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Study outcomes of re-irradiation after salvage total laryngectomy (TL) for patients with recurrent laryngeal cancer. Determine overall survival (OS) and progression-free survival (PFS). Determine the incidence of severe complications associated with re-irradiation with a focus on carotid blowout (CB). Patients previously irradiated, with recurrent or second primary cancer of the larynx status-post salvage TL who received a second course of radiation from 2000 to 2017 were identified. Toxicities were measured using the CTCAE 4.0. Major toxicities were defined as grade 3+. Survival data and Kaplan-Meier curves were computed in SAS 9.4. Twenty-six patients were included in the analysis. Seventeen had progression of disease and 16 died during the follow-up period. Nine patients had no evidence of disease (NED) at last follow-up. One-, two-, and five-year OS were 65.8%, 44.2%, and 23.2%. One-, two-, and five-year PFS were 48.4%, 24.7%, and 18.5%. The most common severe toxicities were fibrosis (61.5%), dysphagia (53.8%), and wound healing complication (23.1%). Four patients (15.4%) suffered carotid blowouts. Two blowouts were preceded by manipulation of the aerodigestive tract. Patients undergoing re-irradiation for recurrent laryngeal cancer have a poor prognosis with high risk of progression or recurrence. Re-irradiation may offer survival benefit at the expense of significant toxicities. The incidence of severe toxicity is high enough to warrant pretreatment counseling. Carotid blowout was seen in 15% of patients unrelated to cancer progression. Caution should be exercised in re-irradiated patients before instrumentation of the aerodigestive tract.

BACKGROUND: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) are a well-known pathological entity. We have encountered several patients with MD of the ACL, found to have a anterior translation of tibia a exceeding 5 mm with an intact ACL. We studied this cohort and investigated the likely cause of this. METHODS: A retrospective search of our department's radiology system to identify all patients referred from the knee orthopaedic clinic for MR imaging over a span of 10 years. All patients had MD within the substance of the ACL and an intact ACL. We evaluated the degree of anterior translation of the tibia (ATT) in relation to the femur in mucoid degeneration of ACL. RESULTS: We identified 464 consecutive cases. The mean age was 52 years. There was a male predominance of 261 to 203 female. The average PTF measurement was 2.4 mm with a range of 0-20mm. Of the 464 cases, 3 397 patients had an insignificant ATT of < 5 mm. (0mm. 67. 67 67 patients had a ATT >5 mm. Of them, 32.8% had a ATT of 6 mm, 53.7% had a ATT range between 7 and 9 mm, with the remaining 13.4% above 9 mm in length. CONCLUSION: It is essential to look for other secondary signs of ACL tears and not only focus on ATT as well as correlate this with clinical findings.

Introduction The Universal Neonatal Hearing Screening programme was implemented in Ireland in 2014. Approximately 100 infants are identified with a permanent childhood hearing impairment (PCHI) each year, an incidence of 1.5/1,000. Best practice dictates that all children who are identified with PCHI should have access to prompt paediatric assessment to determine the need for aetiological investigations. The implementation of the UNHS programme did not include any increased resource for paediatrics thus raising concern regarding timely access to medical assessment. This survey aimed to assess the provision of aetiological assessment services nationally with a view to informing future service development. Methods All paediatricians involved in aetiological assessment were identified from the national audiology lead. A questionnaire was developed using the BAAP standards and was sent by post with email reminders. Results were collated on excel. Results 38 consultants were identified of whom 37 responded. 33 paediatricians reported that they assessed children with PCHI in clinic. Only 6/33 had received any specific training in the assessment of PCHI infants. This work was not included in any job plan and no additional posts had been developed. Only 1 paediatrician reported participating in a regional support network, but the vast majority (92.9%) surveyed expressed an interest in developing a regional network. 5/33 (15%) saw the infants in a dedicated hearing clinic. Waiting time for assessment was beyond the recommended timeframe in all cases, (range 2–52 weeks, average of 14.4 weeks). Only 8/29 (27%) assess by 6 weeks of age, the time limit for treatment of congenital CMV infection. Access to MRI is limited, only 12 (28.6%) reported having access to MRI within 12 weeks of age thus the majority of MRI require sedation. 77% routinely refer all children with PCHI to ophthalmology. Conclusion The above survey highlights significant deficits in the paediatric component of the UNHS. Identified gaps include; inadequate appropriately trained staff and lack of timely access to necessary investigations and tertiary services. A national multi-disciplinary working group has been developed to address the deficits and ensure an improvement in service provision.

