Tissue banking in ENT: challenges and methods

Clinical OtolaryngologyVolume 39, Issue 3 p. 177-182 Correspondence: Our Experience Latest trends in the assessment and surgical management of snoring in England: a prospective questionnaire study S. Gupta, Corresponding Author S. Gupta Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKCorrespondence: S. Gupta, The Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Road, London WC1X 8DA, UK. e-mail: [email protected]Search for more papers by this authorT. Nicoli, T. Nicoli Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKSearch for more papers by this authorB. Kotecha, B. Kotecha Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKSearch for more papers by this author S. Gupta, Corresponding Author S. Gupta Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKCorrespondence: S. Gupta, The Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Road, London WC1X 8DA, UK. e-mail: [email protected]Search for more papers by this authorT. Nicoli, T. Nicoli Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKSearch for more papers by this authorB. Kotecha, B. Kotecha Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, London, UKSearch for more papers by this author First published: 19 April 2014 https://doi.org/10.1111/coa.12245Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume39, Issue3June 2014Pages 177-182 RelatedInformation

"Qvist, George, (13 April 1910–28 July 1981), Surgeon, Royal Free Hospital, since 1946, Willesden General Hospital, since 1956, Royal National Throat, Nose and Ear Hospital, since 1950" published on by Oxford University Press.

"Beards, Samuel Arthur, (died 2 March 1975), Hon. Surgeon, Royal National Ear, Nose and Throat Hospital; formerly Consulting Laryngologist St Mary Abbots Hospital, W8" published on by Oxford University Press.

This book is intended for young trainees in the field of head and neck surgery who have some knowledge of the subject, and who are in the early stages of acquiring experience and expertise in operative surgery. It is about the prevention and rectification of problems and complications. Surgical procedures for the correction of established complications are described. Included are chapters on the thyroids, benign cervical swellings, the parotid, radical neck dissection, the nose and paranasal sinuses, the ear, the oral cavity and oropharynx, the larynx, the trachea, the hypopharynx, and the esophagus. Each chapter contains a list of helpful references. The author is consultant ear, nose, and throat surgeon to Guy's Hospital and the Royal National Throat, Nose, and Ear Hospital, London, and has been trained on both sides of the Atlantic, having served as fellow and assistant professor at the State University of Iowa. Shaheen defines a surgical

It is commonly acknowledged that otitis media with effusion (OME) can cause behavioural disturbances and that this can be relieved by grommet insertion. However, this widely-held perception has not been documented in the literature. In this study parents were asked to complete a short behavioural questionnaire on the day of the admission and 6 weeks later. A total of 32 children admitted to the Day Care Unit for insertion of grommets at The Royal National Throat, Nose and Ear Hospital, London, UK, were recruited. There was a significant behavioural change, evident by the difference in the scores before and after grommet insertion (P < 0.001).

It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.

Five patients with laryngeal lymphoma who presented at the Royal National Throat, Nose and Ear Hospital between 1953 and 1979 are described. The literature is reviewed and it is found that 40 cases have been previously reported. A modification of a previous clinical classification is presented. Long-term hoarseness as a presenting symptom, and difficulty in making the diagnosis is emphasized. It is found that most cases are supraglottic, non-ulcerated, pale laryngeal masses. There is no sex or age preference and Hodgkin's lymphoma has not been described in the larynx. A significant number of cases are, and remain localized to the larynx, and consequently have a good prognosis with radiation therapy. However, careful evaluation by experts, and long-term follow-up is emphasized.

An expert at setting up pathology laboratories in developing countriesBalbir Nehaul rose from humble beginnings to become Guyana's government pathologist and microbiologist, the first Guyanese person to be appointed to...

This retrospective, comparative study involves 13 patients with sphenoiditis from 2 specialist centres: the Royal National Throat, Nose and Ear Hospital, Gray's Inn Road (7 patients) and the National Hospital for Nervous Diseases, Queen's Square (6 patients). It was found that the ENT patients had a very much longer history, had more nasal symptoms, and suffered none of the neurological complications attributable to the disease. All the neurological patients presented with a complication after a comparatively short history and had few nasal symptoms. One ENT patient was found to have a mucopyocoele, whereas 5 were found in the neurological patients, all of whom had bony deficiencies demonstrated by radiology and at surgery. Once diagnosed and treated the ENT patients all made full recoveries while 3 of the neurological patients remain with sequelae of the disease. Our study suggests that dehiscences of the surrounding bone increase the risk of potentially serious intracranial problems from sphenoiditis, whereas the chronicity of symptoms is of secondary importance.

