Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment

Objective: To assess the frequency of nodal involvement and its prognostic value in malignant tumors of the paranasal sinuses, particularly in maxillary sinus squamous cell carcinoma. Design: Retrospective review. Setting: Tertiary cancer center. Patients: The medical records of 704 consecutive patients surgically treated for malignant tumors of the paranasal sinuses from January 1968 to March 2003 were reviewed. The tumors were staged according to American Joint Committee on Cancer-International Union Against Cancer 2002 classification. Only patients with clinically positive nodes underwent a neck dissection. Main Outcome Measures: Lymph node metastases (at presentation or during follow-up, occurring alone, or with concurrent local recurrence and/or distant metastasis). Also analyzed were local recurrence (occurring alone or with concurrent distant metastasis), distant metastasis (occurring alone), and overall survival. Results: The tumor site was the ethmoid sinus in 305 cases and maxillary sinus in 399 cases. At baseline, 5 patients (1.6%) in the ethmoid sinus group and 33 (8.3%) in the maxillary sinus group presented with positive nodes (P<.001); during follow-up, nodal recurrences (alone or simultaneous with T and/or M recurrence) occurred in 15 and 51 patients, respectively, and the corresponding 5-year incidence estimates were 4.3% and 12.5% (P=.001). The highest incidence of node metastases was found in maxillary sinus squamous cell carcinoma, particularly in T2 tumors. Five-year overall survival estimates were 45.3% for patients with N0 tumors and 0% for those with N+ (N1, N2, or N3) ethmoid sinus tumors, and 50.6% and 16.8%, respectively, for patients with maxillary sinus tumors. Conclusions: Lymph node metastases are a poor prognostic factor for patients with malignant tumors of the paranasal sinuses. The incidence of these metastases is low, particularly in ethmoid sinus tumors. A prophylactic treatment of the neck in patients with N0 tumors (surgery or radiotherapy) might be considered in T2 squamous cell carcinoma of the maxillary sinus and in undifferentiated carcinoma of the ethmoid sinus. ©2008 American Medical Association. All rights reserved

Magnetic order in double-layer manganites (La(1-z)Pr(z))1.2Sr1.8Mn2O7: intrinsic properties and role of the intergrowths

We report on an investigation of the double-layer manganite series (La(1-z)Pr(z))1.2Sr1.8Mn2O7 (0 <= z <= 1), carried out on single crystals by means of both macroscopic magnetometry and local probes of magnetism (muSR, 55Mn NMR). Muons and NMR demonstrate an antiferromagnetically ordered ground state at non-ferromagnetic compositions (z >= 0.6), while more moderate Pr substitutions (0.2 <= z <= 0.4) induce a spin reorientation transition within the ferromagnetic phase. A large magnetic susceptibility is detected at {Tc,TN} < T < 250K at all compositions. From 55Mn NMR spectroscopy, such a response is unambiguously assigned to the intergrowth of a ferromagnetic pseudocubic phase (La(1-z)Pr(z))(1-x)Sr(x)MnO3, with an overall volume fraction estimated as 0.5-0.7% from magnetometry. Evidence is provided for the coupling of the magnetic moments of these inclusions with the magnetic moments of the surrounding (La(1-z)Pr(z))1.2Sr1.8Mn2O7 phase, as in the case of finely dispersed impurities. We argue that the ubiquitous intergrowth phase may play a role in the marked first-order character of the magnetic transition and the metamagnetic properties above Tc reported for double-layer manganites.Comment: 11 pages, 9 figures. Submitted to Phys. Rev.

Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women's Health and Well-Being Survey

Background: The prevalence of alcohol, tobacco and illicit drug use has been reported to be higheramongst lesbian and bisexual women (LBW) than their heterosexual counterparts. However, few studieshave been conducted with this population in Australia and rates that have been reported vary considerably.Methods: A self-completed questionnaire exploring a range of health issues was administered to 917women aged 15-65 years (median 34 years) living in Western Australia, who identified as lesbian orbisexual, or reported having sex with another woman. Participants were recruited from a range of settings,including Perth Pride Festival events (67.0%, n = 615), online (13.2%, n = 121), at gay bars and nightclubs(12.9%, n = 118), and through community groups (6.9%, n = 63). Results were compared against availablestate and national surveillance data.Results: LBW reported consuming alcohol more frequently and in greater quantities than women in thegeneral population. A quarter of LBW (25.7%, n = 236) exceeded national alcohol guidelines by consumingmore than four standard drinks on a single occasion, once a week or more. However, only 6.8% (n = 62)described themselves as a heavy drinker, suggesting that exceeding national alcohol guidelines may be anormalised behaviour amongst LBW. Of the 876 women who provided data on tobacco use, 28.1% (n =246) were smokers, nearly double the rate in the female population as a whole. One third of the sample(33.6%, n = 308) reported use of an illicit drug in the previous six months. The illicit drugs most commonlyreported were cannabis (26.4%, n = 242), meth/amphetamine (18.6%, n = 171), and ecstasy (17.9%, n =164). Injecting drug use was reported by 3.5% (n = 32) of participants.Conclusion: LBW appear to use alcohol, tobacco and illicit drugs at higher rates than women generally,indicating that mainstream health promotion messages are not reaching this group or are not perceivedas relevant. There is an urgent need for public health practitioners working in the area of substance useto recognise that drug consumption and use patterns of LBW are likely to be different to the widerpopulation and that special considerations and strategies are required to address the unique and complexneeds of this population