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Objective: Assessing the main allergens in the pediatric population from the largest urban area in the country. Methods: Clinical letters of patients referred with possible allergic rhinitis (AR) were retrospectively reviewed over the past 5 years. Results: Five hundred and fifty-five patients were included. Males suffer twice as often with AR than females and have high titers of allergens. House dust mites (44.7%) and grass pollen (29%) were the main allergens in our area, with 48% of patients sensitized to both allergens. Half of the patients had the diagnosis of AR confirmed with positive allergen-specific tests. For the other half, the diagnosis was based on a clinical assessment performed by a pediatric otolaryngologist. Conclusions: Half of suspected AR children have environmental allergen sensitivity confirmed by testing, and a large number had a clinical diagnosis of AR after an otolaryngology consultation. Our findings can help clinicians to initiate AR treatment considering the most problematic allergens in the area.
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Cystic hygroma (CH) is a benign congenital lymphatic malformation, occurring predominantly in children, typically as an asymptomatic neck mass. Surgical resection or sclerotherapy is the recommended treatment options. A retrospective review of four cases of adult-onset CH was performed over 2 years by a single surgeon across two institutions. Four patients (two females, median age 31.5 years) who presented with supraclavicular neck masses (range 5-17 cm) are discussed. Ultrasound and MRI demonstrated supraclavicular masses, suggestive of CH. All patients underwent surgical resection. Post-operative courses were uncomplicated, with a mean length of stay of 4 days. All histological samples returned as CH. As of yet, there are no guidelines on the management of CH. Individualised care tailored to each patient, following careful discussion is the most prudent approach. This study demonstrates that surgical resection is a safe and effective treatment for adults in this rarely encountered clinical entity.
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Neoplasias de Cabeza y Cuello , Linfangioma Quístico , Niño , Femenino , Humanos , Adulto , Linfangioma Quístico/diagnóstico por imagen , Linfangioma Quístico/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/cirugía , Cuello/diagnóstico por imagen , Cuello/cirugía , Resultado del Tratamiento , UltrasonografíaRESUMEN
OBJECTIVE: Our objective was to review skin prick allergy testing (SPAT) results in patients with symptomatic rhinitis in an Irish population. METHODS: A fifteen-year retrospective review of our database of symptomatic patients with rhinitis was performed. All patients who had SPAT performed during this interval were included. Data was analysed in terms of demographics and dominant allergens. RESULTS: 1158 patients were included. 617 Females vs 541 Males. Age range five to eighty-five years old. Mean age thirty-four years. 49% of our patients tested positive to at least one aeroallergen. The most common allergens were dust mites (23%) and timothy grass (22%). Patients born during the Irish pollen season (April-July) were between 5 and 7 times more likely to be sensitive to timothy and ryegrass pollens compared to others tested. 241 patients had both SPAT and serum allergen specific IgE testing (SASIgET) performed; positive results were consistent between both groups. CONCLUSION: Results demonstrated that half of our patients with symptomatic rhinitis had allergen sensitisation. Dust mites and grass were the main allergens in our area. Our nurse led clinic has allowed efficient patient education and the development of a unique Irish SPAT database. Retesting a patient with a known allergy test result it is not indicated.
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OBJECTIVE: Oral cavity squamous cell carcinoma (SCC) may present with early invasion of mandibular bone. Preoperative planning of surgery is essential considering patient's postoperative quality of life. Our purpose was to evaluate the efficacy of computer tomography scan (CT) and magnetic resonance imaging (MRI) in detecting mandibular bone involvement in oral SCC. METHODS: A retrospective study was conducted on 98 patients with SCC of floor of mouth, lower alveolus and retromolar trigone operated on with curative intent. Preoperative CT and MRI scans were re-reviewed by a consultant radiologist and original histology slides were re-reviewed by 3 pathologists. RESULTS: Forty-five patients were included in the final study. Combined CT and MRI had a sensitivity of 100% and a specificity of 72%. CONCLUSION: The results suggest that combined CT and MRI have diagnostic utility in detecting mandibular invasion by oral cancer, but with a significant false positive rate.
