Biomedical subjects

Neil Bhattacharyya

Publications and source records attributed to Neil Bhattacharyya.

At least 37 records · Page 2Linked to original sources

PubMed2004

Clinical outcomes after revision endoscopic sinus surgery.

OBJECTIVE: To determine if patients undergoing revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis obtain significant symptomatic benefit from surgery. DESIGN: Prospective controlled clinical trial. METHODS: Adult patients undergoing revision ESS were evaluated preoperatively with a computed tomographic scan and the Rhinosinusitis Symptom Inventory. After the revision ESS, patients were reevaluated with the Rhinosinusitis Symptom Inventory. Data were analyzed for symptom score changes and effect sizes, changes in medication, and economic variables. Improvements in sinonasal symptom scores, medication use, and economic variables were compared with those of a contemporaneous control group of patients undergoing primary ESS and matched for age, sex, and Lund score. RESULTS: The 21 patients (mean age, 44.8 years) who completed evaluation after revision ESS had a mean follow-up of 12.4 months. Mean preoperative Lund score was 12.6. Large effect sizes indicating significant symptom improvements were noted for nasal obstruction (effect size, -1.9), hyposmia (-0.9), and headache (-0.6), as well as nasal (-1.1) and total symptom domains (-0.9; P<.05 in all cases). Nasal steroid and nonsedating antihistamine use did not decrease significantly after ESS, but oral antibiotic use showed a downward trend (net change, - 2.9 wk/y; P =.23). Improvements in clinical symptoms were statistically similar to corresponding improvements in the matched cohort of patients undergoing primary ESS. CONCLUSIONS: The symptomatic relief that revision ESS can provide for patients with refractory chronic rhinosinusitis is similar to that following a primary ESS. However, many patients undergoing revision ESS require continued intense medical management of their chronic rhinosinusitis.

Adult↗

PubMed2004

The diagnostic accuracy of computed tomography in pediatric chronic rhinosinusitis.

OBJECTIVE: To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS). SETTING: Multi-institutional prospective dual cohort study. METHODS: Two cohorts of children undergoing CT of the paranasal sinuses were prospectively evaluated. The first cohort consisted of children undergoing CT in preparation for endoscopic sinus surgery (diseased group). The second cohort consisted of children undergoing CT for nonsinusitis reasons (nondiseased control group). Sinus CT scans were scored according to the Lund-MacKay system. Diagnostic accuracy was quantified with the receiver operating characteristic curve. Sensitivity, specificity, and predictive value analyses were conducted. RESULTS: A total of 66 pediatric patients (mean age, 8 years) were studied in the diseased group and exhibited a mean Lund score of 10.4 (95% confidence interval, 9.2-11.5); 192 control patients (mean age, 9 years) exhibited a mean Lund score of 2.8 (95% confidence interval, 2.4-3.2). The area under the curve for the receiver operating characteristic was 0.923 (P<.001), indicating excellent diagnostic accuracy. Adopting a Lund score cutoff of 5 to represent true disease, the CT scan demonstrated a sensitivity and specificity of 86% and 85%, respectively. Lund scores of 2 or less have an excellent negative predictive value, whereas Lund scores of 5 or greater have an excellent positive predictive value (ie, strongly indicate true disease). CONCLUSIONS: The sinus CT scan demonstrates excellent diagnostic accuracy for the diagnosis of pediatric CRS, with excellent sensitivity and specificity. However, its predictive value depends substantially on the base rate prevalence of CRS in the population being evaluated.

Case-Control Studies↗

PubMed2004

Survival and prognosis for cancer of the submandibular gland.

