Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study.

OBJECTIVE: To identify deep neck infection factors related to life-threatening complications. METHODS: This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed. RESULTS: During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001). CONCLUSION: It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

Bacteriology of deep neck infections: analysis of 634 patients.

BACKGROUND: The aim of this study was to review the bacteriology of deep neck infections (DNI) and identify the factors that influence the incidence of causative bacteria. METHODS: A retrospective analysis of 634 patients with DNI was performed. Statistical analysis was used to compare the incidence of common pathogens in various conditions such as age of the patients, aetiology and associated diabetes mellitus. RESULTS: Bacteria were isolated in 514 cultures (81%). Aerobic bacteria were isolated from 246 cultures (39%) and anaerobic bacteria from 61 cultures (10%). Both aerobic and anaerobic bacteria were isolated from 207 cultures (32%). The most common aerobic bacteria were Streptococcus pyogenes (41%) and Staphylococcus aureus (32%). The most common anaerobic bacteria were Peptostreptococcus species (28%), followed by Prevotela species (8%) and Proprionibacterium species (7%). The incidence of anaerobic bacteria was higher in adults, in patients with infections of dental origin and in non-diabetic patients. CONCLUSIONS: The bacteriology of DNI is polymicrobial, including both aerobic and anaerobic bacteria. The incidence of anaerobic bacteria is higher in adults, in patients with infections of dental origin and in non-diabetic patients.

Change of carcinogenic chrysotile fibers in the asbestos cement (eternit) to harmless waste by artificial carbonatization: petrological and technological results.

Asbestos cement materials, mainly the eternit roof ceiling, being widely applied in the past, represent a serious environmental load. The solar radiation, rain and frost cause the deliberation of cement from the eternit roofing and consequently the wind contaminates the surrounding area by the asbestos (chrysotile) fibers. In combination with other carcinogens (e.g. smoking), or at reduced immunity of a man, they may cause serious respiratory diseases and lung cancer. The article presents the procedure and experimental results of artificial carbonatization, applied in the asbestos cement (eternit). The wet crushed and pulverized asbestos cement was thermally modified at 650°C and then the chrysotile fibers easily and completely reacted with the mixture of CO2 and water, producing new Mg-rich carbonates - hydromagnesite and magnesite: [Formula: see text] Applying this methodology, the asbestos-bearing waste can be stabilized and environmentally friendly permanently deposited. Finding a way of neutralizing of extreme pH values (around 12) at large eternit dumps represents also an asset of presented research. Simultaneously, the artificial carbonatization of chrysotile asbestos, applying CO2, offers an alternative way for permanent liquidation of a part of industrial CO2 emissions, contributing to multiple benefit of this methodology.

Biologic importance and prognostic significance of selected clinicopathological parameters in patients with oral and oropharyngeal squamous cell carcinoma, with emphasis on smoking, protein p16(INK4a) expression, and HPV status.

The aim of this study is to evaluate the biologic importance and prognostic significance of selected clinicopathological parameters in patients with oral (OSCC) and oropharyngeal (OPSCC) squamous cell carcinoma, with emphasis on smoking, protein p16(INK4a) (p16) expression, and human papillomavirus (HPV) status.The study sample consisted of 48 patients with OSCC and 44 patients with OPSCC. Half of the patients were nonsmokers and the other half were gender-, age- and tumor localization-matched smokers. p16 expression was detected in 17/48 (35 %) OSCCs and in 36/44 (82 %) OPSCCs and HPV DNA was present in 7/48 (15 %) OSCCs and in 35/44 (80 %) OPSCCs. The sensitivity and specificity of p16 expression for HPV DNA presence were 0.74 and 0.88, respectively. The OPSCCs were more frequently basaloid (p < 0.001) while the OSCCs were more frequently conventional (p < 0.000001). The OSCCs were more likely to recur locally and to be the cause of death (p = 0.009 in both parameters).The HPV-positive tumors were more frequently localized in oropharynx, were basaloid SCCs and were p16- and HPV-positive (p < 0.000001 in all 4 parameters). The HPV-negative tumors were more frequently localized in oral cavity (p < 0.000001), more frequently asociated with local, regional and locoregional recurence (p = 0.011, p = 0.019 and p = 0.030, respectively) and with tumor-related death (p = 0.003). There was no significant difference with regard to smoking history (p > 0.05). The survival of patients with HPV-positive tumors was significantly longer (median 112 months; 95% CI 54 - 112 months) than that of patients with HPV-negative tumors (median 17 months; 95% CI 12 - 39 months) (p < 0.001). The HPV status of OSCC/OPSCC is an important biological and prognostic parameter and should be examined in all cases, using PCR or immunohistochemical detection of surrogate marker p16. Smoking itself does not seem to be an important prognostic factor.

