RESUMEN
BACKGROUND: High-flow nasal oxygen (HFNO) is an emerging technology that has generated interest in tubeless anesthesia for airway surgery. HFNO has been shown to maintain oxygenation and CO2 clearance in spontaneously breathing patients and is an effective approach to apneic oxygenation. Although it has been suggested that HFNO can enhance CO2 clearance during apnea, this has not been established. The true extent of CO2 accumulation and resulting acidosis using HFNO during prolonged tubeless anesthesia remains undefined. METHODS: In a single-center trial, we randomly assigned 20 adults undergoing microlaryngoscopy to apnea or spontaneous ventilation (SV) using HFNO during 30 minutes of tubeless anesthesia. Serial arterial blood gas analysis was performed during preoxygenation and general anesthesia. The primary outcome was the partial pressure of CO2 (Paco2) after 30 minutes of general anesthesia, with each group compared using a Student t test. RESULTS: Nineteen patients completed the study protocol (9 in the SV group and 10 in the apnea group). The mean (standard deviation [SD]) Paco2 was 89.0 mm Hg (16.5 mm Hg) in the apnea group and 55.2 mm Hg (7.2 mm Hg) in the SV group (difference in means, 33.8; 95% confidence interval [CI], 20.6-47.0) after 30 minutes of general anesthesia (P < .001). The average rate of Paco2 rise during 30 minutes of general anesthesia was 1.8 mm Hg/min (SD = 0.5 mm Hg/min) in the apnea group and 0.8 mm Hg/min (SD = 0.3 mm Hg/min) in the SV group. The mean (SD) pH was 7.11 (0.04) in the apnea group and 7.29 (0.06) in the SV group (P < .001) at 30 minutes. Five (55%) of the apneic patients had a pH <7.10, of which the lowest measurement was 7.057. No significant difference in partial pressure of arterial O2 (Pao2) was observed after 30 minutes of general anesthesia. CONCLUSIONS: CO2 accumulation during apnea was more than double that of SV after 30 minutes of tubeless anesthesia using HFNO. The use of robust measurement confirms that apnea with HFNO is limited by CO2 accumulation and the concomitant severe respiratory acidosis, in contrast to SV. This extends previous knowledge and has implications for the safe application of HFNO during prolonged procedures.
Asunto(s)
Manejo de la Vía Aérea/métodos , Anestesia General/métodos , Apnea/sangre , Dióxido de Carbono/sangre , Terapia por Inhalación de Oxígeno/métodos , Mecánica Respiratoria/fisiología , Administración Intranasal , Anciano , Apnea/diagnóstico , Femenino , Humanos , Laringoscopía/métodos , Masculino , Persona de Mediana Edad , Oxígeno/administración & dosificación , Resultado del TratamientoRESUMEN
Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC). We assess the safety and tolerability of adoptive transfer of autologous cytotoxic T lymphocytes (CTLs) specific for the EBV latent membrane protein (LMP) in a patient with recurrent NPC. After infusion, the majority of pulmonary lesions were no longer evident, although the primary tumor did not regress.
Asunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Inmunoterapia Adoptiva/efectos adversos , Inmunoterapia Adoptiva/métodos , Neoplasias Nasofaríngeas/terapia , Linfocitos T Citotóxicos/inmunología , Adulto , Carcinoma , Infecciones por Virus de Epstein-Barr/prevención & control , Humanos , Pulmón/patología , Masculino , Carcinoma Nasofaríngeo , Prevención Secundaria , Trasplante Autólogo/métodos , Resultado del Tratamiento , Proteínas de la Matriz Viral/inmunologíaRESUMEN
Head and neck cancer (HNC) consists of a group of malignancies affecting closely related anatomical regions of the upper aerodigestive tract (UADT), including the oral cavity, salivary glands, upper and lower jaw bones and facial skin; the nasal cavity, paranasal sinuses, pharynx, larynx and thyroid gland (although the latter is often excluded and considered as part of endocrine neoplasms). Of these, 90% of HNCs are histologically squamous cell carcinomas originating from the mucosal lining. These malignancies are strongly associated with certain environmental and life-style risk factors, principally tobacco in both smoked and smokeless forms, excessive alcohol consumption, diets poor in antioxidants and essential micronutrients, UV light, chemicals used in certain workplaces, and viruses, principally certain strains of human papillomavirus (HPV) and Epstein-Barr virus (EBV). These cancers are frequently aggressive in their biological behaviour with local invasion and metastasis to lymph nodes in the neck. Since most patients are already at late stages of disease at the time of diagnosis, the desirable practice of early diagnosis (first sign of the malignant lesion at an initial stage) and early treatment, a critical priority to save lives and retain quality of life, is difficult to implement. Thus, primary prevention has been set as a key goal. This article aims to reinforce the basic knowledge of aetiology, key risk factors related to the development of head and neck cancer, basic features of clinical appearance of this group of cancers, and strategies for prevention and early detection.We also suggest basic research strategies on the basis of current knowledge, which should ultimately lead to the improvement of clinical management.
