tag:blogger.com,1999:blog-44423161778116326742024-03-19T01:31:29.678-04:00My Voice: Laryngectomy and Head and Neck Cancer InformationCreated by Itzhak Brook MD a physician and a laryngectomee. It contains information about head and neck cancer, life after laryngectomy, and manuscripts and videos about Dr. Brook's personal experiences as a patient with throat cancer. It has information about side effects of radiation and chemotherapy; methods of speaking; airway, mucus, stoma, voice prosthesis; eating and swallowing; medical, dental and psychological issues; respiration; anesthesia; travelling; and COVID-19.Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.comBlogger152125tag:blogger.com,1999:blog-4442316177811632674.post-28187295484422726742024-02-20T18:17:00.000-05:002024-02-20T18:17:36.682-05:00Decisional Conflict in Patients with Advanced Laryngeal Carcinoma<p><span style="font-family: Arial, sans-serif;">Heirman and colleagues from the Department
of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam,
<a href="https://pubmed.ncbi.nlm.nih.gov/38366759/" target="_blank">studied the decision conflict in patients with a</a> locally advanced laryngeal
carcinoma (T3 and T4). The decision is challenging due to the treatment choice
between organ preservation and laryngectomy, both with different and high
impact on function and quality of life (QoL). The complexity of these treatment
decisions and their possible consequences might lead to decisional conflict
(DC). This study aimed to explore the level of DC in locally advanced laryngeal
carcinoma patients facing curative decision-making, and to identify possible
associated factors.</span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Participants completed questionnaires on
DC, level of shared decision-making (SDM), and a knowledge test directly after
counseling and 6 months after treatment. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Directly after counseling by their
medical providers, almost all participants (44/45; 98%) experienced clinically significant
DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%)
correct on the knowledge test. Questions related to radiotherapy were answered
best (SD 69%), whilst only 35% (SD 29%) of the questions related to
laryngectomy were answered correctly. Patients' perceived level of SDM (scale
0-100) was 70, and for physicians this was 70 .<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The authors concluded that most patients
with advanced larynx cancer experience high levels of DC. Low knowledge levels
regarding treatment aspects indicate a need for better patient counseling.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_vQmCcuMBiVsT-HYhWUr5DGe_A1dmTvZOeHAHVT3xYl7lTuUiyLF0lbE6p9dzx6C0m5_PRyn0eATODWOTb-bxTLRikvSd_fWCUS0kqIjB4RdpwY2AyRUizCt29I_a5Nbf8sM8X6E8pyhfQa8iD4muBXoE8HVu66QayYW-FII6kl9ujCO7MPlxfplcBMF4/s400/dahl-morals-400.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="264" data-original-width="400" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_vQmCcuMBiVsT-HYhWUr5DGe_A1dmTvZOeHAHVT3xYl7lTuUiyLF0lbE6p9dzx6C0m5_PRyn0eATODWOTb-bxTLRikvSd_fWCUS0kqIjB4RdpwY2AyRUizCt29I_a5Nbf8sM8X6E8pyhfQa8iD4muBXoE8HVu66QayYW-FII6kl9ujCO7MPlxfplcBMF4/s320/dahl-morals-400.jpg" width="320" /></a></div><br /><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-61658064778287838072024-01-27T11:24:00.001-05:002024-01-27T11:24:13.965-05:00A poem by Anne Pitkin about life challenges of Laryngectomee published in JAMA in the Healing and Poetry Section January 23, 2024<p> <i style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;">You can do everything you did before except swim.</i></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;">If you swim, water will flood your lungs</i></div><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;"> through the hole in your neck.</i></div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445063" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">I can buzz Like a swarm of hornets.</div><div class="line" style="box-sizing: inherit;">I can see and I can hear.</div><div class="line" style="box-sizing: inherit;">I can walk into a store and buy groceries.</div><div class="line" style="box-sizing: inherit;">I can answer the phone. I can talk</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445064" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">in a voice not my own, not the instrument</div><div class="line" style="box-sizing: inherit;">by which I think out loud to learn what I am thinking,</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445065" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">the instrument by which you might have known me,</div><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;"> </i>by which I taught my classes, called the dog, loved—</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445066" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">the instrument I songed with, guffawed with</div><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;"> </i>so people could hear me coming,</div><div class="line" style="box-sizing: inherit;">the instrument with which I imitated Ethel Merman,</div><div class="line" style="box-sizing: inherit;">Florence Foster Jenkins, Martin’s parrot,</div><div class="line" style="box-sizing: inherit;">My seventh-grade teacher saying through her nose</div><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;"> I am so tired of the asinine things you kids do…</i></div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445067" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">I am an iceberg’s tip, my substance mute,</div><div class="line" style="box-sizing: inherit;">the moon without a shadow, a grove without wind or birds,</div><div class="line" style="box-sizing: inherit;">a street without nuance.</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445068" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">What used to be fluid lines of speech puddle unfinished,</div><div class="line" style="box-sizing: inherit;">the whispered aside, the quick wisecrack beyond me.</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445069" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">I used to love telling the story of the drunken Brits</div><div class="line" style="box-sizing: inherit;">awaiting the end of the world, counting down,</div><div class="line" style="box-sizing: inherit;">ten, nine, eight…all the way to 1—a pause</div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445070" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">my best cockney,</div><div class="line" style="box-sizing: inherit;"><i style="box-sizing: inherit;">Well, it ain’t the conflagration we’d been bankin’ on.</i></div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445071" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">And it ain’t.</div><div class="line" style="box-sizing: inherit;">Someone online said, <i style="box-sizing: inherit;">I’d rather die.</i></div></div></div><p style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><a class="article-section-id-anchor" id="249445072" style="box-sizing: inherit; color: #981b1e; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px; transition: all 0.15s ease-in-out 0s;"></a><span style="color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;"></span><p class="para" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-feature-settings: "liga", "dlig"; font-size: 16px; line-height: 1.7; margin: 0px 0px 1.25em; overflow-wrap: break-word;"></p><div class="poemSection" style="box-sizing: inherit; color: #333333; font-family: "Guardian TextSans Web", "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 16px;" xmlns:ml="http://www.w3.org/1998/Math/MathML"><div class="stanza" style="box-sizing: inherit;"><div class="line" style="box-sizing: inherit;">I did not. I am here. I am telling you this.</div><div class="line" style="box-sizing: inherit;"><br /></div><div class="line" style="box-sizing: inherit;">Anne Pitkin</div><div class="line" style="box-sizing: inherit;"><br /></div><div class="line" style="box-sizing: inherit;">Read the original <a href="https://jamanetwork.com/journals/jama/fullarticle/2814129 " target="_blank">publication in JAMA </a></div><div class="line" style="box-sizing: inherit;"><br /></div><div class="line" style="box-sizing: inherit; text-align: center;"><br /></div><div class="line" style="box-sizing: inherit; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZUsLkDaKBTfVGeLO4k2h8i5PzLzgmow8sA7y7l3kKkUQOUkqUFw2IznfwbXjSAn-qMkldJfK1hxpyZj_JfdLxca7z0E7QxhqL7562xDepBknYwOs28PlacVLjUxgzmKnFn3Ov8XRbXJo-8pdw4VIWHPFZjX6pv4aV4vkGBln2awNAt6Df8iCMi5Upyq4e/s1275/MV5BNmMwYmE2MTctMDU3Yi00OTdmLTk0YTItZGE4ZjU3ZGFkMWRkXkEyXkFqcGdeQXVyMDYxMTUwNg@@._V1_.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="847" data-original-width="1275" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZUsLkDaKBTfVGeLO4k2h8i5PzLzgmow8sA7y7l3kKkUQOUkqUFw2IznfwbXjSAn-qMkldJfK1hxpyZj_JfdLxca7z0E7QxhqL7562xDepBknYwOs28PlacVLjUxgzmKnFn3Ov8XRbXJo-8pdw4VIWHPFZjX6pv4aV4vkGBln2awNAt6Df8iCMi5Upyq4e/s320/MV5BNmMwYmE2MTctMDU3Yi00OTdmLTk0YTItZGE4ZjU3ZGFkMWRkXkEyXkFqcGdeQXVyMDYxMTUwNg@@._V1_.jpg" width="320" /></a></div><br /><div class="line" style="box-sizing: inherit; text-align: center;"><br /></div><div class="line" style="box-sizing: inherit;"><br /></div><div class="line" style="box-sizing: inherit;"><br /></div></div></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-70942359496343364222024-01-07T17:03:00.003-05:002024-01-22T11:51:14.884-05:00Artificial Intelligence helping laryngectomees to speak again<p> The developments in artificial intelligence
led to developments that can help laryngectomees use new ways by which they can
speak again. Most of these methods are in the developmental stages. However, some,
such as Google Duplex is available today.</p><p class="MsoNormal" style="line-height: 150%;"><o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;"><a href="https://www.techtarget.com/whatis/definition/Google-Duplex#:~:text=Google%20Duplex%20is%20an%20artificial,calls%20on%20a%20person's%20behalf" target="_blank"><b>Google Duplex </b></a>is an artificial