[Extrapleural solitary fibrous tumor mimicking lateral neck cyst--a case report]. / Extrapleurální solitární fibrózní tumor napodobující laterální krcní cystu--kazuistika.

A 62-year-old man was referred to the Department of Dentistry because of ultrasonographic finding of "cystoid lesion with relationship to right parotid gland". During operation, a tumor mass without any relationship to parotid gland but attached to the right internal carotid artery was found. Grossly, the tumor was well circumscribed, spheric, measuring 40 mm in diameter; it was of solid, firm appearance and tan-to-white color on cross section. Microscopically, the tumor cells were round to spindle-shaped with vesicular nuclei and eosinophilic cytoplasm, arranged in fascicular pattern. Immunohistochemically, the cells expressed vimentin, CD 34, smooth muscle actin, and bcl-2 protein. On the basis of microscopical appearance and results of immunohistochemistry, the diagnosis of solitary fibrous tumor (cellular variant) was established. One year after resection, the patient is free of disease. A new concept of this uncommon mesenchymal tumor is discussed.

Low grade myofibroblastic sarcoma of tongue: a case report.

A case of a 24-year-old woman with a 6 weeks lasting nodule of the right margin of the tongue is described. The nodule was 20 mm in diameter and showed surface ulceration. The diagnosis of low grade myofibroblastic sarcoma was supported by histological, immunohistochemical and electronmicroscopic examination. Although the tumor resection was not complete, the patient is free of disease 1 year after operation. The differential diagnostics of low grade myofibroblastic sarcoma is discussed.

High dose rate brachytherapy in the treatment of oral cancer--the preliminary one institution experience.

Low dose rate brachytherapy is well established treatment modality of oral cancer. Data about high dose rate brachytherapy (HDR BT) are still scarce with heterogenous results. The aim of our study was to evaluate preliminary results in a small group of oral cancer patients treated by HDR BT. Seventeen applications were performed on 16 patients in years 2001-2004, in 15 cases for new tumor (mobile tongue 10x, floor of mouth 2x, lip 3x) and in 2 cases for local recurrence after radiotherapy. Ten treatments (for T1-2N0 tumors and recurrences) were performed with brachytherapy alone (18 x 3 Gy twice daily), seven patients (T2-3 N0-2 tumors) were treated with a combination of external beam radiotherapy (40-68 Gy) and brachytherapy (2-6 x 3 Gy twice daily). The plastic tubes technique was used for brachytherapy. Follow-up periods were between 8-46 months (median 17). Fifteen patients were disease free during follow-up period. One patient (brachytherapy alone for T2N0M0 mobile tongue cancer) died immediately after neck dissection for the neck recurrence due to the heart failure. The other one died due to distant metastases but without local recurrence. Acute complications were mucositis gr. II at maximum, late complications were ulcer of soft tissues in 3 and superficial bone necrosis in 2 cases. The evaluation of the brachytherapy implants was done according ICRU 58 recommendations. Hyperfractionated high dose rate brachytherapy alone or as a boost to external beam radiotherapy is feasible with promising local control. Carefull planning of the implant and mandibular shielding are necessary to avoid complications.