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• HPV16 and HPV33 are more common in HIV-negative and HIV-positive women, respectively. • Co-infections with the HR HPV types are more common among HIV-positive women. • Women with cervical cytologic abnormalities are HPV+. To characterize high-risk HPV types associated with cervical precancerous lesions in women living in Yaounde, Cameroon, and to determine their distribution with HIV status. Women with abnormal pap smears recorded from February 2015 to May 2019 at Saint Martin de Porres' Health Centre, Yaounde, Cameroon, were recruited in this study after obtaining informed consent. Pap smears were collected and re-examined. Human immunodeficiency virus (HIV) serology was determined. HPV16, 18, 33, and 45 were assessed using standard PCR. All included participants (370) were HPV-positive and had either low grade squamous intraepithelial lesions (67.03%) or high grade squamous intraepithelial lesions (31.35%). They were subdivided into HIV-positive (N =102) and HIV-negative (N =268). In the HIV-negative subgroup, we observed 66.04% HPV16-positve, 41.79% HPV18-positve, 21.27% HPV33-positve and 8.21% HPV45-positve. In the HIV-positive subgroup, we observed 22.55% HPV16-positve, 5.88% HPV18-positve, 75.49% HPV33-positve, and 49.02% HPV45-positve. Married HIV-positive participants (47.14 ± 1.19) were older than both their single counterparts (34.94±1.22, P = 0.0008) and HIV-negative participants (41.43 ± 0.79, P = 0.0001). Single HIV-positive women reported higher numbers of miscarriages (P = 0.0023), and had later first sexual intercourse than HIV-negative (P = 0.0079) women. Our study suggested differential expressions in high-risk HPV types with HIV status and cervical precancerous lesions and warrants more extensive studies. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 pandemic resulted in the cessation of elective surgery. The continued provision of complex head and neck cancer surgery was extremely variable, with some UK centres not performing any cancer surgery. During the pandemic, Guy's and St Thomas' NHS Foundation Trust received high numbers of coronavirus disease 2019 admissions. This paper presents our experience of elective complex major head and neck cancer surgery throughout the pandemic. Methods: A head and neck cancer surgery hub was set up that provided a co-ordinated managed care pathway for cancer patients during the pandemic; the Guy's Cancer Centre provided a separate, self-enclosed coronavirus-free environment within the hospital campus. Results: Sixty-nine head and neck cancer patients were operated on in two months, and 13 patients had a microvascular free tissue transfer. Nosocomial infection with coronavirus disease 2019 was detected in two cases (3 per cent), neither required critical care unit admission. Both patients made a complete recovery and were discharged home. There were no deaths. Conclusion: Performing major head and neck surgery, including free flap surgery, is possible during the pandemic; however, significant changes to conventional practice are required to achieve desirable patient outcomes. [ABSTRACT FROM AUTHOR]

In order to improve our ability to predict cloud properties, radiative balance and climate, it is crucial to understand the mechanisms that trigger the formation of new particles and their growth to activation sizes. Using an array of real time aerosol measurements, we report a categorization of the aerosol population taken at Villum Research Station, Station Nord (VRS) in North Greenland during a period of 88 days (February–May 2015). A number of New Particle Formation (NPF) events were detected and are herein discussed. Air mass back trajectories analysis plotted over snow-sea ice satellite maps allowed us to correlate early spring (April) NPF events with air masses travelling mainly over snow on land and sea ice, whereas late spring (May) NPF events were associated with air masses that have passed mainly over sea ice regions. Concomitant aerosol mass spectrometry analysis suggests methanesulfonic acid (MSA) and molecular iodine (I 2 ) may be involved in the NPF mechanisms. The source of MSA was attributed to open leads within the sea ice. By contrast, iodine was associated with air masses over snow on land and over sea ice, suggesting both abiotic and biotic sources. Measurements of nucleating particle composition as well as gas-phase species are needed to improve our understanding of the links between emissions, aerosols, cloud and climate in the Arctic; therefore our ability to model such processes. [ABSTRACT FROM AUTHOR]

Parathyroid cysts are uncommon entities. Symptomatic parathyroid cysts are extremely rare with approximately only 200 cases reported in the literature. Only ten cases have been reported with recurrent laryngeal nerve paralysis and none in the radiological literature. We present a case of parathyroid cyst and recurrent laryngeal nerve paralysis with illustrations of the clinical, radiological and pathological appearances as well as discussion on the management of this condition. [ABSTRACT FROM AUTHOR]