PURPOSE: We sought to determine survival and factors affecting survival for patients with cancer of the submandibular gland. METHODS: All cases of surgically treated cancer of the submandibular gland were extracted from the Surveillance, Epidemiology and End Results database for the time period 1988 to 1998. After tabulation of demographic, tumor-specific, and survival data, Kaplan-Meier survival analysis was conducted according to histopathologic results. Cox regression analysis stratified for histopathology was conducted to determine factors that influenced survival. RESULTS: A total of 370 cases of submandibular gland cancer were analyzed. Adenoid cystic carcinoma accounted for 42.2% of cases followed by mucoepidermoid carcinoma (22.2%). Overall mean, median, and 5-year survival times and rate were 82 months, 97 months, and 59.7% for the entire cohort, respectively. Adenoid cystic carcinoma exhibited the best mean survival (99 months), whereas squamous cell carcinoma exhibited the poorest mean survival (52 months). Younger age, decreased tumor grade, and radiation therapy were found to improve survival (P <.001,.005, and.015, respectively). Gender, tumor size, extraglandular extension, and nodal positivity did not statistically influence survival. CONCLUSIONS: Significantly different survival can be expected depending on individual tumor histopathology in submandibular gland cancer. Tumor grade and radiation therapy have important effects on prognosis.

Adenocarcinoma↗

PubMed2004

The effectiveness of immersion disinfection for flexible fiberoptic laryngoscopes.

OBJECTIVE: We sought to determine whether high-level disinfection renders fiberoptic laryngoscopes free of nonviral infectious microorganisms. METHODS: Six flexible fiberoptic laryngoscopes in heavy use were subjected to surveillance cultures at the beginning, middle, and end of the clinical workday after high-level disinfection to determine if microorganisms could be recovered. Control cultures were obtained by direct contamination of the endoscope with saliva. The rate of microorganism recovery from the endoscopes after high-level disinfection was determined and compared with control specimens. RESULTS: Among a total of 48 cultures submitted from in use but disinfected fiberoptic laryngoscopes, 1 positive culture (positive rate, 2.1%) for mold species was recovered. No positive bacterial cultures occurred. Eleven of 11 (100%) control cultures were positive for bacterial species (P < 0.001). The confidence interval for the risk of microorganism contamination of a disinfected laryngoscope ranged from 0.11% to 11.6%. CONCLUSION: High-level disinfection provides a reasonably effective method of reducing bacterial and fungal contamination of flexible fiberoptic laryngoscopes. Appropriate surveillance technique should be used in each clinical setting with flexible fiberoptic scopes to ensure adequate disinfection effectiveness.

Disinfection↗

PubMed2004

Incidental paranasal sinus imaging abnormalities and the normal Lund score in children.

OBJECTIVES: Our goal was to determine the incidental Lund score for pediatric patients without chronic rhinosinusitis (CRS). METHODS: Pediatric patients with computed tomography scans of the orbit or brain were identified. Patients with a clinical history of sinonasal disorders or skeletal facial trauma were excluded. The remaining scans were scored according to the Lund-MacKay system. Pneumatization of the frontal and sphenoid sinuses was also recorded. A scaled Lund score was computed, and the mean Lund score for this normal population was determined. RESULTS: One hundred ninety-two computed tomography scans were examined (mean age, 9.0 years). The frontal sinuses and sphenoid sinuses were absent in 40.1% and 1.6% of cases, respectively. The mean scaled Lund score in this pediatric population without CRS was 2.81 (95% confidence interval, 2.40 to 3.22). This result differed statistically from a score of 0 (P < 0.001). Only 37 (19.3%) patients had completely radiographically normal sinuses. CONCLUSIONS: The mean incidental Lund score in the absence of CRS approaches 3, and this should be considered when determining the diagnostic likelihood of CRS in pediatric patients.

Adolescent↗

PubMed2004

An objective assessment of the advantages of retrograde parotidectomy.

OBJECTIVE: This study was undertaken to determine whether the retrograde parotidectomy approach is more efficient than standard anterograde parotidectomy without compromise of surgical effectiveness. METHODS: A retrospective analysis of patients undergoing parotidectomy was conducted. Cases were divided into those undergoing retrograde facial nerve dissection and those undergoing standard anterograde facial nerve dissection. From the review of medical records, standard demographic information, surgical time, histopathology, estimated blood loss, and use of facial nerve monitoring were determined. Pathology was reviewed to determine the size of the overall resection specimen as well as the size of the lesion excised and margin status. Postoperative complications were also recorded. Statistical comparisons were conducted between these 2 approaches for these clinical variables such as surgical time, blood loss, tumor margin status and relative volume of tissue removed during parotidectomy. RESULTS: 45 patients undergoing parotidectomy met inclusion criteria. The average patient age was 50.8 years with a female preponderance (73%). There were 19 standard parotidectomies and 26 retrograde approaches. Compared to standard parotidectomy, retrograde parotidectomy consumed less operative time (3.2 versus 1.8 hours, respectively), decreased intraoperative blood loss (67.9 cc versus 40.3 cc, respectively), and resulted in less removal of normal parotid tissue (volume of normal parotid tissue removed in excess of tumor: 23.0 cc versus 6.0 cc, respectively). No significant difference in surgical margin status was noted between anterograde and retrograde parotidectomy (P = 0.452). CONCLUSIONS: In appropriately selected cases, compared with standard anterograde parotidectomy, retrograde parotidectomy is more efficient and spares normal parotid tissue without compromising surgical margins. Facial nerve monitoring provides a useful adjunct for retrograde dissection.

