Lymphangiomas are rare benign tumors of the lymphatic system, most often found at birth and before the age of 2 years. The head and neck region are the most frequent locations for lymphangioma. Involvement of the adult larynx in isolation is rare, and only a few cases have been reported so far. We report the case of a patient with a left false vocal cord reddish tumor presenting with hemoptysis and voice cracking. The surgical excision of mass was performed by direct laryngoscopy-assisted CO2 laser. The histopathological report revealed the diagnosis as cavernous lymphangioma. After a follow-up of 1 year, the patient is free of recurrence with all laryngeal functions being normal.
Abstract Background Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications. Aims To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients. Methods This systematic review and component network meta‐analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta‐Analyses (PRISMA‐NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk‐of‐bias tool (V.2.0) and the online Confidence in Network Meta‐Analysis (CINeMA) application. Results Twenty‐four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs. Conclusions This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality. Relevance to clinical practice This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.
Despite the many studies on the associated risk of cardiovascular and cerebrovascular events in patients with hypercholesterolemia (HCh), an association between HCh and the development of idiopathic sudden sensorineural hearing loss (ISSNHL) has been examined in only a few case-control studies. We tested the hypothesis that HCh is a risk factor for developing ISSNHL.Using the Taiwan Longitudinal Health Insurance Database, we conducted a historical prospective cohort study to compare patients diagnosed with HCh from January 1, 2001, through to December 31, 2006 (N = 73,957) with age-matched controls (N = 73,957). We followed each patient until the end of 2009 and evaluated the incidence of ISSNHL for a minimum of 3 years after the initial HCh diagnosis.The incidence of ISSNHL was 1.62 times higher in the HCh cohort than in the non-HCh cohort (10.67 versus 6.61 per 10,000 person-years). Using Cox proportional hazard regressions, the adjusted hazard ratio was 1.60 (95% confidence interval [CI] = 1.39-1.85). An increased risk of developing ISSNHL, with adjusted hazard ratios of 1.48 (95% CI = 1.08-2.04) and 1.69 (95% CI = 1.18-2.43), was observed in HCh patients with newly diagnosed comorbidities of stroke or stroke combined with coronary artery diseases, which are both expected to reflect the severity of HCh.A diagnosis of HCh may indicate an independent risk for ISSNHL. This finding suggests that an underlying vascular mechanism contributes to the development of ISSNHL. We suggest that physicians counsel patients with HCh to seek medical attention if they have hearing impairments, because they may also have an increased risk of developing ISSNHL.
Nasopharyngeal carcinoma (NPC) is the most common malignant neoplasm of the nasopharynx. Despite improvements in the clinical treatment strategies for NPC, NPC patients usually have poor survival rates because of late diagnosis, tumor metastasis, and recurrence. Therefore, the identification of potential diagnostic and prognostic markers for NPC is imperative. We investigated the differential expression of cell adhesion-related genes (gene ontology:0003779) and tumorigenesis-related genes (GSE12452) in patients with NPC. The correlations between synaptopodin-2 (SYNPO2) immune expression and clinicopathological features were analyzed using Pearson chi-square test. Multivariate analysis was performed using Cox proportional hazards model. SYNPO2 expression was significantly higher in NPC tumor tissues than in nontumor tissues. High SYNPO2 expression was significantly associated with the advanced disease stage (P = .006). Univariate analysis showed that high expression of SYNPO2 was associated with poor disease-specific survival, distal metastasis-free survival, and local recurrence-free survival in patients with NPC. Notably, our multivariate analysis demonstrated that high SYNPO2 expression was substantially correlated with inferior disease-specific survival (hazard ratio = 1.968, P = .012) and local recurrence-free survival (hazard ratio = 3.386, P = .001). Overall, our findings reveal that SYNPO2 may aid in the development of potential prognostic biomarkers for NPC patients.
To explore the recurrence rate of idiopathic sudden sensorineural hearing loss (ISSNHL).Using the Taiwan Longitudinal Health Insurance Database, we compared in a retrospective cohort study 45,715 patients with ISSNHL between January 2001 and December 2006 with 45,715 age-, gender-, and comorbidity-matched controls without ISSNHL. We followed each patient from 180 days after the initial diagnosis until the end of 2009 and evaluated the incidence of ISSNHL for 3 years minimum.The cumulative incidence of ISSNHL recurrence was 4.99%. Cox proportional hazard regressions showed that the 50- to 64-year-old age group had a higher adjusted hazard ratio (1.59; 95% confidence interval: 1.40-1.81) than did the 0- to 34-year-old age group. Different comorbidities did not significantly affect the incidence of ISSNHL relapse.The risk of an ISSNHL relapse in patients with a history of ISSNHL was higher than was the risk of a first occurrence of ISSNHL in the Controls. We suggest that physicians counsel patients with a history of ISSNHL to seek medical attention if they have hearing impairments because they may also have a high risk of an ISSNHL relapse.2B.
Primary nasopharyngeal papillary adenocarcinoma is a rare nasopharyngeal neoplasm with a good prognosis and a low propensity for regional recurrence. To date, only few cases of primary nasopharyngeal papillary adenocarcinoma have been reported in the literature.A 24-year-old female patient presented with intermittent hemoptysis and blood tinge nasal discharge.An exophytic and pedunculated mass over the roof of the nasopharynx was found on nasopharyngoscope. Biopsy was done and the pathology confirmed well-differentiated primary nasopharyngeal papillary adenocarcinoma, strongly positive for CK7, and transcription termination factor 1; but negative for thyroglobulin. The final diagnosis was primary nasopharyngeal papillary adenocarcinoma, well-differentiated, pT1N0M0, stage I.The patient underwent excision of nasopharyngeal tumor under sinuscopic assistance.: No local recurrence or distant metastasis was noted during the 6 months of follow-up.We aim at highlighting the importance of a thorough differential diagnosis of nasopharyngeal tumor. Further investigation is still needed for providing evidence to standardize the treatment protocol.
Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses is a rare but aggressive neoplasm with a poor prognosis and a strong propensity for regional recurrence and distant metastasis. Diagnosis is challenging and relies on immunohistochemical study. Treatment includes surgical resection, radiation therapy, chemotherapy, or a combination of these modalities. However, the optimal therapeutic strategy is still controversial. Due to its rarity, the complexity of the histological diagnosis, and the variety of the treatment regimens, we presented a case of primary small cell neuroendocrine carcinoma in the nasal cavity with description of the clinical manifestation, pathology features, and our treatment regimen.An 82-year-old female patient with hypertension presented with right epistaxis on and off with nasal obstruction for several days.An exophytic mass over the posterior end of the right inferior turbinate was found on nasopharyngoscope. Biopsy was done and the pathology confirmed small cell carcinoma, strongly positive for cytokeratin (AE1/AE3) and insulinoma-associated protein 1 (INSM-1), scatteredly positive for chromogranin A, synaptophysin and CD56. The final diagnosis was small cell neuroendocrine carcinoma of right nasal cavity, pT1N0M0, stage I.The patient underwent wide excision of right intra-nasal tumor and post-operative radiotherapy with a dose of 6600 cGy in 33 fractions.No local recurrence or distant metastasis was noted during the 12 months of follow-up.Multimodality treatment remains the most common therapeutic strategy, although no proven algorithm has been established due to the rarity of this disease. Further investigation is needed for providing evidence to standardize the treatment protocol.
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