A comparative study of parapharyngeal space tumors over a 7 year period experience in tertiary care hospital

Background: Tumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. Our series of 10 PPS tumors provides an overview of the clinical course and management of PPS tumors.Methods: This retrospective study included clinical data from patients treated for PPS tumors from 2011 to 2018 at the Stanley medical college hospital, Chennai. Results: After careful analysis of the outcome of the study, we have found out that there was no local recurrence in any patient during the follow-up period. Though few approaches are advised in the literature, In our study transoral approach may be advocated as the first choice for excision of parapharyngeal space tumors, except for malignant tumors and neurogenic tumor. Trans cervical approach is used for malignant and neurogenic tumors, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck.Conclusions: In our study, middle aged male population was most commonly affected. Pleomorphic adenoma is the most common PPS tumor; prestyloid compartment is mostly affected by these tumors. As per the previous studies, trans cervical approach is first choice for excision of parapharyngeal space tumors. In our study, trans oral approach is also a suitable, safe approach for pre styloid non vascular lesions and trancervical approach can be reserved for postsyloid and malignant lesions.

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Intralesional Sclerotherapy with Polidocanol in the Management of Head and Neck Vascular Lesions

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2016.v24i3.131 ◽

2016 ◽

Vol 24 (3) ◽

pp. 136-140

Author(s):

Arindam Das ◽

Anindita Sengupta ◽

Debashis Ghosh ◽

Deepjoy Bose ◽

Subhadip Dhara ◽

...

Keyword(s):

Head And Neck ◽

Local Anesthetic ◽

Tertiary Care ◽

Neck Region ◽

Cost Effective ◽

Surgical Excision ◽

Vascular Lesions ◽

Care Hospital ◽

Therapeutic Modalities ◽

First Choice

Introduction Vascular lesions (Hemangioma or vascular malformation) in the head and neck region are quite common and need therapeutic intervention if they become symptomatic or cosmetically unacceptable. Different therapeutic modalities including cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgery and/or embolization are available. Advances in laser surgery as well as sclerotherapy techniques have improved our ability to treat extensive lesions. Surgical excision sometimes becomes very difficult due to massive per-operative bleeding and proximity to major neurovascular structures. In this study we have tried to find a simpler, easily available, safe and cost-effective therapy to treat these vascular lesions. Materials and Method A pilot case study was conducted in a tertiary care hospital in Kolkata for a period of one year. Polidocanol was selected as the sclerosing agent for treatment of head and neck vascular lesions for its safety and its local anesthetic effect. 3% Polidocanol was injected in 20 lesions. Result 20 patients with head and neck vascular lesions treated with polidocanol sclerotherapy were followed up for 12 months. The study included 20 patients (12 female and 8 male) with mean age 20.3 years (range 6-62 years). Of these 20 patients 14 had 90% to 100% result and in 6 patients we obtained only mild improvement. Discussion Sclerotherapy is now becoming the first choice of treatment in head and neck vascular lesions. Polidocanol is a mixture of 5% ethyl alcohol and 95% hydroxypolyethoxydodecane, the detergent action of which induces a rapid overhydration of endothelial cells, leading to vascular injury and regression of vascular lesions. As the same time it is a local anesthetic, so treatment is painless. Conclusion It is a less invasive, cost effective, painless OPD based management for head and neck vascular lesions having good functional and aesthetic outcome.

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Parapharyngeal space tumors: considerations in 26 cases

Sao Paulo Medical Journal ◽

10.1590/s1516-31801999000100006 ◽

1999 ◽

Vol 117 (1) ◽

pp. 34-37 ◽

Cited By ~ 8

Author(s):

Alfio José Tincani ◽

Antonio Santos Martins ◽

Albina Altemani ◽

Rui Carlos Scanavini Jr. ◽

Gilson Barreto ◽

...

Keyword(s):

Parapharyngeal Space ◽

Malignant Tumors ◽

Soft Tissue Sarcomas ◽

Needle Aspiration ◽

High Rate ◽

Benign Tumors ◽

Malignant Neoplasms ◽

Surgical Morbidity ◽

Neurogenic Tumors ◽

Parapharyngeal Space Tumors

CONTEXT: Parapharyngeal space tumors comprise less than 0.5% of all head and neck neoplasms.1 The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital – UNICAMP. CASES SERIE: Of these, 17 (65.5%) had benign and 9 (34.6%) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3%) and malignant neoplasms (44.5%). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate of recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.

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Primary Parapharyngeal Space Tumors in a Mexican Cancer Center

Otolaryngology ◽

10.1016/j.otohns.2005.01.013 ◽

2005 ◽

Vol 132 (4) ◽

pp. 587-591 ◽

Cited By ~ 39

Author(s):

Kuauhyama Luna-Ortiz ◽

Jaime Esteban Navarrete-Alemán ◽

Martín Granados-García ◽

Angel Herrera-Gómez

Keyword(s):

Parapharyngeal Space ◽

Tumor Resection ◽

Surgical Approaches ◽

Cancer Center ◽

Peripheral Nerve Sheath Tumors ◽

Parapharyngeal Space Tumors ◽

Adjacent Structures ◽

First Choice ◽

Cervical Approach ◽

Mandibular Swing

OBJECTIVE: To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. METHODS: A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). RESULTS: Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. CONCLUSION: Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.

