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Tongue Carcinoma

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1621. Acute pain management: scientific evidence (3rd Edition)

in every case, early recognition and treatment of incipient chronic pain by a vigilant healthcare system is necessary for cost- effective intervention. The National Pain Strategy document that underpins the 2010 Australian Pain Summit summarises the emerging literature on social, human and economic costs of undertreated acute and chronic pain — establishing pain as a major disease burden ( and proposing an integrated new framework for management of acute, chronic and cancer pain (...) . Anesthesiology 110(5): 955–6. Johnston M, Brouwers M & Browman G (2003) Keeping cancer guidelines current: results of a comprehensive prospective literature monitoring strategy for twenty clinical practice guidelines. Int J Technol Assess Health Care 19: 646–55. Marret E, Elia N, Dahl JB et al (2009) Susceptibility to fraud in systematic reviews. Anesthesiology 111: 1279–89. Neal JM (2009) Retraction. Reg Anesth Pain Med 34(4): 385. NHMRC (1999) A Guide to the Development, Implementation and Evaluation

2015 National Health and Medical Research Council

1622. Clinicopathologic features and prognostic analysis of Waldeyer ring B-cell lymphoma. Full Text available with Trip Pro

-myelocytomatosis viral oncogeneav (MYC) gene abnormalities were investigated using interphase fluorescence in situ hybridization.Among the 65 patients, there were 12 nasopharynx cases, 49 tonsil cases, and 4 tongue root cases. Moreover, there were 49 cases of diffuse large BCL (DLBCL) and 16 cases of follicular lymphoma (FL). More than 60% of the patients had Ann Arbor stage III/IV disease, with infiltrated neighboring organs, invaded spleens, and increased lactate dehydrogenase (LDH) levels. Tumor cells were (...) positive for multiple myeloma antigen 1 (MUM1), BCL-2, BCL-6, and C-MYC. EBER expression was detected in lymphoma cells of 2 cases. Alteration frequencies of IRF4, BCL-2, BCL-6, and C-MYC were 24.6%, 32.3%, 27.7%, and 30.7%, respectively. Approximately 67.69% cases had stages 0 to II disease, while 32.31% cases had stage III disease. Five-year overall survival rate was 65.12%. Eastern Cooperative Oncology Group performance status (ECOG) score ≥2 was the only adverse factor for overall survival. IRF4

2020 Medicine

1623. Transoral floor of mouth lipoma resection: A technical multimedia analysis. (Abstract)

Transoral floor of mouth lipoma resection: A technical multimedia analysis. Lipomas are common benign mesenchymal tumors that originate from mature adipocytes throughout the body, with 13-20% occurring in the head and neck region, however only 1-4.4% affect the oral cavity, where they are found predominately in the cheek, followed by the tongue, lips, palatal mucosa, gingiva, and floor of the mouth. Herein, we present a multimedia analysis of transoral floor of mouth lipoma resection in a 58

2020 American Journal of Otolaryngology

1624. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

quickly. This causes LCH cells to build up in certain parts of the body, where they can damage or form . LCH is not a disease of the Langerhans cells that normally occur in the skin. LCH may occur at any age, but is most common in young children. Treatment of LCH in children is different from treatment of LCH in adults. The and the are described in separate sections of this summary. Use our to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based (...) on the type of cancer, the age of the patient, and where the trials are being done. about clinical trials is also available. Family history of cancer or having a parent who was exposed to certain chemicals may increase the risk of LCH. Anything that increases your risk of getting a disease is called a . Having a risk factor does not mean that you will get ; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for LCH include

2018 PDQ - NCI's Comprehensive Cancer Database

1625. CCS and CPCA Position Statement on the Approach to Syncope in the Pediatric Patient Full Text available with Trip Pro

of sudden death or heart disease in young individuals Abnormal cardiac examination New medication with potential cardiac side effects (eg, ) Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green light” indicates normal variants with no further management needed. AV, atrioventricular; bpm, beats per minute; ECG, electrocardiogram; PVC, premature ventricular complexes. ∗ Manual (...) , 2016 Accepted: September 28, 2016 ; Received: September 13, 2016 ; | ---- Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. ---- | ---- Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. ---- | ---- Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green

