Mobile interventions provide a sophisticated yet simple tool to improve perioperative healthcare. Future considerations to address include usage fatigue and Health Insurance Portability and Accountability Act compliance concerns.

We present the case of a 44-year-old woman with a 28-year history of intranasal heroin use who developed severe necrosis of the nasal mucosa and septal perforation. She denied any prior insufflation of cocaine or other substances. Necrosis of the septum was recurrent and persistent despite repeated debridement. Necrosis and perforation of the nose and palate are welldescribed consequences of intranasal cocaine abuse, often attributed to cocaine's vasoconstrictive properties. However, there have been few reports of similar effects associated with heroin. This case and other recent reports of non-vasoconstrictive substances causing nasal and palatal necrosis suggest that vasoconstriction alone may be an incomplete explanation for the pathogenesis of cocaine induced midline destructive lesions (CIMDL). Cocaine and other recreational drugs, including heroin, may cause midline destruction through a common non-vasoconstrictive mechanism, possibly mediated by antineutrophil cytoplasmic antibodies. ARTICLE HISTORY

Objective Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite. Study Design Retrospective analysis. Setting National Cancer Database (NCDB). Subjects and Methods The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival. Results The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors (P = .340) and stage III and IV tumors (P = .154). Conclusion This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis.

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