Asunto(s)
Detección Precoz del Cáncer/métodos , Neoplasias de Cabeza y Cuello , Prevención Secundaria/métodos , Distribución por Edad , Trastornos Relacionados con Alcohol/complicaciones , Areca/efectos adversos , Investigación Biomédica/métodos , Investigación Biomédica/tendencias , Terapia Combinada , Dieta/efectos adversos , Progresión de la Enfermedad , Salud Global/tendencias , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/etiología , Neoplasias de Cabeza y Cuello/prevención & control , Neoplasias de Cabeza y Cuello/terapia , Humanos , Medicina Tradicional China/métodos , Prevención Primaria/métodos , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Tabaquismo/complicacionesRESUMEN
BACKGROUND: The purpose of this study was to present our prospectively evaluated positron emission tomography (PET)-directed policy for managing the neck in node-positive head and neck squamous cell carcinoma (N+HNSCC) after definitive radiotherapy (RT) with or without concurrent systemic therapy. METHODS: One hundred twelve consecutive patients who achieved a complete response at the primary site underwent a 12-week posttherapy nodal response assessment with PET and diagnostic CT. Patients with an equivocal PET underwent a repeat PET 4 to 6 weeks later. Patients with residual CT nodal abnormalities deemed PET-negative were uniformly observed regardless of residual nodal size. RESULTS: Median follow-up from commencement of RT was 28 months (range, 13-64 months). Residual CT nodal abnormalities were present in 50 patients (45%): 41 PET-negative and 9 PET-positive. All PET-negative residual CT nodal abnormalities were observed without subsequent isolated nodal failure. CONCLUSION: PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Tomografía de Emisión de Positrones , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/radioterapia , Cisplatino/uso terapéutico , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/radioterapia , Masculino , Persona de Mediana Edad , Cuello , Neoplasias Faríngeas/diagnóstico por imagen , Neoplasias Faríngeas/radioterapia , Radioterapia Conformacional , Carcinoma de Células Escamosas de Cabeza y Cuello , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma Papilar/secundario , Neoplasias Orbitales/secundario , Neoplasias de la Tiroides/patología , Anciano , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Humanos , Masculino , Evisceración Orbitaria , Neoplasias Orbitales/patología , Neoplasias Orbitales/cirugía , TiroidectomíaRESUMEN
INTRODUCTION: Lingual thyroid is a rare embryological abnormality that occurs as a result of failed descent of the thyroid gland. CASE REPORT: We report the case of a 39-year-old male with an incidental finding of a lingual thyroid during intubation for surgery for lower limb fractures. A sleep study indicated an RDI of 38.6, consistent with severe sleep apnoea. The ectopic thyroid was excised via a suprahyoid approach, with resolution of apnoeic symptoms post-operatively. A follow-up sleep study subsequent to his operation confirmed an RDI of 3.7. CONCLUSION: This is the first time a lingual thyroid causing sleep apnoea has been studied with pre- and post-treatment sleep studies. This is also the first recorded instance of lingual thyroid causing sleep apnoea has been recorded in a male.
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Tiroides Lingual/complicaciones , Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/cirugía , Adulto , Humanos , Hallazgos Incidentales , Imagen por Resonancia Magnética , Masculino , Polisomnografía , Complicaciones Posoperatorias/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which retropharyngeal liposarcoma occurred in a patient who had had multiple previous subcutaneous lipomas excised. This paper explores this very unusual presentation and discusses the difficulties in the diagnosis and management of this rare tumour.
Asunto(s)
Liposarcoma/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Faríngeas/diagnóstico , Enfermedad Aguda , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Humanos , Liposarcoma/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Neoplasias Faríngeas/cirugía , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Retropharyngeal haematomas (RPHs) are rare but potentially life-threatening conditions that require a prompt diagnosis. However, the clinical scenario is not always straightforward as their presentation may be insidious, with no specific signs or symptoms. Treatment of RPH is conservative in the majority of cases, with close observation. Nevertheless, surgical intervention is sometimes indicated for large, non-resolving haematomas. We present the case of a 53-year-old woman on anticoagulant therapy who required evacuation of a traumatic RPH. We also propose a clinical protocol for the management of these entities according to our experience and previous literature reports.