Blood Loss, Surgical↗

PubMed2004

Contemporary staging and prognosis for primary tracheal malignancies: a population-based analysis.

OBJECTIVE: Determine staging characteristics and survival outcomes for primary malignancies of the trachea. Design Cross-sectional analysis of national cancer database. METHODS: Cases of primary tracheal malignancy were extracted from the Surveillance, Epidemiology, and End Results database for the time period 1988-2000. T-stage, N-stage, and overall stage of presentation were determined. Mean, median, and 5-year survival statistics were computed using Kaplan-Meier survival analysis for each tumor histology and for the overall cohort according to stage. RESULTS: Ninety-two cases with adequate histologic information were identified. Mean age at presentation was 59.3 years with an equal sex distribution. Squamous cell carcinoma was the most common tumor type (41 cases) followed by adenoid cystic carcinoma (19 cases). Forty-nine cases (53%) presented with stage 3 or stage 4 disease. Squamous cell carcinoma exhibited poorer survival (mean survival, 44.0 month, 5-year survival, 34%) than adenoid cystic carcinoma (mean survival, 115 month, 5-year survival, 78%). Five-year unadjusted survival rates according to overall stage were 52.8%, 70.0%, 75.0%, 15.1%, respectively. CONCLUSIONS: Primary tracheal malignancies often present with advanced stage. Patients with squamous cell carcinoma of the trachea have poorer prognoses when compared with adenoid cystic carcinoma and other tumor types. Staging tracheal cancer with a TNM-based system helps predict survival. EBM RATING: C.

Carcinoma, Adenoid Cystic↗

PubMed2004

Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures.

BACKGROUND: Operating room efficiency is an important concern in most hospitals today. Little work has been reported to evaluate the contribution of anesthesia residents to changes in anesthesia-controlled time-related efficiencies in the operating room. The goal of this study was to measure the impact of the initiation of new residents to the operating room on anesthesia-related time measures of operating room efficiency. METHODS: Using the computerized operating room information systems, specific data regarding anesthesia-controlled times were extracted over three distinct 2-week periods over the course of 1 academic year. These included the first 2 weeks of July, when most of the operating rooms were staffed by attending physicians working alone; 2 weeks in September when new anesthesia residents were working in a 2:1 ratio with staff; and 2 weeks in May. The induction times, emergence times, and room turnover times were compared over these three periods for first-year anesthesia residents. Standard descriptive statistics were computed. Analysis of variance testing was then conducted comparing each of these time periods. Significance was set at P < 0.05. RESULTS: A total of 3,004 surgical procedures were performed during the 2-week study periods in July, September, and May, respectively. For the July, September, and May groups, the mean anesthesia induction times were 17.3, 19.0, and 20.8 min (P = 0.047); the emergence times were 8.7, 9.7, and 10.0 min, (P = 0.024); and the corresponding mean room turnover times were 47.6, 48.5, and 48.6 min (P = 0.907), respectively. CONCLUSION: Although statistically significant time differences were found, these data strongly suggest that the initiation of anesthesia trainees to the operating room has no clinically or economically meaningful adverse effect on the anesthesia-controlled time component of operating room efficiency.

Anesthesia↗

PubMed2004

Airway protection and the laryngeal mask airway in sinus and nasal surgery.

