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  • ISSN: 2379-948X
    Volume 3, Issue 6
    Research Article
    Jeyanthi Kulasegarah*, Esther O'Regan, Susan Kennedy, Mary Toner and Conrad Timon
    The elevated risk of second primary malignancy (SPM) in patients with head and neck squamous cell carcinoma (HNSCC) is well established. Despite the advances in loco regional control achieved by modern surgery and chemoradiation, survival with HNSCC has not meaningfully improved, in part due to continuing risk of development of SPMs in these patients. Our objective was to determine the prevalence of SPM among patients with HNSCC in Ireland. A retrospective study of patients diagnosed with two or more HNSCC between January 2000 and Jun 2012 was conducted in two tertiary referral centers. Out of a population of 604 patients, we identified 72patients (11.9%) with SPM. Our third primary malignancy prevalence rate was 3.0% (18 patients) while the fourth primary malignancy rate was 0.5% (3 patients). Fifty seven males and 15 females between ages of 36 to 78 (mean age 58.3 +/- SD 10.01) were reviewed. The majority of the population smoked tobacco (87.5%) and consumed alcohol (76.1%).Among patients with SPM, 68% (49 patients) had metachronous lesions while 32% (23 patients) had synchronous lesions. In conclusion, multiple primary tumours in patients with an index HNSCC are relatively common in Ireland and represent a significant obstacle to improvement in survival. Our SPM rate is 11.9% in keeping with current literature. Oral cavity and oropharynx are major sites for primary and SPM, which is well documented in the literature.
    Case Report
    Russel R Kahmke*, John Van Arnam and Liana Puscas
    Olfactory neuroblastoma (ONB) is a rare, malignant neuroendocrine tumor with potential to develop outside the normal means and distribution of olfactory neuroepithelium. With four published cases, we present a patient with a frontal sinus ONB invading the dura after receiving whole brain radiation for non-Hodgkin Lymphoma 20 years before. Imaging and biopsy revealed a frontal sinus malignant neuroendocrine neoplasm with posterior table and dural involvement. She underwent a combined craniofacial resection with adjuvant stereotactic radiosurgery. She subsequently developed metastatic disease. The element of radiation introduced a variable that undoubtedly affected her loco regional control and overall survival.
    Erica Cristina Campos e Santos*, Natalia Maria Couto Bem Mendonca, Matheus Freitas Leite, Milton Pamponet da Cunha Moura, Sandro de Menezes Santos Torres, Washington Luiz de Cerqueira Almeida and Paulo Sergio Lins Perazzo
    Introduction: Waardenburg syndrome (WS) was first described by P.J. Waardenburg. The same author estimates such syndrome is responsible for 1,43% of all congenital deafness. WS presents a variable spectrum as four clinical presentations. The diagnosis is clinical using specific criteria established in 1992 by Farrer et al. The prognosis depends on the presence of comorbidities such as delay in neuropsychomotor behavior and adequate educational intervention.
    Case report: JPCS, male, 2 years old, grandmother refers deafness.
    Physical exam: Face inspection: hypo pigmentation of right iris, normal pigmentation of left iris. Otoscopy: normal.
    Additional testing: Otoacoustic Emissions: absent bilaterally; BERA: wave I absent; Ear CT: semicircular canals dysplasia. The patient was forwarded to a hearing rehabilitation center.
    Discussion: The patient presents the following major criteria for diagnosis: neurological congenial deafness, heterochromic iris, first degree relative affected. Assertive and precocious diagnosis allows audiological intervention with cochlear implants and excellent prognosis with audiological rehabilitation.
    Final comments: Waardenburg Syndrome is a rare disease and with great importance particularly in pediatric population because precocious intervention has a great impact in the patient's life quality.
    Kenneth W. Kross* and Jos M.A. de Jong
    Objective: Total laryngectomy is often performed as salvage therapy after loco-regional radiotherapy for larynx carcinomas. A well known long-term postoperative complication is stenosis of the proximal oesophagus. A better passage can be obtained by dilatation of the stenosis by using the Savary-Gilliard polivinyl-chloride bougies. Methods/Results: We present a series of 3 patients with spinal cord injury after dilatation for stenosis in the upper oesophagus. All patients were treated with dilatation using the Savary-Gilliard polivinyl-chloride bougies.
    Conclusions: This procedure which might be performed regularly in some patients might cause unexpected morbidity.
    Zrria White*, Andrew Sapthavee, Deepak Jajoo and James W. Schroeder
    Objectives: Report a rare case of obstructive fibrinous tracheal pseudomembrane (OFTP) in a pediatric patient and to present a literature review on OFTP.
    Methods: A PubMed search was conducted which revealed a total of 21 individual case reports and 6 case series of OFTP. Relevant data was collected from these publications and analyzed.
    Results: 55 patients with OFTP were identified. Age ranged from 6wk to 85yr, with mean age (± SD) of 34.34 yr (±25.6). 33 were female and 22 were male. The reason for initial intubation varied, and included trauma (n=5), altered sensorium (n=9), respiratory failure (n=15), and intubation for surgical procedure (n=21). The duration of intubation ranged from 30 minutes to 17 days, with mean duration (±SD) of 76.24 hours (±103.72). The duration from extubation until onset of symptoms was almost immediate to 2 weeks, with mean duration (±SD) of 52.30 hours (±73.51). No clear risk factor for development of OFTP was identified. Majority of patients, 45/55 (82%), were treated with bronchoscopy. Most patients, 49/55 (89%), recovered, without any sequelae, but there were few deaths, 3/55 (5%).
    Conclusion: OFTP is a rare, but serious and potentially life threatening cause of post extubation respiratory distress. No risk factor could be identified which may predispose to development of OFTP. Bronchoscopy confirms the diagnosis and removal of the fibrinous exudate is associated with a high rate of recovery without sequelae.
    Short Communication
    Byung In Han*, Pan-Woo Ko and Ho-Won Lee
    Tinnitus is the perception of sound without an external source, commonly stated as a “buzzing” or “ringing” in the ears. The causes of tinnitus are hearing loss, somatosensory system dysfunction, and auditory cortex lesions. In most cases, serious underlying pathologies are rare. The most common cause is hearing loss. However, hearing loss does not always lead to tinnitus, and tinnitus patients do not always have hearing loss. The first is explained by the “inhibitory gating mechanism” and the latter that all tinnitus sufferers are assumed to have some degree of hearing impairment which is not sometimes detected by standard audiological examinations. Recent popular treatments are pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy. The treatment goals should be aimed at symptomatic relief or the management of associated distress.
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