ABSTRACT
Palpable cervical lymph nodes are common in children and are a frequent reason for presentation to both primary and secondary care. Enlarged lymph nodes are most commonly the result of self-limiting infection, and in children, are rarely the first indicator of a malignant process. This article presents an evidenced-based approach to evaluating these patients.
Subject(s)
Lymph Nodes , Lymphadenopathy , Humans , Child , Neck/diagnostic imaging , Referral and ConsultationSubject(s)
Cyclin-Dependent Kinase Inhibitor p16/metabolism , Oropharyngeal Neoplasms/metabolism , Oropharyngeal Neoplasms/pathology , Squamous Cell Carcinoma of Head and Neck/metabolism , Squamous Cell Carcinoma of Head and Neck/secondary , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neck Dissection , Oropharyngeal Neoplasms/surgery , Predictive Value of Tests , Squamous Cell Carcinoma of Head and Neck/surgeryABSTRACT
IL10, but not IL12 or T regulatory cells in the circulation of newly presenting, pre-treatment head and neck squamous cell carcinoma (HNSCC) patients, has been shown previously to be related to survival over a mean follow-up period of 15 months. Here, we followed the same patients for a longer period to determine whether these associations change. Pre- and post-treatment serum IL10/IL12 and circulating T regs were measured using ELISA and flow cytometry respectively and were correlated with survival after a 33 month average follow-up in a cohort of newly presenting HNSCC patients (n=107), with cancers of the hypopharynx (n=16), larynx (n=36), oral cavity (n=21), oropharynx (n=25), sinonasal (n=4) or unknown origin (n=5). Although the mean survival time of patients with detectable levels of IL10 pre-treatment was lower (40.6 months) than that of those without detectable levels of IL10 (45.6 months), the difference was no longer significant, in contrast to earlier follow-up data. In conclusion, although serum levels of IL10 may be a prognostic indicator for HNSCC patients over the short-term, they become less significant as follow-up time increases.
Subject(s)
Carcinoma, Squamous Cell/blood , Head and Neck Neoplasms/blood , Interleukin-10/blood , Interleukin-12/blood , Interleukin-2 Receptor alpha Subunit/blood , T-Lymphocytes, Regulatory/immunology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/immunology , Cohort Studies , Female , Follow-Up Studies , Head and Neck Neoplasms/immunology , Humans , Interleukin-10/immunology , Interleukin-12/immunology , Interleukin-2 Receptor alpha Subunit/immunology , Male , Middle Aged , PrognosisABSTRACT
In light of the introduction of the European Working Time Directive and Modernising Medical Careers initiative, this article reports the results of a study to see whether junior doctors possess adequate skills to correctly interpret lateral soft tissue neck X-rays and if they receive adequate training.
Subject(s)
Clinical Competence/standards , Education, Medical, Undergraduate/standards , Medical Staff, Hospital/education , Neck/diagnostic imaging , Otolaryngology/education , Otorhinolaryngologic Diseases/diagnostic imaging , Education, Medical, Undergraduate/organization & administration , Humans , RadiographyABSTRACT
Schwannoma of the facial nerve is an extremely rare condition with an incidence far lower than that of vestibular schwannoma. We discuss the case of a woman who had been diagnosed as having vestibular schwannoma and referred to our hospital. Initially, we concurred with the diagnosis, but on reassessment of magnetic resonance imaging scans before surgery, we revised the diagnosis to facial nerve schwannoma. This allowed us to counsel the patient appropriately preoperatively regarding the expected outcome. We discuss the importance of this case and the lessons to be learned from it.
