights the importance of septic emboli in the differential diagnosis of cavitating lung nodules, and of assessment of the EJV as well as internal jugular vein in the context of oropharyngeal infection.

Face working memory deficits in developmental prosopagnosia: Tests of encoding limits and updating processes.

Developmental prosopagnosia (DP) is a condition in which individuals experience life-long problems recognising faces. In recent years, unpacking the nature of the impairments of this population has been the focus of numerous studies. One focus has been on the nature of face-based memory impairments for such individuals, with the onus being mainly on long-term memory deficits. Far fewer have considered the nature of face-based working memory (WM) impairments for DP cases, and the current study seeks to address this. One recent WM study (Shah et al., 2015) reported that the maintenance of faces over time in WM was spared among DPs, and argued instead that face encoding was limited in some way. Here we further explore the nature of face-based WM impairments in DP across two experiments designed to probe encoding limits (Experiment 1) and WM updating processes (Experiment 2). In Experiment 1 we manipulated the number of faces (1-4) to encode into WM and presented these simultaneously. We reasoned that if face encoding among DPs was inefficient or imprecise, then increasing encoding demands (WM load) would disproportionately impair WM accuracy compared to controls. However, we found that DP cases were consistently poorer than controls across all face load conditions, suggesting that front-end encoding problems are only part of the deficit. In Experiment 2, to measure updating four faces were shown sequentially for encoding into WM and accuracy was analysed as a function of whether the test face had been presented first, second, third or last in the encoding sequence. DPs had significantly poorer WM than controls for later faces but not the first face encoded in the sequence, and showed an attenuated recency effect. To account for these findings, we discuss the potential role of comparison processes at retrieval, impairments in configural face processing, and the impact of noise in the face identification system of individuals with DP.

Recurrence of food bolus impaction of the oesophagus: a retrospective observational study.

BACKGROUND: Most cases of oesophageal food bolus impactions (FB) are one-off events, but recurrence is recognised. The aims of this study are to establish the recurrence rate of food bolus impaction and to identify features associated with recurrence. METHODS: Clinical records of all FB cases were reviewed and the following information was recorded (patient identifier, age, gender, dates of admission, history of oesophageal pathologies). Results of investigations were also recorded (contrast swallow, endoscopies, oesophageal manometry and pH studies). Cases were coded according to the most common oesophageal pathologies. RESULTS: 99 patients fulfilled inclusion criteria and consisted of 65 males and 34 females. Recurrence was noted in 9 patients who did not demonstrate any significant difference compared with cases suffering a single episode of FB in terms of age (Median 61 years IQR 49-79 years, Mann-Whitney U test 374.5, p = 0.71) or gender (recurrences in 3/34 females and 6/65 males, Pearson chi-square test 0.004, p = 0.99). 86 patients had investigations performed. Logistic regression demonstrated that hiatus hernia was the only oesophageal pathology demonstrating statistical significance in its association with FB recurrence (odds ratio 4.77 95% CI 1.15-19.82, p = 0.032). All other variables (oesophageal pathologies, age and gender of patients) were not statistically significant (p > 0.35). CONCLUSION: The rate of recurrence of FB in our study group was 9%. Hiatus hernia was the only oesophageal pathology associated with recurrence of FB. It is not possible to draw any conclusions regarding the role of hiatus hernia in the causation of recurrence of FB.

The management of simple snoring.

Simple snoring is a very common problem that presents a number of different challenges. The initial difficulty is in confirming the presence of snoring, next one must exclude any other nocturnal respiratory pathology and finally a decision as to an appropriate treatment must be made. There are many different ways of achieving these objectives, but no one-way has a clear advantage in terms of both accuracy and cost effectiveness. In this review the authors do not intend to give a didactic method for the management of simple snoring but to discuss the pros and cons of various different options in order to help physicians make a choice based on local priorities.