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Newman JG, Ibrahim S, Ruiz ES, Prasai A, Siegel J, Fitzgerald A, Goldberg M, Koyfman SA. Risk-Stratification using the 40-Gene Expression Profile (40-GEP) Test Identifies Patients with Node Negative Cutaneous Squamous Cell Carcinoma (cSCC) at Higher Risk of Metastasis Who May Benefit from Adjuvant Radiation Therapy (ART). Int J Radiat Oncol Biol Phys 2023; 117:S153. [PMID: 37784387 DOI: 10.1016/j.ijrobp.2023.06.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) ART is a standard treatment used to reduce the risk of metastasis and recurrence in moderate‒to‒high-risk cSCC patients. Indications for ART have been largely based on pathologic risk factors and informed by staging systems, and while radiation oncologists generally designate a >10% risk threshold for usage of ART, there is no consensus on which groups of tumors may benefit from ART. The 40-GEP test has been independently validated to predict a cSCC patient's risk for regional/distant metastasis in patients with one or more high-risk clinicopathologic factors and reports three biologic risk groups: Class 1 (low, ∼7%), Class 2A (moderate, 20-25%), and Class 2B (high risk, >50%) for metastasis. This study aims to evaluate whether a biomarker informed risk stratification approach using a 40-GEP result could refine the ability to select patients with node negative cSCC at higher risk of metastasis who are most likely to benefit from ART. MATERIALS/METHODS In this retrospective study, all patients had primary cSCC tissue with verified clinicopathologic information of tumors with one or more high-risk factors, met clinical testing criteria, were comprehensively staged, and had outcomes data (n = 954). Patients with node positive disease, or those with nodal failure within 3 months of diagnosis were excluded (n = 19). From the n = 935, an intermediate risk population wherein ART is often considered was defined as Brigham and Women's Hospital (BWH) ≥T2a (n = 489). Kaplan-Meier survival analysis and log-rank test were used to assess metastasis free survival (MFS). Univariate Cox regression compared metastasis rates between 40-GEP results. RESULTS The 3-year MFS rate for this eligible for ART cohort was 82.4% The 40-GEP demonstrated statistically significant risk stratification with MFS rates of 92.4%, 76.1% and 59.4% for Class 1, Class 2A and Class 2B, respectively (p<0.0001). Cox regression was significant for Class 2A and 2B compared to Class 1, with a 3.2-fold and 6.4-fold increase in metastasis, respectively (p<0.0001). 64% (59/92) of all metastases received a Class 2A result, and 44% (14/32) of Class 2B patients metastasized. 46% (223/489) of the cohort received a Class 1 result. Of patients staged BWH T1 (n = 446), those with a Class 2A and 2B had an 88.7% and 66.7% MFS rate, respectively. CONCLUSION Within this eligible for ART population, patients with Class 2A or 2B 40-GEP results have inferior rates of MFS, while Class 1 patients have <10% risk of metastasis. Nearly half of this population received a 40-GEP Class 1 result and could be considered for treatment de-intensification trials. Conversely, patients with low-risk BWH T1 stage, who are traditionally not considered for ART, that received a Class 2A or 2B (>10% risk of metastasis) could be considered for adjuvant therapy.
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Affiliation(s)
- J G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - S Ibrahim
- Rochester Dermatologic Surgery, Victor, NY
| | - E S Ruiz
- Department of Dermatology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA
| | - A Prasai
- Castle Biosciences Inc., Friendswood, TX
| | - J Siegel
- Castle Biosciences Inc., Friendswood, TX
| | | | - M Goldberg
- Castle Biosciences Inc., Friendswood, TX
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Teklay S, Green F, Prasai A, Moor J. 1558 Epiglottic Abscess: A Rare Complication of Adult Epiglottitis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
This report summarises a case of a 23-year-old female who was found to have an epiglottic abscess, an unusual complication of epiglottitis not commonly reported in the literature. Despite the reduced incidence of childhood epiglottitis following widespread Haemophilus Influenzae vaccination, the adult incidence is nonetheless increasing, which would lead to expected higher numbers of resultant complications.
Abscess formation should form part of the differential diagnosis when epiglottitis fails to adequately respond to medical management. In these cases, cross-sectional imaging is often required in order to guide surgical management. This involves endoscopic transoral incision and drainage under general anaesthesia, which here brought rapid resolution. Perioperative support of the anaesthetic team is vital: if endotracheal intubation is not possible, a surgical tracheostomy may be required.
We reaffirm that endoscopic examination by experienced personnel is appropriate in the initial and ongoing investigation of supraglottic laryngeal infections in order to make a diagnosis and evaluate an airway in stable patients. Such patients must be managed on a ward with airway trained nursing staff and an escalation plan in case of airway compromise. In patients that present in airway obstruction, airway stabilization, with early input from ENT surgeons and anaesthetists, is the priority.