intelligence (AI) technology that mimics a human voice and makes phone calls on
a person's behalf. It enables users to perform a variety of tasks -- including
make reservations, schedule appointments and perform other functions -- without
having to speak to someone.<o:p></o:p></p><p class="MsoNormal" style="line-height: 150%;"><a href=" https://whispp.com/ " target="_blank"><b>Whispp’s</b> language independent AI
technology</a> and calling app converts whispered speech and vocal cord impaired
speech into a clear and natural voice of one’s choice, without any delay. By
providing recordings, one’s Whispp voice can sound like the person’s own
healthy voice.<o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;">Other methods of generating speech
are under development. <a href="https://pubmed.ncbi.nlm.nih.gov/37127759/" target="_blank"><b>Tank and his colleague</b>s</a> from the University of Texas at
Austin, have developed a non-invasive language decoder that can reconstruct
speech from functional MRI data. This technology can one day help people who
have lost their ability to speak called a semantic decoder. <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;"><a href="https://www.laronix.com/?fbclid=IwAR1TidjMAlrc4neHhmQqM5PrOifKJUas0VBAs4FyRlpsu3urFLm1dpD4ltQ" target="_blank"><b>The Australian start-up Laronix</b></a> is
developing a bionic device that uses AI-based voice-cloning technology to
restore the voices of laryngectomees.</p><p class="MsoNormal" style="line-height: 150%;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5f7QOIX9S28PXPkO4HIC3f5ysIHD1wTFCpfRP81lMD2RPEhmAd-58nBudLenHa-kiLfXilfXtE-U9NZ_pYdUJFTMB9ULW3mUWrpSxZmdH-GfYW3yfqcXAzDG0s25Pk41R2uaSbW38V1xNTfK1yzg9RybEjOo5iWE3IHBmjYbWpiJJwVrRhzKdCJ-v0iOR/s1200/artificial-intelligence-featured-image.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="630" data-original-width="1200" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5f7QOIX9S28PXPkO4HIC3f5ysIHD1wTFCpfRP81lMD2RPEhmAd-58nBudLenHa-kiLfXilfXtE-U9NZ_pYdUJFTMB9ULW3mUWrpSxZmdH-GfYW3yfqcXAzDG0s25Pk41R2uaSbW38V1xNTfK1yzg9RybEjOo5iWE3IHBmjYbWpiJJwVrRhzKdCJ-v0iOR/s320/artificial-intelligence-featured-image.png" width="320" /></a></div><br /><p class="MsoNormal" style="line-height: 150%; text-align: center;"><br /></p><p class="MsoNormal" style="line-height: 150%;"><br /></p><p class="MsoNormal" style="line-height: 150%;"> <o:p></o:p></p>
<p class="MsoNormal" style="line-height: 150%;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-66372210537490784622023-12-29T12:39:00.000-05:002023-12-29T12:39:09.585-05:00Dysautonomia in oral and head and neck cancer patients<p>Dysautonomia is an umbrella term referring to a group of
several medical conditions that cause a malfunction of the Autonomic Nervous
System (ANS). This is the part of the nervous system that controls automatic
processes or the things that one’s body does without having to think about
them, such as heart rate, blood pressure, digestion, dilation, and constriction
of the pupils of the eye, kidney function, and temperature control. Dysautonomia
can be acute and reversible or non-reversable, chronic and progressive.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Dysautonomias in adults often are associated with, and may
be secondary to, another disease process or a drug. Common secondary causes
include medications, chemotherapy, radiation treatments, spinal cord or head
injury, or diabetes .<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Oral, head and neck cancer patients that receive radiation
as part of their treatments, can have varying degrees of scatter radiation to
these structures, and years after treatment develop some of the manifestations
of dysautonomia. When the ANS doesn’t work as it should, it can cause heart and
blood pressure problems, trouble breathing, and loss of bladder control among
other symptoms.<o:p></o:p></p>
<p class="MsoNormal">People living with various forms of dysautonomia have
trouble regulating some of the ANS systems, which can result in
lightheadedness, fainting, unstable blood pressure, abnormal heart rates, and malnutrition.<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Balance Problems<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Fatigue<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Nausea, Vomiting, GI Trouble<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Irregular Heart Rate and Blood
Pressure<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Fainting/ Loss of Consciousness<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Lightheadedness, Dizziness,
Vertigo<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Brain Fog/ Forgetfulness<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">● Exercise intolerance<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">Patients with autonomic disorders
usually require a multi-disciplinary team, as autonomic disorders can impact
almost every organ and system of the body. While each specialist will have his
or her own areas of expertise, it is still important for each member of the
patient’s team to be familiar with the most up-to-date information on the
patient’s autonomic disorder.<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">There is no cure for
dysautonomia. Secondary forms of dysautonomia may improve with treatment of the
underlying disease. The best that can be done is to deal with the various
manifestations of it and their individual symptoms. Treating symptomology is not
the same as treating the disease and is a coping mechanism not a cure.
Lifestyle changes will be necessary for many of the symptoms to be reduced or
mitigated.<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal;">Read more about dysautonomia at <a href="https://thedysautonomiaproject.org/dysautonomia/">https://thedysautonomiaproject.org/dysautonomia/</a>
<o:p></o:p></p>
<br /><p class="MsoNormal" style="line-height: normal;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTa8ANzfsAoGjsYluTxnNR83hurd2sCd9tIlzGW30z6NHuN43ieclTzZCLgbRPDNkpa5l0ZLUEmnB5LRNVAG4itSVF_j98Wt1mqu5p3OWRsa7NFF-JMhy1y-AmkvMW0iV9te6u37gvwa3Ldk81yjMybhWPBH29TsOV_vgYH5ELrdtLLh7c2_-CNa2iPsUq/s747/Dysautonomia-Awareness-747x620.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="620" data-original-width="747" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTa8ANzfsAoGjsYluTxnNR83hurd2sCd9tIlzGW30z6NHuN43ieclTzZCLgbRPDNkpa5l0ZLUEmnB5LRNVAG4itSVF_j98Wt1mqu5p3OWRsa7NFF-JMhy1y-AmkvMW0iV9te6u37gvwa3Ldk81yjMybhWPBH29TsOV_vgYH5ELrdtLLh7c2_-CNa2iPsUq/s320/Dysautonomia-Awareness-747x620.jpg" width="320" /></a></div><br /><p class="MsoNormal" style="line-height: normal; text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-83566834277947524042023-12-16T13:47:00.008-05:002023-12-16T14:06:25.705-05:00 Patients requiring multiple dilations are at increased risk of persistent dysphagia long-term.<p> </p><p class="MsoNormal">Following total laryngectomy (TL) or laryngopharyngectomy
(TLP), patients may develop strictures that Head Neck require multiple
dilations to treat. However, the risk factors associated with dysphagia
refractory to a single dilation are unknown.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p>Cortina et al from the Massachusetts Eye and Ear, Boston, studied the risk factors to requiring dilations after TL/TLP. 49 patients who underwent at least one stricture dilation after TL/TLP between
March 2013 and March 2022 were evauated. Thirty-five
(71%) patients underwent multiple dilations. Pharyngocutaneous fistula, primary
chemoradiation therapy, and a shorter time interval from TL/TLP to first
dilation were independently associated with dysphagia requiring multiple
dilations. Patients in the multiple dilations group had a higher rate of
limited diet and G-tube dependence compared to patients in the single dilation
group.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The authors concluded that shorter time interval to
stricture formation is a prognostic indicator of the need for multiple
dilations following TL/TLP. Patients requiring multiple dilations are at
increased risk of persistent dysphagia long-term.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbFQCMX4NdajhFsO8IAFUqU_Bj_x8QJOSqoKa08bC7rjWcKUAGnsuUUD8WPhJZleJJS7KazkVHRAokRXAlrRtsbFIvQzdSjkjb-lNSlgzDiq2ynchLpZBlhZWgf7zbPeOLIeJHIaPiw1Dju8MpzVReOYnF7uezzxKHUlCmv2L3eG_alCixj81IExKZP1Ns/s350/350x250_ezd_balloons.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="250" data-original-width="350" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbFQCMX4NdajhFsO8IAFUqU_Bj_x8QJOSqoKa08bC7rjWcKUAGnsuUUD8WPhJZleJJS7KazkVHRAokRXAlrRtsbFIvQzdSjkjb-lNSlgzDiq2ynchLpZBlhZWgf7zbPeOLIeJHIaPiw1Dju8MpzVReOYnF7uezzxKHUlCmv2L3eG_alCixj81IExKZP1Ns/s320/350x250_ezd_balloons.jpg" width="320" /></a></div><br /><p class="MsoNormal" style="text-align: center;">Endoscopic dilation balloon</p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-15122832098503207912023-11-06T13:39:00.001-05:002023-11-06T13:39:08.728-05:00Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety after Laryngectomy<p> </p><p class="MsoNormal"><a href="https://pubmed.ncbi.nlm.nih.gov/34490903/" target="_blank">Wulff and colleagues from Zealand University Hospital,</a> Køge,
Denmark.; determine health-related quality of life (HRQoL), including voice
problems, dysphagia, depression, and anxiety after total laryngectomy, and
investigate the associations between HRQoL and the late effects.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The 172 participants scored worse than normative reference
populations on all scales/itemss, except one, and almost half of the
scales/items showed a clinically relevant difference. Moderate/severe dysphagia
was present in 46%, moderate/severe voice problems in 57%, depression in 16%,
and anxiety in 20%. Younger age, increasing numbers of comorbidities,
increasing voice problems, increasing dysphagia, and increasing depression
symptoms, were associated with a lowered EORTC QLQ-C30 summary score.<o:p></o:p></p>
<p class="MsoNormal">The study illustrated that a substantial proportion of
participants experienced clinically significant late effects and increasing
