The characterization of oxaliplatin-induced peripheral neuropathy using electromyography in gastrointestinal cancer patients

Oxaliplatin-induced peripheral neuropathy (OIPN) is a common dose-dependent chemotherapy complication in gastrointestinal cancer (GIC). This side effect may restrict therapeutic dose elevation of oxaliplatin. Here, OIPN frequency and determinants of neuropathy appearance in oxaliplatin-treated GIC patients. A total of 102 GIC patients who underwent chemotherapy with fluorouracil, folinic acid and oxaliplatin (FOLFOX4) regimen participated in this longitudinal study. Electromyography (EMG) was accomplished for ulnar, radial, sural, peroneal nerves and superficial peroneal nerve (SPN) before, 3, and 6 months after treatment. National Cancer Institute-Common Toxicity Criteria V.3 and clinical version of the Total Neuropathy Score were used for the neuropathy diagnosis at six months after treatment onset. Of all entered patients, twelve people discontinued this study, and five patients passed away. About 85 patients remained three and six months after chemotherapy onset. Approximately 95% of patients three months after chemotherapy demonstrated OIPN manifestations. Finally, data for 81 patients having neuropathy were analyzed. Mean age of patient 64.0±10.9 years. There were about 3.7%, 30.9%, 63% grade III, II, I of neuropathy, respectively. Interestingly, a significant decrease in action potential (AP) amplitude of SPN, sural and radial nerves but not ulnar and peroneal was observed after treatment onset. However, only the ulnar nerve indicated a substantial deceleration of nerve conduction. Age, sex, weight, past medical diseases, smoking and acute neuropathy were not significantly associated with OIPN. The occurrence of OIPN is detectable by electrophysiological changes of SPN, radial, and sural nerves at three and six months after starting chemotherapy with the FOLFOX4 regimen

Clinical Feature of Extranodal Presentation of Non Hodgkin Lymphoma in Head and Neck

Non Hodgkin lymphoma (NHL) constitutes 5% of all head & neck cancer. The incidence of it has been increased over the last four decades. One of main characteristic of NHL is extranodal presentation that has different pattern in various part of world. A retrospective was designed in a tertiary referral center. It has been done between January 1996 and March 2006. All clinical and pathological characteristics were evaluated. 129 patients were included in this study, 89 male and 49 female. The mean age was 49 year. The most common site of involvement was Waldeyers ring and the most common presenting symptom was cervical mass. 48% of patients had lymphadenopathy and 12% had B symptom. The most common histologic type was diffuse large cell lymphoma. In our series male to female ratio was 2.2 that are more than other studies .it seems that extranodal presentation is more common in Iranian patients than other population

The Effect of Functional Endoscopic Sinus Surgery on Pulmonary Improvement of Controlled Asthmatic Patients with Chronic Sinusitis

The relationship between asthma and sinusitis has been proposed in many reports but the role of sinus surgery in their treatment is still controversial. Therefore, the effect of functional sinus surgery in patients with controlled asthma was evaluated. Fifty six patients with a history of sinusitis in whom maximum medical treatment had failed and also those with a history of asthma who were in a stable condition at time of surgery and were candidates for endoscopic sinus surgery were selected. All those who underwent functional endoscopic sinus surgery were re-evaluated at last one year later for pulmonary and sinus status. The patients' characteristics were prospectively recorded during the study period from January 2007 to November 2009. Finally, the results of the assessments were analyzed. Among 56 studied patients, 35 (62.5%) were female and 21 (37.5%) male. Preoperative imaging, evaluated according to Lund Mac Kay score, had a mean score of 19.5±5. The average effect of FESS in asthma improvement was 69.6%. Asthma improvement had a significant relationship with the duration of asthma and sinusitis before surgery. Functional endoscopic sinus surgery can effectively treat sinusitis in asthmatic patients. Earlier intervention in the course of pulmonary disease may warrant a better outcome

Diagnostic Efficacy of Fine Needle Aspiration in Parotid Mass

Introduction: The preoperative diagnostic evaluation of the parotid lesion is a valuable aid in planning the operation and the approach to intervention. Among different diagnostic tools, Fine Needle Aspiration has a key role. However, the exact efficacy of this technique in our center had not been thoroughly investigated. Materials and Methods: Between January 2000 and June 2007 a subset of 64 patients who had agreed to undergo preoperative FNAB was selected. The FNAB diagnoses were compared with those of the surgical specimens as the gold standard. Then, sensitivity, specificity, predictive value, and pertinent characteristics of the patients were evaluated. Finally, the results were analyzed with SPSS version14. Results: During the study period, 81 patients underwent parotidectomy, only 64 of whom had the FNA before surgery, so only the data collected from 64 patients were evaluated. The most common clinical presentation 75% (48 patients) was a parotid mass. The second common presentation was facial paralysis at 17.2% (11 patients), followed by pain at 7.8%.  The result of FNA sensitivity was 82.5% and specificity was 93.3%. The accuracy of the test was 87.5%. Positive predictive value was 93.3% and negative predictive value was 82.35%. Conclusion: Fine-needle aspiration cytology is a reliable method in the evaluation of parotid tumors with a fairly high specificity and sensitivity rate

Airway Management in a Toddler with a Giant Hemangioma of the Tongue

Background: Induction of general anesthesia in a patient with compromised airway has always caused dilemma to anesthesiologist, especially for toddler this is paramounted. Case Presentation: An 18 month old boy had a huge sized lingual mass which not only filled entire oral cavity but protruded outside the mouth up to about 5 cm. Having in mind the diagnosis of hemangioma, prior to induction it was attempted to reduce the mass but could be reduced only minimally by manual decompression. While the tongue, still outside the mouth, with full preparedness for anesthesia was induced maintaining the spontaneous ventilation. During laryngoscopy and intubation the tongue was pulled out of the oral cavity to ease the passage of the endotracheal tube. The mass was excised successfully and patient had an uneventful postoperative course. Conclusion: Maintenance of spontaneous ventilation is the crucial safety element during induction