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Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i12.39635 ◽

2021 ◽

Vol 12 (12) ◽

pp. 133-139

Author(s):

Ashumi Gupta ◽

Neelam Jain

Keyword(s):

Sensitivity And Specificity ◽

Malignant Tumors ◽

Frozen Section ◽

Tertiary Care ◽

False Negative ◽

Significant Proportion ◽

False Negative Rate ◽

Accurate Diagnosis ◽

Care Hospital ◽

Ovarian Masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

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Efficacy of Bortezomib plus dexamethasone as a first line treatment in newly diagnosed cases of Multiple Myeloma: A Single Centre Study in a Tertiary Care Hospital

Journal of Dhaka Medical College ◽

10.3329/jdmc.v28i1.45754 ◽

2020 ◽

Vol 28 (1) ◽

pp. 34-41

Author(s):

Mahbuba Sharmin ◽

Mohammad Manirul Islam ◽

Abdul Aziz ◽

Salauddin Shah ◽

Md Jalilur Rahman ◽

...

Keyword(s):

Multiple Myeloma ◽

Partial Response ◽

Intracranial Haemorrhage ◽

Response Rate ◽

Malignant Tumors ◽

Tertiary Care ◽

Care Hospital ◽

Newly Diagnosed ◽

Overall Response ◽

Highly Effective

Background: Multiple Myeloma (MM) accounts for 1% of malignant tumors and 10%–15% of hematopoietic neoplasms. Bortezomib, a first in class proteasome inhibitor, induces apoptosis and growth arrest and reverse chemoresistence in Myeloma cell and has demonstrated no irreversible adverse effect on haemopoietic stem cell. Dexamethasone increases the response rate. Thus, Bortezomib plus dexamethasone represent highly effective regimen for previously untreated Multiple Myeloma cases and significantly higher response rates approximately 70%– 90% have been observed.This combination thus may serve the basis of future strands of care in Multiple Myeloma patients. Objective: The aim of the study was to assess the efficacy , safety and tolerability of Bortezomib in newly diagnosed cases of Multiple Myeloma patients in Bangladesh. Materials & Methods: This prospective observational study was carried out in the Haematology department of BSMMU from June 2017 to December 2018. Patients received inj. Bortezomib (1.3mg/m2 ) 4 cycles as an intravenous bolus on days 1,4,8,11 in a three week cycle (twice weekly administration) in indoor and same patients as day care basis in outpatients department. Dexamethasone at 40 mg was given intravenously or orally on the day of and day after inj Bortezomib.A self administered questionnaire containing different set of questions regarding Multiple Myeloma were used for data collection. Results: Among the study population, 93% of patients had anaemia followed by bone pain (86%) and renal impairment (39%). Out of 25 patients,complete response achieved in 13 patients (52%), where 4 patients(16%) showed partial response,6 (24%) showed very good partial response and 2 (8%) patients showed no response. The overall response rate was 92% belonged to partial,very goofd partial and no respone respectively. Death occurred in 3 cases (12%). 5 patients (20%) developed Bortezomib induced peripheral neuropathy.Life threatening intracranial haemorrhage occurred in two patients (8%). Death occurred in 3 cases (12%),2 patients due to intracranial haemorrhage and another from cardiac arrest. In this study,S. creatinine, â2 microglobulin and bony lesion variables showed significant association with treatment response. Conclusion: Bortezomib plus dexamethasone is a highly effective and safe regimen for previously untreated multiple myeloma patients. This novel therapy in myeloma represent a new trearment paradigm targeting both tumor and microenvironment which has markedly improve overall response(OR), long progression free survival (PFS) and overall survival (OS)across in all risk groups. Moreover,it can be administered safely in the outpatient setting provided by clinicians. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 34-41

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Adjuvant Hormonal Therapy in Postmenopausal Women with Breast Cancer: Physician’s Choices

International Journal of Breast Cancer ◽

10.1155/2012/849592 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Asim Jamal Shaikh ◽

Shiyam Kumar ◽

Sajjad Raza ◽

Maria Mehboob ◽

Osama Ishtiaq

Keyword(s):