levels of these were associated with a lowered HRQoL.<o:p></o:p></p><p class="MsoNormal" style="text-align: center;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDILcDwZ6uzBZY7KUpiJ9adnwNODCjCkmUB9W7WHea6UdoeYOmJkSPvm250AB3XH-1SfwicV_xwOpADY0Ez1PlxfRBoqwwatLO4tZ-U2dciktNAonfD58Knfy7p0genL98_HgY33LiLiTAH-sCvVbA-8Nsu1iihfS-inFUt6W2HVns1QrR2eHEYbIwQDoV/s1000/quality%20of%20life%20shutterstock_265671650.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="455" data-original-width="1000" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDILcDwZ6uzBZY7KUpiJ9adnwNODCjCkmUB9W7WHea6UdoeYOmJkSPvm250AB3XH-1SfwicV_xwOpADY0Ez1PlxfRBoqwwatLO4tZ-U2dciktNAonfD58Knfy7p0genL98_HgY33LiLiTAH-sCvVbA-8Nsu1iihfS-inFUt6W2HVns1QrR2eHEYbIwQDoV/w360-h216/quality%20of%20life%20shutterstock_265671650.jpg" width="360" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal"><br /></p>
<br />Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-57660141878197293042023-11-02T12:04:00.004-04:002023-11-02T16:38:40.161-04:00Loneliness and quality of life in head and neck cancer patients<p> </p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Patients with head and neck cancer (HNC) are at risk of loneliness
because of the effects of the disease and its treatment on important social
interactive functions such as appearance, speech, facial expression, and
eating. <a href="https://pubmed.ncbi.nlm.nih.gov/32665074/ " target="_blank">Dahill and colleagues from Aintree University Hospital,</a> Liverpool, UK,
evaluated the association between loneliness and the quality of life, mental
illness, physical health, and premature mortality. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The investigators survived 140 patients treated for primary
squamous cell HNC between 2015 and 2016. Tumor sites were oropharyngeal (42%),
oral (35%), laryngeal (14%), and elsewhere (9%). <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">In response to the question "<i>How often do you feel
lonely?"</i> three-quarters said "<i>hardly ever"</i> and only
6% <i>"often</i>". Similar responses were obtained for the other
three indicator questions. It is encouraging that a relatively small proportion
had serious issues with loneliness. Similarly, one-quarter had feelings of
loneliness and a minority had serious problems. Patients who were younger, who
lived in more deprived circumstances, who had advanced disease and had been
treated with chemotherapy or radiotherapy reported greater levels of
loneliness. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The study showed that loneliness was associated with a worse
overall quality of life, and worse physical and social-emotional function. Dahill
and colleagues recommended that lonely patients need to be identified as early
as possible so that <a href="https://dribrook.blogspot.com/p/overcoming-depression-after.html" target="_blank">support and interventions </a>can be implemented and outcomes
improved. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Information about support and interventions to help individuals with HNC <a href="https://dribrook.blogspot.com/p/overcoming-depression-after.html" target="_blank">click this link</a>. </span></p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIbxcMSom9kz5DSOdDX1b555XLdfCwwQAo-c8pS8xu_Rb2nIe3e8gw9uW1Mox0BBrs1iw_7tkfLFN2FwUhqXavThcMy0_1uJeCN-ESz5Fibs8I6IyGmDTQc9rKN-aZdRS2b8jBvo_c2CXTofmqUXpQcs2rFrOHTmMRjx1DbyBuNgI_OY-HxLUzqzKW4xP7/s1920/older-2864181_1920sml.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1920" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIbxcMSom9kz5DSOdDX1b555XLdfCwwQAo-c8pS8xu_Rb2nIe3e8gw9uW1Mox0BBrs1iw_7tkfLFN2FwUhqXavThcMy0_1uJeCN-ESz5Fibs8I6IyGmDTQc9rKN-aZdRS2b8jBvo_c2CXTofmqUXpQcs2rFrOHTmMRjx1DbyBuNgI_OY-HxLUzqzKW4xP7/w359-h238/older-2864181_1920sml.jpg" width="359" /></a></div><br /><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-84780123390453522152023-10-28T16:07:00.001-04:002023-11-02T12:14:31.047-04:00Tobacco Cessation Following Laryngeal Cancer Diagnosis Predicts Response to Treatment and Laryngectomy-Free Survival<p>Krutz and colleagues from the University of Oklahoma Health
Sciences Center s<a href="https://pubmed.ncbi.nlm.nih.gov/37890055/" target="_blank">tudied the effect of tobacco cessation following laryngealcancer diagnosis</a> on response to first-line therapy, laryngectomy-free survival,
and overall survival in patients who were current smokers at the time of
diagnosis.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The authors evaluated 140 patients diagnosed with laryngeal
squamous cell carcinoma, who were smokers at the time of diagnosis, and were
treated with first-line definitive radiation or chemo/radiation with the intent
to cure. <o:p></o:p></p>
<p class="MsoNormal">Of the 140 current smokers, 61 patients (45%) quit smoking
prior to treatment initiation. Smoking, quitters had 3.7 times higher odds of
achieving a complete response to first-line therapy than active smokers (odds
ratio: 3.694 [1.575-8.661]; P = .003). <span style="mso-spacerun: yes;"> </span>Quitters
were 54% less likely to require salvage laryngectomy within 7 years of
diagnosis than active smokers (hazard ratio: 0.456 [0.246-0.848]; P = .013).
Quitters had a statistically significant increase in 7-year overall survival
compared to active smokers (P = .02).<o:p></o:p></p>
<p class="MsoNormal">This is the first study to show that in newly diagnosed
laryngeal cancer patients who are current smokers at the time of diagnosis,
tobacco cessation significantly increases therapy response, laryngectomy-free
survival, and overall survival. These data stress the importance of
systematically incorporating tobacco cessation programs into laryngeal cancer
treatment plans.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibvFyK29rMWVFrdU-utEEwtv3P97Gs8CQP1uvLmVSHIqmPSNFb2IlPPPCDLfP0S0t4nlcbliMYyOnjB0yuw4bP1xBpswa02Xs6ST2LG6Jarw4E8y2OyVv2Gwo_PmTS4ioV6tCgTkmCZlrhF8Q-gyXf210LvLqwElnjcpdwMLEONs6gKTsQKuhxtlF8LXHw/s1840/8bqkvzw-gucbtthzfcrcwq.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1040" data-original-width="1840" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibvFyK29rMWVFrdU-utEEwtv3P97Gs8CQP1uvLmVSHIqmPSNFb2IlPPPCDLfP0S0t4nlcbliMYyOnjB0yuw4bP1xBpswa02Xs6ST2LG6Jarw4E8y2OyVv2Gwo_PmTS4ioV6tCgTkmCZlrhF8Q-gyXf210LvLqwElnjcpdwMLEONs6gKTsQKuhxtlF8LXHw/w346-h224/8bqkvzw-gucbtthzfcrcwq.jpg" width="346" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p class="MsoNormal"><br /></p>
<br />Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-57298671440372612442023-09-30T16:47:00.001-04:002023-09-30T16:52:16.510-04:00Who is the best surgeon and what is the best place to have laryngectomy?<p> </p>
<p class="MsoNormal">Saraswathula<span style="mso-spacerun: yes;"> </span>from
Johns Hopkins University in Baltimore, and colleagues <a href="https://pubmed.ncbi.nlm.nih.gov/35634691/" target="_blank">evaluated therelationship between surgeon volume</a> and operative morbidity and mortality for
laryngectomy.<o:p></o:p></p>
<p class="MsoNormal">The Nationwide Inpatient Sample was used to identify 45,156
patients who underwent laryngectomy procedures for laryngeal or hypopharyngeal
cancer between 2001 and 2011. <o:p></o:p></p>
<p class="MsoNormal">The authors found that higher-volume surgeons were more
likely to operate at large, teaching, nonprofit hospitals and were more likely
to treat patients who were white, had private insurance, hypopharyngeal cancer,
low comorbidity, admitted electively, and to perform partial laryngectomy,
concurrent neck dissection, and flap reconstruction. Surgeons treating more
than 5 cases per year were associated with lower odds of medical and surgical
complications, with a greater reduction in the odds of complications with
increasing surgical volume. Surgeons in the top volume quintile (>9
cases/year) were associated with a decreased odds of in-hospital mortality (OR
= 0.09 [0.01-0.74]), postoperative surgical complications (OR = 0.58
[0.45-0.74]), and acute medical complications (OR = 0.49 [0.37-0.64]). Surgeon
volume accounted for 95% of the effect of hospital volume on mortality and
16%-47% of the effect of hospital volume on postoperative morbidity.<o:p></o:p></p>
<p class="MsoNormal">The authors concluded that there is a strong volume-outcome
relationship for laryngectomy, with reduced mortality and morbidity associated
with higher surgeon and higher hospital volumes. Observed associations between
hospital volume and operative morbidity and mortality are mediated by surgeon
volume, suggesting that surgeon volume is an important component of the
favorable outcomes of high-volume hospital care. <o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDY4Y38o0cG6uqPHUKLSymWxDDbdFmis3_jjBHJV-RzeF7TkhCEFP61YCf3OYUJGXuLPRJNgFPlUcTVJjvGKbOLj3HU0USamzk9CH0uRT2XeLuo4VTqbFpnYoTMg1-xZMbAz2-XW7jLBV4n_KdPvTGhyphenhyphendR5zwnd6upSxUkaDScNZ3O-PAN6yNvxdR-5Htn/s648/1503353282643.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="364" data-original-width="648" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDY4Y38o0cG6uqPHUKLSymWxDDbdFmis3_jjBHJV-RzeF7TkhCEFP61YCf3OYUJGXuLPRJNgFPlUcTVJjvGKbOLj3HU0USamzk9CH0uRT2XeLuo4VTqbFpnYoTMg1-xZMbAz2-XW7jLBV4n_KdPvTGhyphenhyphendR5zwnd6upSxUkaDScNZ3O-PAN6yNvxdR-5Htn/s320/1503353282643.jpg" width="320" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-18893385075134132772023-08-16T11:50:00.002-04:002023-08-16T11:54:23.957-04:00Fatal Tracheoesophageal Puncture Leakage Associated With Lenvatinib.<p></p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Fatal tracheoesophageal puncture leakage associated with Lenvatinib
treatment was reported by <a href="https://www.cureus.com/articles/163441-fatal-tracheoesophageal-puncture-leakage-associated-with-lenvatinib#!/" target="_blank">Salvatori S. and Tanvetyanon<span style="mso-spacerun: yes;"> </span>T. </a><span style="mso-spacerun: yes;"> </span>from
Moffitt Cancer Center and Research Institute, Tampa, FL. The report was
published in Cureus [15(8): e43490].</span><span face="Arial, sans-serif" style="font-size: 12pt;"> </span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Tracheoesophageal puncture (TEP) is a voice restorative is often
used in laryngectomees. Though generally safe, TEP may develop leakage.
