Mohamed S Taha

The added value of pretreatment DW MRI in characterization of salivary glands pathologies

OBJECTIVE To evaluate the added value of diffusion weighted magnetic resonance imaging (DW-MRI) in characterization of salivary gland lesions. STUDY DESIGN A prospective study was carried out between January 2013, and March 2015. METHODS The study included 46 patients. The consultant radiologist, who reviewed the scans to comment on the apparent diffusion coefficient (ADC) value and ADC histogram was blind to the suspected pathology. Radiological findings were then compared to clinical and histological findings. RESULTS The diagnostic performance of DW-MRI for identification of malignant lesions showed that the sensitivity, specificity, and positive and negative prediction value were 100%, 92%, 91.3%, and 100%, respectively. CONCLUSION The specific ability of DW-MRI to probe tissue microstructures is an interesting complement to the currently used imaging procedures in the characterization, and even grading of malignancies. ADC mapping is an easy, cost effective promising tool that has neither radiation exposure, nor amalgam artifacts and can be used in helping characterization of salivary glands lesions. LEVEL OF EVIDENCE 1B.

Value of hyperbaric oxygen therapy in the management of malignant otitis externa patients

Background Malignant external otitis is a rapidly spreading bacterial infection that is aggressive in nature and may be fatal if left untreated. Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the entire body is placed in an airtight chamber at increased atmospheric pressure and has been proven to be effective for a number of different medical conditions. Objective The aim of this study was to assess the usefulness of HBOT as an adjunctive treatment in patients with malignant otitis externa. Patients and methods Forty-three diabetic patients, who had malignant otitis externa, underwent control of diabetes mellitus and were treated with ciprofloxacin. HBOT was administered to 15 patients as an adjunctive treatment. All the patients were evaluated clinically (in terms of ear discharge, granulations, and pain severity) and radiologically by a temporal bone computed tomography scan. The minimum follow-up duration in both groups was 2 months. HBOT was administered in one session every other day for 2 months, resulting in a total of 30 sessions. Patient factors analyzed included age, sex, ear discharge, and pain severity. Results A total of 43 patients (28 men, 15 women) were divided into two groups: group A (28 patients) only received the antibiotic ciprofloxacin and group B (15 patients) was treated with ciprofloxacin and hyperbaric oxygen. The severity of pain improved considerably and the pain score decreased markedly from score 3 (severe) to score 0 (no pain) after 1 month in 46.7 and 93.3% of the patients by the end of the second month in comparison with patients treated only with the antibiotic: 0% after 1 month and 28.5% after 2 months. On clinical and microscopic examination, both ear discharge and granulations in the external canal had improved considerably. There was no ear discharge in 80% of patients in group B after one month treathent, 93.3% after 2 months, in comparison with 0% after 1 month, 28.5% after 2 months treatment in group A, highly statistically significant (P<0.001). Conclusion The addition of HBOT to medical treatment is highly effective and has facilitated considerable improvement in patients.

Pre-treatment apparent diffusion coefficient mapping: differentiation of benign from malignant laryngeal lesions.

OBJECTIVE To determine whether a threshold apparent diffusion coefficient value may help to differentiate laryngeal carcinomas from benign lesions. METHODS Fifty-three patients with laryngeal masses were recruited; four of them were excluded because of susceptibility artefacts. In the remaining 49 patients, the pathological results showed 32 laryngeal carcinomas and 17 benign lesions. The diagnostic value of diffusion-weighted magnetic resonance imaging for the identification of malignant lesions was determined. In addition, the agreement between diffusion-weighted magnetic resonance imaging and histopathology was assessed. Moreover, the sensitivity, specificity, and negative and positive predictive values of the apparent diffusion coefficient in detecting benign and malignant lesions were analysed. An apparent diffusion coefficient histogram was also produced. RESULTS An apparent diffusion coefficient value of 1.1 × 10-3 mm2/second produced the best result when used as the cut-off point to differentiate malignant from benign masses. CONCLUSION An apparent diffusion coefficient threshold of 1.1 × 10-3 mm2/second is optimal for distinguishing laryngeal carcinomas from benign lesions. Apparent diffusion coefficient values were lower for patients with laryngeal carcinomas than for those with benign lesions.