A Giant Hemangioma of the Tongue

Introduction: Vascular abnormalities are relatively uncommon lesions, but head and neck is a common region for vascular malformation which is classified as benign tumors. In this paper, the authors report a rare presentation of vascular malformation in the tongue and its managements. Case Report: An 18 months 2 old child presented with a giant mass of tongue which caused functional and aesthetic problem. The rapid growth pattern of cavernous hemangioma was refractory to corticosteroid. The lesion was excised without any complication. Since the mass was so huge that not only filled entire oral cavity but was protruding outside, airway management was a great challenge for anesthesia plan and at the same time surgical technique was difficult to select. Conclusion: Despite different recommended modalities in managing hemangiomas of the tongue, in cases of huge malformations, surgery could be the mainstay treatment and provided that critical care measures are taken in to account, could be performed very safely

Outcomes of Concurrent Endoscopic Sinus Surgery and Rhinoplasty: A Case Control Study

To evaluate results of concurrent functional endoscopic sinus surgery (FESS) and nasal plastic surgery in terms of safety, efficacy and patient satisfaction, and compare them with the results of single procedures. We conducted a prospective case control study in three groups of patients with chronic sinusitis and nasal deformity; 25 cases had concurrent FESS and rhinoplasty, 25 controls had FESS, and 25 controls had rhinoplasty alone. The patients preoperative and postoperative sino-nasal outcome test (SNOT22) and also patients' satisfaction using the visual analogue scale were evaluated after one year. There were no significant differences between aesthetic indexes of concurrent surgery and control groups. Also, we found no significant inter-group difference between SNOT22 scores. There was no major complication in the studied patients. Conducting nasal plastic surgery and FESS concurrently can be a feasible surgery with functional and aesthetic results comparable to those with individual FESS or rhinoplasty

Correlation of Preoperative Sinusitis Patients’ Characteristics with Final Diagnostic Findings

Chronic rhinosinusitis (CRS) is a common disease which is usually diagnosed clinically, considering the combination of natural history, physical examination and imaging studies. This study aimed to evaluate the clinical value of routine postoperative histopathologic examination (POHE) in patients with a clinical diagnosis of chronic rhinosinusitis with polyposis (CRSWP), or without polyposis (CRSWOP One hundred of patients with clinically approved CRSWP and CRSWOP were enrolled in this study. All patients underwent complete physical examination, scoring paranasal sinuses involvement by Lund-Mackay (LM) CT scoring scale, determining the extent of polyposis by Stumberger's endoscopic classification, and assessing health related quality of life by Sinonasal Test 22 (SNOT22) questionnaire. After FESS, histopathologic results were compared with preoperative clinical diagnosis. Among our patients, 65% were male, and the rest of them were female. Also, 66% of them suffered from CRSWP, and the rest of them were CRSWOP. LM CT score and SNOT22 score was 36.62±12, 17.11±6, and 43.62±20 respectively. Only in one of patients with CRSWP, POHE was other than what was expected preoperatively (adenoid cystic carcinoma). In all other cases,  POHE was well correlated with preoperative clinical diagnosis. HRQOL was better in males, absence of septal deviation and CRSWOP (P<0.05). Para nasal sinuses involvement in preoperative CT was more severe in the presence of eosinophil in POHE (P=0.008) and in patients with class 3 Stumberger's classification (P<0.001). This study suggested preoperative clinical diagnosis of CRS considering the combination of natural history, physical examination and imaging studies can be accurate, and POHE is indicated only in suspicious cases

Sleep Disorders in ESRD Patients Undergoing Hemodialysis

Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS) determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035), dialysis dose (P=0.001), blood creatinine levels (P=0.037), upper airways obstruction (P=0.035), hepatomegaly (P=0.006), hepatic failure (P=0.001), higher blood TSH levels (P=0.039), history of hypothyroidism (P=0.005), and the use of levodopa (P=0.004), anti-hypertensive medications (P=0.006), benzodiazepines (P=0.006), Eprex (Erythropoietin) (P=0.001), Venofer (Iron Sucrose Injection) (P=0.013), and phosphate-binders agents (P=0.018). Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered

Epidemiology of Oral Cavity Cancers in a Country Located in the Esophageal Cancer Belt: A Case Control Study

Introduction: As one of the most common cancers among head and neck malignancies, cancer of the oral cavity probably has some variations in countries with a high prevalence of esophageal cancer.  Materials and Methods: Patients with oral cavity cancer who were treated at two tertiary referral centers from January 1999 to January 2009 were included in this study. In addition to demographic data, information regarding personal and family history of head and neck cancer, use of dentures, presence of immune deficiency, consumption of alcohol, and incidence of cigarette smoking was collected. Additionally, a history of opium usage was obtained from the participants in this study. Moreover, an appropriately matched control group was selected for comparisons between the risk factors.   Results: A total of 557 patients were entered into this study over a 10-year period, of whom 219 (39.3%) were female and the remaining 338 (60.7%) were male. The tongue was the most common site of cancer and 9% of the patients had a history of opium abuse, but more than half of the patients did not have any recognized risk factors. The incidence and stage of cancer had a significant relationship with cigarette smoking (P= 0.013).   Conclusion: Tongue cancer in non-smokers is the predominant pattern of oral cavity cancer in Iran