Lenvatinib is a tyrosine kinase inhibitor (TKI) with anti-tumoral activity
against head and neck malignancies. TKIs, including lenvatinib, have been
associated with organ perforation or fistula formation. The authors described a
patient with adenoid cystic carcinoma of the larynx who had a TEP for several
years. After approximately two weeks of treatment with lenvatinib, the patient
developed a leakage of TEP. Despite several interventions, the patient died
three months afterward due to a retropharyngeal abscess secondary to <i>Fusobacterium
nucleatum </i>infection. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">To the authors’ knowledge, this is the first report of fatal
lenvatinib-associated TEP leakage. They urge clinicians to be cognizant of the potentially rapid development of this complication when prescribing TKI for
patients with TEP.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="font-size: 12pt; line-height: 150%; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><o:p> </o:p></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="line-height: 150%;"></span></p><div class="separator" style="clear: both; font-family: Arial, sans-serif; font-size: 12pt; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvD2-cwneqRQ6meXRltdSJ6gFP-VVV4Kc7KIqdFAXLRTBxkRODP7A2q_cZTLat4fQZKlm_Qy4624xWilBXoPoX-3HpBcaA3Jr_5QFFl5dpMbqNb952gxS0GoqG6mDDO6sttGLm2uNuwCAKcuBk4hvEoPQiyF0GmuxSvIZDBXlefZYsgLAaZzM0FgXFu4gb/s314/leakage-through-voice-prosthesis.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="250" data-original-width="314" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvD2-cwneqRQ6meXRltdSJ6gFP-VVV4Kc7KIqdFAXLRTBxkRODP7A2q_cZTLat4fQZKlm_Qy4624xWilBXoPoX-3HpBcaA3Jr_5QFFl5dpMbqNb952gxS0GoqG6mDDO6sttGLm2uNuwCAKcuBk4hvEoPQiyF0GmuxSvIZDBXlefZYsgLAaZzM0FgXFu4gb/s1600/leakage-through-voice-prosthesis.webp" width="314" /></a></div><br /><o:p><span style="background-color: white;"><span face="Raleway, Arial, Helvetica, sans-serif" style="color: #333333;"><span style="font-size: 14px;"><b>Leakage through voice prosthesis barrel (central leakage):</b></span></span></span></o:p><p></p>
<p class="MsoNormal" style="line-height: 150%;"><br /></p><br /><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-14503907112690006232023-07-12T18:20:00.000-04:002023-07-12T18:20:05.930-04:00Quality of sexual life after total laryngectomy for cancer.<p><a href="https://pubmed.ncbi.nlm.nih.gov/37142505/ " target="_blank"> Babin</a> and colleagues from
the Department of Otolaryngology of the University of Caen France, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1879729623000510?via%3Dihub " target="_blank">reviewed 24 studies</a> that evaluated sexual life after total laryngectomy (TL) for cancer. The
main endpoint was the impact of impairment of quality of sexual life after TL.
The secondary endpoints were the type of sexual impairment, associated
variables and their treatment.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"> The study population
consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio
of 7.5/1. Impaired quality of sexual life was reported by 47% of patients on
average. Erectile and ejaculatory function and ejaculatory behavior of male
patients decreased after TL. Other impairments comprised decreases in libido,
frequency of sexual intercourse and satisfaction. Tracheostomy, advanced
disease stage, young age and associated depression were factors for impairment.
In all, 23% of patients reported lack of postoperative support in this area.<o:p></o:p></p>
<p class="MsoNormal">The authors concluded that laryngectomy impacted both
patients and partners, negative effects being reported in more than 30% of
cases. The physical transformation has aesthetic and emotional impact,
inhibiting sexuality. the quality of sexual life is severely impacted by TL for
cancer. There is patient demand for improved management of sexuality.<br /><o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPwzeWMW4m7WEFgbd6f38Je-GU6yVxCYR0Nc-SLEAhm0wUXxvcsMrE3_W5c9iqM1JEx-fDKxbeBnHLFK9pACc1PdTCnATn95Wax5v4iv2pCp9r_9uGezEiD06Od7A7CVLnSySUcirakSLnw-mJyoh-fFCeoQL7Bpns0_8a92XMon1FO5JLdAPTtmLmCh0Y/s940/how-to-say-i-love-you.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="788" data-original-width="940" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPwzeWMW4m7WEFgbd6f38Je-GU6yVxCYR0Nc-SLEAhm0wUXxvcsMrE3_W5c9iqM1JEx-fDKxbeBnHLFK9pACc1PdTCnATn95Wax5v4iv2pCp9r_9uGezEiD06Od7A7CVLnSySUcirakSLnw-mJyoh-fFCeoQL7Bpns0_8a92XMon1FO5JLdAPTtmLmCh0Y/s320/how-to-say-i-love-you.png" width="320" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p>
<span style="font-family: "Calibri",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-language: HE; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-51384020060045258132023-06-12T11:56:00.003-04:002023-06-12T12:14:11.760-04:00RESOURCES FOR LARYNGECTOMEES By Itzhak Brook MD , M Sc,<p> </p><p class="MsoNormal"><b>•<span style="mso-spacerun: yes;"> </span>The
Laryngectomee Guide. Paperback and Kindle at <span style="font-family: "Calibri",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://goo.gl/z8RxEt"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">http://goo.gl/z8RxEt</span></a> </span><span style="font-family: "Arial",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-bidi; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi;"> </span><span style="mso-spacerun: yes;"> </span>Free download at </b><a href="https://www.entnet.org/laryngectomee-guide/"><b>https://www.entnet.org/laryngectomee-guide/</b></a><b><span style="mso-spacerun: yes;"> </span>(helpful for new patients)<o:p></o:p></b></p>
<p class="MsoNormal"><b>The Laryngectomee Guide is available (Free eBooks) in 24
languages. </b><a href="https://dribrook.blogspot.com/2018/08/the-laryngectomee-guide-is-available-in.html"><b>https://dribrook.blogspot.com/2018/08/the-laryngectomee-guide-is-available-in.html</b></a><b>
<o:p></o:p></b></p>
<p class="MsoNormal"><b><o:p> </o:p></b></p>
<p class="MsoNormal"><b>•<span style="mso-spacerun: yes;"> </span>The
Laryngectomee Guide Expanded Edition, 5TH<span style="mso-spacerun: yes;">
</span>edition., Paperback and Kindle at </b><a href="https://www.amazon.com/dp/B0BBJPY5P2"><b>https://www.amazon.com/dp/B0BBJPY5P2</b></a><b><span style="mso-spacerun: yes;"> </span>Free download at </b><a href="https://bit.ly/3QGTqNa"><b>https://bit.ly/3QGTqNa</b></a><b><o:p></o:p></b></p>
<p class="MsoNormal"><b>(Recommended for seasoned patients)<o:p></o:p></b></p>
<p class="MsoNormal"><b><o:p> </o:p></b></p>
<p class="MsoNormal"><b>•<span style="mso-spacerun: yes;"> </span>The
“Laryngectomee Guide for COVID-19 Pandemic” provides information for
laryngectomee and neck breathers how to cope with the pandemic. The E books are
free. Available at <a href="https://amzn.to/3i5XncR">https://amzn.to/3i5XncR</a>
<span style="mso-spacerun: yes;"> </span>as paperback, and at<span style="mso-spacerun: yes;"> </span><a href="https://bit.ly/3hZHynb">https://bit.ly/3hZHynb</a>
<span style="mso-spacerun: yes;"> </span>as eBook (free).<o:p></o:p></b></p>
<p class="MsoNormal"><b><o:p> </o:p></b></p>
<p class="MsoNormal"><b>•<span style="mso-spacerun: yes;"> </span>“My Voice:
A Physician’s Personal Experience with Throat Cancer.” Paperback and Kindle at </b><a href="http://goo.gl/j3r51V"><b>http://goo.gl/j3r51V</b></a><b><span style="mso-spacerun: yes;"> </span>Free download at </b><a href="https://dribrook.blogspot.com/p/my-voice-physicians-personal-experience.html"><b>https://dribrook.blogspot.com/p/my-voice-physicians-personal-experience.html</b></a><b><span style="mso-spacerun: yes;"> </span><o:p></o:p></b></p>
<p class="MsoNormal"><b><o:p> </o:p></b></p>
<p class="MsoNormal"><b>•<span style="mso-spacerun: yes;"> </span>Rescue
breathing of neck breathers including laryngectomees<o:p></o:p></b></p>
<p class="MsoNormal"><b>Video:<span style="mso-spacerun: yes;"> </span><a href="https://www.youtube.com/watch?v=YE-n8cgl77Q">https://www.youtube.com/watch?v=YE-n8cgl77Q</a>
<span style="mso-spacerun: yes;"> </span><o:p></o:p></b></p>
<p class="MsoNormal"><b>Manual: <a href="https://bit.ly/3k1iRO5">https://bit.ly/3k1iRO5</a>
<span style="mso-spacerun: yes;"> </span><o:p></o:p></b></p>
<p class="MsoNormal" style="text-align: center;"><b><o:p> </o:p></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaVG4LGc_GAHo7jExVtO5cxImniA053hz1AXTJW9Nx8EULW7R0v3R2G9zD2mXvPyCUXsjGQWCKIRqcd7fKxGPSNQfJ3Iq2lto3BP_XzTH-SYTYyF4vqamd7ZdVkwidp7CKwlDTJ73cb1IDD1APCq_Hsu9PAlFq3HvGzLpPfkJl5c5vMMb0z3lIAFzMhQ/s831/links-resources.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="468" data-original-width="831" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaVG4LGc_GAHo7jExVtO5cxImniA053hz1AXTJW9Nx8EULW7R0v3R2G9zD2mXvPyCUXsjGQWCKIRqcd7fKxGPSNQfJ3Iq2lto3BP_XzTH-SYTYyF4vqamd7ZdVkwidp7CKwlDTJ73cb1IDD1APCq_Hsu9PAlFq3HvGzLpPfkJl5c5vMMb0z3lIAFzMhQ/s320/links-resources.jpg" width="320" /></a></b></div><b><br /></b><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-74085217598428377622023-05-05T12:45:00.004-04:002023-05-05T12:53:40.810-04:00 Pravastatin antifibrotic efficacy in reversing radiation-induced fibrosis after radiation therapy for head and neck cancer<p> </p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><a href="https://www.sciencedirect.com/science/article/abs/pii/S0360301619302500?fbclid=IwAR139h8ee0Rj2maK3-uvrvIUPMtL_824REAdPwvxG9urP1SDteEDx5K2GO0#:~:text=This%20trial%20showed%20that%20pravastatin,the%20concept%20of%20fibrosis%20reversibility" target="_blank">A prospective stud</a>y done by Celine Bourgier and colleagues
