The role of histology on the outcome of sinonasal carcinomas treated with radiotherapy: a single institution experience.

PURPOSE: Sinonasal malignancies are a rare group of head and neck cancers. We aimed to report the oncological outcomes based on histological types in patients who underwent radiotherapy. MATERIALS AND METHODS: In this single-institution study, we retrospectively retrieved and analyzed data of patients with sinonasal carcinomas who underwent radiotherapy during 2011-2016 as part of their treatment. The 3-year rate of local, regional, and distant recurrences, and overall survival were evaluated according to the histological type. RESULTS: A total of 28 patients were evaluated in this study, the majority of whom were male (60%). Squamous cell carcinoma (SCC), adenoid cystic carcinoma (ACC), and adenocarcinoma (ADC) were found in 15 patients (53.5%), 8 (28.5%), and 5 (18%), respectively. The highest rates of local and regional recurrences were observed in ACC and SCC, respectively. Distant recurrences were numerically more common in ADC. The 3-year OS was 48%, 50%, and 73% in SCC, ADC, and ACC, respectively. CONCLUSION: Different histopathologies of sinonasal cancer seem to have different patterns of failure, and this may be considered in the treatment approach.

Our Experience in Subadventitial Dissection vs. Intracapsular Dissection Technique of Carotid Body Tumors Surgery.

This study provides a single-center experience involving intracapsular dissection for Shamblin II carotid body tumors (CBTs) and compares the outcomes with the classic technique of subadventitial resection. Based on the preliminary results, it seems that the enucleation technique facilitates the dissection of carotid body tumors, offering protection to cranial nerves and the internal/external/common carotid artery by utilizing the capsule as a barrier. The classic subadventitial resection approach and the enucleation technique have comparable postoperative complications. However, it is crucial to continue following the patients who underwent these resection techniques to determine the long-term outcomes. Moreover, the enucleation technique significantly reduces surgery duration and intraoperative blood loss.

Increasing stage and depth of invasion (DOI) in patients with tongue cancer during the COVID-19 pandemic: A time series study.

Background and Aims: The outbreak of the Coronavirus disease 2019 (COVID-19) pandemic had a significant effect on the diagnosis and treatment of head and neck cancers. Therefore, in this study, we decided to discuss the impact of COVID-19 on the stage and histological characteristics of patients with tongue cancer from March 2020 to March 2021 and compared to the previous 3 years. Methods: In this time series study, patients diagnosed with squamous cell carcinoma of the operated tongue cancer were divided into two groups. Patients who operated from March 2020 to March 2021 (n = 36) and patients who operated 3 years ago (n = 70) were included in the study. The results were analyzed using SPSS 21 software. Results: The study found that during the pandemic, the stage of tongue cancer in patients who underwent surgery was higher than before the pandemic (p = 0.01). Moreover, the depth of invasion was significantly higher during the COVID-19 outbreak in the pathology sample of the patients (p = 0.006), while the involvement of lymph nodes and other variables between the groups was not statistically significant. Conclusion: COVID-19 has adverse effects on the diagnosis and treatment of tongue cancer. Also, it leads to advanced stages of the tumor and increases the depth of invasion of the cancer. Hence, it is important to plan correctly and appropriately for the diagnosis and treatment of these patients in conditions such as the COVID-19 pandemic.

Carotid Sheath Dissection and Histopathology During Neck Dissection in Head and Neck Carcinomas.

To investigate the carotid sheath in neck dissection (ND) specimens histopathologically in patients with head and neck carcinomas who had no evidence of previous neck surgery or direct involvement of the carotid sheath in their pre- or intra-operative evaluations. In this study, carotid sheath (CS) specimens of 40 patients with head and neck carcinomas (HNCA) who, depending on the condition of the primary tumor, required unilateral or bilateral elective or therapeutic selective neck dissection were histopathologically investigated by an expert head and neck pathologist to find any lymphoid or thyroid like tissue or tumor cells infiltration. A total of 50 carotid sheath (CS) specimens were investigated. None of the samples showed any evidence of tumor infiltration or accumulation of lymphatic tissue. We conclude that in patients with no histopathologic involvement of the carotid sheath in pre-operative or intra-operative tumor invasion, it is not necessary to remove CS in routine neck dissection.

Intracapsular Dissection Approaches (Enucleation) in Surgical Resection of Carotid Body Tumors.

