Notes

Discerning serotonin reuptake inhibitors or perhaps serotonin-norepinephrine reuptake inhibitors while pregnant: Toddler as well as childhood results.
Objectives The aim of this study was to analyze the risk of malignancy in salivary gland tumors on the basis of the Milan System for Reporting Salivary Gland Cytopathology. Methods A retrospective review was performed of the charts of patients with salivary gland tumors in whom the final diagnosis was confirmed by surgical excision. Preoperative fine needle aspiration results were categorized according to the Milan System for Reporting Salivary Gland Cytopathology non-diagnostic (category I), nonneoplastic (category II), atypia of undetermined significance (category III), neoplasm (category IV), suspicious for malignancy (category V), and malignant (category VI). Fine needle aspiration and final diagnosis were compared, and the risk of malignancy and operative/oncological outcomes were analyzed. Results A total of 288 patients were enrolled in this study. Postoperative histopathologic salivary gland malignancies were found in 30 (10.4%) patients. Risk of malignancy was 7.1%, 0%, 48.0%, 4.8%, 88.7%, and 100% in categories I, II, III, IV, V, and VI, respectively. The most common malignant tumor in category III was salivary duct carcinoma (37.5%), followed by acinic cell carcinoma (25.0%), mucoepidermoid carcinoma (25.0%), and squamous cell carcinoma (12.5%). The 5-year survival rate of patients with malignant tumors showed no statistical difference between category III and category V/VI (P = .140). Risk of malignancy was 88.9% and 100% in category V and VI, respectively. Conclusions A half of atypia of undetermined significance (category III) cases were malignant. Once diagnosed, the prognosis of malignant tumor in category III was similar with that in category V/VI.Objective The purpose of this prospective, randomized, single-blinded, placebo-controlled study was to investigate the effects of radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) techniques on patients' quality of life (QOL) and to compare the techniques with a placebo procedure. Methods A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into placebo, RFA, diode laser, and MAIT groups at a ratio of 1222. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. Quality of life was assessed with the Glasgow Health Status Inventory (GHSI). Results The GHSI total score increased statistically significantly in all the groups, including placebo. There were no significant differences in the GHSI total score change between RFA, diode laser, and MAIT groups. The MAIT procedure improved the GHSI total score significantly more than the placebo procedure (P = .04). Conclusion All inferior turbinate surgery techniques lead to a significant improvement in the patients' QOL, and no significant differences were found between the techniques. The placebo treatment also improved the QOL significantly. Only the MAIT technique improved the QOL significantly more compared to placebo.Background It is believed that carrying out laryngectomy in tracheotomized patients leads to higher postoperative complications and stomal recurrence compared to carrying out the procedure upfront without prior tracheotomy. We believe that emergency laryngectomy is a feasible procedure in most cancer centers and can be carried out for indications beyond acute airway obstruction as well and complex reconstruction procedures can be also carried out simultaneously. We hereby describe our experience with emergency laryngectomy with or without pharyngectomy. Methods Retrospective analysis of prospectively maintained data base was carried out. Patients who had undergone emergency laryngectomy in our department, from 2014 to 2018, were analyzed, and their clinicodemographic and histopathological features were noted. The indications for surgery and postoperative complications were charted down. Survival data of patients were also noted. Results Seven patients have undergone emergency laryngectomy, 5 for acute airway obstruction and 2 for acute bleeding. Five patients were chemoradiotherapy failures, whereas 2 patients were operated upfront. Two out of 7 patients had pyriform fossa carcinoma, whereas rest of the patients had carcinoma of glottis. Reconstruction with pectoralis myocutaneous/pectoralis muscle only flap was carried out in 4 patients. Minor salivary leak was noted in 4 patients at varying time intervals from second week onward. Two patients had post radiotherapy chondroradionecrosis, without any residual/recurrent tumor. Three out of 7 patients developed recurrence which was salvageable in only 1 patient. Conclusion Emergency laryngectomy can be safely carried out in emergency setting in most cancer centers, more so over it can be carried out for indications beyond acute airway obstruction and combined with complex reconstruction procedures.Purpose Burkitt lymphoma is an aggressive B-cell lymphoma curable with dose-intensive chemotherapy derived from pediatric leukemia regimens. Treatment is acutely toxic with late sequelae. We hypothesized that dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) may obviate the need for highly dose-intensive chemotherapy in adults with Burkitt lymphoma. Methods We conducted a multicenter risk-adapted study of DA-EPOCH-R in untreated adult Burkitt lymphoma. Low-risk patients received three cycles without CNS prophylaxis, and high-risk patients received six cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeninges were involved. learn more The primary endpoint was event-free survival (EFS), and secondary endpoints were toxicity and predictors of EFS and overall survival (OS). Results Between 2010 and 2017, 113 patients were enrolled across 22 centers, and 98 (87%) were high risk. The median age was 49 (range, 18-86) years, and 62% were ≥ 40 years. Bone marrow and/or CSF was involved in 29 (26%) of patients, and 28 (25%) were HIV positive. At a median follow-up of 58.7 months, EFS and OS were 84.5% and 87.0%, respectively, and EFS was 100% and 82.1% in low- and high-risk patients. Therapy was equally effective across age groups, HIV status, and International Prognostic Index risk groups. Involvement of the CSF identified the group at greatest risk for early toxicity-related death or treatment failure. Five treatment-related deaths (4%) occurred during therapy. Febrile neutropenia occurred in 16% of cycles, and tumor lysis syndrome was rare. Conclusion Risk-adapted DA-EPOCH-R therapy is effective in adult Burkitt lymphoma regardless of age or HIV status and was well tolerated. Improved therapeutic strategies for adults with CSF involvement are needed (funded by the National Cancer Institute; ClinicalTrials.gov identifier NCT01092182).
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