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Affiliation(s)
- S Teklay
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - F Green
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A Prasai
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Moor
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Rogers SN, Allmark C, Bekiroglu F, Edwards RT, Fabbroni G, Flavel R, Highet V, Ho MWS, Humphris GM, Jones TM, Khattak O, Lancaster J, Loh C, Lowe D, Lowies C, Macareavy D, Moor J, Ong TK, Prasai A, Roland N, Semple C, Spencer LH, Tandon S, Thomas SJ, Schache A, Shaw RJ, Kanatas A. Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial. Eur Arch Otorhinolaryngol 2021; 278:3435-3449. [PMID: 33346856 PMCID: PMC7751263 DOI: 10.1007/s00405-020-06533-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). METHODS A pragmatic cluster preference randomised control trial with 15 consultants, 8 'using' and 7 'not using' the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. RESULTS Consultants saw a median (inter-quartile range) 16 (13-26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (- 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. CONCLUSION This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.
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Affiliation(s)
- Simon N. Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Liverpool, L39 4QP UK
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christine Allmark
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Fazilet Bekiroglu
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Gillon Fabbroni
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | | | - Victoria Highet
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Michael W. S. Ho
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Gerald M. Humphris
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Terry M. Jones
- Liverpool Head and Neck Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9GA UK
| | - Owais Khattak
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christopher Loh
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | | | - Cher Lowies
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Dominic Macareavy
- Chair of the Head and Neck Patient and Carer Research Forum, Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - James Moor
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - T. K. Ong
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - A. Prasai
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Nicholas Roland
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University, Shore Road, Belfast, Newtownabbey, Co, BT37 0QB Antrim, Belfast UK
- South Eastern Health and Social Care Upper Newtownards Road, Belfast, BT16 1RH UK
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Sank Tandon
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Steven J. Thomas
- Oral and Maxillofacial Surgery Department, Bristol University, Lower Maudlin Street, Bristol, UK
| | - Andrew Schache
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Richard J. Shaw
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
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Affiliation(s)
- C. Tapking
- Department of Surgery University of Texas Medical Branch and Shriners Hospitals for Children – Galveston 815 Market Street Galveston TX 77550 U.S.A
- Department of Hand, Plastic and Reconstructive Surgery Burn Center, BG Trauma Center Ludwigshafen University of Heidelberg Ludwig‐Guttmann‐Straße 13 Ludwigshafen 67071 Germany
| | - A. Prasai
- Department of Surgery University of Texas Medical Branch and Shriners Hospitals for Children – Galveston 815 Market Street Galveston TX 77550 U.S.A
| | - L.K. Branski
- Department of Surgery University of Texas Medical Branch and Shriners Hospitals for Children – Galveston 815 Market Street Galveston TX 77550 U.S.A
- Division of Plastic, Aesthetic and Reconstructive Surgery Department of Surgery Medical University of Graz Graz Austria
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Brown FL, Mishra T, Frounfelker RL, Bhargava E, Gautam B, Prasai A, Betancourt TS. 'Hiding their troubles': a qualitative exploration of suicide in Bhutanese refugees in the USA. Glob Ment Health (Camb) 2019; 6:e1. [PMID: 30854217 PMCID: PMC6401374 DOI: 10.1017/gmh.2018.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach. METHODS Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted. RESULTS Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness. CONCLUSIONS This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees' social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
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Affiliation(s)
- F. L. Brown
- War Child Holland, Amsterdam, The Netherlands
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - T. Mishra
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - R. L. Frounfelker
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- SHERPA Research Centre, CIUSS Centre-Ouest de l-ile de Montreal, Montreal, Canada
- McGill University, Montreal, Canada
| | | | - B. Gautam
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Hundeshagen G, Jay JW, Prasai A, Foncerrada G, Smith JM, Nguyen AV, Cambiaso-Daniel J, Herndon DN, Enkhbaatar P, Branski LK, Finnerty CC. 35 First in Vitro and in Vivo Experiences with a New Synthetic Dermal Substitute with Dual Microporous Structure. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Hundeshagen
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J W Jay
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - A Prasai
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - G Foncerrada
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J M Smith
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - A V Nguyen
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - J Cambiaso-Daniel
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - D N Herndon
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - P Enkhbaatar
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - L K Branski
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
| | - C C Finnerty
- University of Texas Medical Branch, Galveston, TX; Shrines Hospitals for Children Galveston, Galveston, TX
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Gauchan S, Thapa C, Prasai A, Pyakurel K, Joshi I, Tulachan J. Effects of intrathecal fentanyl as an adjunct to hyperbaric bupivacaine in spinal anesthesia for elective caesarean section. Nepal Med Coll J 2014; 16:5-8. [PMID: 25799801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hyperbaric bupivacaine is the most common drug used in spinal anesthesia for caesarean section. The aim of this study was to compare the effects of adding fentanyl to intrathecal bupivacaine on the onset and duration of spinal anesthesia and its effect on mother and neonate. Seventy healthy parturients with singleton pregnancy scheduled for elective cesarean section were randomly allocated to receive subarachnoid block with 0.5% bupivacaine heavy 2.4 ml (Group A) or fentanyl 20 microgram (0.4 ml) added to 0.5% bupivacaine heavy 2 ml (Group B). Blood pressure, heart rate, respiratory rate, oxygen saturation, along with characteristics of spinal block were assessed throughout the surgery and in the postoperative ward until the patient requested for analgesia. It was found that duration of sensory block was prolonged in fentanyl group (p < 0.05). Duration of complete analgesia (97 ± 8.23 minutes vs 153 ± 7 minutes; p value = 0.00) and effective analgesia (134 ± 5.6 minutes vs 164 ± 9; p value = 0.00) were also found to be prolonged in Group B. There was not much difference in the occurrence of side effects in both the groups. Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.