OBJECTIVES/HYPOTHESIS: The objective was to compare the laryngeal mask airway and endotracheal tube for airway protection from blood during sinonasal surgery. STUDY DESIGN: Nonrandomized, controlled, prospective clinical trial. METHODS: Patients scheduled to undergo sinonasal surgery (septoplasty and/or endoscopic sinus surgery) were prospectively enrolled and grouped according to type of airway during general anesthesia with choice of airway device based on the anesthesiologist's preference. Clinical data were tabulated by case including airway device, patient age, weight, estimated blood loss, airway pop-off pressure, and emergence quality. At the conclusion of surgery, the airway was examined through the laryngeal mask airway or endotracheal tube with a flexible fiberoptic bronchoscope to determine the amount of blood present on the vocal cords or in the trachea. The airway device was also evaluated postoperatively for the presence of blood. RESULTS: Seventy-six adult patients were initially enrolled; two were excluded because fiberoptic evaluation of the airway could not be completed. Of the remaining 74 patients, an endotracheal tube and laryngeal mask airway were used in 31 and 43 patients, respectively. The two groups did not differ with respect to age, weight, estimated blood loss during surgery, pop-off pressure, or emergence quality (all P >.05). Patients managed with an laryngeal mask airway were significantly less likely to have blood staining the airway (glottis or trachea) than patients with an endotracheal tube (19.5% vs. 84.8%, chi test [P <.001]). However, the endotracheal tube provided better protection than the laryngeal mask airway against distal tracheal blood contamination (3.2% vs. 14.6%, respectively [P =.110]). CONCLUSION: The laryngeal mask airway provides better protection of the upper airway from blood contamination during sinonasal surgery than a standard endotracheal tube, but there is a higher incidence of distal tracheal contamination. The laryngeal mask airway is a reasonable alternative to endotracheal intubation for airway management in sinonasal surgery.

Adult↗

PubMed2004

Bacterial infection after endoscopic sinus surgery: a controlled prospective study.

OBJECTIVES/HYPOTHESIS: The objective was to determine whether infections occurring after endoscopic sinus surgery represent overgrowth of sinonasal flora versus de novo bacterial infection. STUDY DESIGN: Prospective controlled cohort study. METHODS: A cohort of adult patients was prospectively followed after endoscopic sinus surgery. Baseline postoperative control cultures of the ethmoid sinus were obtained. Patients with acute infectious exacerbations of chronic rhinosinusitis had endoscopic culture, and these results were compared with baseline culture data. RESULTS: One hundred thirteen patients were followed for a mean period of 14.5 months after endoscopic sinus surgery. Baseline postoperative culture data revealed that the ethmoid labyrinth was sterile in 23% of cases, carried oral flora in 18% of cases, and was colonized in 60% of cases. Gram-positive cocci, particularly staphylococcal species, were the most common colonizing organisms (41% of cases). Twenty acute exacerbations were cultured in 17 patients during the follow-up period. All infectious cultures recovered bacteria; one culture recovered only oral flora. Gram-positive cocci predominated (56% of isolates) with Staphylococcus aureus being the most common isolate (28%). Of the 36 isolates, only 9 isolates (25%) corresponded to bacteria identified at the time of baseline culture. CONCLUSION: Although the postoperative sinonasal cavity may be colonized by bacteria after endoscopic sinus surgery, infections arising postoperatively most commonly represent de novo infections by bacteria other than colonizing bacteria. Empirical therapy based on baseline data may be misleading; acute exacerbations of chronic rhinosinusitis after endoscopic sinus surgery should be cultured to guide optimal antibiotic therapy.

Chronic Disease↗

PubMed2003

Surgical treatment of cervical nodal metastases in patients with papillary thyroid carcinoma.