Problem statement: Hepatic-only metastasis in colorectal cancer is not a rare clinical finding and can account for 30% of cases. However, only 10-25% of cases are suitable for hepatic resection as part of their treatment pathway. We sought to document our own findings by reviewing patients with hepatic-only disease. Approach: A retrospective analysis was designed to include all patients seen at our institution from 1st January 2000 until 30th June 2010 and information as derived from the patients’ records. Results: Forty-four (44) patients were found, with an average age of 60.8 years and a male preponderance. The majority of patients (approximately 57%) with hepatic-only metastases developed their disease following adjuvant therapy. Better overall survival was seen when a primary tumor had a low grade of histological differentiation and fewer than 3 hepatic lesions appreciated on conventional radiology. Better outcome was seen in patients who underwent hepatic resection. Conclusion: Patients with hepatic-only metastases are not uncommon within our institution. Hepatic resection afforded better outcome and compares favorably with published literature.

The present study examines the relations between adolescent motherhood and children’s behavior, substance use, and internalizing problems in a sample of 1,368 children of 712 female twins from Australia. Adolescent motherhood remained significantly associated with all mental health problems, even when using a quasiexperimental design capable of controlling for genetic and environmental confounds. However, the relation between adolescent motherhood and offspring behavior problems and substance use was partially confounded by family background variables that influence both generations. The results are consistent with a causal relation between adolescent motherhood and offspring mental health problems, and they highlight the usefulness of behavior genetic designs when examining putative environmental risks for the development of psychopathology. The generalizability of these results to the United States, which has a higher adolescent birth rate, is discussed.

An adult female domestic shorthair cat was evaluated for chronic upper respiratory disease and vomiting. A diagnosis of idiopathic megaesophagus with intermittent gastroesophageal intussusception (GEI) was made based on radiographic and endoscopic examinations. The GEI was manually reduced by use of a stomach tube during the endoscopic procedure. An incisional gastropexy was performed to prevent recurrence. Gastroesophageal intussusception is a rare condition in cats. In dogs it is usually associated with rapid progression of clinical signs, culminating in death. In this cat, the condition was associated with chronic signs, probably due to the intermittent nature of the GEI.

Background A complete pathological response occurs in 10–30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. Methods A systematic review was performed using PubMed and Embase databases. Keywords included: ‘rectal’, ‘cancer’, ‘transanal’, ‘conservative’, ‘complete pathological response’, ‘radiotherapy’ and ‘neoadjuvant’. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. Results Purely conservative ‘watch and wait’ strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. Conclusion Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres.

Chronic idiopathic constipation may be the result of an autonomic neuropathy. This hypothesis was tested in 23 constipated patients and 17 age matched controls, using the acetylcholine sweat spot test devised to test autonomic integrity in diabetes. Acetylcholine (0.01%) was injected in the dorsum of the foot painted with a mixture of starch and iodine. Active sweat glands appeared on the surface of the skin as small black dots which were photographed and counted, using a grid with 60 subareas. Two measurements were made: the number of dots per unit subarea (sweat spot test score) and the % number of abnormal subareas (with less than six spots). These two parameters were correlated. The median sweat spot test score was 9.53 in patients and 13.92 in controls (p = 0.0001), the receiver operating characteristic curve showing that a score of 12 delimited normal and abnormal subjects. Increasing age was correlated with a low score in patients, probably because of prolonged symptoms. Seventy per cent of patients and one control had a borderline or abnormal number of subareas. These results suggest that idiopathic constipation is associated with a degree of autonomic denervation. The sweat spot test is an easy, inexpensive method to test this hypothesis and deserves a place in the clinical assessment of slow transit constipated patients.