Allergic Rhinitis and its Impact on Asthma scores in asthmatic patients with and without allergic rhinitis

Background Allergic rhinitis and allergic asthma are chronic inflammatory conditions that frequently coexist, both with hallmark eosinophilia. Immunotherapy is an established treatment for allergic diseases. Noninjective routes for immunotherapy, such as the sublingual route, are thought to be valuable therapeutic options for respiratory allergy. Aim of the study In the present study, sublingual immunotherapy (SLIT) using multiple allergens was administered to allergic asthmatic patients with and without allergic rhinitis aiming to evaluate the clinical efficacy of and changes in allergen-specific antibodies during SLIT and its effect on control of asthma severity and nasal allergy scores. Patients and methods The study included 40 patients in two groups: group I included 20 asthmatic patients and group II included 20 patients with both proven bronchial asthma and allergic rhinitis. All patients were subjected to assessment of the status of asthma and hence its degree of control using the Global Initiative for Asthma (GINA) guidelines; patients received SLIT according to the results over a period of 1 year and were clinically reassessed monthly. In addition, for the recruited candidates, the initial total immunoglobulin E (IgE) levels were measured and pulmonary function tests were performed at the time of recruitment and repeated after 6 months and 1 year of the initiation of the course of SLIT. SLIT was stopped for asthmatic patients during acute exacerbation and resumed after complete asthma control. Results There was a statistically significant decrease in blood eosinophils but a statistically insignificant decrease in total IgE 1 year after SLIT in both groups. Results of specific IgE to food and inhalants revealed that there was statistically significant reduction in the number of allergens in both groups 1 year after SLIT. Results of the skin prick test revealed similar results. Our results revealed that the scores of, both Allergic Rhinitis and its Impact on Asthma and GINA had improved in all patients after 1 year of continuous therapy. Conclusion SLIT is a safe treatment strategy that significantly reduces symptoms and medication requirements and improves asthma control in both asthmatic patients with and without allergic rhinitis. SLIT using multiple allergens lowered the allergen burden in both asthmatic patients with and those without allergic rhinitis. Level of evidence 1b (Clinical Decision Rule tested within one clinical center).

Pulmonary function of patients with chronic rhinosinusitis and the impact of endoscopic sinus surgery

Background There is growing evidence that chronic rhinosinusitis (CRS) may be associated with lower airway manifestations. The difference in pulmonary function between normal individuals and patients with CRS and whether endoscopic sinus surgery (ESS) has a positive effect on the lower airway still remains controversial. The aim of this study was to compare pulmonary function tests (PFTs) in normal individuals and CRS patients and to investigate the outcomes of ESS on PFTs in patients with CRS. Patients and methods A prospective study was carried out on 25 normal adults (group I) and 25 adult CRS patients (group II). PFTs were used to compare the lower airway condition between the two groups. Another comparison in PFTs was made in patients with CRS to evaluate the effectiveness of ESS at 1 week preoperatively and 1 month, postoperatively. Results In group I, all participants had forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) of at least 80%, with a mean of 0.84±0.07, compared with the preoperative FEV1/FVC values of group II, which ranged from 61 to 70% in five (20%) patients, from 71 to 79% in 10 (40%) patients, and were equal to or higher than 80% in 10 (20%) patients. FEV1/FVC was significantly lower in group II patients than in group I participants (P=0.04). At 1 month postoperatively, the FEV1/FVC values of group II ranged from 61 to 70% in two (8%) patients, from 71 to 79% in 13 (52%) patients, and were equal to or higher than 80% in 12 (48%) patients; the mean FEV1/FVC was 0.9±0.50. These values were significantly higher (P=0.02) compared with the preoperative values. Conclusion This study provides corroborative objective evidence that patients with CRS may have nonmanifest lower airway infection compared with normal individuals and ESS is efficacious in the improvement of such infection.

Value of vitamin D assessment in patients with head and neck squamous cell cancer before treatment

Introduction The 5-year survival of patients with head and neck squamous cell carcinoma (HNSCC) has not changed dramatically over the last decades despite the use of various therapeutic modalities, including surgery and/or chemoradiation. Thus, new approaches remain necessary to prevent cancer, reduce recurrence, and improve treatment with reduction of its side effects. There is recent evidence that vitamin D promotes cell differentiation and decreases cell proliferation, invasion, angiogenesis, and metastasis. Thus, it has been hypothesized that vitamin D may protect against cancer at multiple sites. Objective The aim of this study was to evaluate serum level of vitamin D (VD), calcium, and phosphate in patients with HNSCC before treatment as a step in studying its impact on HNSCC development and progression. Type of the study This prospective study was conducted between March 2013 and October 2014 at Ain Shams University Hospitals, Cairo, Egypt. Patients and methods The study included 80 participants categorized into two groups. Group A included 50 (36 males and 14 females) patients with various HNSCC sites; their median age was 54.8 ± 12.7 years. Group B included 30 (20 males and 10 females) sex-matched and age-matched healthy volunteers as controls; their mean age was 50.5 ± 12.0 years. Results The median VD level in group A was 40.35 (31.9–55) and for group B it was 118.75 (55.0–175) (P < 0.001), indicating a significant decrease of VD in group A than in group B. VD deficiency (<37.5 nmol/ml) in group A was 42%, which was significantly more than that in group B, which was only 3%. Conclusion This study showed that vitamin D deficiency is prominent in patients with head and neck squamous cell carcinoma before treatment than in controls. Although it may expose the patients to increased risk of therapy-related morbidity and poor outcome, it may constitute an inexpensive prophylactic and cost-effective option in the therapeutic armamentarium as a synergistic agent to traditional treatment options.

