Radiological localization of Schneiderian papilloma.

BACKGROUND: It has been recently reported that the site of attachment of Schneiderian papillomas can be predicted with high accuracy on preoperative computed tomography (CT) scans using bony osteitic changes as an indicator. The objective of this study is to evaluate, in a blinded fashion, the reliability of the osteitis sign at predicting the site of attachment of Schneiderian papillomas. METHODS: A retrospective cohort study of patients who underwent endoscopic surgical resection for inverted papilloma (IP) or cylindrical papilloma between September 2002 and September 2009 in a tertiary care rhinology center was carried out. The preoperative sinus CT scans were collected and reviewed by a fellowship-trained and experienced head and neck radiologist who was blinded to the intraoperative findings. The radiologist attempted to identify and grade bony osteitic changes in the sinuses. The radiological findings were then correlated with the actual site of attachment reported by the surgeon in the operative report. RESULTS: A total of 34 patients were evaluated. Six (18%) patients had a single site of osteitis and 28 (82%) were found to have multiple sites of osteitis. The sensitivity and specificity of the radiological prediction based on the degree of osteitis was found to be 74% (46.5-90.3%) and 0% (0-17%), respectively. The predictive value of the radiological localization was 41%. CONCLUSION: Osteitic changes are very common nonspecific findings on CT scans of patients with Schneiderian papillomas. Their presence as well as the degree of osteitis did not allow preoperative localization of tumor attachment.

Sternoclavicular joint osteomyelitis following head and neck surgery.

OBJECTIVES/HYPOTHESIS: To review all reported cases of sternoclavicular joint (SCJ) osteomyelitis following head and neck surgery. STUDY DESIGN: Retrospective case review. METHODS: PubMed search and one additional case from our institution. RESULTS: Twelve cases were reviewed, and the following recommendations are suggested: risk factors for SCJ osteomyelitis should be identified; early and prompt diagnosis of SCJ osteomyelitis is warranted; tracheostoma care and careful examination of the skin should not be neglected; meticulous screening for cancer recurrence is imperative; if SCJ infection is suspected, cancer recurrence must be ruled out with biopsies; and surgical debridement is considered the gold standard of treatment. Administration of newer-generation antibiotics is a reasonable choice when the infection is detected early, as is maintaining a low threshold for surgical treatment if disease persists or progresses. CONCLUSIONS: Osteomyelitis of the SCJ following head and neck surgery is uncommon and must be distinguished from malignancy with biopsies. Early diagnosis and treatment are imperative. Laryngoscope, 2010.

Postoperative arm massage: a support for women with lymph node dissection.

PURPOSE/OBJECTIVE: To evaluate the usefulness of arm massage from a significant other following lymph node dissection surgery. DESIGN: Randomized clinical trial with a pretest-posttest design. Data were collected prior to surgery, within 24 hours post surgery, within 10 to 14 days post surgery, and 4 months post surgery. SAMPLE: 59 women, aged 21 to 78 undergoing lymph node dissection surgery and who had a significant other with them during the postoperative period. METHODS: Subjects were randomly assigned to intervention and control groups. Subjects' significant others in the intervention group were first taught, then performed arm massage as a postoperative support measure. RESEARCH MAIN VARIABLES: Variables included postoperative pain, family strengths and stressors, range of motion, and health related costs. FINDINGS: Participants reported a reduction in pain in the immediate postoperative period and better shoulder function. CONCLUSION: Arm massage decreased pain and discomfort related to surgery, and promoted a sense of closeness and support amongst subjects and their significant other. IMPLICATION FOR NURSING PRACTICE: Postoperative massage therapy for women with lymph node dissection provided therapeutic benefits for patients and their significant other. Nurses can offer effective alternative interventions along with standard procedures in promoting optimal health.