A patient with chronic cough and recent dysphagia was found to have a retrotracheal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic scan confirmed a retrotracheal lesion, which was believed to be of lymphatic origin. A thyroid scan demonstrated downward displacement of the left lobe but little uptake in the mass. Histological findings of mediastinal biopsies were inconclusive. A large retrotracheal thyroid adenoma was easily excised through a right thoracotomy. The approach to diagnosis and, in cases of doubt, the safety of surgical access through thoracotomy for thyroid lesions in this unusual site is discussed.

Sacral fractures have not been described well in dogs. The records of 32 dogs diagnosed with sacral fractures were evaluated for neurologic deficits at presentation and discharge. Follow-up was in the form of telephone survey or physical examination at recheck. A score was assigned for each dog at presentation, discharge, and follow-up (0 for normal, 1 for minor deficits, and 2 for major deficits). Fractures located lateral to the sacral foramina were called abaxial, and those medial to the sacral foramina were called axial. Axial fractures had significantly more severe deficits at presentation (p = 0.00017) and discharge (p = 0.03063), but not at follow-up. Neurologic status did not improve significantly during hospitalization in either fracture group, but had improved significantly at follow-up.

The Brown Bowel Syndrome is characterised by degeneration and pigmentation of large bowel mucosa. We present a report of this unusual syndrome in which, for the first time, a functional deficit, reflected in a reduced internal and sphincter tone, is documented. This abnormality was reversed following sub-total colectomy and vitamin E therapy.

The literature on short œsophagus and its relationship with peptic ulceration is reviewed, and the theories regarding this association are discussed. A theory is put forward suggesting that both congenital shortening of the œsophagus and acquired shortening due to cicatrisation following ulceration are comparatively rare, and that the majority of the cases diagnosed as short œsophagus radiologically are primarily cases of hiatus insufficiency associated with spasm of the longitudinal muscle fibres, resulting from irritation due to flow of gastric juice into the œsophagus. A lax hiatus may result either from a developmental deficiency due to delayed descent of the stomach or to a loss of elasticity of the tissues in later life. In most cases of “congenital short œsophagus”, the condition is not congenital and the œsophagus is only shortened by spasmodic contraction. Two cases of short œsophagus and cancer are added to those previously published, the date of diagnosis (September 1938) in one of them (Case 2...

The origins of short-distance low-voltage X-ray therapy are referred to and its scope and advantages discussed. The systems of dosage employed by other workers are described. The system of dosage and dose distribution that we have adopted is set out, and the technique employed is illustrated by reference to actual cases treated. The results of treatment are referred to briefly. Stress is laid upon the desirability of achieving as even a distribution of the radiation throughout the tumour as possible by carefully planned treatment or by the use of special applicators. It is pointed out that in this method the maximum and minimum tumour dose is determined as accurately as possible in every case. The method is compared with that known as “X-ray cauterisation” and with methods where the dose is based solely on immediate tumour response. It is thought that the method advocated avoids both underdosage of the deeper parts of the tumour, therefore minimising the risk of subsequent recurrence, and overdosage of th...

Surgery and radiotherapy are still the only known methods of curing cancer. In some instances surgery, and in others radiation, offers the patient his best chance of recovery, but these two methods are not mutually exclusive, for there are many cases in which a combination of the two will produce better results than either can obtain alone. The importance of co-operation between surgeon and radiotherapist in deciding upon the treatment to be adopted for cancer patients, and often in the actual administration of treatment as well, is recognised, and many examples could be given. There is, for instance, a growing tendency to treat tumours by exposing them surgically for radium or “contact” X-ray therapy. A carcinoma of the lip is to-day usually treated by irradiation, but if the regional lymph nodes are involved and mobile, a block dissection of the neck offers the best prospect of a cure. In this year's Skinner lecture, Paterson1 gave an excellent example of co-operation between surgeon and radiotherapist,...