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Prasai A, Mulheran M, Grubb B.. Characterisation of voltage gated sodium channels in the mammalian central auditory pathway: a therapeutic target for the treatment of tinnitus. Clin Otolaryngol 2007. [DOI: 10.1111/j.1365-2273.2007.01419_15.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prasai A, Mulheran M, Grubb B. Anatomical characterisation of voltage gated sodium channels in the mammalian cochlear nerve spiral ganglia. Clin Otolaryngol 2006. [DOI: 10.1111/j.1365-2273.2006.01341_9.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sunkaraneni VS, Jones SEM, Prasai A, Fish BM. Is unilateral tonsillar enlargement alone an indication for tonsillectomy? J Laryngol Otol 2006; 120:E21. [PMID: 16834797 DOI: 10.1017/s0022215106002027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2006] [Indexed: 11/07/2022]
Abstract
Introduction: Unilateral tonsillar enlargement is often seen in the out-patient setting. Frequently, these patients are listed for tonsillectomy for the purpose of ruling out malignant histology. This study aims to determine the necessity for tonsillectomy.Method: This retrospective case-note review looks at all the tonsillectomies performed for histological examination at our institution over a five year period, and analyses the histological findings in those with unilateral tonsillar enlargement (UTE) alone, and those with UTE with other clinical features (history of chronic pain, dysphagia, the presence of tonsillar or peritonsillar mucosal abnormality, those with cervical lymphadenopathy). All patients who underwent tonsillectomy for the purpose of histological examination from 1 June 1998 to 30 May 2003 were identified and their notes reviewed. Exclusion criteria included cases where there were no pre-operative out-patient notes, those patients where the specimens had been sent from other hospitals, those patients who had malignancy already diagnosed, and those cases where tonsillectomy had been performed by other surgical specialties (e.g. maxillofacial, plastics). There were 1475 tonsillectomies, of which 181 performed over this period were sent for histological analysis. After excluding those patients that did not meet our criteria, we were left with 53 patients who had UTE. The primary outcome measure was the rate of malignancy in the two groups.Results: Of these, 33 had UTE alone, 20 had associated clinical features. In the former group, none of the patients were found to have malignancy. In the latter, nine (45 per cent) had a malignancy. Fisher's exact test was used to test for differences between the UTE alone group versus the UTE plus other features group (p<0.001).Discussion: The prevalence of malignancy in tonsils which exhibit asymmetry with no other clinical features is very low; in our study it was zero. However, other studies have found a small percentage representing underlying malignancy. In view of this, we feel that a ‘watch and wait’ policy is initially more appropriate, and if symptoms or signs are progressive, tonsillectomy should then be advised.
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Affiliation(s)
- V S Sunkaraneni
- Department of Ear, Nose and Throat, Addenbrooke's Hospital, Cambridge, UK.
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Yin XK, Xiang ZG, Prasai A, Lamichhane N. Continuous versus Intermittent Bolus Epidural Anaesthesia in Elderly Surgical Patients. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A prospective study of 70 elderly conventionally continuously randomized patients was done to compare thehaemodynamic changes produced during continuous infusion versus intermittent bolus epidural anaesthesia.The hemodynamic parameters (Blood pressure, Heart rate) were slightly changed in continuous infusiongroup but there was no significant difference compared with baseline value (p>0.05). Whereas, In bolusgroup, the hemodynamic parameters differed significantly compared with baseline values and the patientsin group I. So conclusion of better hemodynamic stability in continuous infusion epidural anaesthesia thanthat in intermittent bolus epidural method in elderly is reached.Key Words: Epidural anaesthesia, haemodynamic, intermittent bolus, continuous infusion.
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