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Follicular variant papillary thyroid carcinoma (FVPTC) may pose a diagnostic challenge due to higher likelihood of lower risk cytology compared to conventional papillary thyroid carcinoma (CPTC). Recent guidelines have recommended the use of sonographic features to guide decisions to biopsy thyroid nodules. The purpose of this study was to evaluate the sonographic features of CPTC and FVPTC. This is a retrospective study design done in an Academic teaching hospital setting. Preoperative ultrasounds of 79 patients with conventional CPTC (48) and FVPTC (31) were reviewed by a radiologist blinded to histological diagnosis. Sonographic features of nodules were classified according to the British Thyroid Association (BTA) U-classification system as normal (U1), benign (U2), indeterminate (U3), suspicious (U4), and malignant (U5). Pathology slides of patients with FVPTC were reviewed by two pathologists and subclassified into encapsulated, well circumscribed/partly encapsulated, and infiltrative subtypes. FVPTC had a significantly lower incidence of any calcifications (p = 0.0005), microcalcifications (p = 0.002), and irregular or lobulated margins (p = 0.03) than CPTC. Differences in hypoechogenicity (p = 0.06), taller > wide shape (p = 0.17) and presence of halo (p = 0.07) were not significant. FVPTC was significantly less likely to be classified sonographically as malignant (U5) (p = 0.006) or suspicious/malignant (U4/5) (p = 0.009) than conventional PTC. Among FVPTC cases, infiltrative FVPTC were more likely to be sonographically classified as suspicious/malignant (U4/5) than non-infiltrative FVPTC. FVPTC nodules are less likely to show sonographic features of malignancy than conventional PTC. Reliance solely on sonographic features for thyroid nodule evaluation may not be sufficient to exclude FVPTC.
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Adenocarcinoma Folicular , Carcinoma Papilar , Cuidados Preoperatorios , Neoplasias de la Tiroides , Ultrasonografía/métodos , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/patología , Adulto , Anciano , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/estadística & datos numéricos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Cáncer Papilar Tiroideo , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tiroidectomía/estadística & datos numéricosRESUMEN
OBJECTIVES/HYPOTHESIS: Previous studies have reported variable results for the impact of bone invasion on survival in oral cancer. It is unclear whether bone invasion in small (≤4 cm) squamous cell carcinomas (SCC) of the oral cavity is an independent adverse prognosticator. Our objective was to investigate impact on survival of bone invasion in SCC of floor of mouth (FOM), lower alveolus (LA), and retromolar trigone (RMT) ≤4 cm in size. STUDY DESIGN: Retrospective study of 96 patients with SCC of the FOM, LA, and RMT undergoing primary surgical treatment. METHODS: Original pathology reports and slides were reviewed by three pathologists. Level of bone invasion was categorized as cortical or medullary. Main outcome measures were local control (LC) and overall survival (OS). RESULTS: Bone invasion was present in 31 cases (32%). On review of pathology slides, all cases of bone invasion demonstrated medullary involvement. Median follow-up was 36 months for all patients, and 53 months for patients not dying from cancer. Among tumors ≤4 cm, bone invasion was associated with significantly worse LC (P =.04) and OS (P =.0005). Medullary invasion (hazard ratio: 2.2, 95% confidence interval: 1.1-4.4, P =.03), postoperative radiotherapy (hazard ratio: 0.3, 95% confidence interval: 0.1-0.5, P <.001), and positive pathologic nodal status (hazard ratio: 4.1, 95% confidence interval: 1.9-8.6, P <.001) were independent predictors of worse OS among the entire cohort. CONCLUSIONS: Mandibular medullary bone invasion is a poor prognosticator in oral cancers, irrespective of small size of primary tumor. Such cases should be considered for postoperative radiotherapy. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:849-854, 2017.