Intracapsular dissection approaches in surgical resection of carotid body tumors. Laryngoscope, 133:2627-2630, 2023.

Core Needle Biopsy in Suspicious Malignant Thyroid Nodules with Repeated Nondiagnostic Fine Needle Aspiration.

Key message: The clinician could have CNB in mind for thyroid nodules when FNA results were nondiagnostic. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules. Abstract: Usefulness of preoperative tissue sampling and pathology diagnoses in thyroid tumors were accepted worldwide. We investigate the role of Core needle biopsy (CNB) in the thyroid nodules lesions when FNA results are nondiagnostic. We conducted a cross-sectional study to evaluate twenty-six CNBs results of suspicious malignant thyroid nodules with nondiagnostic repeated fine needle aspiration. 25 from 26 CNBs were diagnostic. Twenty-one needle biopsy reports were papillary thyroid carcinoma, three CNB samples diagnosed medullary thyroid carcinoma and one of them had anaplastic results. All diagnostic needle biopsies results were compatible with final pathology. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules while repeated FNA yielded nondiagnostic results.

Factors related to successful closed nasal bone reduction: a longitudinal cohort study.

Fracture of the nasal bone is the most common facial fracture because the nose is the most protruding part of the facial skeleton. Standard treatment is nasal reduction, which may cause patients significant pain and stress. Closed nasal reduction may be unsuccessful because of old fractures, despite physical examination being compatible with a new fracture. This study aimed to investigate factors influencing the success of closed nasal reduction. A total of 80 patients with isolated nasal bone fractures who opted for closed reduction under local anaesthesia were included. Demographic features, days from trauma, and findings of physical examination and lateral nasal X-rays were assessed. Significant nasal bone movement with significant improvement in the deformity was considered a successful reduction. An absence of, or minimal, nasal bone movement was considered unsuccessful. The mean (SD) age of the patients was 28.4 (11.5) the youngest being 15. A total of 56 patients had successful nasal reduction. Younger age (p = 0.021), absence of periorbital ecchymosis (p = 0.042), and no fracture line on lateral nasal X-ray (p = 0.000), were associated with unsuccessful reduction. Although lateral nasal X-ray is not considered a good instrument for diagnosis of a nasal fracture, this study has shown that the absence of a fracture line on a lateral nasal X-ray can be a predictor for unsuccessful reduction in patients older than 15 years.

Occult nodal metastasis in head and neck carcinoma patients treated with chemoradiotherapy.

BACKGROUND AND AIM: Neck lymph node metastasis plays an important role in the prognosis of patients with squamous cell carcinoma of the head and neck. The aim of this study was to evaluate the occult nodal metastasis in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemo radiotherapy. METHODS: In this 5-year prospective study, patients with recurrent head and neck squamous cell carcinomas (HN-SCC) after primary treatment with chemoradiotherapy or radiotherapy that candidate for surgery were enrolled. In total, 50 patients with squamous cell carcinomas of the head and neck with N0 neck were included in the study. Age, initial location of recurrent tumor, T staging in primary and recurrent tumors, neck condition (N0 or N+), and pathology report for neck metastasis, number of affected lymph nodes and duration of tumor recurrence were examined. RESULTS: Out of 50 patients with mean age of 57.04 ± 14.4 years, 13 were female (26%) and 37 (74%) were male. In terms of primary tumor size, 52% (26 patients) were in T2 stage. The primary and recurrent tumor was located in the oral cavity in 33 patients (66%). Nine 0f 50 patients (18%) had occult metastases. CONCLUSION: It seems that END surgery is necessary for treatment the occult lymph node neck metastasis of recurrent head and neck cancers with N0 neck. Therefore, it is possible that END surgery has reduced cervical recurrence in these patients.

Prevalence of submandibular gland involvement in neck dissection specimens of patients with oral cavity carcinoma.

