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Background. The standard initial management of patients with locally advanced pharyngolaryngeal presenting with stridor is tracheostomy. Tracheostomy has been shown to negatively impact cancer-related outcomes. Methods. Retrospective analysis of prospectively collected data of 9 patients, who underwent induction chemotherapy with the aim of prevention of tracheostomy. Presenting features, time to resolution of stridor, and further management are reported. Results. Eight out of 9 patient received chemotherapy within 12 hours of presentation with stridor. There were 4 patients each with primary hypopharynx and larynx. The stage was IVA in 6 patients and IVB in 2 patients. In all patients receiving immediate chemotherapy, clinical stridor resolved within 48 hours. The radiological response rate was 62.5%. The median reduction in size of tumor was 37%.
Conclusion. Immediate neoadjuvant chemotherapy is a feasible and safe option for patients presenting with early stridor and helps in resolution of stridor and avoiding tracheostomy.
Primary pancreatic-malignancies are far more common than pancreatic secondaries, which constitute <10% of all pancreatic-malignancies. [1,2] The most common mode of metastatic spread to pancreas is direct invasion from cancers of neighboring organs, followed by lymphatic and hemato-geneous dissemination as in renal-cell and lung-carcinoma. [3,4]
The advancement in diagnostic techniques has resulted in increased incidence of occult second primary in cancer patients. Here, we report a case of symptomatic oesophageal carcinoma and synchronous asymptomatic colon carcinoma diagnosed through Positron Emission Tomography-Computed Tomography imaging.
Reactivation of remote hepatitis B infection (RHBI) is an important cause of morbidity in hematopoietic cell transplant (HCT) patients. We analyzed the prevalence of RHBI in 205 patients who underwent HCT in our centre, serological events related to hepatitis B virus (HBV) reactivation and role of lamivudine prophylaxis in HCT patients with RHBI. The prevalence of RHBI was 14% (28/205 patients). Of these 28 patients, 15 received lamivudine prophylaxis (14 anti-HBcIgG positive and 1 only anti-HBs positive) while 13 did not receive lamivudine prophylaxis (12 anti-HBs positive and 1 anti-HBcIgG positive). None in prophylaxis group developed HBV reactivation while 12 of 13 in no-prophylaxis group reactivated (P < 0.001). The rate of HBV reactivation was 10% (21/205 patients), which included 9 patients with no evidence of RHBI pre-transplant. We conclude that lamivudine prophylaxis protects against HBV reactivation in HCT patients with evidence of RHBI. Lamivudine prophylaxis should be used not only in patients with anti-HBcIgG positivity but also in those with isolated anti-HBs positivity pre-transplant given the high rate of HBV reactivation in these patients. HBV serology cannot identify all cases with RHBI and therefore does not preclude HBV reactivation post-transplant.
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