Treatments for head and neck cancer are improving, yet they remain toxic and challenging. The incidence of some forms of head and neck cancer (e.g. oropharyngeal) is rising. This creates an enlarging cohort of survivors with complex needs. These needs may be overlooked and undertreated. This overview presents evidence for the unmet survivorship needs of head and neck cancer patients and identifies strategies for the recognition and remedy of these needs in the clinic. There is sufficient evidence to challenge services to redesign follow-up strategies around unmet need using the full multidisciplinary team and to widen focus away from a sole aim of recognition and treatment of recurrent disease. Problems presented include depression, comorbid disease, second malignancy, alcohol and nicotine dependence, eating and drinking difficulties (including dysphagia, dental problems, trismus and sense disturbance) and hypothyroidism. [ABSTRACT FROM AUTHOR]

Since the previous edition of these guidelines, significant changes have taken place in the training and assessment of surgeons and oncologists who treat patients with head and neck cancer. For those intending to become head and neck surgeons, a fellowship in head and neck surgery is virtually mandatory. This paper summarises the current career structure to specialise in head and neck oncology and surgery in the UK. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Although much commoner in the eastern hemisphere, with an age-standardised incidence rate of 0.39 per 100 000 population, cancers of the nasopharynx form one of the rarer subsites in the head and neck.¹ This paper provides recommendations on the work up and management of nasopharyngeal cancer based on the existing evidence base for this condition. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the study, which describes the utilization of modified extended Kocher incision for total thyroidectomy and lateral compartment neck dissection.

A letter to the editor is presented about a study of wide field total thyroidectomy for advanced differentiated thyroid cancer.

The article reflects on a meeting on the topic "Metastatic Neck Disease" held on the 11th Evidence Based Management Day in March, 2013, in Newcastle Upon Tyne. Topics discussed include three classification systems for the extent of neck dissection (ND), several diagnostic procedures for the diagnosis of neck metastasis such as magnetic resonance imaging (MRI), computed tomography (CT), and sentinel lymph node biopsy (SLNB), and postoperative radiotherapy (PORT) for head and neck cancer HNC.

Vitreous fluid obtained from diabetic patients undergoing vitreoretinal surgery is currently used to explore the events that are taking place in the retina for clinical research. However, several confounding factors such as vitreous haemorrhage and concentration of vitreous proteins should be considered in the analysis of the results. In addition, the volume of vitreous fluid obtained after vitrectomy is approximately 1 mL and, therefore, only few peptides can be analysed simultaneously. The recent development of proteome analysis has made it feasible to analyse protein profiles with only a small sample. We have used this approach for exploring pathogenic candidates in both proliferative DR ( PDR) and DME. Regarding mediators of inflammation involved in PDR, it is worthy of mentioning that several factors of the complement system have been found increased in the vitreous fluid from PDR patients in comparison with control subjects. There is scarse information on this issue in DME. However, an overview will be given and our results showing that hemopexin is a candidate in the pathogenesis of DME will be presented. [ABSTRACT FROM AUTHOR]

Background Head and neck cancers [ HNCs] are biologically heterogeneous tumours. The objectives of this study were to describe trends in incidence of HNCs amongst London residents by sex, age, anatomical site, deprivation and ethnicity. Methods Annual age-standardised incidence rates [ ASRs] were calculated on HNC registration data, overall and for specific cancer sites, by sex and morphology (1985-2010) and area-based socio-economic deprivation score (2006-2010). Age-standardised incidence rate ratios [ IRRs] for the main ethnic groups were calculated by cancer site, using White males and females as the reference groups (1998-2009). Results The ASR of HNC in males increased by 40% from 17.3 [95% CI: 15.8-18.6] to 24.2 [95% CI: 22.5-25.8] per 100 000 and in females by 87% from 7.0 [95% CI: 6.2-7.8] to 13.1 [95% CI: 11.9-14.2] per 100 000. Seventy-three per cent of cases spanned four cancer sites: larynx, thyroid, oral and oropharynx. Larynx was most common (23%), and had the highest male: female ratio (6 : 1); ASRs decreased significantly over time, most notably in males [ P < 0.001]. Oral cavity was the second most common (21%), with a male: female ratio of 2 : 1, and increasing ASRs in both sexes [ P < 0.001]. The majority of cases were male (64%) and from deprived areas (59%). Deprivation was associated with a significantly higher incidence for larynx (males), oropharynx (males and females) and oral cavity (females) [ P < 0.05]. The age-specific rate for middle-aged adults (45-64 years) was high for oropharyngeal cancer. The incidence of thyroid cancers increased significantly in both sexes [ P < 0.001], and this was the only site more common in females. One in five cases with known ethnicity was from a non-White group (20%). Compared with their White counterparts, Bangladeshi females had a higher incidence of oral, laryngeal and thyroid cancers; Chinese males and females had a higher incidence of nasopharyngeal cancer; and Pakistani and Indian females and Indian males also had higher incidence of oral cancer. Conclusions HNCs are increasing in London males and females with significant variation by cancer site over time; oral and oropharyngeal cancers show the most significant rise, with implications for public health action and service provision. [ABSTRACT FROM AUTHOR]