Breast Cancer ◽

Postmenopausal Women ◽

Hormonal Therapy ◽

Tertiary Care ◽

Standard Of Care ◽

Care Hospital ◽

Adjuvant Hormonal Therapy ◽

Choice Data ◽

First Choice ◽

Clinical Survey

The choice of adjuvant hormonal therapy in postmenopausal women with hormone receptor positive breast cancer has remained a matter of controversy and debate. The variety of agents is available, with each claiming to be superior. This clinical survey was undertaken to get an impression of the physician’s first choice of therapy in an attempt to find out what questions still need to be answered in the making of “standard of care.” A web-based clinical survey was sent to the cancer physicians around the world, and 182 physicians responded to the survey. Most were medical oncologists in a tertiary care hospital. 36.3% preferred Anastrozole, 35.2% Tamoxifen, and 22.2% Letrozole as their first choice. Data support (67.8%) and safety concerns (30%) were given as the main reasons for the choice, 63.7% switched their therapy, and 24% had to switch because of side effects. 73.6% used 5 years of adjuvant hormonal therapy, 6.6% for 7 years, and 4.4% for 10 years. 61.5% follow their patients 3 times monthly, and 73.2% used laboratory and radiological assessment at each followup.Conclusion. Physicians show disagreement over the choice and duration of hormonal therapy in this patient population. Clinical trials leading to firm recommendations to set standards from which patients benefit the most are needed.

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Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center

Acta Oto-Laryngologica ◽

10.3109/00016489.2015.1104724 ◽

2015 ◽

Vol 136 (3) ◽

pp. 298-303 ◽

Cited By ~ 10

Author(s):

M. C. Iglesias-Moreno ◽

M. A. López-Salcedo ◽

M. Gómez-Serrano ◽

J. Gimeno-Hernández ◽

J. Poch-Broto

Keyword(s):

Parapharyngeal Space ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Parapharyngeal Space Tumors

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Comparison of metabolic effects of glimepride and sitagliptin with metformin in patients suffering from type 2 diabetes mellitus in a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192643 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1467

Author(s):

Preeti Singh ◽

Ruchi Choudhary ◽

V. K. Singh ◽

Prithpal S. Matreja

Keyword(s):

Diabetes Mellitus ◽

Randomized Study ◽

Tertiary Care ◽

Glycosylated Haemoglobin ◽

Comparable Result ◽

Metabolic Effects ◽

Postprandial Blood Glucose ◽

Care Hospital ◽

Open Label ◽

First Choice

Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results.

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Epidemiological Trends and Resistance Associated with Stenotrophomonas maltophilia Bacteremia: A 10-Year Retrospective Cohort Study in a Tertiary-Care Hospital in Hungary

Diseases ◽

10.3390/diseases7020041 ◽

2019 ◽

Vol 7 (2) ◽

pp. 41 ◽

Cited By ~ 15

Author(s):

Márió Gajdács ◽

Edit Urbán

Keyword(s):

Stenotrophomonas Maltophilia ◽

Tertiary Care ◽

University Hospital ◽

Care Hospital ◽

Severe Injuries ◽

First Choice ◽

Invasive Infections ◽

N 93 ◽

Daunting Challenge ◽

Epidemiological Trends

Stenotrophomonas maltophilia has been recognized as an emerging nosocomial pathogen in invasive infections of immunocompromised, severely debilitated patients with significant underlying illnesses. The first-choice drug in these infections is sulfamethoxazole-trimethoprim (SMX/TMP), and resistance to this antimicrobial is a daunting challenge for clinicians. The aim of this study was to assess the prevalence of S. maltophilia bacteremia and SMX/TMP-resistance levels at a tertiary-care university hospital. A total of 175 episodes of S. maltophilia bacteremia were identified (2008–2012: n = 82, 2013–2017: n = 93; p = 0.061), 52% of affected patients were 60 years of age, and had recent surgery, severe injuries or underlying conditions (malignant hematologic diseases and solid tumors) in their history. Sixteen percent of isolates were resistant to SMX/TMP (2008–2012: n = 13.8%, 2013–2017: n = 17.2%; p = 0.076), and out of the resistant strains, 32.7% were also resistant to levofloxacin and colistin. Our findings on the SMX/TMP-resistance were similar to global literature data.

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Clinical presentation and management of parapharyngeal space tumours

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v17i1.7626 ◽

1970 ◽

Vol 17 (1) ◽

pp. 36-41

Author(s):

Mostafa Mahfuzul Anwar

Keyword(s):

Parapharyngeal Space ◽

Neck Surgery ◽

Surgical Approaches ◽

Benign Tumors ◽

College Hospital ◽

Anatomical Structures ◽

Neurogenic Tumors ◽

Medical College ◽

Parapharyngeal Space Tumors ◽

Head Neck Surgery

Methods: Tumors originating in the parapharyngeal space are uncommon. During the period of January 1999 to December 2008. Among them 34 patients underwent surgery for parapharyngeal space tumors at the Department of Otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. Results: Ninety one percent of the parapharyngeal space neoplasms were benign; 9% were malignant. Majority of the benign tumors were salivary gland origin followed by neurogenic tumors. The use of FNAC, computed tomography scan and ultrasound imaging are very useful to assess the location, size, vascularity, tissue origin and relation of parapharyngeal space tumors to surrounding anatomical structures. Conclusion: This information was essential in planning surgical approaches and predicting the prognosis. Details of the management, morbidity, and outcome of these patients were presented. Key words: Tumor; Parapharyngeal space. DOI: 10.3329/bjo.v17i1.7626 Bangladesh J Otorhinolaryngol 2011; 17(1): 36-41

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