Immune checkpoint inhibition is a new and promising therapy approved for the treatment of various malignancies. Pembrolizumab is a potent tumor suppressor that acts by upregulating the immune system to recognize cancer cells which may result in disrupted self-tolerance. We describe a case and perform a literature review of myasthenia gravis with ocular manifestations after treatment with pembrolizumab. Our case had bilateral ptosis refractory to conventional treatment, and she remained functionally blind as a result. The literature review included 28 cases of immune-related myasthenia gravis, and a 30% mortality rate excluding deaths from primary cancer progression was shown. Under half had full symptom resolution (n=13, 46%), and there was no clear correlation between specific management strategies and prognosis. Patients with isolated ocular myasthenia gravis (n=9, 32%) were twice as likely to be symptom-free after treatment compared with generalized myasthenia gravis (75% vs. 39%). Respiratory involvement was associated with twice the mortality rate (60% vs. 33%) and triple the risk of noncomplete symptom resolution (20% vs. 61%). The majority of cases had their pembrolizumab discontinued (n=20, 71%), but 3 were successfully rechallenged by utilizing prophylactic low-dose steroids. Patients with immune-related myasthenia gravis experience increased mortality and morbidity but if steroid-responsive, may benefit from the reintroduction of anti–programmed cell death protein 1 therapy for end-stage malignancy with close monitoring. A high index of clinical suspicion for immune-related adverse effects are critical in an era of rising immunotherapy use.
Background: Nasogastric (NG) feeding is important for a successful recovery in many postoperative head and neck cancer patients. There have been 21 deaths in England since 2005 as a result of misplaced feeding tubes. Misplaced NG feeding tubes are a 'never event' in the Leeds Teaching Hospital Trust. Method: Retrospective analysis of the notes of 80 head and neck oncology patients who underwent surgery between 2014 and 2015 and required NG feeding tube (NGFT) postoperative placement. Completed over four three-monthly cycles. Results: For the first six months, 50% of patients had no record of NGFT postoperative placement and in 70% of cases the length of insertion was not recorded. After the introduction of a new oncology clerking proforma and further staff training, placement was correctly recorded in 100% of patients. Conclusion: Repeat audit cycles and analysis of the data localised the failures in documentation completion to placement of the NGFT in theatres. With a new oncology clerking proforma and further training to the entire oral and maxillofacial surgery team, I successfully improved the completion rate of the NGFT placement documentation.
Methods: Data was collected prospectively over one year of all children presenting to the emergency department and those that were admitted. Data collected included age, aetiology and management.Findings: Over a one-year period, 636 children presented to the emergency department requiring input by the oral and maxillofacial team. The large majority of patients were seen and discharged from the emergency department. Only 91 patients (14%) required admission. The commonest reason for admission was facial lacerations requiring closure under general anaesthetic (50%). Dental abscesses (20%), non-odontogenic infections (15%), facial fractures (5%) and dentoalveolar injuries (4%) accounted for the remainder. Conclusions: Emergency paediatric admissions make up only a small part of the workload for a maxillofacial team. However, we must endeavour to find methods to reduce the number of these admissions. Our department is pursuing avenues in paediatric sedation and day-surgery lists, which may help reduce admissions for facial lacerations and dentoalveolar injuries. In addition, early access to primary care dentists and general practitioners may help reduce the number of children requiring intravenous antibiotics for head and neck infections.
Background: Nasogastric (NG) feeding is important for a successful recovery in many postoperative head and neck cancer patients. There have been 21 deaths in England since 2005 as a result of misplaced feeding tubes. Misplaced NG feeding tubes are a 'never event' in the Leeds Teaching Hospital Trust. Method: Retrospective analysis of the notes of 80 head and neck oncology patients who underwent surgery between 2014 and 2015 and required NG feeding tube (NGFT) postoperative placement. Completed over four three-monthly cycles. Results: For the first six months, 50% of patients had no record of NGFT postoperative placement and in 70% of cases the length of insertion was not recorded. After the introduction of a new oncology clerking proforma and further staff training, placement was correctly recorded in 100% of patients. Conclusion: Repeat audit cycles and analysis of the data localised the failures in documentation completion to placement of the NGFT in theatres. With a new oncology clerking proforma and further training to the entire oral and maxillofacial surgery team, I successfully improved the completion rate of the NGFT placement documentation.http://dx.Background: The immune system plays an important role in the development and progression of cancers, including oral squamous cell carcinoma (OSCC). However, little is known about the immune response in the tumour microenvironment after neoadjuvant chemotherapy. Objective: To investigate the immunological impact of chemotherapy in the tumour microenvironment of OSCC. Methods: We retrospectively analysed a degree of immune cell infiltration and relevance of the programmed death ligand-1 (PD-L1) expression in surgically resected eighteen OSCC specimens from patients with or without pretreatment of certain chemotherapy. Results: No distinct difference was observed on the degree of immune-cell infiltration between two groups. A decreased number of programmed death-1 (PD-1) positive cells were found in the specimens of cancer nest of the neoadjuvant chemotherapy group. In the without neoadjuvant chemotherapy group, 80% specimens showed intermediate to strong expression of PD-L1 protein.Whereas most of the specimens of the neoadjuvant chemotherapy group (75%) showed weak expression. Conclusion: Neoadjuvant chemotherapy in OSCC is useful to induce the number of tumour-infiltrating lymphocytes in the tumour microenvironment. And it was revealed that the expression of PD-L1 changed by the chemotherapeutic agents.http://dx.
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