Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization's Central Ethics Review Board and was also approved by the directors of the participating institutions.

Usefulness of a handheld nebulizer in cough test to screen for silent aspiration.

Cough test to screen for silent aspiration (SA) was reported, and the effectiveness was excellent. However, the device was rather large so that the portability was poor. So, the purpose of this study is to investigate the usefulness of a handheld nebulizer for the test and verify the reproducibility of the method. The subjects were 160 patients who were suspected of having dysphagia and underwent videofluorography (VF) or videoendoscopy (VE). They inhaled 1.0 % citric acid-physiologic saline orally for 1 min using a handheld nebulizer, and the examiner observed the number of coughs: more than five coughs was considered as negative (normal), while less than four coughs was regarded as positive. Among the subjects, 70 patients administered the cough test and VF or VE twice or more at some intervals. The k coefficient was calculated in reproducibility. Using the results of the VF or VE examination as the standards, for SA detection, the sensitivity was 0.86, specificity was 0.71, positive predictive value was 0.53, and negative predictive value was 0.93. The k coefficient was 0.79. In conclusion, the handheld nebulizer was useful in the cough test to screen for SA. Furthermore, satisfactory reproducibility was shown.

[Upper esophageal sphincter bolus flow laterality after unilateral neck dissection].

The unilateral bolus passage through the upper esophageal sphincter (UES) is often observed in swallow evaluations of patients following neck dissection. Head rotation toward the paretic side was reported to be useful to prevent aspiration; however, we often encounter cases of head and neck surgical patients in which the bolus passes through the non-surgical side. Therefore, we investigated UES flow after head and neck surgery to evaluate the laterality to find an effective treatment technique after a head and neck operation. Videofluoroscopic swallowing studies (VFSS) were conducted in 23 oral cancer patients who underwent unilateral neck dissection but not tongue resection. Patients comprised 12 males and 11 females, with a mean age of 62 (SD=14) years. Preoperative VFSS showed that none had a predominant side for UES flow. The laterality of the bolus flow through the UES was predominantly on the side of neck dissection in post-operation. Lateral VFSS showed elevation of the hyoid and the larynx on the non-dissected side was greater compared to the dissected side. Therefore, head rotation toward non-dissected side can be effective for head and neck surgical patients.