OBJECTIVE: To determine if more extensive neck dissection in patients with papillary carcinoma of the thyroid affords a survival benefit vs limited lymphadenectomy of positive nodal disease. DESIGN: Survey analysis of a national cancer database. METHODS: Cases of papillary thyroid carcinoma were extracted from the Surveillance, Epidemiology, and End Results database for January 1, 1988, to December 31, 1999, along with demographic, staging, and treatment variables. Cases were limited to patients who underwent total thyroidectomy and postoperative radioactive iodine treatment along with excision of 1 or more positive cervical nodes. Patients were divided into 2 groups: those undergoing limited lymphadenectomy of only positive nodes and those undergoing more extensive neck dissection with removal of positive and negative nodes. RESULTS: Among 2097 patients with papillary carcinoma meeting treatment criteria, 880 underwent limited lymphadenectomy and 1217 underwent neck dissection. The mean age, sex distribution, primary tumor extent and size, and follow-up duration were not different between these 2 groups (P>.05 for all). The mean survival for patients undergoing limited lymphadenectomy was 135 months, vs 136 months for patients undergoing neck dissection. Actuarial 5-year (10-year) survival rates were 94.4% (91.3%) and 95.9% (92.4%), respectively. Kaplan-Meier survival was not different between groups (P =.40, log-rank test). CONCLUSIONS: Limited lymphadenectomy of positive nodal disease in patients with papillary carcinoma affords survival similar to that of patients undergoing more extensive neck dissections. Therefore, a formal neck dissection may not be required for the effective treatment of cervical nodal metastases in patients with papillary carcinoma of the thyroid.

Adult↗

PubMed2003

Complications and determinants of length of stay for inpatient pediatric otolaryngologic procedures.

OBJECTIVE: To identify clinical factors associated with morbidity, mortality, and length of stay (LOS) for inpatient pediatric otolaryngologic procedures. STUDY DESIGN: Retrospective cohort study. METHODS: Records of patients undergoing pediatric otolaryngologic procedures were extracted from the National Hospital Data Survey for the calendar years 1995 through 1999. These records were examined to determine demographics, morbidity, mortality, type of procedure (as defined by anatomic subsite), and LOS. The effects of morbidity and type of procedure on LOS were identified. RESULTS: A total of 4861 children underwent inpatient otolaryngologic procedures. The overall morbidity rate was 4.6%. The most common morbidity was pneumonia, occurring in 171 patients (3.5%). The presence of any morbidity was associated with a significantly increased LOS (18.4 days vs 4.6 days; P<.001). The occurrence of pneumonia was associated with an increase in LOS to 19.7 days vs 4.7 days in patients without pneumonia (P<.001). Procedures involving the larynx, trachea, or esophagus carried the longest LOS (12.3 days; P<.001) among all procedural categories. The overall mortality rate was distinctly low at 0.4%. However, the occurrence of morbidity was associated with an increased risk of death, with an odds ratio of 8.0 (P =.001). Mortality was highest (13 of 18 deaths) after procedures on the larynx, trachea, or esophagus. CONCLUSIONS: Medical complications in children undergoing inpatient otolaryngologic procedures are associated with significantly increased LOS. Despite procedural complexity, overall mortality is remarkably low. Efforts to decrease medical morbidity in this population may result in decreased LOS and improved clinical outcomes.

Adolescent↗

PubMed2003

Survival and prognosis in Hürthle cell carcinoma of the thyroid gland.

OBJECTIVE: To determine factors that affect survival in patients with Hürthle cell carcinoma of the thyroid gland. METHODS: Data for all cases of Hürthle cell carcinoma that occurred between January 1, 1988, and December 31, 1998, were extracted from the Surveillance, Epidemiology, and End Results database. Clinical data regarding age, sex, tumor size, primary site extension, nodal involvement, and vital status were tabulated. Patients with distant metastases were excluded, and Kaplan-Meier survival analysis was conducted. Survival data for patients with Hürthle cell carcinoma were compared with data for a control group of patients with follicular cell carcinoma matched for age, sex, tumor size, and local disease extension. Cox multivariate regression analysis was conducted to determine the effect of predictor variables on overall survival in Hürthle cell carcinoma. RESULTS: We identified 555 cases of nonmetastatic Hürthle cell carcinoma (mean age at diagnosis, 55.9 years; women, 67.9%). The primary tumor was intrathyroidal in 83.8% of patients, whereas 11.2% had minor local extension. Mean tumor size was 3.5 cm. Mean, 5-year, and 10-year survival for Hürthle cell carcinoma was 109 months, 85.1%, and 71.1%, respectively. Mean survival for 411 matched patients with follicular cell carcinoma was 113 months, which was not statistically different from that of patients with Hürthle cell carcinoma (P =.47, log-rank test). On multivariate analysis, increasing age at diagnosis, male sex, and increasing tumor size were statistically significant predictors of poor survival; degree of primary site extension did not affect survival. CONCLUSIONS: Overall survival for Hürthle cell carcinoma is similar to that of comparably staged follicular cell carcinoma. Increasing age, male sex, and increasing tumor size substantially diminish survival in patients with Hürthle cell carcinoma.