INTRODUCTION: The submandibular gland is commonly removed during neck dissection in patients with head and neck cancer. The patient experiences various complications due to the removal of the submandibular gland. Therefore, the necessity of submandibular gland removal should be evaluated. This study aimed to was to determine the frequency of submandibular gland (SMG) involvement in patients with oral cavity squamous cell carcinoma (SCC). METHODS: In this retrospective study, medical records of patients with oral cavity cancer who were referred to Amir Alam Hospital between 2015 and 2020 were reviewed. Patient data includes surgical report, histopathology report (tumor size, number of lymph nodes involved, and SMG tumor involvement), Tumor Location, History of Smoking, History of Opium, and Alcohol consumption was extracted from patients' medical records and statistically analyzed using SPSS software version 20. RESULTS: Of the total 60 patients, 24 (40%) were female and 36 (60%) were male. Smoking was reported in 55% of patients with a mean of 4.11 pack-year. Alcohol and opium use was observed in 18.3% and 26% of patients. The majority of patients (78.3%) had tongue cancer. More than half of the patients (53.3%) reported tumors of 2 cm or smaller, and 16.7% of patients had tumors larger than 4 cm. The majority of patients (80.3%) did not have cervical lymph node metastasis, 13.1% had 1-2 involved lymph nodes and 4.9% had 3 to 6 involved lymph nodes and there were no cases of metastasis to more than 6 lymph nodes. Finally, no individual had submandibular gland involvement, ie 100% of patients had no submandibular gland metastasis. CONCLUSION: The results confirmed that SMG involvement is very rare in patients with oral SCC and therefore it is not necessary to remove the gland as part of treatment. Preservation of the submandibular gland prevents complications related to the removal of this gland and reduces morbidity and increases the quality of life of patients after surgery.

Impact of the COVID-19 pandemic on the stage and the type of surgical treatment of laryngeal cancer.

PURPOSE: Changes in the entire health care system during COVID-19 epidemic have affected the management of patients with head and neck cancer and posed several clinical challenges for ENT surgeons. Therefore, the present study aimed to investigate the effect of COVID-19 on the stage and the type of surgical treatments used in laryngeal cancer (including total laryngectomy, supracricoid partial laryngectomy (SCPL) and transoral laser microsurgery (TLM)) and also to compare the results of April 2020 to April 2021 with the previous year. MATERIALS AND METHODS: This cross-sectional study was performed on all patients with a diagnosis of laryngeal cancer who underwent surgery in the tertiary care center from April 2020 to April 2021 and the year before the pandemic in the same time. Demographic, cancer stage, and treatment data of all patients were recorded and analysis in two groups. RESULTS: Patients referred at the time of the virus outbreak; 111 were male and 5 were female, and in the group of patients referred before COVID-19, 90 were male and 12 were female. The type of surgical treatment of laryngeal cancer, mean time elapsed from sampling to surgery, stage of disease and mean tumor volume was statistically significant differences in patients before and during the outbreak. CONCLUSION: Patients who referred for diagnosis and treatment at the time of COVID-19 outbreak had more advanced stages of the disease and also the tumor volume was higher in them than patients who had referred before the outbreak. It is necessary to provide new solutions, education and treatment management for patients with laryngeal cancer in such pandemics.

Effect of Otolaryngology Residency Program Training on Obstructive Sleep Apnea Practice.

According to the importance of management of obstructive sleep apnea syndrome by otolaryngologists, this study was designed to investigate knowledge, attitudes and practice of junior and senior residents of otolaryngology and evaluate the effect of current residency training program on choosing the first lines of treatment. A total of 110 residents of otolaryngology were selected. Our study tools were obstructive sleep apnea knowledge and attitudes (OSAKA and OSAKA-KIDS) questionnaires. The participants were classified as junior and senior. Senior residents had significantly higher total knowledge score for OSAKA based on independent t test (12.73 Vs. 10.52). No significant difference was observed for OSAKA-KIDS (11.31 Vs. 10.69). The most frequent choice for the first line was CPAP (63.8%) and weight loss (41.5%) among junior and senior residents, respectively. Although the knowledge of otolaryngology residents increased during their program, the choice of first line treatment in obstructive sleep apnea was different between junior and senior residents. We found a need for further multidisciplinary education for residents especially in the management of sleep apnea particularly toward CPAP usage and this syndrome in pediatrics.

The Effect of Desmopressin Intraoperatively on Hemorrhage During the Rhinoplasty Surgery.

