Treatment outcomes of temporal bone osteoradionecrosis

To investigate the clinical relevance of the classification systems used for temporal bone osteoradionecrosis (ORN) and to define a treatment protocol for temporal bone ORN. Retrospective case series. Amsterdam, department of otorhinolaryngology and head and neck surgery. Classification of temporal bone ORN was performed through use of clinical data and radiologic imaging. Outcomes of conservative and surgical treatment were investigated and compared for different grades of ORN. Of the 49 ears included in this study, 35 were primarily treated conservatively. At start of conservative treatment, 23 were classified as a localized and 8 as a diffuse form of ORN; 4 could not be classified. There was a significant difference in clinical outcome between the localized and diffuse forms of ORN (χ(2) = 5.862, P = .015), and mastoid air cell destruction on preoperative computed tomography scan was found to be a significant predictor for a negative outcome of conservative treatment (χ(2) = 4.34, P = .037). Fourteen ears with diffuse ORN were primarily treated surgically, and 11 were secondarily treated surgically following a period of conservative treatment. Twenty-two patients were treated with subtotal petrosectomy, of which 20 were cured. Three patients were treated with canal wall down mastoidectomy, and 2 had recurrence of disease. Ramsden's classification system is clinically relevant in predicting conservative treatment outcomes. Mastoid air cell destruction on computed tomography differentiates between the localized and diffuse forms of ORN. Given our results and experience with treating temporal bone ORN, we propose a treatment protoco

Outcome of acute intestinal failure

Type 2 acute intestinal failure is characterized by the need for parenteral nutrition (PN) for several months, and is typically caused by complications of abdominal surgery with enteric fistulas or proximal stomas. This study aimed to evaluate clinical management according to quality indicators established by the Association of Surgeons of Great Britain and Ireland. Consecutive patients with type 2 intestinal failure referred to a specialized centre were analysed. Outcomes included the rate of discontinuation of PN, morbidity and mortality. Eighty-nine patients were analysed, of whom 57 had an enteric fistula, 29 a proximal stoma (6 with distal fistulas), and three had intestinal failure owing to other causes. One patient was deemed inoperable, and nine patients died from underlying illness during initial management. Before reconstructive surgery, 94 per cent (65 of 66 operated and 3 patients scheduled for surgery) spent the period of rehabilitation at home. Discontinuation of PN owing to restoration of enteral autonomy was achieved in 65 (73 per cent) of 89 patients. Seven patients developed a recurrent fistula, which was successfully managed with a further operation in four, resulting in successful fistula takedown in 41 of 44 patients undergoing fistula resection. Three patients (5 per cent) died in hospital after reconstructive surgery. The overall mortality rate in this series, including preoperative deaths from underlying diseases, was 16 per cent (14 patients). Intestinal failure care and reconstructive surgery resulted in successful discontinuation of PN in the majority of patients, although disease-related mortality was considerabl

Canalplasty: the technique and the analysis of its results

To describe the technique for canalplasty as performed in the Academic Medical Center, Amsterdam, the Netherlands and to present the results of this technique. Retrospective chart analysis. Charts of patients who underwent a canalplasty prodedure between 2001 and 2010 were reviewed for indication for surgery, side of surgery, age at the time of surgery, gender, smoking habits, surgical outcome, results of pure tone audiometry pre-and post-operatively and the occurrence of complications. 193 canalplasty procedures with or without more extensive otosurgery in 174 patients were performed for various indications in the Academic Medical Center, Amsterdam, the Netherlands between 2001 and 2010. Complete re-epithelialization took approximately 6.7 weeks and was influenced by smoking and the surface needed to re-epithelialize. Complications occurred in 28.0% of cases, of which most (98%) could be regarded as transient. No significant changes in pure tone bone conduction levels at 1, 2 and 4 kHz were observed. This retrospective study shows that technique for canalplasty as used in the Academic Medical Center, Amsterdam, the Netherlands can be used for a wide variety of indications, highlighting its added value in otosurger

The shape of the osseous external auditory canal and its relationship to chronic external otitis

In literature and based on clinical observations, the shape of the osseous external auditory canal (OEAC) has often been suggested to be an etiologic factor in chronic otitis externa (COE). However, to date, no evidence has been presented to confirm this correlation. The aim of this study was to see whether evidence of such a correlation exists, and if so, what shape of the OEAC is related to COE. Using CT scans of 2 groups of patients (with and without COE), a novel and easy to use method was introduced to measure 2 dimensions of the OEAC: the pretympanic recess (the depth (DPTR) and anterior curvature (ACPTR)). In addition, a descriptive classification of the entire OAEC was introduced. The proposed method was demonstrated to be useful as excellent interobserver agreements were found (r = 0.89). No significant differences in the descriptive classifications of the OEAC were observed between COE and the non-COE patients. The DPTR was significantly deeper in COE patients. For the ACPTR, no significant differences were observed. Based on a new method of determining the DPTR, we demonstrate that the DPTR is significantly deeper in COE patients and that the shape of the OEAC is thus of importance in the pathogenesis of CO

Intraperitoneal chemotherapy as adjuvant treatment to prevent peritoneal carcinomatosis of colorectal cancer origin: a systematic review

Peritoneal carcinomatosis (PC) of colorectal cancer (CRC) origin is associated with poor outcome. This systematic review evaluates the available evidence about adjuvant (hyperthermic) intraperitoneal chemotherapy ((H)IPEC) to prevent the development of PC. A systematic search of literature was conducted in August 2013 in PubMed, Embase, and the Cochrane database for studies on (H)IPEC to prevent PC in patients who underwent curative surgery for primary CRC. Seven comparative studies and five cohort studies were selected. Treatment schedules varied between repeated fluoropyrimidine-based IPEC administration in the ambulatory setting to intra-operative (H)IPEC procedures using mitomycin-C or oxaliplatin. The reported rates of major complications related to adjuvant (H)IPEC was low. Four out of five evaluable comparative studies reported a significant difference in the incidence of PC in favour of (H)IPEC. All three comparative studies reporting on survival after intra-operative (H)IPEC showed a significant survival benefit in favour of the experimental arm. Substantial heterogeneity in patient selection, treatment protocols, and treatment effect evaluation among studies was observed. The currently available evidence about adjuvant (H)IPEC in high-risk CRC is limited and subject to bias, but points towards improved oncological outcome and supports further randomised studie