Objective: Numerous factors are considered to impact on the rate of complications during salvage total laryngectomy procedures. Neck dissection could be one of these factors. This study analysed the pattern of lymph node metastasis and rate of occult neck disease during salvage total laryngectomy as well as the impact of neck dissection on survival and complication rates. Method: This was a retrospective analysis of a prospectively maintained laryngectomy database in two large tertiary teaching hospitals. Results: The rate of occult neck disease was 11.1 per cent. Most cases with occult neck disease had rT4 disease. Patients with complications, advanced tumour stage and positive margins had a significant decrease in overall survival. Patients receiving elective neck dissection did not have any survival benefit. Positron emission tomography-computed tomography showed a very high specificity and negative predictive value. Conclusion: According to the low risk of occult neck disease when using contemporary imaging techniques as well as the lack of impact on survival, conservative management of the neck should be considered for crT1-T3 recurrence. [ABSTRACT FROM AUTHOR]

The increasing demands of clinical audit have resulted in the need for accurate data collection. The use of tumour maps allows standardization of the records of patients with head and neck cancer, which facilitates collation of data in multicentre studies and makes interdepartmental comparisons more meaningful. The aim of this study was to develop an improved standard set of tumour maps for recording the stage of head and neck tumours. A review of the existing tumour diagrams was performed to identify those anatomical areas that are not adequately represented or where ambiguity exists. The areas where improvements could be made were identified as: (1) the anterior commissure of the larynx; (2) axial and sagittal views of the larynx; (3) the pyriform fossa and cervical oesophagus; (4) the oropharynx and vallecula; (5) the nasal cavity and paranasal sinuses; and (6) cervical nodal involvement. A new set of tumour maps is presented in an attempt to correct some of the limitations of the existing diagrams. [ABSTRACT FROM AUTHOR]

Background: The introduction of transoral robotic surgery into routine management of patients is complex. It involves organisational, logistical and clinical challenges. This study presents our experience of implementing such a programme and provides a blueprint for other centres willing to establish similar services. Methods: Implementation of the robotic surgery programme focused on several key domains: training, logistics, governance, multidisciplinary team awareness, pre-operative imaging, anaesthesia, post-operative care, finance, patient selection and consent. Programme outcomes were evaluated by assessing operative outcomes of the first 117 procedures performed. Results: The success of the transoral robotic surgery programme has been possible because of the scrupulous planning phase before the first procedure, and the time invested on team awareness and training. Conclusion: Implementation of a new transoral robotic surgery service has led to: the development of a dedicated transoral robotic surgery patient care protocol, the performance of progressively more complex procedures, the inclusion of transoral robotic surgery training and the establishment of several research projects. [ABSTRACT FROM AUTHOR]

Purpose: Intravitreal somatostatin (SST) levels are decreased in patients with diabetic macular oedema. This deficit may be involved in the pathogenesis of this condition. The aim of the present study was to determine SST concentration in the vitreous fluid of patients with chronic uveitic macular oedema (CUMO) and quiescent intraocular inflammation.Methods: Plasma and vitreous fluid samples were obtained during vitrectomy from 11 eyes of patients with CUMO and from 42 eyes of control subjects (idiopathic epiretinal membrane, macular hole). SST concentration was measured by radioimmunoassay.Statistics: χ(2)-square test, Mann-Whitney U-test, Wilcoxon test, Spearman's rank correlation coefficient, and multivariant linear regression models.Results: Plasma SST concentrations were similar in uveitic patients and controls (28.25 pg/ml (21.3-31) vs 28.7 pg/ml (22-29.5); P=0.869). A higher vitreous concentration of proteins was found in uveitic patients (1.59±0.38 mg/ml vs 0.73±0.32 mg/ml, P<0.0001). Vitreous SST was markedly lower in uveitic patients, both in absolute terms and after adjusting for total intravitreous protein concentration (39.37 pg/ml (6.16-172) vs 486.73 pg/ml (4.7-1833), P<0.0001; 33.1 pg/mg (3.9-215.74) vs 629.75 pg/mg (6.91-2024), P<0.0001). No correlations were found between plasma and vitreous concentration of SST in either group (ρ=0.191, P=0.57 and ρ=0.49, P=0.66). There were no correlations between vitreous SST concentration and visual acuity or macular thickness in uveitic patients (ρ=0.302, P=0.31 and ρ=0.45, P=0.13).Conclusions: Intravitreous SST is decreased in patients with CUMO and quiescent intraocular inflammation. The deficit of SST may have a role in the pathogenesis of this condition. [ABSTRACT FROM AUTHOR]