Adenoma, Oxyphilic↗

PubMed2003

Survival and staging characteristics for non-squamous cell malignancies of the maxillary sinus.

OBJECTIVE: To characterize the clinical behavior of non-squamous cell cancer of the maxillary sinus. METHODS: Cases of non-squamous cell maxillary sinus malignancy during 1988 through 1998 were extracted from the Surveillance, Epidemiology, and End Results database. Data for histologic type of tumor, tumor stage, and survival were analyzed using the Kaplan-Meier method to determine mean, median, and 5-year survival statistics for the overall cohort and for individual histologic types of tumor. The effect of tumor stage on overall survival was assessed. To determine relative survival, the non-squamous cell group was compared with a second group of patients with squamous cell carcinoma, matched according to age at diagnosis, year of diagnosis, and T stage. RESULTS: One hundred eighty-eight cases of non-squamous cell malignancy were identified. The mean patient age was 57.8 years, and 143 patients (76%) presented with T3 or T4 tumors. There were 31 adenocarcinomas, 64 adenoid cystic carcinomas, 15 mucoepidermoid carcinomas, 22 melanomas, 45 sarcomas, and 11 undifferentiated carcinomas. The overall mean survival was 63.4 months, and 5-year survival was 45.6%. Adenoid cystic carcinoma exhibited the best mean survival (79 months), whereas melanoma and undifferentiated carcinoma exhibited poor mean survivals (30.3 and 12.8 months, respectively). T stage did not statistically affect overall survival (P =.86). Survival for patients with non-squamous cell cancer was substantially better than survival for the matched group with squamous cell carcinomas (mean survival, 41.5 months; 5-year survival, 27.4%). CONCLUSIONS: Patients with non-squamous cell carcinoma of the maxillary sinus typically present with advanced T stage but have significantly better survival than patients with similar-stage squamous cell carcinoma of the maxillary sinus. T stage has less effect than histologic type of tumor on prognosis in non-squamous cell carcinoma of the maxillary sinus.

Adenocarcinoma↗

PubMed2003

Risk factors for adenotonsillar hypertrophy in children following solid organ transplantation.

OBJECTIVE: Post-transplantation lymphoproliferative disorder (PTLD), or its precursor, Epstein-Barr virus (EBV)-related lymphoid hyperplasia, may first present in the tonsils and adenoids in the pediatric solid organ transplant population. We sought to identify signs and symptoms of and risk factors for adenotonsillar hypertrophy (ATH), a potential precursor to PTLD in children following solid organ transplantation. METHODS: We performed a cross-sectional study of 132 consecutive pediatric solid organ transplant patients at our institution. Questionnaire, physical examination, and laboratory data collection were obtained. Correlation of signs and symptoms of ATH with objective laboratory data was conducted. RESULTS: 132 pediatric transplant recipients (64 renal, 68 liver) were enrolled. Mean age at transplantation was 7.4 (S.D. 6.0) years with a mean follow-up of 49.0 (S.D. 48.4) months post-transplantation. The mean questionnaire score was 8.4 (S.D. 7.9) out of a maximum 65 and the mean physical examination score was 3.9 (S.D. 1.9) out of a maximum 8, with a statistically significant correlation between the two (Pearson's r=0.352, P<0.001). A multivariate linear regression model found recipient EBV seronegativity and younger age at transplantation to be statistically significant risk factors for development of ATH (P=0.024 and 0.035, respectively). CONCLUSIONS: Young age and EBV seronegativity confer increased risk for ATH in pediatric patients undergoing solid organ transplantation. As ATH may be the earliest sign of PTLD, long-term surveillance is required to determine the impact of ATH on quality of life and survival in these patients.

Adenoids↗

PubMed2003

The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis.

