PET-directed management of the neck after definitive RT in node-positive HNSCC appropriately spares neck dissections in patients with PET-negative residual CT nodal abnormalities.

The measurement and achievement of improved patient benefit following a particular medical or surgical intervention has become an increasingly relevant part of the provision of effective healthcare. We have retrospectively analysed patient satisfaction in 56 patients following rhinoplasty via the Glasgow Benefit Inventory (GBI), 25 of whom underwent pre-operative computer imaging planning. We have also audited patient reaction to this technique via a concurrent questionnaire in those subjects who underwent imaging, and correlated this with overall patient outcome. Patient satisfaction with cosmetic rhinoplasty following computer imaging was significantly improved compared to those patients who did not receive imaging.

c Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC). We assess the safety and tolerability of adoptive transfer of autologous cytotoxic T lymphocytes (CTLs) specific for the EBV latent membrane protein (LMP) in a patient with recurrent NPC. After infusion, the majority of pulmonary lesions were no longer evident, although the primary tumor did not regress. CASE REPORT In 2002, a middle-aged man (42 years old) was diagnosed with stage IV (T4 N2c M1) Epstein-Barr virus (EBV)-positive undifferentiated carcinoma with all of the pathological characteristics of nasopharyngeal carcinoma (NPC). This NPC patient (HLA A11, B60, B62) presented with multiple pulmonary metastases. He underwent a course of chemotherapy (3 cycles of induction cisplatin and fluorouracil [5FU]) and high-dose palliative radiotherapy to the nasopharynx and upper (60 Gy in 30 fractions over 6 weeks) and lower (50 Gy) cervical nodes, followed by 3 more cycles of cisplatin and 5FU. This treatment resulted in a complete radiological regression of pulmonary metastases and partial regression of NPC at the primary site. Three years later, the pulmonary metastases became radiologically apparent again and were treated with six cycles of carboplatin and 5FU. Following this, six cycles of gemcitabine were administered. In each case, while a complete regression of the lung metastases was seen, the lesion subsequently recurred, prompting a further nine cycles of gemcitabine. However, despite this, his disease progressed, suggesting resistance to gemcitabine. Carboplatin was added for another nine cycles in late 2006; radiological evidence demonstrated disease progression and resistance to chemotherapy.In September 2007, the patient commenced adoptive immunotherapy, for which he received six infusions (on a fortnightly basis, during a 3-month period) of autologous EBV-specific cytotoxic T lymphocytes (CTLs) directed toward the latent membrane protein (LMP) of this virus (1). This treatment resulted in regression of the majority of pulmonary metastases. To generate these LMP-specific cells, autologous peripheral blood mononuclear cells (PBMCs) were screened for reactivity to two different HLAcompatible LMP 1-and 2-specific CTL epitopes. A response against the LMP 2 peptide epitope SSCSSCPLSK (SSC) (1) was detected in this patient. Subsequently, autologous PBMCs were stimulated with SSC-coated autologous lymphoblastoid cell lines (LCLs) and expanded to yield large numbers of LMP-specific CTL cultures (see the legend to Fig. 1 for details). These cultures were screened for specificity by 51 Cr release assays and for phenotype by flow cytometry after 21 days. In the functional 51 Cr release studies, a single LMP 2 response to the HLA A11-restricted peptide (SSC) was detected (2), as measured by specific 51 Cr release of autologous phytohemagglutinin (PHA) target cells coated with SSC or another LMP-specific peptide epitope, IEDPPFNSL (IED) (Fig. 1) (1). Flow cytometry revealed that these patient-derived CTLs contained a high percentage o...

BACKGROUND: High-flow nasal oxygen (HFNO) is an emerging technology that has generated interest in tubeless anesthesia for airway surgery. HFNO has been shown to maintain oxygenation and CO2 clearance in spontaneously breathing patients and is an effective approach to apneic oxygenation. Although it has been suggested that HFNO can enhance CO2 clearance during apnea, this has not been established. The true extent of CO2 accumulation and resulting acidosis using HFNO during prolonged tubeless anesthesia remains undefined. METHODS: In a single-center trial, we randomly assigned 20 adults undergoing microlaryngoscopy to apnea or spontaneous ventilation (SV) using HFNO during 30 minutes of tubeless anesthesia. Serial arterial blood gas analysis was performed during preoxygenation and general anesthesia. The primary outcome was the partial pressure of CO2 (Paco 2) after 30 minutes of general anesthesia, with each group compared using a Student t test. RESULTS: Nineteen patients completed the study protocol (9 in the SV group and 10 in the apnea group). The mean (standard deviation [SD]) Paco 2 was 89.0 mm Hg (16.5 mm Hg) in the apnea group and 55.2 mm Hg (7.2 mm Hg) in the SV group (difference in means, 33.8; 95% confidence interval [CI], 20.6–47.0) after 30 minutes of general anesthesia (P < .001). The average rate of Paco 2 rise during 30 minutes of general anesthesia was 1.8 mm Hg/min (SD = 0.5 mm Hg/min) in the apnea group and 0.8 mm Hg/min (SD = 0.3 mm Hg/min) in the SV group. The mean (SD) pH was 7.11 (0.04) in the apnea group and 7.29 (0.06) in the SV group (P < .001) at 30 minutes. Five (55%) of the apneic patients had a pH <7.10, of which the lowest measurement was 7.057. No significant difference in partial pressure of arterial O2 (Pao 2) was observed after 30 minutes of general anesthesia. CONCLUSIONS: CO2 accumulation during apnea was more than double that of SV after 30 minutes of tubeless anesthesia using HFNO. The use of robust measurement confirms that apnea with HFNO is limited by CO2 accumulation and the concomitant severe respiratory acidosis, in contrast to SV. This extends previous knowledge and has implications for the safe application of HFNO during prolonged procedures.

This is the first time a lingual thyroid causing sleep apnoea has been studied with pre- and post-treatment sleep studies. This is also the first recorded instance of lingual thyroid causing sleep apnoea has been recorded in a male.