Functional outcomes and complications after salvage total laryngectomy for residual, recurrent, and second primary squamous cell carcinoma of the larynx and hypopharynx : a multicenter retrospective cohort study

Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation. Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis. Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins. Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL

Acupuncture. Informations recueillies au cours d'un séjour en République populaire de Chine, d'avril à juillet 1977

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is there a Future for ONS in Acute Geriatric Wards?

With great interest we read the paper of Lombard et al about the use of Oral Nutrition Support (ONS) in an acute geriatric ward. The results of this paper and experience from our own initiatives raise the question, whether the current available ONS is the way forward to nourish elderly in the future. In our hospital we conducted a similar study (unpublished data comparing different ONS (low volume, high calorie oral supplement vs high calorie oral supplement vs solid, high calorie oral supplement) in 15 older patients admitted to an acute geriatric ward, who were at risk for malnutrition. In that study we calculated the total daily energy and macronutrient content of the standard meals (energy- and protein dense) offered to the geriatric patients. We found that the mean daily energy and macronutrient content covered the actual needs at each meal occasion. The actual dietary intake however was much lower (mean 1093 kcal/day) in comparison with the recommended energy intake (mean 1540 kcal/day) and was less than half of the mean daily energy content provided during the study period (mean 2344 kcal/d). Moreover, on average they did not consume more than 500 kcal during the different meal occasions. This could partially be explained by a faster satiation process in elderly and the changes in taste and smell perception. Although we tried to increase the available energy (= more than actually needed), the restricted number of meal times and their timing is a potential barrier to increase the energy intake. Neelemaat et al have shown that ONS in long term care or during a three month period can be considered as the malnutrition treatment period. In a geriatric ward, providing ONS on top of the daily food provision is potentially only relevant if the ONS has a small volume and is easy to consume (e.g. packaging). However we are convinced that it is time to evaluate other concepts, with a minimal effect on logistics and costs (e.g. protected meal times, food (adjusted to the individual taste perception) availability throughout the day) that enhance the intake from the standard energy-dense diet. Our idea is supported by the latest research agenda proposed by the I-DINE Consortium, although the concepts and ideas are not necessarily new.status: publishe

Does epidemiology of poisoning change over time in an academic emergency department?

status: publishe

Wat is het nu weer, restenarm of vezelarm dieet?

status: publishe

[1,4]-Benzodiazepines as Vasopressin V2 Receptor Antagonists -...

The invention relates to a novel class of [1,4]-benzodiazepine derivatives, processes for their preparation, intermediates usable in these processes, and pharmaceutical compositions containing the compounds. Other aspects of the invention are directed to the use of said [1,4]-benzodiazepine derivatives in therapy based on the capability of said compounds to interfere with the binding of the peptide hormone, vasopressin, to its receptors. In particular as vasopressin V2 receptor antagonists and therefore useful for treating involving increased vascular resistance, cardiac insufficiency, and water retention