OBJECTIVE: To examine the risk of aspiration for liquid versus paste bolus consistencies in patients with unilateral vocal cord paralysis (UVCP). METHODS: The swallowing function of adult patients with UVCP was prospectively studied videofluorographically to examine the incidence of laryngeal penetration and aspiration for both liquid and paste boluses. The degree of penetration or aspiration was quantified using the penetration-aspiration scale (PAS). The presence and location of pharyngeal bolus residue were also documented for each consistency. Results were compared between liquid and paste bolus consistencies. RESULTS: Fifty-five patients with UVCP were studied with a mean age of 60.2 years. Intrathoracic surgery or malignancy accounted for 38 (69.1%) of cases. The mean PAS scores for liquid and paste bolus consistency were 3.1 vs. 1.5, respectively (P < 0.001). The liquid bolus penetrated in 19 (34.5%) patients and was aspirated in 11 (20%) patients. In contrast, the paste bolus penetrated in 12 (21.8%) cases and was aspirated in 0 cases (P < 0.001). Pharyngeal residue was more likely to occur at the base of the tongue or vallecula for the paste bolus consistency versus the liquid bolus. CONCLUSIONS: A significant percentage of patients with UVCP will aspirate thin liquids. Paste bolus consistencies are safer for patients with UVCP as they are much less likely to lead to penetration or aspiration despite a higher prevalence of pharyngeal residue.

Beverages↗

PubMed2003

Clinical effectiveness of coblation inferior turbinate reduction.

OBJECTIVE: We sought to determine the safety and clinical effectiveness of coblation (short for "cold ablation") inferior turbinate reduction for turbinate hypertrophy. METHODS: A consecutive series of adult patients with inferior turbinate hypertrophy were treated with the coblation technique in the office setting. Subjective symptoms were assessed prior to treatment and at the 3- and 6-month intervals after treatment with the Rhinosinusitis Symptom Inventory (RSI) and a short nasal symptom questionnaire. RESULTS: Twenty-four of 26 treated patients completed the protocol. At the 3-month follow-up, statistically significant decreases in the nasal and overall symptom domains of the RSI were noted (changes of -10.5 and -8.7, with P = 0.018 and P = 0.015, respectively). These improvements were also significant at the 6-month follow-up (-20.1 and -15.8 with, P < 0.001 and P < 0.001, respectively). At the 3-month interval, nasal obstruction and amount of time with nasal obstruction were significantly decreased (P = 0.006 and P = 0.011, respectively). These decreases remained statistically significant and slightly larger in magnitude at 6 months (P = 0.001 and P = 0.006, respectively). Postoperative epistaxis occurred in 2 of 24 (8.3%) of patients. CONCLUSION: Coblation inferior turbinate reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit persists at 6 months after the procedure.

Adolescent↗

PubMed2003

Factors affecting survival in maxillary sinus cancer.

PURPOSE: The study goal was to determine survival parameters and clinical factors influencing survival for maxillary sinus malignancies. METHODS: Cases of maxillary sinus malignancy for the time period 1988 to 1998 were extracted from the Surveillance, Epidemiology and End Results database. Cases with distant metastatic disease at presentation were excluded. Clinical information, including tumor histology, grade and stage, and extent of surgery and radiation therapy, were determined. Kaplan-Meier survival and Cox proportional hazards analyses were conducted to determine the influence of these factors on overall survival. RESULTS: The study sample was composed of 650 patients with maxillary sinus cancer (mean age, 64 years; male-to-female ratio, 3:2). The most common histology was squamous cell carcinoma (61.7%), followed by adenoid cystic carcinoma (9.8%). The overall mean (median) survival was 52 months (25 months), and 77.5% and 7.4% of patients presented with advanced (T3/T4) disease or cervical metastasis, respectively. Radiation therapy was administered in 441 patients (67.9%) and significantly improved survival mainly for those with T4 lesions. On multivariate analysis, increasing age, T stage, N stage, and tumor grade independently predicted poorer survival, whereas gender did not. Adenoid cystic carcinoma exhibited a significantly improved overall survival (P <.001). CONCLUSIONS: Survival for patients with maxillary sinus cancer is determined not only by TNM staging but also by tumor histology and grade. TNM staging effectively stratifies patients according to survival. Radiation therapy significantly improves survival for those with T4 lesions.

Carcinoma, Adenoid Cystic↗