Objectives: Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT–anaesthetics department led tracheostomy team. Method: A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. Results: Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13–20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23–40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7–16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. Conclusion: Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation. [ABSTRACT FROM AUTHOR]

Objective: The global coronavirus disease 2019 (COVID-19) pandemic has necessitated rapid alterations to diagnostic pathways for head and neck cancer patients that aim to reduce risk to patients (exposure to the hospital environment) and staff (aerosol-generating procedures). Transoral fine needle aspiration cytology offers a low-risk means of rapidly diagnosing patients with oral cavity or oropharyngeal lesions. The technique was utilised in selected patients at our institution during the pandemic. The outcomes are considered in this study. Method: Diagnostic outcomes were retrospectively evaluated for a series of patients undergoing transoral fine needle aspiration cytology of oral cavity and oropharyngeal lesions during the COVID-19 pandemic. Results: Five patients underwent transoral fine needle aspiration cytology, yielding lesional material in 100 per cent, with cell blocks providing additional information. In one case, excision biopsy of a lymphoproliferative lesion was required for final diagnosis. Conclusion: Transoral fine needle aspiration cytology can provide rapid diagnosis in patients with oral cavity and oropharyngeal lesions. Whilst limitations exist (including tolerability and lesion location), the technique offers significant advantages pertinent to the COVID-19 era, and could be employed in the future to obviate diagnostic surgery in selected patients. [ABSTRACT FROM AUTHOR]

• The 8th TNM edition has received growing attention in oropharyngeal cancer (OPC). • We analyzed survival outcomes compared with 7th and 8th editions in OPC patients after radical chemoradiotherapy (CRT). • Our data showed a better OS stratification in OPC after definitive CRT. To evaluate whether the 8th staging system is a better discriminator of overall survival (OS) than the 7th edition for oropharyngeal cancer patients after definitive (chemo)radiotherapy (CRT). Data from oropharyngeal cancer patients treated with CRT with curative intent between 2010 and 2016 at Guy's and St Thomas' Hospitals were reviewed. Human papillomavirus (HPV) status was ascertained in all cases. Patients were staged using the 7th edition and the 8th edition TNM staging system. Demographics, tumor characteristics and treatment response data were included in univariate and multivariate analysis for OS. OS and disease-free survival (DFS) were estimated using the Kaplan-Meier method. In addition, a multivariate survival Cox regression analysis of several clinical variables was performed. A total of 273 patients were included. The median follow-up was 4.7 years. Overall 63 patients died. In multivariate analysis, HPV status, complete response at 3 months and ≤21 units/week alcohol were prognostic for OS. For the entire cohort, the 5-year OS and DFS rates were 78.1% (95% confidence interval CI 0.719–0.831) and 73.9% (95% CI 0.677–0.792), respectively. Better stratification of OS and DFS was recorded by 8th edition for the entire cohort. In HPV-positive cases, risk stratification based on tobacco smoking and nodal stage resulted in statistically higher discrimination in OS rates (5-year OS 90.7% in low risk patients and 84.6% in intermediate risk, p = 0.05) and DFS rates (5-year DFS 91.5% in low risk and 76.1% in intermediate risk, p = 0.001). The 8th edition TNM staging system provides better OS stratification in oropharyngeal cancer after definitive CRT compared with the 7th edition. Other clinical variables, such as complete response at 3 months, alcohol and tobacco smoking, should also be considered in future classifications as they provide additional risk stratification information in both HPV-positive and HPV-negative disease. [ABSTRACT FROM AUTHOR]

In this work we use cluster analysis of long term particle size distribution data to expand an array of different shorter term atmospheric measurements, thereby gaining insights into longer term patterns and properties of Arctic aerosol. Measurements of aerosol number size distributions (9–915 nm) were conducted at Villum Research Station (VRS), Station Nord in North Greenland during a 5 year record (2012–2016). Alongside this, measurements of aerosol composition, meteorological parameters, gaseous compounds and cloud condensation nuclei (CCN) activity were performed during different shorter occasions. K-means clustering analysis of particle number size distributions on daily basis identified several clusters. Clusters of accumulation mode aerosols (main size modes > 100 nm) accounted for 56% of the total aerosol during the sampling period (89–91% during February–April, 1–3% during June–August). By association to chemical composition, cloud condensation nuclei properties, and meteorological variables, three typical accumulation mode aerosol clusters were identified: Haze (32% of the time), Bimodal (14%) and Aged (6%). In brief: (1) Haze accumulation mode aerosol shows a single mode at 150 nm, peaking in February–April, with highest loadings of sulfate and black carbon concentrations. (2) Accumulation mode Bimodal aerosol shows two modes, at 38 nm and 150 nm, peaking in June–August, with the highest ratio of organics to sulfate concentrations. (3) Aged accumulation mode aerosol shows a single mode at 213 nm, peaking in September–October and is associated with cloudy and humid weather conditions during autumn. The three aerosol clusters were considered alongside CCN concentrations. We suggest that organic compounds, that are likely marine biogenic in nature, greatly influence the Bimodal cluster and contribute significantly to its CCN activity. This stresses the importance of better characterizing the marine ecosystem and the aerosol-mediated climate effects in the Arctic. [ABSTRACT FROM AUTHOR]

