Shoulder function in patients undergoing selective neck dissection with or without radiation and chemotherapy.

BACKGROUND: Shoulder function can be negatively affected during treatment of upper aerodigestive tract carcinoma. The purpose of this study was to investigate the impact of selective neck dissection alone or in combination with radiotherapy and/or chemotherapy. METHODS: We conducted an observational study in adults who underwent selective neck dissection for the treatment of upper aerodigestive tract cancer who were >6 months from completion of their therapy. Recurrent disease and use of flap reconstruction were part of the exclusion criteria. A modified Constant's score was used to evaluate shoulder function. RESULTS: Thirty-four patients (42 selective neck dissections) met the inclusion criterion. Operated shoulder function was significantly (p < .001) decreased as compared to the nonoperated shoulder. There was no statistical difference in the total Constant's score, in the subjective or objective scores among selective neck dissection only, in the selective neck dissection plus radiation therapy, or in the selective neck dissection plus chemoradiation therapy. CONCLUSION: Selective neck dissection can have a negative effect on shoulder function despite spinal accessory nerve preservation. Adjuvant therapy does not contribute additional detriment to shoulder function.

Transblepharoplasty brow suspension with a biodegradable fixation device.

BACKGROUND: Brow droop, eyelid tissue excess, and hyperfunction of the muscles of forehead facial expression may contribute to the aging diathesis of the upper one-third of the face. Many approaches to the brow have been described, including coronal or pretricheal incisions, direct incision of the suprabrow or forehead, and endoscopic techniques. A less frequent technique, the transblepharoplasty browlift (TBBL), has a role in rejuvenating brow position, especially in patients in whom both the eyelids and brows need to be addressed. The Endotine forehead device has been reported to increase speed and ease in providing operative support to the brows, but little has been written about its function with the TBBL approach. OBJECTIVES: The authors describe their results with Endotine brow fixation for browlift through a TBBL approach. METHODS: Between November 2005 and January 2008, 20 patients presented to the senior author (PRL) for browlift and were treated with a TBBL approach and placement of the Endotine device in one of three sizes (3 mm, 3.5 mm, or 4 mm). The surgeon completed an operative questionnaire immediately postoperatively, as well as a satisfaction questionnaire at one and three months postoperatively. Nineteen of the 20 patients were followed up also completed satisfaction questionnaires at one and three postoperative months. The results were tabulated to assess the safety and efficacy of the Endotine device. RESULTS: A 3-mm Endotine browlift device was placed in most patients (13; 68%). The surgeon was satisfied with the performance of the Endotine device, its ease of insertion, and the fixation provided in all cases. The Endotine was always palpable under the skin but visible in only roughly half of patients. At one month, 5% of the fixations were judged by the surgeon to be fair in appearance; the remainder of cases were satisfactory or better. At three months, all fixations were judged as satisfactory or better. Patients reported being very satisfied with the results of the surgery initially (53%), and satisfaction improved with time (74%). After three months, 79% of patients would recommend the procedure to others, an increase from 63% after one month. CONCLUSIONS: The Endotine device provides an effective lift for the brows, allows for easy repositioning, and is much quicker to apply than the sutures placed in a traditional browlift.

Are bulb syringe irrigators a potential source of bacterial contamination in chronic rhinosinusitis?

BACKGROUND: The purpose of this study was to determine if bulb syringe irrigators are a potential source for bacterial contamination in patients with chronic rhinosinusitis. METHODS: Standard 3-oz bulb syringe irrigators (n = 24) were each flushed with the following solutions twice daily: A (n = 8), sterile isotonic saline; B (n = 8), prepared hypertonic saline (3 tsp table salt/L of sterile water); and C (n = 8), prepared baking soda/saline (1 tsp table salt + 1 tsp baking soda/L of commercial sterile water). Syringes were stored on a residential bathroom counter, and two from each group were harvested for culture weekly for 4 weeks. RESULTS: There was no growth from syringes irrigated with any of the three solutions after the first 7 days of irrigation. After the entire 4-week study period, potential pathogens were recovered from 6/8 (75%) bulbs from group A, 0/8 bulbs from group B, and 1/8 bulbs (12.5%) from group C. All positive cultures revealed growth by 1-2 days postinoculation (p = 0.002). The organism recovered from syringes in group A was Pseudomonas fluorescens in all six specimens. The one positive culture in group C represented a single colony of Gram-positive cocci. CONCLUSION: Under realistic conditions, bulb syringes are susceptible to contamination with potential bacterial pathogens, particularly when using unbuffered isotonic saline.

Plasmablastic lymphoma in a previously undiagnosed AIDS patient: a case report.

BACKGROUND: Plasmablastic lymphoma (PBL) is an unusual non-Hodgkin lymphoma (NHL) most commonly found in the head and neck region. The majority of cases are seen in adult HIV-positive patients, although PBL has been reported in HIV-negative patients. The diagnosis of PBL serves as an AIDS-defining illness. METHODS: We report a case of PBL localized to the oral cavity in a previously undiagnosed AIDS patient. The lesion manifested as solitary, ulcerated, and markedly tender. PBL was confirmed by immunohistochemical profile and subsequent tests confirmed AIDS diagnosis. The patient was prescribed highly active antiretroviral therapy (HAART) and concomitant local low dose radiation therapy prior to initiation of chemotherapy. RESULTS: Complete local clinical response was observed after 4 weeks of treatment with HAART and radiation therapy. The response sustained in this patient in the subsequent 11 months following diagnosis. CONCLUSIONS: The diagnosis of PBL has a unique immunophenotypic profile and should raise suspicion for AIDS in these patients. HAART added to treatment has shown improved survival.

Hearing loss as a late complication of radiotherapy in children with brain tumors.

Late postirradiation hearing loss has been well described in the adult population. Few reports exist on the pediatric population. We conducted a retrospective review of 157 consecutive children with brain tumors treated exclusively with irradiation at St Jude Children's Research Hospital. Twenty-six patients developed a hearing loss, 74 did not, and 57 were excluded because of incomplete records. We report a statistically significant 27.41% cumulative risk of a stringent 20-dB hearing loss in the voice frequency range by the fifth year after radiotherapy. The right side demonstrated a significant frequency effect, with a higher incidence of loss in the higher-frequency region. We found no difference in cumulative incidence of hearing shift between the low-, middle-, and high-frequency ranges for either ear. This risk should be anticipated and managed as part of the treatment plan for radiotherapy for the treatment of malignancies. Radiation-induced hearing loss is important to acknowledge so that techniques of hyperfractionation, total dose, ports, preservative infusion medical therapy, or prolonged medical intervention (such as anticoagulants) can be developed that might reduce this disabling problem of postirradiation sensorineural hearing loss in future patients.