Onko nenänielusta löytynyt parillinen sylkirauhanen - päivittyykö ihmisen makroskooppinen anatomia?

Sylkirauhasilla on keskeinen merkitys fysiologisissa toiminnoissa, jotka liittyvät nielemiseen, purentaan, puheen tuottamiseen ja ruuansulatukseen. Ihmisen suurista sylkirauhasista korvasylkirauhanen on kuvattu ajanlaskumme alun aikoihin. Nykyään kolmen suuren parillisen ja lukuisten pienten sylkirauhasten tehtävät, rakenteet ja sijainti tiedetään täsmällisesti. Pieniä sylkirauhasia tai syljentuotantoa nenänielussa ei kuitenkaan yleensä kuvata, vaikka alueelta lähtöisin olevat sylkirauhaskasvaimet tunnetaan. Hollantilainen tutkimusryhmä havaitsi nenänielussa korvatorven aukon läheisyydessä suurena sylkirauhasena pitämänsä parillisen rakenteen potilailla, joita oli molekyylikuvannettu urologisen syövän takia. Nenänielun sylkirauhasiin viittaavat löydökset havaittiin sylkirauhaskudokseen aktiivisesti hakeutuvalla radioaktiivisella lääkeaineella positroniemissiotomografiassa ({PET}). Löydöstä selvitettiin makroskooppisesti ja mikroskooppisesti vainajatutkimuksessa. Siinä ilmeni, että kuvatulla rauhasella on rakenteellisia yhtäläisyyksiä kielenalus- ja pieniin sylkirauhasiin

Effect of coronavirus disease 2019 on recurrences and follow up of head and neck squamous cell carcinoma

Objective. This prospective study aimed to evaluate possible diagnostic delays in head and neck squamous cell carcinoma recurrences due to the changed follow-up protocol during the coronavirus disease 2019 pandemic. Methods. The follow-up appointments of head and neck squamous cell carcinoma patients treated more than one year prior to the pandemic were changed to telephone appointments in order to reduce physical visits to the hospital. All contacts, reasons for contact and recurrent cancers were recorded. Results. There were 17 recurrences during a seven-month study period among 178 patients treated in the previous year (10 per cent); 14 of these recurrences occurred in patients whose treatment had ended less than one year previously and 3 occurred more than one year after treatment had ended. There was no delay in diagnoses of recurrent tumours or treatment despite reduced visits because of the coronavirus disease 2019 pandemic. Conclusion. According to our analyses, no delay was caused in the diagnoses of recurrent diseases. Follow up by telephone or telemedicine can be considered as part of the follow-up protocol one year after the treatment of head and neck squamous cell carcinoma when necessary.</p

Challenging Management of Plexiform Schwannoma and Plexiform Neurofibroma

Plexiform variants of neurofibromas and schwannomas are rare and typically arise in superficial soft tissues in the head and neck region. The treatment of these tumors is challenging and no generally accepted guidelines exist for their optimal management. The purpose of this study was to review the management and longterm prognosis of head and neck plexiform neurofibromas and schwannomas at 2 tertiary care academic hospitals in Finland over a 31-year period. The pathology files were searched for plexiform neurofibromas and schwannomas between the years 1990 and 2020. The case notes were reviewed for full management details. Two plexiform schwannomas and 6 plexiform neurofibromas were identified. Five of the 6 plexiform neurofibromas were managed operatively. All patients with a surgically managed plexiform neurofibroma underwent multiple operations. Sclerotherapy abolished 1 patient's cutaneous plexiform neurofibromas. The management of plexiform neurofibromas and plexiform schwannomas remains challenging. Sclerotherapy may offer a promising management option for cutaneous plexiform neurofibromas.Peer reviewe

Deep neck space infections: an upward trend and changing characteristics

Purpose This study reviews our experience with deep neck space infections (DNIs) requiring surgical intervention, includingcervical necrotizing fasciitis. The aim of the study was to identify predisposing and aggravating factors of the disease andrecognize the possible factors that can lead to life-threatening complications and slow down the healing process.Methods We compare the results to previous data from 1985 to 2005 to fnd possible alterations and changing trends. Thecharacteristics of four lethal cases are described. This retrospective analysis includes patient data from 2004 to 2015 intertiary referral hospital and in total, 277 patients were found.Results Surgical drainage through a neck opening±intraoral incision was made in 215 (77.6%) patients, an intraoral incision was only made in 62 patients (22.4%). ICU care was needed in 66 (23.8%) cases. Odontogenic etiology (44.8%) wasthe most common origin. The most common comorbidity was a psychiatric disorder and/or dementia and occurred in 55(19.9%) patients. Patients with underlying illnesses were more likely to be admitted to the ICU (p=0.020), required a longerICU stay (p=0.004) and repeated surgery (p=0.009). Gas formation seemed to be predictive of a more severe course ofinfection. Early extraction of the odontogenic foci was related to a lower length of stay (LOS) (p=0.039).Conclusion The annual numbers have risen from 14 to 24 cases per year when compared to previous data. DNIs remain cause of lethal complications; the mortality was 1.4% and overall complications occurred in 61 (22.0%) patients.</p

Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer

ObjectivesTo analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC).MethodsRetrospective chart analysis of all 688 HNC patients treated during 2010–2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included (n = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case.ResultsOne hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, n = 67) was more common among younger patients and females. Osteoradionecrosis (12%, n = 29) was more common in the oral cavity cancer group (20.7%, n = 92) compared to all other subsites.ConclusionsLate toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects.Level of evidence4.</p

Diagnostic Accuracy of F-18-FDG-PET/CT and F-18-FDG-PET/MRI in Detecting Locoregional Recurrence of HNSCC 12 Weeks after the End of Chemoradiotherapy: Single-Center Experience with PET/MRI

PurposeIn head and neck squamous cell carcinoma (HNSCC), the early diagnosis and efficient detection of recurrences and/or residual tumor after treatment play a very important role in patient's prognosis. Positron emission tomography (PET) using 2-deoxy-2-F-18-fluoro-D-glucose (F-18-FDG) has become an established method for the diagnosis of suspected recurrence in head and neck carcinomas. In particular, integrated PET/MRI imaging that provides optimal soft tissue contrast and less dental implant artifacts compared to PET/CT is an intriguing technique for the follow-up imaging of HNSCC patients. The aim of this study was to evaluate the benefit of PET/MRI compared to PET/CT in post-treatment follow-up imaging of HNSCC patients.MethodsThis retrospective observational cohort study consists of 104 patients from our center with histologically confirmed HNSCC. All patients received chemoradiotherapy (CRT) and underwent F-18-FDG-PET/CT (n=52) or F-18-FDG-PET/MRI (n=52) scan 12 weeks after the end of treatment. Image analysis was performed by two independent readers according to a five-point Likert scale analysis. ResultsPET/MRI was more sensitive (1.00 vs. 0.77) than PET/CT in the detection of locoregional recurrence. PET/MRI also had better negative (1.00 vs. 0.87) predictive values. AUCs for PET/MRI and PET/CT on patient-based analysis were 0.997 (95% CI 0.989-1.000) and 0.890 (95% CI 0.806-0.974), respectively. The comparison of sensitivity, AUCs, and negative predictive values revealed a statistically significant difference, pConclusionBased on these results, PET/MRI might be considered the modality of choice in detecting locoregional recurrence in HNSCC patients, especially in the more advanced stages in the oral cavity, larynx, or nasopharynx.</p

Fast growth associated with aberrant vasculature and hypoxia in fibroblast growth factor 8b (FGF8b) over-expressing PC-3 prostate tumour xenografts

Background: Prostate tumours are commonly poorly oxygenated which is associated with tumour progression and development of resistance to chemotherapeutic drugs and radiotherapy. Fibroblast growth factor 8b (FGF8b) is a mitogenic and angiogenic factor, which is expressed at an increased level in human prostate tumours and is associated with a poor prognosis. We studied the effect of FGF8b on tumour oxygenation and growth parameters in xenografts in comparison with vascular endothelial growth factor (VEGF)-expressing xenografts, representing another fast growing and angiogenic tumour model. Methods: Subcutaneous tumours of PC-3 cells transfected with FGF8b, VEGF or empty (mock) vectors were produced and studied for vascularity, cell proliferation, glucose metabolism and oxygenation. Tumours were evaluated by immunohistochemistry (IHC), flow cytometry, use of radiolabelled markers of energy metabolism ([F-18] FDG) and hypoxia ([F-18] EF5), and intratumoral polarographic measurements of pO(2). Results: Both FGF8b and VEGF tumours grew rapidly in nude mice and showed highly vascularised morphology. Perfusion studies, pO(2) measurements, [F-18] EF5 and [F-18] FDG uptake as well as IHC staining for glucose transport protein (GLUT1) and hypoxia inducible factor (HIF) 1 showed that VEGF xenografts were well-perfused and oxygenised, as expected, whereas FGF8b tumours were as hypoxic as mock tumours. These results suggest that FGF8b-induced tumour capillaries are defective. Nevertheless, the growth rate of hypoxic FGF8b tumours was highly increased, as that of well-oxygenised VEGF tumours, when compared with hypoxic mock tumour controls. Conclusion: FGF8b is able to induce fast growth in strongly hypoxic tumour microenvironment whereas VEGF-stimulated growth advantage is associated with improved perfusion and oxygenation of prostate tumour xenografts

Kaulakyhmyn sijainti diagnostiikan kulmakivenä

Aikuisen kaulakyhmyn syy on selvitettävä kiireellisesti. Kaulakyhmyn taustalla voi olla lukuisia syitä, mutta ensisijaisesti on suljettava pois sen pahanlaatuisuus. Kyhmyn alkuperän selvittelyn tulee olla järjestelmällistä. On tärkeää selvittää, minkä kaulan rakenteiden alueella kyhmy sijaitsee ja onko se paikallinen muutos kaulan alueella vai yhteydessä johonkin yleissairauteen tai infektioon. Kaulan anatomian hyvä tuntemus auttaa diagnosoinnissa. Kaulakyhmyn hoito vaihtelee kyhmyn etiologian mukaan