Prognostic factors are important for treatment decisions as they help adapt the therapy on a case-to-case basis. Nodal status, number of positive nodes, and presence of extracapsular spread are considered to be the important prognostic factors in head and neck cancer. Some studies suggest that human papillomavirus (HPV) status also influences the outcome of the treatment. This influence can be explained by the variation in tendency to develop regional metastases and by variation in the type of neck node involvement. The study objectives were to compare patients with HPV positive and HPV-negative tumors for survival and prevalence and type of regional metastasis, to identify prognostic factors and to test whether HPV presence is an independent factor of survival. The study included 81 patients treated by surgery including neck dissection for oral or oropharyngeal squamous cell cancer. A computerized medical report was completed for each patient. Analysis of the tumor specimen for the HPV DNA presence was done on paraffin-fixed tissue. HPV DNA detection and typing were performed by PCR with GP5+/GP6+BIO primers and reverse line blot hybridization. Overall, 64% (52/81) of tumors were HPV positive with 80% in the tonsillar site. HPV-positive patients had significantly better both overall (73 vs. 35%) (P=0.0112) and disease-specific (79 vs. 45%) (P=0.0015) survival rates than HPV-negative patients. No significant differences were found in the pN classification, in the number of positive nodes and the presence of extracapsular spread in the involved nodes between HPV positive and HPV-negative tumors. Multivariate analysis showed that significant prognostic factors of survival were the presence of HPV in the tumor, extracapsular spread and tumor size. HPV was the most significant prognostic factor in the studied group of patients with oropharyngeal tumors (HR=0.27, 95%CI 0.12-0.61) and possibly should be considered in treatment decisions.

The characteristics of the extent of the disease in general and of regional lymph node metastasis in particular are probably much less important in the prediction of the outcome of HPV-positive than of HPV-negative tumors. Improved survival of patients with HPV-positive tumors is due mostly to the difference in the local-regional failure rates.

OBJECTIVES:Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa.METHOD:We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor.RESULTS:No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome.CONCLUSION:The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

This paper constitutes a pilot study of a novel measure for assessing proneness to guilt and proneness to shame, Inventář tendence k vině a hanbě (ITVAH, Inventory of Proneness to Guilt and Shame). ITVAH is a scenario-based method distinguishing affective and behavioural components of guilt and shame and also considering the private or public experience of guilt and shame, respectively. Two items (affective and behavioural reaction) were created for each of the 16 scenarios, resulting in total of 32 items. A four-factor measurement model was assumed – Negative behaviour evaluation (NBE), Reparation, Negative self-evaluation (NSE), Withdrawal. Next, we assumed negative correlations of NSE and Withdrawal with self-esteem and self-forgiveness and positive correlations of NBE and Reparation with self-forgiveness. The pilot study was carried out on 249 Czech-speaking adults (67 % women, aged 18–75, Md = 22). An ordinal confirmatory factor analysis with residual covariances between items connected to the same scenarios was conducted. The hypothesized four-factor model was found acceptable. However, we found limited evidence for the hypothesized relationships with self-esteem and self-forgiveness – in contrast to theoretical expectations we found a medium-strong negative relationship between self-forgiveness and affective component of guilt. For further use of the measure in the Czech and Slovak environment it is necessary to assess additional evidence of construct validity and concurrent validity with The Test of Self-Conscious Affect-3 (TOSCA-3).

Sinonasal teratocarcinosarcoma is a rare and locally aggressive malignant tumour of the nose and paranasal sinuses, which has histological features of teratoma and carcinosarcoma. It is more common in men without age predilection. It often relapses locally. Due to the rarity, the exact therapeutic procedure is not defined. In our case, we provide a case report of a 56-year-old man patient with sinonasal teratocarcinosarcoma affecting the left nasal cavity. The symptomatology, dia­gnostic and therapeutic procedure of this rare tumour are discussed. Key words sinonasal teratocarcinosarcoma – proton therapy – tumours of the nose and paranasal sinuses