No abstract

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No abstract

Objective: Nutcracker syndrome represents the constellation of symptoms caused by extrinsic compression of the left renal vein between the aorta and superior mesenteric artery, producing left renal venous outflow obstruction and, frequently, pelvic venous congestion. To relieve the reflux, different treatment modalities are available, including renal vein stenting and transposition of the ovarian vein to the inferior vena cava.Methods: We have presented a video of our technique of decompression of nutcracker syndrome by transposing the left ovarian vein onto the left external iliac vein.Results: Transposition of the left ovarian vein onto the left external iliac vein is a simpler technique, with limited morbidity. The patients recover more quickly and experience sustained relief of symptoms. The technique also avoids the morbidity of a large open abdominal procedure, the use of prosthetic materials, and stents.Conclusions: We have demonstrated a promising technique that could possibly be adapted as the standard of care for nutcracker syndrome in selected patients.

Objective: To determine the rate of autoimmune disease in a head and neck cancer patient population and determine if these patients have increased rates of advanced stage disease. Study Design: Retrospective cross-sectional study Setting: Rural tertiary care center Methods: A multisite single institution multidisciplinary head and neck oncologic patient database was queried to identify patients with autoimmune disease and primary mHNSCC in all primary sites from December 2019 to September 2021. Results: A total of 302 patients were identified, with 83% male and 17% female. In this study, 7.3% of patients were found to have an autoimmune disease or on immune-suppressive medications. Of the patients with immune suppression (autoimmune diseases or taking immune-suppressive agents), increased rates of regional and distant metastatic disease were noted. Statistical analysis demonstrated a relative risk of 1.1376 (95% CI 0.8679 – 1.4912) p = 0.3503 for presentation at advanced stage due to nodal disease and a relative risk of 1.4141 (95% CI 0.1876 – 10.6595) p = 0.7367 for presentation at advanced stage due metastatic disease in the autoimmune population. Conclusion: This study suggests that patients with autoimmune diseases and/or on immune-suppressive medications may present with more advanced stages of head and neck squamous cell carcinoma compared to patients without immune suppression. These findings further emphasize the importance of counseling patients on immune-suppressive medications and other risk factors for head and neck squamous cell carcinoma.