from Université de Montpellier, France; .showed that pravastatin (a statin) is
an efficient antifibrotic agent in patients with established cutaneous and
subcutaneous radiation-induced fibrosis (RIF) after radiation therapy for head
and neck cancer.</span><span face="Arial, sans-serif"> </span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The primary endpoint was reduction of RIF
thickness by more than 30% at 12 months, as measured by cutaneous
high-frequency ultrasonography. Secondary endpoints included RIF severity
reduction, pravastatin tolerance, and quality of life.</span><span face="Arial, sans-serif"> </span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Sixty patients were enrolled from February 2011 to
April 2016. The mean interval between RIF diagnosis and pravastatin initiation
was 17.1 months. Pravastatin was stopped before 11 months of treatment in 18
patients (because of grade ≥2 adverse events related to pravastatin in 8
patients [13%]). In the 40 patients in whom pravastatin efficacy was assessed
by high-frequency ultrasonography at baseline and at 12 months of treatment, a
reduction of RIF thickness ≥30% was observed in 15 of 42 patients (35.7%). At the 12-month clinical evaluation, RIF
severity was decreased in 50% of patients (n = 21), and the patients' self-perception, mood state, and social
functioning were significantly improved. Pravastatin was well tolerated.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><o:p> </o:p></span><span face="Arial, sans-serif">The authors concluded that this phase 2
prospective study supports the notion of radioinduced fibrosis reversibility.
It showed that pravastatin (40 mg/d for 12 months) is an efficient antifibrotic
agent in patients with grade ≥2 cutaneous and subcutaneous fibrosis after head and neck cancer radiation therapy.</span></p><p class="MsoNormal" style="line-height: 150%;"><span face="Arial, sans-serif"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheK8DOo4DH_R0IGsHCjl8LgRc8Agwze5xcbE0BUZHjFFfMuKwmzmT6T-QkVm4xEuPtA0lMJkhmbX-QNL4T-yYaIJYyLESSkirQPeaCtuav-HB5C5L8OAADcCGBp67szZNo6YvZKeeLoVBx_mrUZudcGyO8z63iG7iBgJzrrZLnYD3EghYDAM1Z-gCfVA/s600/6a920ade-ef3b-46b8-9cd1-83ac8660654a.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="450" data-original-width="600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheK8DOo4DH_R0IGsHCjl8LgRc8Agwze5xcbE0BUZHjFFfMuKwmzmT6T-QkVm4xEuPtA0lMJkhmbX-QNL4T-yYaIJYyLESSkirQPeaCtuav-HB5C5L8OAADcCGBp67szZNo6YvZKeeLoVBx_mrUZudcGyO8z63iG7iBgJzrrZLnYD3EghYDAM1Z-gCfVA/s320/6a920ade-ef3b-46b8-9cd1-83ac8660654a.jpg" width="320" /></a></div><br /><span face="Arial, sans-serif"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-37408836180611129342023-01-05T10:09:00.005-05:002023-10-22T14:38:00.139-04:00Hyperventilation in neck breathers including laryngectomees. <p> Hyperventilation can occur in neck breathers including
laryngectomees. Hyperventilation reduces the level of carbon dioxide in the
blood. It can upset the acid-base balance in the blood making it more alkaline.
The syndrome is characterized by repeated episodes of excessive ventilation in
response to fear, anxiety or panic. It can also occur during an orgasm or
intense sexual activity, as well as heavy physical activity.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Neck breathers are more prone to this condition because
rapid breathing ventilate the lungs quicker than in non-neck breathers as the
inhaled air enter the trachea through the stoma, bypassing the upper airways.<o:p></o:p></p>
<p class="MsoNormal">The existence of hyperventilation in laryngectomees <a href="https://drive.google.com/file/d/1jHClFRxzx7uQkoh2FnNyRBf7qe-7ioZs/view?usp=share_link" target="_blank">was evaluated by Brook </a>by sending a questioner to 256 laryngectomees. Fifty-four of the 72
individuals who return the questioner experienced one or more episodes of
hyperventilation. It was associated with heavy physical activity in 28 (51%)
individuals, sexual activity in 15 (38%), anxiety in 8 (15%), and intense
coughing in 7 (13%). The symptoms experienced were: fast or deep breathing in
all cases, shortness of breath (50 or 96%); anxiety, fear, panic, or strong
feeling of dread or doom (38 or 70%); dizziness (27 or 50%); generalized
weakness (16 or 30%); sweating (13 or 34%); fainting (4 or 7%); and chest pain
(4 or 7%).<o:p></o:p></p>
<p class="MsoNormal">This small survey illustrates that laryngectomees do experience
hyperventilation syndrome. <o:p></o:p></p>
<p class="MsoNormal">Further studies are warranted to prospectively evaluate the
incidence of hyperventilation in laryngectomees and other neck breathers. Such
studies may highlight the need to address, prevent and treat this condition in
laryngectomees.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXGd_sQt9TqHQJ-jOqCv9f5P9SA-Nbq-PiB_MDrSJIDn8I_s84NbOiGlF263k-pu0b_iBfRFuaKUGMXSGeZBj-vQFRxkjEaeJizFJlMwnb6ankrzQbqFklsWwYxZvASVxcEk91d0g7pqk4gOnv6zKizreOy6qy_-zJHDWpL-Wm6fkrBQQbXiVsoatOZw/s1200/323607_2200-1200x628.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXGd_sQt9TqHQJ-jOqCv9f5P9SA-Nbq-PiB_MDrSJIDn8I_s84NbOiGlF263k-pu0b_iBfRFuaKUGMXSGeZBj-vQFRxkjEaeJizFJlMwnb6ankrzQbqFklsWwYxZvASVxcEk91d0g7pqk4gOnv6zKizreOy6qy_-zJHDWpL-Wm6fkrBQQbXiVsoatOZw/s320/323607_2200-1200x628.webp" width="320" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-47556086687884660532022-11-07T19:10:00.002-05:002022-11-07T19:15:05.325-05:00First total laryngectomy by Theodor Billroth 150 years ago.<p> </p><p class="MsoNormal" style="line-height: normal; text-align: center;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">On December 31, 1873, in the Vienna
surgery clinic, the German surgeon <a href="https://www.sciencedirect.com/science/article/abs/pii/S1879729622001144?via%3Dihub " target="_blank">Theodor Billroth managed what no previous surgeon had been able to: complete a</a>blation of the larynx in a human
being, which quickly came to be known as “total laryngectomy”, without harmful
immediate consequences. Billroth dared what none before had done. He had come
to the conclusion that “the only way of saving life was to remove the entire
larynx.”<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This first total ablation of the larynx,
preceded by a tracheotomy, was one of the great surprises of 19th century
surgery.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: normal;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This was possible because of the prior
experimental study of laryngeal ablation performed in dogs by Vincent Czerny. The
French physician Henri Chouppe enthused: “when experimental studies lead to
practical results, one should hasten to do It”.<o:p></o:p></span></p><p class="MsoNormal" style="line-height: normal;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: normal; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLjinG-jn7B-mW9PP42PfkkiF2Dfsbxbjvu8S9JhE5klbS0KWZuiTQO30ArskDOhCg28o7MfXhdTj4k7KPcFlqf6UTdafUCL2Y4I21vNl-i7mJQ0CkrLRda-QCA1Ievw58uHvhnM8uZT7SlY7hKNmv2owNMN6USdPmjldBG40iuCWfM46wzoukmtWnzQ/s1320/293572036e6e964293b73fd84414fd8b.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1320" data-original-width="955" height="352" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLjinG-jn7B-mW9PP42PfkkiF2Dfsbxbjvu8S9JhE5klbS0KWZuiTQO30ArskDOhCg28o7MfXhdTj4k7KPcFlqf6UTdafUCL2Y4I21vNl-i7mJQ0CkrLRda-QCA1Ievw58uHvhnM8uZT7SlY7hKNmv2owNMN6USdPmjldBG40iuCWfM46wzoukmtWnzQ/w279-h352/293572036e6e964293b73fd84414fd8b.jpg" width="279" /></a></div><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><span style="font-family: "Arial",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-bidi; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi;"><div><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><span style="font-family: "Arial",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-bidi; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-bidi;"><br /></span></span></div><div style="text-align: center;"><a href="https://www.sciencedirect.com/science/article/abs/pii/S1879729622001144?via%3Dihub " style="font-family: "Times New Roman"; font-size: medium; text-align: left;" target="_blank"> </a> Theodor Billroth operating<span style="font-size: 11pt;"> </span></div></span></span><p></p>