Objectives To analyse survival and toxicity outcomes in patients treated with primary intensity-modulated radiotherapy ( IMRT) for oropharyngeal squamous cell carcinoma ( OPSCC) in the era of routine human papilloma virus ( HPV) testing. Design Single-institution case series. Setting Tertiary Head and Neck Cancer Unit. Participants A total of 186 patients received IMRT (+/− chemotherapy) for radical primary treatment of OPSCC between March 2010 and December 2013. HPV status was available for 88% of cases. Median radiation dose was 65 Gy in 30 daily fractions. 90% of stage III/ IV patients received concurrent chemotherapy or cetuximab. Main Outcome Measures Overall, disease-free and disease-specific survival; rates of late xerostomia and dysphagia. Results A total of 177 patients completed treatment (Stage I/ II: 23; Stage III/ IV: 154), with median follow-up of 26 months. Estimated 3-year overall survival ( OS), disease-free survival ( DFS) and disease-specific survival ( DSS) rates were 77.2% (70.5-83.9), 72.3% (65.4-79.2) and 80.2% (74.1-86.3). Estimated 3-year OS, DFS and DSS for HPV-positive patients were 90.9% (85.2-96.6), 87.9% (81.4-94.4) and 91.8% (86.3-97.3). A previously identified risk stratification method was validated, showing improved OS for low-risk over high-risk patients ( HR 0.09, P < 0.001). The 2-year feeding tube retention rate was 6%, and 2-year grade ≥2 xerostomia rate was 38% (23% if mean contralateral parotid dose <24 Gy). Conclusions Outcomes with IMRT are favourable, particularly in the HPV-positive patient group. This data further supports the use of a previously described prognostication model that can be used to select patients for escalation/de-escalation clinical trials. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Establishing and integrating a transoral robotic surgery programme into routine oncological management of head and neck cancer" published in November 22, 2022 issue.

Objective: Pharyngocutaneous fistula is a serious complication following total laryngectomy. We report a simple technique which is useful in assessing the adequacy of pharyngeal closure following total laryngectomy. Method: Installation of 1.5 per cent hydrogen peroxide into the oral cavity, while observing for leakage at the pharyngeal repair. Results: We have found this technique to be useful in 22 patients undergoing total laryngectomy with pharyngeal resection and neck dissection. Conclusion: This method ensures that pharyngeal closure has been technically adequate. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the views of the present group of otolaryngological trainees on a number of issues related to the planned changes to higher surgical training.

Background:Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.Objectives:This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.Methods:Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan–Meier method.Results:The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.Conclusion:Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes. [ABSTRACT FROM AUTHOR]

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the evidence base pertaining to the management of metastatic neck disease in the setting of an unknown primary and provides recommendations on the work up and management for this group of patients receiving cancer care. [ABSTRACT FROM AUTHOR]

