Search

BACKGROUND American Thyroid Association (ATA) low-intermediate-risk papillary thyroid cancer (PTC) patients without structural and biochemical evidence of disease on initial post-treatment evaluation have a low risk of recurrence. Studies have shown that with current ultrasound scans (US) and thyroglobulin assays, recurrences mostly occurred 2-8 years after initial therapy. The ATA recommends that neck US be done 6-12 months after surgery to establish patient's response to therapy, then periodically depending on risk of recurrence. The lack of clarity in recommendations on timing of follow-up US and fear of recurrence leads to frequent tests. OBJECTIVES To evaluate the utility of routine neck US in ATA low-intermediate-risk PTC patients with no structural disease on neck US and non-stimulated thyroglobulin

Aim: Phoenix canariensis hort. ex Chabaud is one of the most important palm plants. In spite of that, it has not been extensively investigated from a phytochemical or a biological perspective. Materials & methods: Air-dried powdered leaves and pollen grains of the plant were extracted using 70% ethanol. The residues were fractionated with different solvents of increasing polarity. Antioxidant, anti-inflammatory, hepatoprotective, anti-hyperglycemic activities were determined using adult male albino rats of wistar strain. Results: Phytochemical investigation of Phoenix canariensis (Arecaceae) leaves and pollens led to the isolation of five compounds; isorhamnetin-3-O-β-glucoside and isorhamnetin 7-O-rutinoside from the leaves in addition to isorhamnetin-3-O-rutinoside and rutin together with β sitosterol-3-O-β-D-glucoside from pollens. The 70% ethanolic extracts of both organs were found to possess the highest antioxidant activity followed by their ethyl acetate fractions. Seventy percent ethanolic leaf extract and its ethyl acetate fraction showed the most potent hepatoprotective, anti-inflammatory and anti-hyperglycemic activities as compared with reference drugs. Isorhamnetin-7-O-rutinoside and β-sitosterol-3-O-β-D-glucoside were isolated from the genus and from Phoenix canariensis for the first time. Conclusion: This study reveals that Phoenix canariensis is an efficient natural source of safe antioxidants, anti-hyperglycemic, anti-inflammatory and hepatoprotective agents.

The nutritional value of pollens of Phoenix canariensis Chabaud, Arecaceae, was evaluated. HPLC analysis of vitamins revealed the predominant presence of vitamin C (109.13 ppm), followed by vitamin A (53.71 ppm) and vitamin E (40.60 ppm) and the total carbohydrates (28.12%), proteins (17.10%). In addition, 16 amino acids of which nine are essential (75.07%), and seven are non-essential (24.93%) were determined. On the other hand, two steroidal saponins (dioscin and methyl protodioscin) were isolated from the pollens, their structures were elucidated by spectroscopic techniques, including 1H NMR and 13C NMR. Their content in the 70% ethanolic extract was quantified using reversed phase HPLC and found to be 0.013% and 19.35%, respectively. The modulatory effect of the isolated compounds on the prevention of benign prostatic hyperplasia induced in rats and their moderate curative effect on stressed testicular tissue were studied. Being a good source of carbohydrates, proteins, vitamins, and amino acids pollens of P. canariensis can be used as a promising source of dietary supplement. Meanwhile pollens can act as prophylactic agent against benign prostatic hyperplasia. Keywords: Benign prostatic hyperplasia, Saponins, Nutritional value, Vitamins, Carbohydrates, Amino acids, HPLC

Phoenix canariensis is a commonly grown, yet understudied, palm plant. The phytochemical screening of leaves and pollens revealed the presence of flavonoids, saponins, tannins, sterols and/or triterpenes. Quantitative estimation of constituents, revealed that the total polyphenolics were higher in the leaves (69.9) than in pollens (29.98) expressed in mg gallic acid equivalent/g d.wt, the total flavonoids calculated as rutin equivalent were (23.86 mg/g) in leaves and (17.20 mg/g) in pollens, the total tannins content was 55.18 and 3.31 mg tannic acid equivalent/g fresh wt, while the total steroids content were 2.6 and 12.4 mg β-sitosterol equivalent/g d.wt, in leaves and pollens, respectively. Eighteen phenolic compounds and ten flavonoids were identified by HPLC. GLC analysis of lipids, revealed identification of phytosterols (4.93 and 28.90%), saturated (35.35 and 40.56%) and unsaturated (62.42 and 59.01%) fatty acids in leaves and pollens, respectively. Proximate analysis revealed a total moisture content of (6.4 and 7.7 %), crude fiber (32.22 and 39.50%), total ash (12.1 and 8.1%) and acid insoluble ash (4.7 and 7.6 %) for leaves and pollens, respectively. Moreover, spathe headspace volatile analysis combined with GC-MS revealed the presence of fifty-two compounds constituting 72.84% of the total oil composition where α- copaene predominates (18.72%).

Objective: To report an extremely rare case of neuroendocrine tumour with simultaneous involvement of both the facial nerve and the deep lobe of parotid gland. Method: case report and English language literature review concerning neuroendocrine neoplasm involving the facial nerve with emphasis on clinical presentation. Results: We report a unique case of adenoma with neuroendocrine differentiation which involved both the mastoid segment of the right facial nerve and also the deep lobe of the parotid gland on the ipsilateral side. Both tumours were not contiguous and were anatomically separate from each other. A CT scan of the whole body revealed no other neuroendocrine tumours. Conclusion: To the best of our knowledge, this is the first report in the English language literature of a neuroendocrine tumour to involve both the vertical mastoid segment of the facial nerve with simultaneous involvement of the deep lobe of parotid gland as a separate lesion.