2016 Canadian Cardiovascular Society

1626. Milk Thistle (PDQ®): Health Professional Version

and selective estrogen receptor modulator activity of silymarin compared with ethinylestradiol in ovariectomized rats. Phytomedicine 17 (2): 116-25, 2010. [ ] Scambia G, De Vincenzo R, Ranelletti FO, et al.: Antiproliferative effect of silybin on gynaecological malignancies: synergism with cisplatin and doxorubicin. Eur J Cancer 32A (5): 877-82, 1996. [ ] Bhatia N, Zhao J, Wolf DM, et al.: Inhibition of human carcinoma cell growth and DNA synthesis by silibinin, an active constituent of milk thistle (...) has also been shown to neutralize a wide range of . Reports that associate the flavonolignans with potential estrogenic effect (e.g., via mediation of the ) are sparse and currently not supported by or experimental evidence.[ ] Laboratory experiments conducted using cancer have suggested that silibinin enhances the of and against and cancer cells.[ ] Silybin appears to have direct anticancer effects against , breast, and tumor cells.[ ] Silybin may also affect the cell cycle in cancer cells

2018 PDQ - NCI's Comprehensive Cancer Database

1627. Use of Local Anesthesia for Pediatric Dental Patients

/anxiolysis can help the patient have a positive experience during adminis- tration of local anesthesia. 3-5 In pediatric dentistry, the dental professional should be aware of proper dosage (based on weight) to minimize the chance of toxicity and the prolonged duration of anesthesia, which can lead to accidental lip, tongue, or soft tissue trauma. 6 Knowledge of gross and neuroanatomy of the head and neck allows for proper placement of the anesthetic solution and helps minimize complications (e.g (...) action in the area. 9 Epinephrine is contraindicated in patients with hyperthyroidism. 9 The dose should be kept to a minimum in patients receiving tricylic antidepressants since dysrhythmias may occur. Levonordefrin and norepinephrine are absolutely contraindicated in these patients. 9 Patients with significant cardiovascular disease, thyroid dysfunction, diabetes, or sulfite sensitivity and those receiving monoamine oxidase inhibitors, tricyclic antidepressants, or phenothiazines may require a med

2015 American Academy of Pediatric Dentistry

1628. Management Considerations for Pediatric Oral Surgery and Oral Pathology

concluded there is no evidence to support 31-34 or refute 1 the prophylactic removal of disease-free impacted third molars. Factors that increase the risk for surgical complications (e.g., coexisting systemic conditions, location of peripheral nerves, history of temporomandibular joint disease, presence of cysts or tumors) 32,33 and position and inclination of the molar in question 35 should be assessed. The age of the patient is only a secondary consideration. 35 Referral to an oral and maxillofacial (...) lesions in the pediatric population. The largest epidemiologic studies in the U.S. place the prevalence rate in children at four to 10 percent with the exclusion of infants. 61,62 Although the vast majority of these lesions re- present mucosal conditions, developmental anomalies, and reactive or inflammatory lesions, it is imperative to be vigilant for neoplastic diseases. Regardless of the age of the child, it is important to estab- lish a working diagnosis for every lesion. This is based

2015 American Academy of Pediatric Dentistry

1629. Urticaria

(leaving a residual pigmented lesion, such as petechial haemorrhage, purpura, or bruising). There may be systemic symptoms, such as fever, malaise, and arthralgia. Causes include infection (hepatitis B or C, glandular fever, or streptococcal infection), certain drugs (for example penicillins, fluoxetine, thiazide diureticss, allopurinol, quinolones, or carbamazepine), autoimmune disease, paraproteinaemia, and malignancy. Basis for recommendation Basis for recommendation This information is based (...) of antihistamines, the dose of the first choice antihistamine should be increased gradually to up to four times the standard licensed dose (if appropriate). Assessing disease severity and impact on quality of life: this update includes the recommendation to consider assessing disease severity and impact on quality of life using validated tools, such as the Urticaria Activity Score (UAS7) and the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), respectively. Previous changes Previous changes May 2016