Pectoralis major flap reconstruction in the prevention of wound breakdown and fistula formation after salvage laryngectomy: a controlled study

Background Patients undergoing salvage laryngeal surgery after high-dose radiotherapy or concurrent chemotherapy/radiation therapy regimen are more prone to develop pharyngocutaneous fistulas (PCFs). The fistula rates reported are as high as 70%. Aim of the study The aim of this study was to assess the effectiveness of pectoralis major muscle flap (PMF) in prevention of fistula formation and in enhancing wound healing in patients undergoing salvage laryngectomy. Patients and methods We compared results from patients of salvage laryngectomy repaired with pectoralis major flap with those of a similar group repaired by primary wound closure in 36 consecutive patients. Group A included 16 patients who underwent PMF following salvage total laryngectomy (12 male and four female patients; median age 56 years; interquartile range, 49.8-61.8). The other group included 20 patients who underwent primary closure of the wound without PMF (group B) (15 male and five female patients; median age 43 years; interquartile range, 36-54). Minimum follow-up in both groups was 3 months. Results The incidence of PCF in group A was 6.2% and that of wound gap was 6.2%, and there was no carotid blowout. The results in group B were as follows: 60% PCF rate and poor wound healing with gapping in 40% of patients and carotid blowout in 25% of patients (P < 0.001). The mean duration to fistula closure was 20 days in group A compared with 57.5 days in group B. Conclusion Pectoralis major flap will give the patients the advantages of less fistula formation, good wound healing, early oral feeding, short hospital stay and protection against catastrophic vascular blowouts.

Impact of preoperatative tracheostomy on tracheostome recurrence and overall survival in patients undergoing laryngectomy

Background The development of tracheostomerecurrence after total laryngectomy is a complication with a dismal prognosis .The average survival rate of tracheostome recurrence (TR) is 7.5%, ranging from 1.7% to 40%The TR consists of diffuse infiltration of tumor into the soft tissues of the neck and mediastinum; hence the control of this disease is difficult. Objective To analyze the impact of preoperative tracheostomy ontracheostome recurrence (TR), regional recurrence (RR), and overall survival (OS) in patients undergoing primary laryngectomy. Material and methods Thirty three consecutive patients, who underwent primary total laryngectomy for locally advancedlaryngeal squamous cell carcinoma, were enrolled in this study. Patients whounderwent primary chemo-radiotherapy, partial laryngectomyor those treated palliatively wereexcluded from the study.Patient factors analyzed included age,gender, primarytumor site, TNM classification, type of procedure, thyroid gland management, extent of neck dissection and preoperative tracheostomy (POT). The timeinterval between tracheostomy and definitive surgery was calculated. Results A total of 33 patients underwent total laryngectomy(TL) for squamous cell carcinoma of the larynx.Thirty patients (90.9%) were males, while 3 (9.1%) patients were females. Their mean age was 57.7 (±11.6) years, 26 (78.8%) of them were smokers, their follow up mean time was 23 (±6.6) months. Tracheostomy recurrence occurred in 3 (9.1%) patients and regional recurrence in another 3(9.1%) patients. The 2 years survivalfor the whole patients was 84.8% and overall survival was 81.1%. Nineteen patients had POTbetween 10 to 21days (median 15)prior to TL surgery. Fourteen patients had their tracheostomy at the time of surgery .There was no statistical significant difference between both groups as regard overall survival, stomal recurrence and regional recurrence. Conclusion Our results are in keeping with more recent studies, which suggest that POT is notnecessarily related to stomal recurrence or poor oncological outcome.

Folic acid and vitamin-B 12 in idiopathic sensorineural hearing loss in children

Aim The aim of the study was to evaluate the role of vitamin-B 12 and folate blood concentrations in children suffering from moderate, severe, and severe-to-profound sensorineural hearing loss (SNHL). Materials and methods This study was conducted on 95 children: 30 children with severe-to-profound SNHL who were scheduled for cochlear implantation, 25 children who are hearing aid users for moderate and severe SNHL, and another 40 healthy volunteers considered as the control group. Full audiological examination was performed to all children, as well as computed tomographic scan and MRI to temporal bone were performed for the SNHL groups. Results Median vitamin-B 12 and folic acid levels were significantly higher in the control group 3 than in the SNHL groups 1 and 2 patients (P Conclusion Study demonstrated that the serum levels of folate and vitamin-B 12 are decreased in patients with SNHL. Measurement of folic acid and vitamin-B 12 in patients suffering SNHL might be useful. These data may give us some clues about how hearing loss is developed in these patients.