We read with interest the article by Kheterpal et al. 1regarding impossible mask ventilation. This is a very important but rare event, and this large study gives us a clear idea about its incidence and, for the first time, what the associated risk factors are.We note that in all but 4 of the 77 cases of impossible mask ventilation, the patients had received neuromuscular blockade “in the process of induction or management of the airway,” with succinylcholine being used in 65 patients and a nondepolarizing agent in the remaining patients. However, it is not clear at what stage of airway management that the neuromuscular blocker was administered in these cases—was it before difficulty with mask ventilation being encountered or given after problems occurred to improve the situation, and did ventilation indeed improve? Furthermore, only 19 patients (25%) proved difficult to intubate, which suggests that there was opportunity for improving the conditions for mask ventilation. Kheterpal et al. do go on to discuss the problem in assessing the role of muscle relaxants in mask ventilation difficulties, but the documentation for each case did not include an assessment of mask ventilation before and after neuromuscular blockade. It would be interesting to note if there is a difference in the incidence of impossible mask ventilation with or without neuromuscular blockade being given at induction (before attempts at mask ventilation). This may be an area for further investigation, although as with this study, a large population sample would be required.In our experience, optimum depth of anesthesia and neuromuscular blockade provide the best conditions for both mask ventilation and tracheal intubation (in patients in whom an awake technique, transtracheal catheter, or awake tracheostomy are not indicated). Neuromuscular blockade given at induction and before attempts at mask ventilation is the most common practice in our institution for patients requiring tracheal intubation. In addition, we have found that using intermittent positive pressure ventilation by means of a Penlon Nuffield 200 ventilator (Penlon Ltd., Abingdon, United Kingdom) while holding a mask is beneficial for assessment of adequacy of mask ventilation and also useful for training. This approach has the advantage of allowing a two-handed mask technique for more challenging airways and continual monitoring of airway pressure from the pressure gauge on the ventilator. Monitoring airway pressure in this way provides an objective measure of the seal that is achieved with the mask and patency of the airway. Mask technique can then be optimized by reference to clinical signs (e.g. , chest expansion), airway pressure/peak pressure, and capnography. We also encourage initial management of the airway without use of an oropharyngeal/Guedel airway to improve and optimize these fundamental airway skills. Mask ventilation is our core skill, and we believe subjective and objective assessment throughout training is required to maintain this art and limit airway disasters.*Royal National Throat, Nose and Ear Hospital, London, United Kingdom. johnmyatt@doctors.org.uk

BACTERIOLOGICAL FINDINGS IN ACUTE OTITIS MEDIA

CT scans of 100 patients from the Rhinology Clinic at the Royal National Throat, Nose and Ear Hospital were reviewed in order to test the precepts forming the basis of functional endoscopic sinus surgery, especially as they relate to the radiological investigation. These were: (a) the site of origin of sinus infection, (b) The relevance of certain anatomical variants in the middle meatus to sinus infection and (c) The use of CT as the radiological method of diagnosis in all cases. Obstruction in the middle meatus and ostiomeatal complex was associated with an increased incidence of opacity in the sinuses but the primary site of disease was not established: the concept that sinus disease takes origin in the middle meatus was not proven. Anatomical variants in the middle meatus were not associated with an increase in sinus opacity and there was no evidence that these anomalies have any effect on sinus disease by causing middle meatal stenosis. The radiological assessment of patients with inflammatory naso-sinus disease should start with plain X-ray. CT is unnecessary as a routine examination. It should be reserved for the pre-operative assessment of patients for endoscopic surgery, its main function being to show important anatomical landmarks.