This clinical trial discusses the efficacy of premedication with desmopressin in the management of bleeding and clears the surgical field during rhinoplasty surgery. This study is a randomized, double-blinded placebo-control clinical trial. Seventy patients were enrolled in this study and divided into two equal intervention-control groups. Thirty minutes before surgery, the intervention group received 500 ml of normal saline containing 0.1 µg/kg desmopressin and, the control group received 500 ml of normal saline. According to the surgeon's opinion, the local distribution of bleeding was dramatically different in both groups. While DDAVP receivers had grade 1 or 2 bleeding (according to the FROMME-BOEZAART grading score), the control group had grade 3 or 4 bleeding, and this difference was statistically meaningful. It seems that intravenous DDAVP can reduce bleeding and clear the surgical field during rhinoplasty surgery, but further studies are needed to determine the exact role and dose of the DDAVP.

Desmopressin effects on bleeding during functional endoscopic sinus surgery on patients with chronic rhinosinusitis.

OBJECTIVE: In this study we aimed to determine whether Desmopressin (DDAVP) can alter bleeding and improves surgeon visual field and decrease operation time or lessen use of anesthesiology medication in a clinical trial study. METHOD: This study is a randomized clinical trial using the permuted block randomization method. 44 patients were enrolled in study and divided into two equal intervention-control groups. The intervention group received maximum dose of 0/2 micrograms per kg of DDAVP. In the control group, 30 min before the surgery, 100 ml of normal saline will be injected. RESULTS: The amount of bleeding was 517/17 cc in control group during surgery while it was 387/72 cc in group receiving DDAVP which is significantly lower. The satisfaction of surgeon regarding suitable visual field was 6/45 in control group while it was 3/77 in DDAVP receivers which is lower. CONCLUSION: It seems that intravenous DDAVP can reduce bleeding during surgery and offer an enhanced vision for surgeon during surgery but it has no potential efficacy on reduction of period of surgery and need for anesthesiology medication like remifentanil and isoflurane.

Subacute Thyroiditis in COVID-19 Patients.

INTRODUCTION: Since December 2019, novel coronavirus (COVID-19) infection has been identified as the cause of an outbreak of respiratory illness in Wuhan, China. The classic presentation of COVID-19 infection was described as fever, myalgia, cough, and fatigue. Whether coronavirus can directly attack the endocrine glands is unclear. OBJECTIVE: Post-viral subacute thyroiditis (SAT, de Quervain thyroiditis) has been reported following other viral infection. A limited number of SAT after COVID-19 infection have been reported up to now. METHODS: Here, we reported 6 patients with SAT and positive COVID-19 serology tests. Demographic, clinical, biochemical, and imaging data were presented. RESULTS: In this study, 6 patients (4 women and 2 men) with clinician manifestations and physical examination in favor of SAT were described. Cervical ultrasonography showed bilateral hypoechoic areas in the thyroid gland which was suggestive of SAT. Elevated C-reactive protein, erythrocyte sedimentation rate, free thyroxine, free tri-iodothyronine, and undetectable thyrotropin were found in laboratory evaluations. Both IgM and IgG were positive for COVID-19 infection, but the PCR tests were negative in all patients. Patients had history of working in a COVID center and/or family member hospitalized due to COVID-19 pneumonia. Patients were followed up for 1 month and were treated effectively with steroids. CONCLUSION: This report may help physicians to identify lesser-known manifestations and complications of COVID-19. Early diagnosis of COVID-19 infection results in the prevention of further transmission.

The role of core needle biopsy in parotid glands lesions with inconclusive fine needle aspiration.

OBJECTIVES: Usefulness of preoperative tissue sampling and pathology diagnoses in parotid gland tumors were accepted worldwide. We investigate the role of CNB in the parotid gland lesions when FNA results are inconclusive. METHODS: We conducted a cross sectional study to evaluate CNB results from fifty-two patients with history of parotid gland lesion and inconclusive previous fine needle aspiration. RESULTS: In this study, 45 out of 52 CNB results determined definite histological subtype diagnosis. Four CNB reports were inconclusive and three CNB results were compatible with malignancies, but did not define definite diagnosis. Calculated sensitivity for diagnosis of malignancy was 96% and specificity was 85%. Negative predictive value, positive predictive value, and accuracy for CNB in detecting malignancy, were calculated 94%, 90%, and 92%, respectively. CONCLUSIONS: When FNA is not conclusive, CNB may be used as a precise method to evaluate the parotid gland lesions.

Advanced glycation end-products and advanced oxidation protein products levels are correlates of duration of type 2 diabetes.