2018 NICE Clinical Knowledge Summaries

1630. Balanitis

. Other infections including anaerobes and sexually transmitted infections (STIs). Skin conditions such as contact dermatitis, seborrhoeic dermatitis, psoriasis, lichen planus, or lichen sclerosus. Pre-malignant penile conditions. Balanitis affects about 4% of uncircumcised boys between the ages of 2–5 years. Complications may include phimosis, meatal stenosis, urethral stricture, sexual dysfunction, and penile squamous cell carcinoma, depending on the underlying cause. A diagnosis of balanitis should (...) of foreskin ('Cayenne pepper' spots). It may be secondary to irritation due to prolonged skin contact with urine (a 'dysfunctional foreskin'). Circinate balanitis — this is a chronic balanitis which may occur in men with post-infective Reiter's syndrome and/or psoriasis, although it can occur in isolation. It presents with well-demarcated red or grey plaques on the glans penis with a ragged white border, which coalesce to form 'geographical' areas with a white margin. Pre-malignant conditions (carcinoma

2018 NICE Clinical Knowledge Summaries

1631. Diarrhoea - adult's assessment

(for example, small bowel resection, internal fistulae). Chronic pancreatitis, pancreatic carcinoma. Radiation enteropathy. Endocrine disorders — for example, hyperthyroidism, diabetes (may be metformin-associated), hypoparathyroidism, Addison’s disease. Cystic fibrosis. Factitious diarrhoea — the person adds water to their stools or uses laxatives. Small bowel enteropathy (for example Whipple’s disease, tropical sprue, amyloid). Hormone secreting tumours (for example VIPoma, gastrinoma, carcinoid (...) . Other causes include drugs, anxiety, food allergy, and acute appendicitis. Causes of chronic diarrhoea include irritable bowel syndrome, diet, inflammatory bowel disease, coeliac disease, and bowel cancer. Diarrhoea is one of the most common symptoms for which people seek medical advice. Assessment for acute and chronic diarrhoea should include: Determining onset, duration, frequency, and severity of symptoms. Identifying red flag symptoms. Ascertaining the underlying cause. Looking

2018 NICE Clinical Knowledge Summaries

1632. Feverish children - risk assessment

should be accepted as a valid indicator of fever. Feverish illness in young children usually indicates an underlying infection, and fever is part of the body's natural response to this. It is theorized that fever may inhibit bacterial and viral replication, and strengthen the body's immune response to pathogens. In a minority of children, fever may be due to a non-infectious condition such as Kawasaki disease or malignancy. [ ; ; ; ] Prevalence How common is it? A UK prospective cohort study (1991 (...) associated symptoms suggesting an underlying cause of fever. Any perinatal complications such as maternal fever and/or premature delivery. Any significant medical conditions, such as known immunosuppression or immunodeficiency. Any recent antipyretic drug and/or antibiotic use. The child's immunization history, and any missed immunizations. Any recent foreign travel. Any recent contact with people with serious infectious diseases. Parental/carer health beliefs about fever and previous family experience

2018 NICE Clinical Knowledge Summaries

1633. Angio-oedema and anaphylaxis

Angio-oedema and anaphylaxis Angio-oedema and anaphylaxis - NICE CKS Share Angio-oedema and anaphylaxis: Summary Angio-oedema is swelling of deep dermis, subcutaneous, or submucosal tissue, often affecting the face (lips, tongue, and eyelids), genitalia, hands, or feet. Less commonly, submucosal swelling affects the bowel and airway. The main types are allergic angio-oedema, non-allergic drug reaction (usually caused by angiotensin-converting enzyme [ACE] inhibitor treatment), hereditary angio (...) to assess whether venom immunotherapy would be suitable. Statement 4. Ongoing training in adrenaline auto-injector use. [ ] Background information Background information Definition What is it? