Carcinoma ex pleomorphic adenoma of soft palate with cavernous sinus invasion

<p>Abstract</p> <p>Background</p> <p>Carcinoma ex pleomorphic adenoma (CXPA) is an aggressive salivary gland malignancy and rare in minor salivary gland. A soft palate CXPA initially presenting as direct cavernous sinus (CS) invasion is very rare.</p> <p>Case Presentation</p> <p>A 60-year-old male had a 3-month history of a small soft palatal mass with progressing left cheek numbness, proptosis, and disturbed vision. Biopsy of soft palatal tumor showed pleomorphic adenoma. Magnetic resonance imaging showed a tumor involving left maxilla, and extended from pterygopalatine fossa, inferior orbital fissure to CS. Excision of tumor revealed CXPA. Adjuvant concomitant chemo-radiation therapy (CCRT) was given. The tumor recurred 5 months later in left CS which was re-treated with CCRT. The disease status was stable at 2 years after the diagnosis of CXPA.</p> <p>Conclusion</p> <p>We present this case to emphasize that patients with symptoms such as facial numbness, proptosis and disturbed vision should be carefully investigated for lesions invading CS by perineural spread.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Predictive Factors for Ureteral Double-J-Stent-Related Symptoms: A Prospective, Multivariate Analysis

Whether the length of stent affects stent-related symptoms after urological procedures remains controversial. We aimed to evaluate the predictive factors for stent-related urinary tract symptoms after uncomplicated ureteroscopic lithotripsy (URSL). Methods: We prospectively recruited a total of 59 patients who underwent URSL and 6-Fr double-J ureteral stent placement. The demographic and perioperative data and stent characteristics, including the length (22, 24 or 26 cm), position of proximal end (upper calyx or pelvis), position of distal end (crossing midline or not), and configurations of both ends (complete or incomplete curl) were recorded. All patients completed a self-administered questionnaire to evaluate the stent-related urinary symptoms, bladder pain, flank pain and hematuria 1 week after the procedure. All variables were analyzed by a proportional odds logistic regression model. Results: Twenty-two male (37.3%) and 37 (62.7%) female patients were enrolled in this study. Their mean age was 53.7 ± 12.9 years. The mean body height was 161.9 ± 7.9 cm (range, 145.9–178 cm). In multivariate analysis, the 26-cm stent was independently associated with the severity of frequency, urgency, and nocturia symptoms. Crossing the midline of the distal end was significantly associated with urge incontinence. The 24-cm and 26-cm stents were both very strongly associated with the severity of hematuria. Crossing the midline of the distal end was significantly associated with bladder pain. Conclusion: The length of stent and crossing the midline of the distal end were significantly associated with stent-related symptoms after URSL. Selection of the proper length of double-J stent is the most important factor in minimizing stent-related symptoms

What Key Drivers Are Needed To Implement Material Efficiency Strategies? An Analysis Of The Electrical And Electronic Industry In Malaysia And Its Implications To Practitioners

A circular economy can be achieved by the efficient use of materials across different industries and sectors. In the manufacturing sectors, practicing material efficiency is one of the effective strategies to reduce material usage and solid waste generation. However, due to many unknown factors, such as key drivers to enhance material efficiency, most of the time, manufacturers are practicing at the minimum level of material saving. This study aims to examine the key drivers of material efficiency among electrical and electronic (E&E) companies to fulfill the aims of sustainable manufacturing. The data collection and synthesis were conducted using semi-structured interviews and an analytical hierarchy process survey. In this study, thirteen key drivers were found. Five internal drivers and eight external drivers with different priorities were found to influence E&E companies in the practice of material efficiency strategies. In addition, the drivers’ implications to different practitioner groups are suggested. To conclude, achieving material efficiency can be done effectively if the incentivized key drivers are clearly notified. This research is important to show the key drivers that influence the implementation of material efficiency strategies in the E&E industrie

Pre-Treatment Levels of C-Reactive Protein and Squamous Cell Carcinoma Antigen for Predicting the Aggressiveness of Pharyngolaryngeal Carcinoma

<div><p>The levels of squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) can be used to predict tumor invasion, lymph node metastasis, staging and survival in patients with oral cavity cancer. The present study analyzed the relationship between pre-treatment levels of SCC-Ag and CRP in relation to clinicopathological factors in patients with pharyngolaryngeal cancer (PLC) and determined whether elevated levels of CRP and SCC-Ag were associated with tumor metabolic activity via [18F] fluorodeoxyglucose positron emission tomography (FDG-PET). We retrospectively recruited one hundred and six PLC patients between June 2008 and December 2011. All patients received computed tomography (CT)/magnetic resonance imaging (MRI) and FDG-PET staging analyses, and the serum levels of SCC-Ag and CRP in these patients were measured prior to treatment. A SCC-Ag level ≥2.0 ng/ml and a CRP level ≥5.0 mg/L were significantly associated with clinical stage (P<0.001), clinical tumor status (P<0.001), and clinical nodal status (P<0.001). The elevation of both SCC-Ag and CRP levels was correlated with the standardized uptake value (SUV) max of the tumor (≥8.6 mg/L) and lymph nodes (≥5.7 ng/ml) (P = 0.019). The present study demonstrated that the presence of high levels of both pre-treatment SCC-Ag and CRP acts as a predictor of clinical stage, clinical tumor status, and clinical nodal status in patients with PLC. Moreover, elevated levels of SCC-Ag and CRP were associated with a high metabolic rate as well as the proliferative activity measured according to the SUVmax of the tumor and lymph nodes. Therefore, elevated levels of these two factors have the potential to serve as biomarkers for the prediction of tumor aggressiveness in cases of PLC.</p> </div

Univariate Log-rank test of prognostic covariates in 103 patients with pharyngolaryngeal squamous cell carcinoma regarding 4-year disease-free and overall survival.

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml.</p>†<p>differentiation: 8 cases the differentiation could not be identified.</p

The associations between preoperative SUVtumor-max/SUVnodal-max and CRP/SCC-Ag (n = 106).

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen; SUVtumor-max: maximum standardized uptake valve in tumor; SUVnodal-max: maximum standardized uptake valve in lymph nodes.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml.</p><p>SUVtumor-max (−): SUVtumor-max level <8.6 mg/L; SUVtumor-max (+): SUVtumor-max level ≥8.6 mg/L; SUVnodal-max (−): SUVnodal-max <5.7 ng/ml; SUVnodal-max (+): SUVnodal-max ≥5.7 ng/ml.</p>*<p>Chi-square test.</p

Characteristics of the 106 pharyngolaryngeal carcinoma patients.

*<p>SD: Standard deviation.</p