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Major haemorrhage is a rare complication after chemoradiotherapy for oropharyngeal squamous cell carcinoma. This is managed by interventional neuroradiology with endovascular embolisation of the bleeding vessel. This study aimed to describe radiological and clinical predictors of haemorrhage.
Methods
A retrospective case series was conducted of all patients with oropharyngeal squamous cell carcinomas who suffered a major haemorrhage requiring embolisation during or after treatment with chemoradiotherapy or radiotherapy alone, between 2013 and 2021, in Western Australia.
Results
This study included 14 patients, in two groups: haemorrhage group (n = 70) and tumour stage matched non-haemorrhage group (n = 7). Patients who haemorrhaged had a larger average transverse axial tumour size on pre-treatment computed tomography (38 mm vs 22 mm; p = 0.02) and tumours tended to involve the proximal aspect of the offending bleeding vessel. All patients who haemorrhaged developed deep cavitating or ulcerative tumour bed changes on post-treatment imaging (p < 0.0001).
Conclusion
Tumour bed ulceration or cavitation appears to be highly predictive of haemorrhage in this patient cohort.
A 43-year-old woman presented with a 3-week history of globus sensation and malaise. A computed tomography scan of her neck showed a large right paratracheal abscess secondary to an infected tracheal diverticulum. The patient was admitted under the ENT surgical team, and underwent incision and drainage of the abscess. There were no post-operative complications and she was discharged home after 2 days, on oral antibiotics.
Conclusion
This case demonstrates that a tracheal diverticulum may become infected and present as a cervical abscess. To our knowledge, this is the fourth reported case in the international literature of abscess formation related to an infected tracheal diverticulum.
To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure.
Methods
A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia.
Results
Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30).
Conclusion
Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.
This study aimed to assess olfactory dysfunction in patients at six months after confirmed coronavirus disease 2019 infection.
Methods
Coronavirus disease 2019 positive patients were assessed six months following diagnosis. Patient data were recoded as part of the adapted International Severe Acute Respiratory and Emerging Infection Consortium Protocol. Olfactory dysfunction was assessed using the University of Pennsylvania Smell Identification Test.
Results
Fifty-six patients were included. At six months after coronavirus disease 2019 diagnosis, 64.3 per cent of patients (n = 36) were normosmic, 28.6 per cent (n = 16) had mild to moderate microsmia and 7 per cent (n = 4) had severe microsmia or anosmia. There was a statistically significant association between older age and olfactory dysfunction. Hospital or intensive care unit admission did not lead to worse olfactory outcomes compared to those managed in the out-patient setting.
Conclusion
At six months after coronavirus disease 2019 diagnosis, approximately two-thirds of patients will be normosmic. This study is the first to describe six-month outcomes for post-coronavirus disease 2019 patients in terms of olfactory dysfunction.
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