Résumé But de l’étude La prévention de la transmission des infections transmises par transfusion sanguine dépend de la bonne sélection des donneurs et de la réalisation des tests sérologiques adéquats pour la détection des agents pathogènes, notamment les virus des hépatites B et C et le virus de l’immunodéficience humaine (VIH). Le but de cette étude était double : déterminer les séroprévalences des infections dues aux VHB, VHC, VIH et de la syphilis parmi les donneurs de sang de l’hôpital central de Yaoundé (HCY) et déterminer les caractéristiques sociodémographiques, afin de trouver des stratégies pour améliorer la sécurité transfusionnelle au Cameroun. Patients et méthodes Il s’agit d’une étude rétrospective ayant porté sur 9024 donneurs de sang consécutifs de l’HCY dans la région du centre, Cameroun, inclus de janvier à décembre 2013. Les données ont été recueillies sur les questionnaires de pré-don et des résultats des tests biologiques de qualification effectués sur les dons de sang au laboratoire de l’HCY avec des tests Elisa. Résultats L’âge moyen des donneurs était de 28 ans. Le sex-ratio M/F était de 14,8. Selon le mode de don, 97,2 % étaient des donneurs de compensation et 76,8 % étaient des nouveaux donneurs. Au total, 19,3 % des donneurs étaient positifs pour au moins un agent infectieux, parmi eux 1,5 % étaient positifs pour au moins 2 marqueurs viraux. Les séroprévalences globales de l’AgHBs, des anti-VHC, des anti-VIH et de la syphilis étaient respectivement de : 12,6 %, 3,2 %, 3,3 % et 0,2 %. Pour l’AgHBs, la prévalence était significativement plus élevée chez les hommes ( p = 0,001) et les nouveaux donneurs ( p = 0,003). La prévalence des anti-VHC était significativement plus élevée parmi les nouveaux donneurs ( p = 0,05). La prévalence des anti-VIH était significativement plus élevée chez les nouveaux donneurs (3,7 % vs 2,2 % ; p = 0,02). Conclusion Le profil du donneur camerounais est de type compensation et nouveaux donneurs. Les séroprévalences du VIH, du VHB, du VHC et de la syphilis parmi les donneurs de sang sont élevées et reflètent l’importance de ces agents dans notre milieu. Objectives Prevention of blood transfusion-transmitted infections includes blood donor screening and effective infectious markers screening for donated blood. This study had two main objectives: to determine seroprevalence of HBV, HCV, HIV and syphilis in blood donors of the Yaoundé Central Hospital and to study sociodemographic factors of blood donors. Patients and methods A retrospective study of consecutive blood donors’ records from January to December 2013 was conducted. Seroprevalence of hepatitis B, hepatitis C, human immunodeficiency viruses and syphilis were determined in 9024 whole blood donations collected in the Yaoundé Central Hospital in the centre region, Cameroon using Elisa kits. Results Mean age of donors was 28 years. The male to female ratio was 14.8. Most of blood donors were replacement donors (97.2%) and first-time donors (76.8%). Up to 19.3% of the donors tested positive for at least one infectious agent, in which 0.1% presented a positive test for three viruses (HIV, HCV and HBV). The overall seroprevalence in blood donors was 12.6% for HBsAg, 3.2% for hepatitis C antibody, 3.3% for HIV-1/2 antibodies and 0.2% for syphilis. The prevalence of HBsAg was significantly higher in men ( P = 0.001), among first-time donors ( P = 0.003), in blood group A ( P = 0.01) and those with the rhesus positive blood ( P = 0.01). The prevalence of anti-HCV was significantly higher among first-time donors ( P = 0.05). The prevalence of anti-HIV was significantly higher in first-time donors (3.7% vs 2.2%, P = 0.02). Conclusion First-time blood donors and replacement donors are the two types of donors in Cameroon. Replacement donors are considered as having a major risk of transmission of infections to recipients. The seroprevalence of HIV, HBV, HCV, and syphilis among these donors is high and reflects how much these agents are present in Cameroon. Effective infectious markers screening and organization of blood donors into an association of volunteer's donors are necessary to secure blood transfusion in Cameroon. [ABSTRACT FROM AUTHOR]

Background:With the increasing use of chemoradiotherapy protocols, total laryngectomy carries increasing risks such as pharyngocutaneous fistula. There is little reference to the use of antibiotic prophylaxis in salvage surgery. This study aimed to determine the current practice in antibiotic prophylaxis for total laryngectomy in the UK.Method:A questionnaire was designed using SurveyMonkey software, and distributed to all ENT-UK registered head and neck surgeons.Results:The survey revealed that 19 surgeons (51 per cent) follow a protocol for antibiotic prophylaxis in primary total laryngectomy and 17 (46 per cent) follow a protocol in salvage total laryngectomy. Only 11 (30 per cent) use anti-methicillin-resistant Staphylococcus aureus agents in their antibiotic prophylaxis. The duration of prophylaxis varies considerably. Nineteen surgeons (51 per cent) revealed that their choice of antibiotic prophylaxis reflected non-evidence-based practices.Conclusion:There appears to be little evidence-based guidance on antibiotic prophylaxis in primary and salvage total laryngectomy. The survey highlights the need for more research in order to inform national guidance on antibiotic prophylaxis in primary and salvage total laryngectomy. [ABSTRACT FROM PUBLISHER]

