Sentinel Lymph Node Biopsy & Superficial Oesophageal Cancer..?
Since its popularization in the management of head and neck melanomas in early 1990s, the use of SLNB has been gaining wide acceptance as a staging modality in several head and neck malignancies. Hayashi H. et al recently (Surgery. 2006 Feb;139(2):224-35)  experimentally and clinically the evaluated the feasibility of endoscopic CT Lymphography in superficial oesophageal cancer and concluded it has potential in SLNB and mapping of oesophageal lesion.

Abstract: BACKGROUND: To evaluate experimentally and clinically the feasibility of a newly developed technique of endoscopic computed tomography (CT) lymphography with endoscopic submucosal injection of iopamidol for esophageal sentinel lymph node (SLN) mapping and biopsy examination. METHODS: Nine anesthetized dogs underwent CT after endoscopic submucosal injection of 2 mL iopamidol; 1.25-mm thick CT images were obtained before and at 1, 3, 5, 7, and 10 minutes after contrast injection. Clinically, 12 patients with superficial esophageal cancer (preoperative imaging stage: cT1, cN0) underwent CT lymphography in a similar fashion at 1, 5, and 10 minutes after peritumoral injection, followed by radical esophagectomy and regional lymph node dissection under CT lymphography guidance. RESULTS: CT lymphography visualized the draining lymphatic vessels and SLNs within 5 minutes after contrast injection. All 14 SLNs in dogs (average, 1.5 nodes per animal; range, 1-2) and 28 SLNs in patients (average, 2.3 nodes per patient; range, 1-4) were found intraoperatively at the correct location under CT lymphography guidance. Lymph node metastasis could be detected with excellent sensitivity and accuracy in this small number of patients with no false-negative findings; metastasis was positive only in the preoperatively identified SLNs in 4 patients and in both SLNs and distant nodes in 1 patient, and was negative in all resected nodes in the remaining 7 patients. CONCLUSIONS: Endoscopic CT lymphography appears to allow accurate identification of direction and locations of lymph flow and SLNs, and has the potential clinical applicability for esophageal SLN mapping and biopsy examination, but will require a large study to determine its accuracy and usefulness

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Coming Events of Importance to Otolaryngologists in Africa...
 

1. 8th International Otology Course of the Jean Causse Ear Clinic
   June 22-24, 2006; Béziers, France
2. 110th American Academy of ORL,Head & Neck Surgery Annual Meeting & OTO EXPO
   September 17-20, 2006;
   Toronto, Canada.
3. 42nd South African ENT Congress joint meeting with the British Association of Otolaryngology - Head & Neck Surgery
   October 29-November 1, 2006;
   Cape Town, South Africa.

         For more Worldwide otolaryngological events and conferences....Click Here

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Horizontal Canal BPPV - How Common.....?       

A recent retrospective study, with Evidence Based Medicine rating of 4,  from Turkey (Cakir BO et al, Otolaryngol Head Neck Surg. 2006 Mar;134(3):451-454) examined the record of 169 patients managed for BPPV over a 4 year period and discovered that horizontal canal BPPV (H-BPPV) constitutes over 10%

Abstract: OBJECTIVE: To assess the correct incidence of horizontal semicircular canal (H-SCC) benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Retrospective assessment of patients with BPPV. METHODS: All patients with BPPV were included and the rates of involvement of posterior, horizontal, and anterior SCCs were determined. RESULTS: One hundred sixty-nine patients with the diagnosis of BPPV were evaluated. One hundred forty-four patients (85.2%) were found to have posterior SCC (P-SCC) involvement, and there were 20 patients (11.8%) with horizontal SCC (H-SCC) and 2 patients (1.2%) with anterior SCC (A-SCC) involvement. Three patients (1.8%) had simultaneous H-SCC and P-SCC BPPV ipsilaterally. Geotropic nystagmus was seen in 17 out of 23 patients (73.9%) in roll test, and ageotropic nystagmus was seen in the remaining 6 patients (26.1%). CONCLUSION: H-SCC constitutes 13.6% of all BPPV cases. H-SCC BPPV with geotropic nystagmus is more common. H-SCC BPPV can coexist with ipsilateral P-SCC BPPV. However, in some cases of H-SCC BPPV, Dix-Hallpike maneuver can cause vertigo and horizontal nystagmus. This may be confused with P-SCC BPPV. Therefore, the roll test must be performed in all cases in addition to Dix-Hallpike maneuver and both ears must be evaluated with respect to all SCCs for BPPV

What is the diagnosis?

• Parting Shot...
  If you have an interesting case to discuss or share with other Otolaryngologists all over Africa, feel free to email Me or at best go to otolaryngology in Africa blogsite and post your case
• Also, if you are among those who requested for a copy of DODA at the last ORLSON Meeting @ Port Harcourt, please take time to view the DODA - FAQ page, you should have received your copy by now. If you have difficulty on using the program, please text +2348032472069.
• An online video demonstration of doda is available at http://www.otolaryngologyinafrica.net/doda_video.htm  This video takes about 30 - 45 minutes to fully load on a broad band network the first time, but once fully loaded could be viewed over and over again
• If you have anything you want to communicate with other Otolaryngologists - news, request, etc, feel free to email your communication to orl-mailer@ otolaryngologyinafrica.net. Your request will appear in member's page soon to be created.
• Reviewers wanted for otolaryngology news journals watch page. If you are an Otolaryngologist in Africa and will like to be our journal reviewer, please feel free to email orl-mailer@otolaryngologyinafrica.net

Till Next Week,

Biodun

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