<p class="MsoNormal" style="line-height: normal;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-46498547120011798952022-10-11T11:12:00.002-04:002022-10-11T11:13:57.287-04:00Comparison of anxiety and depressive of head and neck cancer patients before and during the 2019 coronavirus pandemic.<p> </p><p class="MsoNormal">Jiani Liu and colleagues from <span style="mso-spacerun: yes;"> </span>Sun Yat-sen University, Zhuhai, China, <span style="mso-spacerun: yes;"> </span><a href="https://pubmed.ncbi.nlm.nih.gov/36217615/" target="_blank">studied the effect of the COVID-19 pandemic o</a>n
the anxiety and depressive symptoms of cancer patients before and during the
2019 coronavirus pandemic.<o:p></o:p></p>
<p class="MsoNormal">A total of 526 head and neck cancer patients were included
in the final analysis; 27% of cases experienced anxiety and depression before the
pandemic and 50 % during the COVID-19 pandemic. (P=0.018). <o:p></o:p></p>
<p class="MsoNormal">The present study demonstrates the significant impact of
COVID-19 on the psychological states of cancer patients. This findings indicating
the need for appropriate changes in treatment decisions, enhanced
psychotherapy, and interventions to reduce the incidence of anxiety,
depression, and even suicide during the pandemic.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNwpjjns-Ok9N1n7FmT5FH-ygXjM0lPD0Foe-qbGBbkiHyo5F1zQ1N2EndkbMyQdH8PKOyPRuJe5isoGPGpJuxS24MAu4hMAp_YOsQqXHawyI3D-jHTr6VOV9QwyB77kSz5OkViNECPvs_iuRdxqY8kZqnfQuJNrlwsPIUNIAw-1Ub3pIhyFL6BpWIwQ/s297/download.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="170" data-original-width="297" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNwpjjns-Ok9N1n7FmT5FH-ygXjM0lPD0Foe-qbGBbkiHyo5F1zQ1N2EndkbMyQdH8PKOyPRuJe5isoGPGpJuxS24MAu4hMAp_YOsQqXHawyI3D-jHTr6VOV9QwyB77kSz5OkViNECPvs_iuRdxqY8kZqnfQuJNrlwsPIUNIAw-1Ub3pIhyFL6BpWIwQ/s1600/download.jpg" width="297" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-19168059666509858532022-08-23T18:22:00.001-04:002022-08-23T18:29:02.977-04:00"The 5th Edition of the Laryngectomee Guide Expanded Edition is available.<p><span color="windowtext" face="Arial, sans-serif">The 5th Edition of the Laryngectomee
Guide Expanded Edition is available now. The 325 pages Expanded Guide is an
updated and revised edition of the original Laryngectomee Guide. It is three
time larger than the original Guide and also contains information how
laryngectomees can protect themselves from COVID-19. It provides information
that can assist laryngectomees and their caregivers with medical, dental and
psychological issues. It contains information about side effects of radiation
and chemotherapy; methods of speaking; airway, stoma, and voice prosthesis
care; eating and swallowing; medical, dental and psychological concerns.</span></p>
<p class="MsoNormal"><span class="MsoHyperlink"><span color="windowtext" face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; text-decoration: none; text-underline: none;">The <a href="https://bit.ly/3QGTqNa" target="_blank">E Book is free for download. </a><o:p></o:p></span></span></p>
<p class="MsoNormal"><span class="MsoHyperlink"><span color="windowtext" face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; text-decoration: none; text-underline: none;">The Guide is also <a href="https://www.amazon.com/dp/B0BBJPY5P2" target="_blank">available in Amazon</a> <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></p>
<p class="MsoNormal"><span class="MsoHyperlink"><span color="windowtext" face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; text-decoration: none; text-underline: none;">Itzhak Brook MD <o:p></o:p></span></span></p><p class="MsoNormal"><span class="MsoHyperlink"><span color="windowtext" face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; text-decoration: none; text-underline: none;"><br /></span></span></p><p class="MsoNormal"><span class="MsoHyperlink"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG4Mc3zxtJrwuzK23iixsS6yu4t_AxOToLjq1NEQSAzLzhqSy8i0fgdX6ZbjvYButPP7NuWgTV1CkzZ1nvVAx5oB3VjAuivJ1fBa7nvF48h8vbthw5tceixRPOOJmid_pWO5rPz1LrqO3fpRZvt5vGf2JriDCJpiIl14c8VR4wIZ82bO6FBOFFfa-X6g/s500/EXP.LARY.5.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="314" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG4Mc3zxtJrwuzK23iixsS6yu4t_AxOToLjq1NEQSAzLzhqSy8i0fgdX6ZbjvYButPP7NuWgTV1CkzZ1nvVAx5oB3VjAuivJ1fBa7nvF48h8vbthw5tceixRPOOJmid_pWO5rPz1LrqO3fpRZvt5vGf2JriDCJpiIl14c8VR4wIZ82bO6FBOFFfa-X6g/s320/EXP.LARY.5.jpg" width="201" /></a></div><br /><span color="windowtext" face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi; text-decoration: none; text-underline: none;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-26202312771646168462022-04-28T09:36:00.004-04:002022-04-28T09:44:38.629-04:00Atorvastatin is associated with reduced cisplatin-induced hearing loss in head and neck cancer petients<p></p><p class="MsoNormal">Cisplatin is widely used to treat cancers. It is the most ototoxic
drug in clinical use, resulting in permanent hearing loss in approximately 50%
of treated patients. There is a major need for therapies that prevent
cisplatin-induced hearing loss. Studies in mice suggest that concurrent use of
statins reduces cisplatin-induced hearing loss.<o:p></o:p></p>
<p class="MsoNormal">Fernandez and her colleagues (from the National Institute on
Deafness and Other Communication Disorders, and Johns Hopkins University,
Maryland ; University of Rochester Medical Center, New York; and Medical
University of South Carolina, Charleston, South Carolina; USA) retrospectively examined
hearing thresholds from 277 adults treated with cisplatin for head and neck
cancer. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773379/pdf/jci-131-142616.pdf " target="_blank">The results were published in Clinical Trial Journal of Clinical <span style="mso-spacerun: yes;"> </span>Investigation in 2021</a>.<o:p></o:p></p>
<p class="MsoNormal">Pretreatment and posttreatment audiograms were collected
within 90 days of initiation and completion of cisplatin therapy. The primary
outcome measure was a change in hearing as defined by the National Cancer
Institute Common Terminology Criteria for Adverse Events (CTCAE).<o:p></o:p></p>
<p class="MsoNormal">Among patients on concurrent atorvastatin, 9.7% experienced
a CTCAE grade 2 or higher cisplatin-induced hearing loss compared with 29.4% in
nonstatin users (P < 0.0001).<o:p></o:p></p>
<p class="MsoNormal"><span style="mso-spacerun: yes;"> </span>Analysis showed that
atorvastatin use was significantly associated with reduced cisplatin-induced
hearing loss (P ≤ 0.01). An adjusted odds ratio (OR) analysis indicated that an
atorvastatin user is 53% less likely to acquire a cisplatin-induced hearing
loss than a nonstatin user (OR = 0.47; 95% CI, 0.30-0.78). Three-year survival
rates were not different between atorvastatin users and nonstatin users (P >
0.05).<o:p></o:p></p>
<p class="MsoNormal">The data indicate that atorvastatin use is associated with
reduced incidence and severity of cisplatin-induced hearing loss in adults
being treated for head and neck cancer. A prospective study is currently conducted to evaluate the efficacy of statins in preventing hearing loss by
cisplatin.<o:p></o:p></p><br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidJJ2oc-89KjrOMbAuALJMvpp-9l-YbiOUJ_jvx2wBfrdLVUx7ZIZU6NcQ_DzUB-ykcWS3xN3C5FBAyvDzZSZbX1VbwYcBn2eixHkZmr7OfXZ3fTPEHK1HKjyrNagl8xTBNWPuEx8X7pMkqHxzoCw2KZQ09pyG140GbeAucI6ZPKwN7Lx4utIrW8TZuQ/s1200/Advanced-Hearing-Solutions-All-About-Ototoxic-Hearing-Loss.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="628" data-original-width="1200" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidJJ2oc-89KjrOMbAuALJMvpp-9l-YbiOUJ_jvx2wBfrdLVUx7ZIZU6NcQ_DzUB-ykcWS3xN3C5FBAyvDzZSZbX1VbwYcBn2eixHkZmr7OfXZ3fTPEHK1HKjyrNagl8xTBNWPuEx8X7pMkqHxzoCw2KZQ09pyG140GbeAucI6ZPKwN7Lx4utIrW8TZuQ/s320/Advanced-Hearing-Solutions-All-About-Ototoxic-Hearing-Loss.jpg" width="320" /></a></div><br /><p style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-63743571253387365592022-02-17T12:45:00.001-05:002022-02-17T12:47:14.648-05:00Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma:<p> </p><p class="MsoNormal"><span style="font-family: "Times New Roman",serif; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">Paroxysmal
hypertension can be associated with failure of the carotid artery baroreceptors
due to past exposure to radiation treatment. <a href="https://rdcu.be/cHaXa" target="_blank">A case report describes a patient</a>
whose repeated paroxysmal hypertensive episodes were ameliorated following
placement of a carotid artery stent for the treatment of carotid artery
stenosis. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">The patient
that was diagnosed with hypopharyngeal squamous cell carcinoma in 2006, and
received 70 Gy intensity-modulated radiotherapy in 2006 and underwent a total
laryngectomy in 2008. He experienced paroxysmal hypertensive episodes since
2010 that exacerbated in frequency in 2019. Eighty percent left internal
carotid artery stenosis was demonstrated by ultrasound and arteriography.