We present herein the proposal of the European Laryngological Society working committee on nomenclature for a systematic classification of open partial horizontal laryngectomies (OPHL). This is based on the cranio-caudal extent of laryngeal structures resected, instead of a number of different and heterogeneous variables present in existing nomenclatures, usually referring to eponyms, types of pexy, or inferior limit of resection. According to the proposed classification system, we have defined three types of OPHLs: Type I (formerly defined horizontal supraglottic laryngectomy), Type II (previously called supracricoid laryngectomy), and Type III (also named supratracheal laryngectomy). Use of suffixes 'a' and 'b' in Type II and III OPHLs reflects sparing or not of the suprahyoid epiglottis. Various extensions to one arytenoid, base of tongue, piriform sinus, and crico-arytenoid unit are indicated by abbreviations (ARY, BOT, PIR, and CAU, respectively). Our proposal is not intended to give a comprehensive algorithm of application of different OPHLs to specific clinical situations, but to serve as the basis for obtaining a common language among the head and neck surgical community. We therefore intend to present this classification system as a simple and intuitive teaching instrument, and a tool to be able to compare surgical series with each other and with non-surgical data. [ABSTRACT FROM AUTHOR]

Salvage laryngectomy (SL) is associated with high levels of morbidity. Rates of pharyngocutaneous fistulae (PCF) are as high as 35 % in some series. Patients at highest risk of such complications may be candidates for altered surgical management in terms of additional tissue transfer, or delayed tracheoesophageal puncture. This study investigates the relationship between the time from primary radiotherapy (RT) to salvage surgery and the development of PCF. 26 consecutive patients who underwent SL between 2000 and 2010 were identified from our institutional database. Demographic, staging, treatment and complication data were collected. Subgroup analysis was performed using the Student's t test or Mann-Whitney U test for continuous variables and either Chi-squared test or Fisher's Exact test for categorical variables. 26 patients underwent SL between October 2003 and July 2010. Of these, 15 (58 %) developed a PCF. On analysis of the time between pre-operative RT and surgery, a significant difference was seen, with a mean time of 19.5 months in those who developed a PCF versus 47.0 months in those who did not ( p = 0.02). Patient characteristics, treatment, and pathology results were comparable between the two groups. There was no significant difference in distribution of the other covariates between the PCF and non-PCF groups. We reported a high rate of PCF and identified an association between PCF and a short time from primary treatment to salvage surgery. Identifying factors associated with higher rates of post-operative morbidity allows surgeons to adapt surgical planning in an attempt to minimize rates of PCF. [ABSTRACT FROM AUTHOR]

Background:The prevalence of occult neck metastasis in patients undergoing salvage total laryngectomy remains unclear, and there is controversy regarding whether elective neck dissection should routinely be performed.Method:A retrospective case note review of 32 consecutive patients undergoing salvage total laryngectomy in a tertiary centre was performed, in order to correlate pre-operative radiological staging with histopathological staging.Results:The median patient age was 61 years (range, 43–84 years). With regard to lymph node metastasis, 28 patients were pre-operatively clinically staged (following primary radiotherapy or chemoradiotherapy) as node-negative, 1 patient was staged as N1, two patients as N2c and one patient as N3. Fifty-two elective and seven therapeutic neck dissections were performed. Pathological analysis up-staged two patients from clinically node-negative (following primary radiotherapy or chemoradiotherapy) to pathologically node-positive (post-surgery). No clinically node-positive patients were down-staged. More than half of the patients suffered a post-operative fistula.Conclusion:Pre-operative neck staging had a negative predictive value of 96 per cent. Given the increased complications associated with neck dissection in the salvage setting, consideration should be given to conservative management of the neck in clinically node-negative patients (staged following primary radiotherapy or chemoradiotherapy). [ABSTRACT FROM PUBLISHER]

Introduction:Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator.Methods:This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis.Results:Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent.Conclusion:It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome. [ABSTRACT FROM AUTHOR]

An abstract of the article "Myostatin serum levels in heart failure," by E. Zamora and colleagues is presented.

PurposeIntravitreal somatostatin (SST) levels are decreased in patients with diabetic macular oedema. This deficit may be involved in the pathogenesis of this condition. The aim of the present study was to determine SST concentration in the vitreous fluid of patients with chronic uveitic macular oedema (CUMO) and quiescent intraocular inflammation.MethodsPlasma and vitreous fluid samples were obtained during vitrectomy from 11 eyes of patients with CUMO and from 42 eyes of control subjects (idiopathic epiretinal membrane, macular hole). SST concentration was measured by radioimmunoassay. Statistics: χ2-square test, Mann-Whitney U-test, Wilcoxon test, Spearman's rank correlation coefficient, and multivariant linear regression models.ResultsPlasma SST concentrations were similar in uveitic patients and controls (28.25 pg/ml (21.3-31) vs 28.7 pg/ml (22-29.5); P=0.869). A higher vitreous concentration of proteins was found in uveitic patients (1.59±0.38 mg/ml vs 0.73±0.32 mg/ml, P<0.0001). Vitreous SST was markedly lower in uveitic patients, both in absolute terms and after adjusting for total intravitreous protein concentration (39.37 pg/ml (6.16-172) vs 486.73 pg/ml (4.7-1833), P<0.0001; 33.1 pg/mg (3.9-215.74) vs 629.75 pg/mg (6.91-2024), P<0.0001). No correlations were found between plasma and vitreous concentration of SST in either group (ρ=0.191, P=0.57 and ρ=0.49, P=0.66). There were no correlations between vitreous SST concentration and visual acuity or macular thickness in uveitic patients (ρ=0.302, P=0.31 and ρ=0.45, P=0.13).ConclusionsIntravitreous SST is decreased in patients with CUMO and quiescent intraocular inflammation. The deficit of SST may have a role in the pathogenesis of this condition. [ABSTRACT FROM AUTHOR]

