Laryngeal dysplasia carries a significant risk of malignant transformation. This risk triples with increasing severity of dysplasia. Transformation often occurs late and is not related to the grade of dysplasia. There is little evidence, therefore, to support the early discharge of patients with mild/moderate dysplasia, which is practised by some clinicians.
Currently there is no good evidence for the use of biomarkers in predicting the future behavior of laryngeal dysplastic lesions. Only 3 studies showed statistically significant results. Better reporting of studies using the REMARK (REporting recommendations for tumor MARKer prognostic studies) consensus guidelines should help to improve this in the future.
Aim: To review recent literature on the diagnosis and management options for globus pharyngeus. Recent Findings: Strong evidence for the cause of globus pharyngeus is lacking however there is some research to suggest a possible link between laryngopharyngeal reflux (LPR) and globus pharyngeus. Radiological investigations used to find the cause of globus pharyngeus are often normal with little evidence to support their routine use. There are no long term controlled studies investigating the effectiveness of proton pump inhibitors (PPI's) for the treatment of globus pharyngeus however, these are commonly used. A recent nonplacebo-controlled study has shown promising results using liquid alginate suspension to treat laryngopharyngeal reflux symptoms. Other treatment modalities used, such as speech and language therapy, have shown some improvement in symptoms but these are often small trials. Summary: Globus pharyngeus is a clinical diagnosis. Investigations should be reserved for those with atypical symptoms. Thorough clinical evaluation and examination, including fibreoptic laryngoscopy, are key points in management.
OBJECTIVE: 1) Analyze the expression of multiple subsets of T regulatory cells (Tregs) in the peripheral blood of HNSCC patients. 2) Examine the effect of treatment on the expression of Treg cell subsets. METHOD: A four color flow cytometry system was employed to assess the percentage of CD4ϩCD25ϩ lymphocytes expressing FOXP3ϩ in the peripheral circulation of 60 HNSCC patients, both pre-and post-treatment, in comparison with 20 normal healthy controls. Additional phenotypic markers (cytotoxic T-lymphocyte antigen; CD152 and chemokine receptor 7; CD197) were used to further characterize subsets of Tregs. RESULTS: In normal controls 39.66.1% of CD4ϩCD25ϩ cells were FOXP3ϩ positive; this was significantly elevated in HNSCC patients both pre-and post-treatment (50.83.0% and 61.62.8% respectively; pϽ0.05). The percentage of CD4ϩ CD25ϩFOXP3ϩ Tregs expressing CD152 was 20.46.1% in controls, compared to 29.42.5% and 34.82.6% in pre-and post-treatment patients, respectively. The frequency of CD4ϩCD25ϩFOXP3ϩCD197ϩ was significantly decreased to 13.91.1% in pre-and 10.21.1% in post-treatment patients compared with 18.72.7%, in healthy controls (pϽ0.05). There was no association between Treg subsets and the site of primary tumor. CONCLUSION: This preliminary study has shown that HNSCC affects phenotype of Treg subsets in the peripheral blood, but this is apparently not altered by treatment. Further analyses are ongoing to assess the profile of Tregs in tumor infiltrating lymphocytes and correlate these with the comparable subset in the peripheral blood. Value of Rotational Test in Peripheral Vertigo PatientsDaogong Zhang, MD, PhD (presenter); Zhaomin Fan, MD; Haibo Wang, MD OBJECTIVE: To explore the clinical value of different parameters of rotational test in the diagnosis of peripheral vertigo. METHOD: 176 peripheral vertigo patients were analyzed in this study. All the patients underwent the rotational test and caloric test. The patients were divided into the different groups according to the value of unilateral weakness (UW) or directional preponderance (DP) in caloric test. The results of different four parameters of rotational test among the different groups were evaluated. RESULTS:The abnormal rate of gain, phase, directional preponderance, and time constant of rotational test was 6.8%, 38.6%, 31.8%, and 32.4% respectively in 176 patients. The rate via the combination of four parameters was 62.5%. There existed a statistically significant difference in value of phase and directional preponderance between peripheral vertigo and control group (pϽ0.05). CONCLUSION: Individual rotational test parameters showed lower sensitivity in identifying peripheral vertigo. The combination of rotational test parameters improved predictive capabilities. Phase had the greatest clinical significance in its ability to find peripheral vestibular system injury. The DP value had important influence on the results of rotational test, which indicated that rotational test could reflect the compensation status of peripheral vertigo. Only longit...
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