Angioplasty and stenting of the left carotid artery was performed. A Doppler
ultrasound study performed 5 months after the stent placement did not reveal
any hemodynamic stenosis in the left carotid artery. The patient experienced
postprandial hypotension and had experienced only three episodes of paroxysmal
hypertension in the following 24 months. He was able to abort paroxysmal
hypertensive episodes by eating warm food. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family: "Times New Roman",serif; mso-ascii-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-hansi-theme-font: major-bidi;">This
is the first report of a patient whose paroxysmal hypertensive episodes that
occurred following radiation of the neck subsided after placement of a stent in
a stenotic carotid artery. The exact mechanism leading to this phenomena is
unknown but may be due to several factors. The reversal of the carotid artery
stent and improvement in blood flow to the carotid artery baroceptors may play
a role in this phenomenon. Conclusion: The ability to ameliorate paroxysmal
hypertensive episodes in a patient with carotid artery stenosis by stent
placement may be a promising therapeutic intervention for paroxysmal
hypertension.<o:p></o:p></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEidFSG8ffFk0mZFWnD2Sa-bLOLMyIHj5Euriam4BHbGrXOuM2Ken95WvKpYlPhrxGI19FeCinqM88dWmWPRk10uys-LtxUUFuY5V_npeA0-jFoipraKRG1Js5R87SlyRA1BDmIWON7vxuNPfH6SQ9hGjyUA48p5qLSlwNoG1MXJViLU4C8jOSZ6aefgCQ=s320" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="320" data-original-width="251" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEidFSG8ffFk0mZFWnD2Sa-bLOLMyIHj5Euriam4BHbGrXOuM2Ken95WvKpYlPhrxGI19FeCinqM88dWmWPRk10uys-LtxUUFuY5V_npeA0-jFoipraKRG1Js5R87SlyRA1BDmIWON7vxuNPfH6SQ9hGjyUA48p5qLSlwNoG1MXJViLU4C8jOSZ6aefgCQ" width="251" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div> Angiogram of the left carotid artery before stenting showing 80% stenosis<p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjavkgcCMzOblxaKs_mWNQTIzSTohpTR6-757GXJ67BUlhte2A6XvBlguS92UUxJqpwUamfjP7XjILBQzCMRBXeEdwYkhisBoAjfeFTjGoScV7d767XtSQ7vc3mxx1vbnqkuslwn98WOUhwb0tlyS40aF3FEvZTTsXMy8IaO1LJ-aQxX1edpQ1qAj3veA=s266" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="266" data-original-width="202" height="301" src="https://blogger.googleusercontent.com/img/a/AVvXsEjavkgcCMzOblxaKs_mWNQTIzSTohpTR6-757GXJ67BUlhte2A6XvBlguS92UUxJqpwUamfjP7XjILBQzCMRBXeEdwYkhisBoAjfeFTjGoScV7d767XtSQ7vc3mxx1vbnqkuslwn98WOUhwb0tlyS40aF3FEvZTTsXMy8IaO1LJ-aQxX1edpQ1qAj3veA=w237-h301" width="237" /></a></div><br /> Angiogram of the left carotid artery after stenting, no stenosis<p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-91796954943969794522022-01-22T16:31:00.002-05:002022-01-22T16:31:44.013-05:00Tracheitis in a laryngectomee due to Gram-negative bacteria<p> </p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laryngectomees run the risk of developing
respiratory tract infections. A laryngectomee who developed trachitis is
presented <a href="https://drive.google.com/file/d/1ru_mM5LuIVvYqOO35Ue2CyJF3VmQKw19/view?usp=sharing" target="_blank">Brook to illustrate</a> the risks and difficulties encountered in
managing this infection in neck breather. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">The patient presented with coughing of
viscous green purulent sputum. He has been wearing a heat moisture exchanger
filter (HME) spoke through a tracheo-esophageal voice prosthesis. The symptoms
started 2 days after his voice prosthesis started to leak whenever he consumed liquids.
<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Sputum culture grew heavy growth of <i>Klebseilla
oxytoca, </i>and<i> Moraxella catararhalis,</i> and medium growth of<i>
Stenothrophomonas (Xanthohmonas) maltophilia. </i>The patient recovered after
he was treated with oral levofloxacin <span style="mso-spacerun: yes;"> </span>for
5 days. Humidification of the trachea and the airway was maintained by repeated
insertions of 3-5 cc respiratory saline into the stoma at least once every two
hours; and by breathing humidified air. The leaking voice prosthesis was
replaced enabling the patient to consume adequate amount of fluids. <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This is the first report of bacterial
tracheitis due to multiple Gram-negative aerobic and facultative bacteria in a
laryngectomee. The etiology of tracheitis in this patient is most likely due to
aspiration of oral flora that contained these organisms through the leaking
voice prosthesis (, or their acquisition through the stoma. A change in the
consistency and color of the sputum was most likely due to the tracheal
inflammation caused by these organisms. Obtaining a bacterial culture enabled
their recovery and adequate elimination.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">Laryngectomees are at risk of aspirating
liquids containing bacteria. When unclean liquids get into the lower
respiratory tract, they can sometimes cause infection. Developing aspiration
pneumonia depends on how much liquid is inhaled and how much is coughed out, as
well as on the individuals' immune system.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;">This report highlights the importance of obtaining
bacterial cultures and antimicrobial susceptibility that enabled eliminating
the pathogens and restoring adequate mucus production. Treatment with a short
course of antimicrobial as well as maintaining adequate hydration and respiratory
tract humidification can restore the adequacy of the mucus. <o:p></o:p></span></p><p class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjwKX92QUcAMbwEU88MakhTB02jKh6X6OMDlx6-CybiAmiUcIKqi_1kDkCGSPXrNkozRAbYibpPzB8x4PfIpThVj7W9sfs5itWTrjMWpI_s0WgMullBjGb6Girw2GIHyM5T0mWgp9WlWkEzxqGCU4p_c-hkV___gx70hUhsV_ZiDKimBn0rPwNFkLl4cw=s259" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="194" data-original-width="259" height="194" src="https://blogger.googleusercontent.com/img/a/AVvXsEjwKX92QUcAMbwEU88MakhTB02jKh6X6OMDlx6-CybiAmiUcIKqi_1kDkCGSPXrNkozRAbYibpPzB8x4PfIpThVj7W9sfs5itWTrjMWpI_s0WgMullBjGb6Girw2GIHyM5T0mWgp9WlWkEzxqGCU4p_c-hkV___gx70hUhsV_ZiDKimBn0rPwNFkLl4cw" width="259" /></a></div><br /><span style="font-family: "Arial",sans-serif; mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-74843491558287753632021-12-15T12:34:00.004-05:002021-12-15T12:53:01.987-05:00Getting infected with both COVID-19 and influenza viruses<p> </p>
<p class="MsoNormal">Co-infection of COVID-19 with other respiratory pathogens
w<span style="font-family: inherit;">hich may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge
new concern. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267808/" target="_blank">Eleven prevalence studies </a>with total of 3,070 patients with COVID-19, and 79 patients with
concurrent COVID-19 and influenza were evaluated by Dadashi et al from Department
of Microbiology, School of Medicine, Alborz University of Medical Sciences,
Karaj, Iran .</span>The overlap of COVID-19 and influenza, as two epidemics at the
same time can occur in the cold months of the year. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267808/" target="_blank">The prevalence of influenza infection was </a>0.8% in patients with confirmed COVID-19. The frequency of
influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and
0.4% in the America. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">This information highlights the importance of getting
properly vaccinated for both COVID-19 and influenza and practicing safe
prevention (wearing masks and maintaining distance) as advised by the local
health authorities. Neck breathers including laryngectomee should practice
extra vigilance to avoid respiratory infections.<o:p></o:p></p><p class="MsoNormal" style="text-align: center;"><br /></p><p class="MsoNormal" style="text-align: center;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhO_Um9ACj6UBPeQQylR1-R1jc1gyGWWEYK2-Hvd60i9NfznUfT6mElGDpLBrnw78AudAuUsydW-4q7TduK-mfL1TFvzbZInlvMqEayRVYXaewX3js4KA46lYx1CygVD9MoJ8mTBhwgz6UD-I1t9diZbJ6nc0FY43vsmsw5n0_tceGFOO422NEa-INAng=s700" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="700" height="183" src="https://blogger.googleusercontent.com/img/a/AVvXsEhO_Um9ACj6UBPeQQylR1-R1jc1gyGWWEYK2-Hvd60i9NfznUfT6mElGDpLBrnw78AudAuUsydW-4q7TduK-mfL1TFvzbZInlvMqEayRVYXaewX3js4KA46lYx1CygVD9MoJ8mTBhwgz6UD-I1t9diZbJ6nc0FY43vsmsw5n0_tceGFOO422NEa-INAng=s320" width="320" /></a></div><br /><p class="MsoNormal" style="text-align: center;"><br /></p><br /><p class="MsoNormal" style="text-align: center;"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-38909122066349426842021-10-19T12:56:00.002-04:002021-10-19T12:56:47.815-04:00Discordant in Detection of COVID-19 in the Nasopharynx Versus Trachea for Patients With Tracheostomies<p>Patients with tracheostomies have an anatomically altered
connection between their upper and lower airways that could impact SARS-CoV-2
testing. <a href="https://onlinelibrary.wiley.com/doi/10.1002/lary.29617" target="_blank">Smith and colleagues from the University of Michigan</a> retrospectively
compared the detection of SARS-CoV-2 in hospitalized patients with COVID-19 and