The heterogeneity within individual distinct cancer types in terms of behaviour, response to therapy and prognosis is well recognized. A major goal of translational research projects has therefore been to define clinically significant subgroups of individual tumour types by analysis of mRNA as well as protein expression. An essential premise of such investigations is that expression of these key molecules is a true reflection of conditions present within the neoplastic cells in vivo. The aim was to investigate the effect of methods of tissue handling and storage on expression of mRNA. mRNA expression in 60 biopsy samples obtained from 10 patients with colorectal tumours was examined. The mRNA expression profile and the level of expression of specific mRNA species were significantly affected by the procedures used for collection and storage of tissue samples. Significant variation in the level of expression (both increased and decreased) of transcripts was detectable after 15 min, and by 120 min there was a fourfold increase in the number of genes with a more than twofold change in the level of expression. Reliable interpretation of results of gene expression at the mRNA level requires standardized protocols for tissue procurement.

West Nile virus (WNV) is a mosquito-borne virus that has caused a large number of deaths in the United States since the first outbreak in New York City in 1998. The outbreak initially was limited to the northeast but has since spread across the entire continental United States. WNV causes a variety of clinical symptoms, but the most severe consequences result from central nervous system infection, resulting in meningitis, encephalitis, or meningoencephalitis. We present a case of a 62-year-old male with metastatic cancer, who died as a result of WNV encephalitis. This is followed by a discussion on the epidemiology of WNV and a detailed summary of the methods and resources available to make a diagnosis of WNV infection postmortem. The material presented in the discussion should provide the forensic pathologist with all the information necessary to make a diagnosis of WNV infection postmortem. If nothing else, the routine collection and storage of serum, cerebrospinal fluid, and tissue for every case can enable the forensic pathologist to make this diagnosis even in cases in which WNV is not suspected until after autopsy.

The increasingly complex subclassification of tumors based on clinical and molecular characteristics, as well as the large sample sizes needed for clinical trials, pose new challenges to the recruitment of patients for studies. Currently, less than 10% of all cancer patients are enrolled in clinical trials, limiting their external validity, but also leaving room for improvement in the recruitment of patients. Clinical trials are often complicated by low inclusion rates, inadequate data collection, high non-completion rates and costs, and often provide insufficient data for post-hoc subgroup analyses. We believe that a prospective observational cohort study can provide standardized and validated collection of clinical data, tissue and blood samples and patient-reported outcome measures, and can improve patient recruitment for clinical trials. The Prospective Dutch ColoRectal Cancer cohort is a prospective multidisciplinary nation-wide observational cohort study in the Netherlands, a country with a yearly colorectal cancer incidence of 15,000 patients. The goal of the study is to facilitate future basic, translational and clinical research in the field of colorectal cancer for both national and international research groups with short or absent inclusion periods, even for studies with stringent inclusion criteria. All patients &amp;gt; 18 years with histologically proven colorectal cancer are asked to participate. Four essential features characterize the study: 1) a patient-centered informed-consent approach; 2) a framework to systematically collect long-term clinical follow-up and patient-reported outcomes; 3) an infrastructure for the standardized collection and storage of tissue and blood samples and 4) efficient recruitment for clinical trials which is facilitated by the innovative cohort multiple randomized controlled trial (cmRCT) design. The cmRCT design allows patients to participate in multiple non-conflicting clinical trials. We believe that the key to the development of a sustainable cohort study is the collaboration with existing organizations using their expertise, and preventing duplicate data entry and unnecessary costs. To these ends, close collaborations with other national initiatives, like the national cancer registry (hosted by IKNL), the national pathology registry PALGA, and the national biobanking infrastructure BBMRI-NL have been established. An effective governance structure to secure the privacy of patients and hospitals, and to facilitate research is needed. This study will provide long-term clinical data, tissue and blood samples, and patient-reported outcome measures collected under a broad informed consent, of a large cohort of patients with colorectal cancer. The available data and tissue will facilitate basic, translational and clinical research. Furthermore, the design of this cohort study can be used as an example for other tumor types. Citation Format: Robert R.J. Coebergh van den Braak, Geraldine R. Vink, Martijn G.H. van Oijen, Mirre E. de Noo, Sophie A. Kurk, Maarten J.P. Burbach, Alice M. Couwenberg, Anne M. May, Helena M. Verkooijen, Gerrit A. Meijer, Miriam Koopman. The prospective Dutch colorectal cancer cohort: A prospective nation-wide observational cohort study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1827.