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Case Report of Advanced Childhood Nasopharyngeal Carcinoma: Is Radiotherapy Dose Deescalation the Right Way in Good Responders to Induction Chemotherapy

Objectives:. Treatment of childhood NPC similar to adults consists of radiotherapy and chemotherapy, but distant failure is often observed, which led to introducing the induction chemotherapy followed by radiation or chemoradiation. The improved survival rates raised the question of late toxicity. The options for lowering the toxicity rate is the application of advanced radiotherapy techniques like IMRT and VMAT, and deescalation of the radiation dose in good responders and early NPC.Case report: We report a case of13-years old male patient with a high-risk childhood undifferentiated NPC, stage cT4 cN2b M0. He presented with unilateral swallowing at the middle third of left muscle sterenocleidomastoideus, and headache, fever, sore throat and intermittent nasal bleeding for an year. Diagnostic MRI and PET/CT showed good concordance for primary tumor extension and lymph node involvement. Three coursesinduction chemotherapy were applied according to NPC2003-GPOH protocolwith good treatment response. The restaging PET/CT found no distant metastasis. Deescalated protocol of radiotherapy alone was delivered to 50.4 Gy total dose with IGRT, VMAT irradiation technique. At three month PET/CT follow up a solitary bone lesion was detected.Conclusion: The present case proved that in high risk patients more aggressive treatment strategies should be recommended with no omission of concurrent chemotherapy even after full response. Deescalation of radiotherapy dose probably is not appropriate in this group of patients. MRI and PET CT should be used as complementary imaging modalities for early detection of locoregional or distant metastasis

Three-dimensional seismic investigations of the Sevastopol mud volcano in correlation to gas/fluid migration pathways and indications for gas hydrate occurrences in the Sorokin Trough (Black Sea)

New 3-D seismic investigations carried out across the Sevastopol mud volcano in the Sorokin Trough present 3-D seismic data of a mud volcano in the Black Sea for the first time. The studies allow us to image the complex three-dimensional morphology of a collapse structured mud volcano and to propose an evolution model. The Sevastopol mud volcano is located above a buried diapiric structure with two ridges and controlled by fluid migration along a deep fault system, which developed during the growth of the diapirs in a compressional tectonic system. Overpressured fluids initiated an explosive eruption generating the collapse depression of the Sevastopol mud volcano. Several cones were formed within the depression by subsequent quiet mud extrusions. Although gas hydrates have been recovered at various mud volcanoes in the Sorokin Trough, no gas hydrates were sampled at the Sevastopol mud volcano. A BSR (bottom-simulating reflector) is missing in the seismic data; however, high-amplitude reflections (bright spots) observed above the diapiric ridge near the mud volcano at a relatively constant depth correspond to the approximate depth of the base of the gas hydrate stability zone (BGHSZ). Thus we suggest that gas hydrates are present locally where gas/fluid flow occurs related to mud volcanism, i.e., above the diapir and close to the feeder channel of the mud volcano. Depth variations of the bright spots of up to 200 ms TWT might be caused by temperature variations produced by variable fluid flow

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Nasal obstruction – a symptom with social significance

Nasal obstruction is a symptom, not a diagnosis. The assessment of nasal congestion has objective and subjective methods. Nasal congestion or obstruction is one of the most frequent symptoms encountered in primary care and specialist clinics, and it is often the predominant symptom in upper respiratory tract disorders, such as allergic rhinitis, rhinosinusitis, nonallergic rhinitis, and nasal polyposis. According to the WHO (1997) about 12% of the population of the earth suffer from varying degrees of difficulty expressed nasal breathing and decreased sense of smell

Measurement of Nasal Mucociliary Clearance by Saccharin Test

The nasal mucosa lines the entry of the respiratory tract and is in constant contact with a great variety of inhaled microbial antigens and allergens. Mucociliary clearance is defined as cleaning of upper and lower airway by interaction of nasal mucus and ciliary beating. Inhaled particles, bacteria and virus are trapped in the mucus and are transported by the beat of the cilia to the pharynx where they are either swallowed or coughed up.The main purpose of this study is to examine the capabilities of the saccharin test and its application in determination of the modified mucociliary clearance time (MTC) by obstructive nasal breathing, caused by different local pathology. The essence of the test is that a small amount of saccharin is placed approximately 1 cm behind the anterior end of the inferior turbinate. In the presence of normal mucociliary action, the saccharin will be swept backwards to the nasopharynx and a sweet taste perceived.15 healthy volunteers and 15 patients with obstructive nasal breathing were tested with the saccharin test. Most of the similar studies indicate different clearance times as normal, averaging between 5 and 19 minutes (max. 36 minutes). Results, out of the norm, were registered in cases with present nasal breathing disorder. Our research does not show considerable difference in this respect.Regardless of whether normal or pathological mucociliary clearance is concerned, the saccharin test appears to be simple, inexpensive and reproducible examination, appropriate for quick and reliable valuation of mucociliary function or dysfunction

Case Report of Advanced Juvenile Nasopharyngeal Angiofibroma with Cavernous Sinus Involvement: Advantages of Advanced Radiotherapy Thechnique Volumetric Modulated Arc Therapy

Objectives: In very advance unresectable stages Juvenile nasopharyngeal angiofibroma (JNA)radiotherapy is treatment of choice. Usually JNA is in close proximity to different organ at risk, which necessitates accurate and precise radiation delivery. Series reported the application of IMRT (Intensity Modulated Radiotherapy) with good sparing of organ at risk, but the literature search found no report on VMAT (Volumetric Modulated Arc Therapy) treatment in case of JNA.Clinical case: The present publication report for first time a patient irradiated with VMAT and IGRT (Image guided radiotherapy) for JNA. The stage of the tumor based on CT and MRI was IIIB according to Radkovsi with cavernous sinus invasion. Moderate total radiation dose 36 Gy in 1.8 Gy per fraction was delivered. No early and late toxicity was recorded. The patient is followed up every six months and persistent residual tumor on MRI was seen, but no bleeding onphysical exam. At one year follow up this is accepted as good local control.Conclusion: VMAT and IGRT could be safely applied with reduction of the radiation dose at organ of risk. VMAT is promising in the treatment of juvenile angiofibroma with advantages over conventional radiotherapy, but as this is case report of only one patient, further experience with VMAT is needed in JN