tracheostomies.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">The authors employed SARS-CoV-2 RNA nucleic acid
amplification test (NAAT) in 45 newly <span style="mso-spacerun: yes;"> </span>tracheotomized
patients in nasopharyngeal (NP) and tracheal (TR) samples taken within a
48-hour period.<o:p></o:p></p>
<p class="MsoNormal">Thirty-two (71.1%) of the 45 patients had entirely
concordant results after tracheostomy. However, 13 (28.9%) patients had at
least one set of discordant results, the majority of which were NP negative and
TR positive. <o:p></o:p></p>
<p class="MsoNormal">The authors concluded that patients with tracheostomies may
have a higher false-negative rate if only one site is assessed for SARS-CoV-2. They
recommend analyzing samples from both the nasopharynx and trachea for these
patients until more prospective data exist.<o:p></o:p></p><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-_TwwVe-h75s/YW74xW_S6_I/AAAAAAACp98/L7YgLTBntZUgk0dCOJAIpphKVt9cwz5mACLcBGAsYHQ/s600/covid_swab_600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="380" data-original-width="600" height="203" src="https://1.bp.blogspot.com/-_TwwVe-h75s/YW74xW_S6_I/AAAAAAACp98/L7YgLTBntZUgk0dCOJAIpphKVt9cwz5mACLcBGAsYHQ/s320/covid_swab_600.jpg" width="320" /></a></div><br /><p class="MsoNormal"><br /></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-34118647489941231492021-10-04T15:49:00.002-04:002021-10-13T17:41:56.786-04:00Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy<p> <a href="https://pubmed.ncbi.nlm.nih.gov/34490903/" target="_blank">Wulff and colleagues </a>of the Department of
Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital,
Køge, Denmark, determine the health-related quality of life ,
including voice problems, dysphagia, depression, and anxiety after total
laryngectomy, and investigate the associations between health-related quality of life and the late
effects. Included were 172 participants having undergone a laryngectomy 1.6 to 18.1 years
ago for laryngeal/hypopharyngeal cancer. </p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Participants scored worse than normative reference
populations on all scales/items except one. Moderate/severe dysphagia was
present in 46%, moderate/severe voice problems in 57%, depression in 16%, and
anxiety in 20%. Decreasing age, increasing numbers of comorbidities, increasing
voice problems, increasing dysphagia, and increasing depression symptoms, were
associated with a lowered summary score.<o:p></o:p></p>
<span style="line-height: 107%;"><span style="font-family: inherit;">The authors concluded that a substantial proportion
of participants experienced clinically significant late effects and increasing
levels of these were associated with a lowered health-related quality of life.</span></span><div><span style="line-height: 107%;"><span style="font-family: inherit;"><br /></span></span></div><div style="text-align: center;"><span style="line-height: 107%;"><span style="font-family: inherit;"><br /></span></span></div><div style="text-align: center;"><span style="line-height: 107%;"><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-yGxeXqBti88/YVtauSzMYsI/AAAAAAACp8c/pBet_HL4ucgbIg4YyS74aITTCyiZe5ebwCLcBGAsYHQ/s600/as.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="600" height="160" src="https://1.bp.blogspot.com/-yGxeXqBti88/YVtauSzMYsI/AAAAAAACp8c/pBet_HL4ucgbIg4YyS74aITTCyiZe5ebwCLcBGAsYHQ/s320/as.jpg" width="320" /></a></div><br /><span style="font-family: inherit;"><br /></span></span></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-73457148695212916682021-09-07T17:00:00.006-04:002021-09-20T13:22:08.785-04:00Risk of aspiration when Provox Life FreeHands Flexivoice HME is not inserted correctly<p> I would like to highlight a potentially serious problem that
occurred to me when I used the new Life
HME filter. I placed it INCORRECTLY with the side with only 2 bars facing the
stoma (see pictures) and it got separated and fell into the trachea after
several minutes. Fortunately, I was able to cough it out.</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">Make sure that you attach the HME correctly with the side
that has 3 bars (shaped like z) facing your stoma (see picture). If one has
questions they should contact their SLP or Atos representative.<o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-VtseyK7KCnc/YTfR_LNJsqI/AAAAAAACp58/ETjaylPwTD0wgZRnPsARjYvIrHxUQU7NQCLcBGAsYHQ/s640/IMG_0836.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="590" height="320" src="https://1.bp.blogspot.com/-VtseyK7KCnc/YTfR_LNJsqI/AAAAAAACp58/ETjaylPwTD0wgZRnPsARjYvIrHxUQU7NQCLcBGAsYHQ/s320/IMG_0836.jpg" width="295" /></a></div><div style="text-align: center;">Filter side that should NOT face the stoma</div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-zmJP94P68tA/YTfSAOnJEUI/AAAAAAACp6A/GiLTz_c3c8sjBIoMvRvmyY_yS8T8r28MgCLcBGAsYHQ/s640/IMG_0835.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="618" data-original-width="640" height="309" src="https://1.bp.blogspot.com/-zmJP94P68tA/YTfSAOnJEUI/AAAAAAACp6A/GiLTz_c3c8sjBIoMvRvmyY_yS8T8r28MgCLcBGAsYHQ/s320/IMG_0835.jpg" width="320" /></a></div><span style="text-align: center;"><div style="text-align: center;">Filter side that should </div><div style="text-align: center;">face the stoma </div><div style="text-align: center;"> </div></span></div><div><div style="text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-0jPre5mdNao/YTfR9YBhxlI/AAAAAAACp54/PjZ4Ip0N4nQtIKE91kuK_b8p-v9WXwuhwCLcBGAsYHQ/s640/IMG_0838.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="640" height="320" src="https://1.bp.blogspot.com/-0jPre5mdNao/YTfR9YBhxlI/AAAAAAACp54/PjZ4Ip0N4nQtIKE91kuK_b8p-v9WXwuhwCLcBGAsYHQ/s320/IMG_0838.jpg" width="320" /></a></div><p class="MsoNormal" style="text-align: center;">Correct way to insert HME to the FreeHands Flexivoice </p></div>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0tag:blogger.com,1999:blog-4442316177811632674.post-4274451762089018382021-08-12T11:08:00.004-04:002021-10-05T16:37:48.135-04:00Hospitalization and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic<p> </p><p class="MsoNormal" style="line-height: 150%;"><span face="Arial, sans-serif">People with total laryngectomy (PTL) have
an altered anatomy for breathing and speaking. The presence of a neck stoma
poses an additional virus entry point aside from the nose, mouth and
conjunctiva. This could increase the susceptibility to COVID-19 for PTL.</span></p>
<p class="MsoNormal" style="line-height: 150%;"><span face="Arial, sans-serif">Govender and colleagues from the University
College Hospital in London <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1460-6984.12656 " target="_blank">performed a national audit to provide</a> data on
shielding, hospital admissions and mortality for patients with total
laryngectomy in the UK over the pandemic. </span><span style="background-color: white;"><span style="color: #1c1d1e; font-family: Open Sans, sans-serif;">Data were obtained from 1216 PTL from 26 centers across the UK.</span></span><span style="background-color: white; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;"> </span><span style="background-color: white; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;">A total of 24 (2% of total sample) tested positive for COVID-19. </span>Eight of the 24 PTL that were hospitalized
with COVID -19 died within 28 days. <span style="background-color: white; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;">During the data collection time frame, 12% had a hospital admission (</span><i style="background-color: white; box-sizing: border-box; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;">n</i><span style="background-color: white; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;"> = 151) with a median length of stay of 1 day (1–133 days). A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19.</span></p><p class="MsoNormal" style="line-height: 150%;">Although the overall mortality in PTL over
the first lockdown did not appear to be higher than the “best case” estimates
from previous years one in three PTL who acquired COVID-19 and were admitted to
hospital, died within 28 days of testing positive. </p>
<p class="MsoNormal" style="line-height: 150%;"><span style="background-color: white; color: #1c1d1e; font-family: "Open Sans", sans-serif; font-size: 16px;">Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation.</span></p><p class="MsoNormal" style="line-height: 150%;"><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span></p><p class="MsoNormal" style="line-height: 150%;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-Ot0cF0QNd0g/YRU5WBGkYZI/AAAAAAACp3Q/37HO4aiCrIMt5FxtjWczcCohTxk9XwaKQCLcBGAsYHQ/s331/download.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="152" data-original-width="331" height="147" src="https://1.bp.blogspot.com/-Ot0cF0QNd0g/YRU5WBGkYZI/AAAAAAACp3Q/37HO4aiCrIMt5FxtjWczcCohTxk9XwaKQCLcBGAsYHQ/s320/download.jpg" width="320" /></a></div><br /><span face=""Arial",sans-serif" style="mso-ascii-theme-font: minor-bidi; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-bidi;"><br /></span><p></p>Dr. Itzhak Brookhttp://www.blogger.com/profile/10376072923664589581noreply@blogger.com0