This study aimed to assess outcomes of revision endoscopic stapling and external excision of pharyngeal pouch. A 5-year prospective study was performed on all patients requiring revision pouch surgery following primary endoscopic stapling. Data were collected retrospectively. Eighteen patients underwent revision pouch surgery. In seven patients, pouch size was down-graded from 3 to 2, and these were stapled endoscopically. Two leaks resulted. Eleven patients with grade 1 or 3 pouches underwent external excision of pouch, with no post-operative complications. As per results external excision of pouch is safe for grade 1 and 3 pouches. It avoids risking redundant mucosa and recurrence of symptoms which can complicate stapling and enables a myotomy to be performed to reduce cricopharyngeal hypertonicity. The highest predictable success is with grade 2 pouches, whose size is amenable to adequate endoscopic stapling. However, the "staple over staple" effect of revision stapling leads to unpredictable fibrosis, which can contribute to risk of perforation.

Introduction:The Hayes-Martin manoeuvre involves ligation of the posterior facial vein and superior reflection of the investing fascia below the mandible to preserve the marginal mandibular nerve. The peri-facial nodes thus remain undissected. We perform this manoeuvre routinely during modified radical neck dissection for metastatic oropharyngeal squamous cell cancer. Here, we review the oncological safety and marginal mandibular nerve preservation rates of this manoeuvre from 2004 to 2009.Method:Retrospective review of the head and neck oncology database (2004–2009) at Addenbrooke's Hospital, Cambridge, UK, a tertiary referral centre for head and neck oncology.Results:Thirty-four patients underwent modified radical neck dissection for metastatic oropharyngeal squamous cell carcinoma. The primary tumour included the tonsil in 19 cases, base of tongue in 10 and posterior pharyngeal wall in 5. The neck nodal status was N1 in 4 cases, N2a in 11, N2b in 10, N2c in 4 and N3 in 5. All patients had adjuvant radiotherapy. Median follow up was four years (range, two to five). No peri-facial nodal region recurrences were seen. Four patients had temporary marginal mandibular nerve weakness; beyond two months, no weakness was seen.Conclusion:In neck dissections for oropharyngeal squamous cell carcinoma, the marginal mandibular nerve and accompanying facial nodes can be safely preserved without oncological risk using the Hayes-Martin manoeuvre.

The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland.A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors.A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to follow-up. No recurrences have been noted in the cohort at follow-up.

Our objective is to evaluate the pickup rate of a significant pathology, on barium swallow, in patients who present to our clinic with a feeling of a lump in the throat (globus symptoms). Hospital--secondary referral centre. This is a retrospective study of 192 patients who had barium swallow in our department between August 2009 and August 2010. We revised 500 case notes to rule in 192 who presented with only a feeling of a lump in their throat. All patients with positive clinical findings, such as dysphagia, odynophagia, referred otalgia, hoarseness of voice, weight loss, neck swelling or vocal cord palsy, were ruled out. Eight patients were diagnosed on barium swallow as having significant pathology: five with diverticulae and three patients with oesophageal web. The percentage of significant pathology in our study is 4.17% (eight patients). Out of those eight cases, there was no malignant pathology identified on further panendoscopy. Our conclusion is that barium swallow adds very little to the diagnosis of Globus Pharyngeus, but it plays a role in the reassurance particularly from the patients' perspective.

This is a retrospective study of 100 consecutive patients who attended our ENT outpatient clinic in 6 month-period from April to September 2006. All of them presented with Asymmetrical SNHL. They were all investigated with MRI scan of the IAM and CPA. We did not employ any guidelines or protocols as to when to request MRI in patients with Asymmetrical SNHL. The mean age for the studied group was 52.97. Gender distribution in the studied group was 53% for males and 47% for females. The pickup rate was 1% for CPA lesion which was vestibular schwannoma. However, incidentally, there were 15% of cases with vascular loop at the CPA.

Dukhan, a giant mature onshore field in Qatar, presents a unique challenge to manage multidimensional data within surveillance workflows. A unified data infrastructure is the key enabler for proper field performance monitoring, bridging operational locations to decision-making centers. In this respect, Qatar Petroleum (QP) is integrating reservoir and data management workflows into a single hub that shifts linear workflows into real-time decision-making and action-oriented processes. The strategic advantage of this approach is to provide technology and data real-time, readily available for the key decision-makers. As a strategic initiative, implementation has presented unique challenges in infrastructure modification and technology uptake. The envisaged solution architecture lies on capabilities of QP's workflows in delivering web components, leveraging multifunctional collaboration, and closing operational gaps within the surveillance workflows. The solution is delivered through a unified platform where periodic/sporadic production information is tied to asset operational models across different sub-systems integrating all surveillance workflows. The benefits include a fully collaborative environment, a solid data management system to enable timely decisions, and improved shortfall management. Integrating people and processes with the right balance of technology results in enhanced operational efficiencies and recoveries. Despite challenges, QP has gained significant advantages in early adoption and development of this technology, and its implementation has revolutionized the approach to surveillance. In view of the above, the combination of the above aspects resulted in significant increase in compliances, minimized mitigation turnaround time and generated better collaboration within operating units. This paper describes experiences and challenges of QP project from conception through implementation integrating people and process with the right balance of technology across field operations and how it has resulted in enhanced operational efficiency and production recovery with full asset awareness.

This paper presents a new algorithm for the calculation of stream surfaces for tetrahedral grids. It propagates the surface through the tetrahedra, one at a time, calculating the intersections with the tetrahedral faces. The method allows us to incorporate topological information from the cells, e.g., critical points. The calculations are based on barycentric coordinates, since this simplifies theory and algorithm. The stream surfaces are ruled surfaces inside each cell, and their construction is started with line segments on the faces. Our method supports the analysis of velocity fields resulting from computational fluid dynamics (CFD) simulations.