AIMS: Diabetes is associated with the excess formation of advanced glycation end-products (AGEs) and advanced oxidation protein products (AOPP), and low levels of ferric reducing ability of plasma (FRAP). However, the trend of oxidative and antioxidant markers levels according to diabetes duration is unclear. MAIN METHODS: In a case-control study, 240 patients with diabetes and 100 healthy controls were enrolled. Patients were divided into four groups according to the duration of diabetes, including newly diagnosed, 1-5, 5-10, and 10-15 years. Serum AGEs, AOPP, and FRAP levels were compared among groups. KEY FINDINGS: AGEs and AOPP were higher and FRAP was lower in patients with diabetes compared to healthy controls. Serum levels of AGEs increased progressively with increasing in diabetes duration. AGEs levels were 68.97 ± 7.28% in newly-diagnosed, 73.43 ± 12.96% in 1-5 years and 80.44 ± 13.84% in 10-15 years of diabetes duration (pairwise p-values <0.05). In linear regression analysis the correlation among AGEs, AOPP, FRAP, and diabetes duration remained significant after adjustment for age, BMI, HDL, HbA1c, waist circumference, microvascular complications, and coronary artery diseases. ROC analysis showed AGEs could predict the duration of diabetes when patients with 10-15 years duration of diabetes were compared to patients with 1-5 years duration of diabetes (AUC = 0.676, p-value = 0.003). SIGNIFICANCE: Diabetes promotes AGEs, and AOPP production, independent of glycemic control and patients age. Serum levels of AGEs increase progressively with increasing duration of diabetes. AGEs may be helpful in estimating chronicity of diabetes.

Dual peer mentoring program for undergraduate medical students: exploring the perceptions of mentors and mentees.

Background: Despite the advantages of dual peer mentoring, there are a few reports of implementing and evaluating such programs for medical students. This study aimed at exploring the perceptions of mentors and mentees about the dual peer mentoring program for the first year undergraduate medical students of Tehran University of Medical Sciences. Methods: This qualitative study was conducted at the end of the first year of implementing the mentoring program. All mentees and mentors were invited to participate in focus group discussions. Data were analyzed using a qualitative content analysis. Results: All mentors (n= 12) and a group of mentees (n= 21) participated in focus group discussion sessions. We provided a variety of supports for the mentees including academic and psychosocial support and positive relationship; as a result, some developments occurred to the mentors We also explored participants' views on some unique aspects of the program such as student-authorized, dual mentoring, and role model sessions. Conclusion: Our participants found the mentoring program beneficial in various academic achievements and psychosocial supports for both the mentors and the mentees. Dual peer mentoring program can be an alternative to school administered programs.

Bone mineral metabolism and subsequent hospitalization with poor quality of life in dialysis patients.

BACKGROUND: Significant impairment in health-related quality of life (HRQOL) among dialysis patients could be partly explained by some co-morbid disorders, such as chronic kidney disease-mineral and bone disorder (CKD-MBD). Also disturbance in calcium and phosphorus metabolism would increase mortality and morbidity. Therefore, further efforts to treat these abnormalities may improve the survival. OBJECTIVES: We designed a large multicenter population-based study in Iran to describe and assess the relation between HRQOL, hospitalization, and bone metabolism markers. PATIENTS AND METHODS: We enrolled a total of 5820 dialysis patients from 132 dialysis centers in different parts of the country whom were volunteers to cooperate between October 2010 and August 2011. The Iranian adapted version of the Kidney disease quality of life-short form (KDQOL-SF(TM)) version 1.3 questionnaire was used to assess the health related quality of life. The clinical and demographic characteristics were gathered from patients' data files. RESULTS: The mean (SD) age of patients was 54.88 (16.36) years, and the range was 2 to 99 years. Of all patients, 43.1% were female. The scores of kidney disease component summary (KDCS), physical component summary, mental component summary, and total quality of life were significantly higher in the lower quartile of corrected serum calcium and higher quartile of serum parathyroid hormone (PTH) levels (P < 0.05). In a regression analysis of multilevel data, while corrected serum calcium level was associated with total KDCS and short form health survey (SF-36) scores after adjusting for other variables, hospitalization was directly correlated with serum phosphorus level and had reverse correlation with dialysis duration and quality of life. CONCLUSIONS: In the current study, quality of life was correlated with serum calcium level, calcium-phosphate product, and serum PTH level, while hospitalization was correlated only with serum phosphorus level. However, quality of life was inversely correlated with hospitalization.