Background:Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.Objective:To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.Subjects and methods:Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.Results:Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.Conclusion:Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre. [ABSTRACT FROM PUBLISHER]

The article presents a clinical study which investigates the significance of understanding the natural history of untreated head and neck squamous cell carcinoma. It highlights the method performed for the study, which featured patients who were considered unsuitable for surgery, chemotherapy or radiotherapy. The study, which uses tracheostomy and gastronomy tube insertion as interventions, identified the rate of survival of patients with untreated head and neck cancer.

AIMS: The follow-up of patients with head and neck cancer is an essential aspect of their management. Follow-up provides support and reassurance for patients and will allow early detection of recurrence and second primary tumours. However, there is little evidence of a survival benefit from follow-up. With prolonged follow-up periods, multidisciplinary teams may be under increasing pressure to see more patients and this could have a negative effect on the time and quality of consultations given to individual patients. The aim of the present study was to analyse the current trends in the follow-up of head and neck cancer patients after treatment with curative intent in the UK. MATERIALS AND METHODS: A postal questionnaire was sent to all members of the British Association of Head and Neck Oncologists. RESULTS: Three hundred and twenty-seven questionnaires were sent and 214 were returned, making a response rate of 65.4%. One hundred and ninety-eight (61%) of these were deemed appropriate for evaluation and of these 111 (56%) clinicians followed up patients for a minimum of 5 years with 25 (13%) following patients for 10 years and 44 (22%) for life. Within the set of clinicians following patients for 5 years, 24 (12%) followed up patients with salivary gland and thyroid malignancies for a longer period of time. All clinicians concurred that the reasons for follow-up are to support patients, to detect local recurrences or metastases, second primary tumours and to monitor and manage the complications of treatment. CONCLUSIONS: Most of the clinicians followed up their patients up to a minimum of 5 years, with a significant minority who followed up the patients treated for cancers of the head and neck for longer periods. More studies are needed to elucidate the rationale and evidence for follow-up and to determine the adequate period of surveillance. [ABSTRACT FROM AUTHOR]

Aims: The follow-up of patients with head and neck cancer is an essential aspect of their management. Follow-up provides support and reassurance for patients and will allow early detection of recurrence and second primary tumours. However, there is little evidence of a survival benefit from follow-up. With prolonged follow-up periods, multidisciplinary teams may be under increasing pressure to see more patients and this could have a negative effect on the time and quality of consultations given to individual patients. The aim of the present study was to analyse the current trends in the follow-up of head and neck cancer patients after treatment with curative intent in the UK. Materials and methods: A postal questionnaire was sent to all members of the British Association of Head and Neck Oncologists. Results: Three hundred and twenty-seven questionnaires were sent and 214 were returned, making a response rate of 65.4%. One hundred and ninety-eight (61%) of these were deemed appropriate for evaluation and of these 111 (56%) clinicians followed up patients for a minimum of 5 years with 25 (13%) following patients for 10 years and 44 (22%) for life. Within the set of clinicians following patients for 5 years, 24 (12%) followed up patients with salivary gland and thyroid malignancies for a longer period of time. All clinicians concurred that the reasons for follow-up are to support patients, to detect local recurrences or metastases, second primary tumours and to monitor and manage the complications of treatment. Conclusions: Most of the clinicians followed up their patients up to a minimum of 5 years, with a significant minority who followed up the patients treated for cancers of the head and neck for longer periods. More studies are needed to elucidate the rationale and evidence for follow-up and to determine the adequate period of surveillance. [Copyright &y& Elsevier]

The article focuses on a study which examines the subclassification of cytologically indetermine thyroid nodules into either follicular neoplasms and other pathology. In this study, cytology reports of all thyroid fine-needle aspirations (FNAs) that were performed at a single institution and reported as Thy 3 or follicular lesions were assessed. It concluded that the assessment of risk for thyroid malignancy was improved by subclassification of Thy 3 nodules into Thy 3A and Thy 3B.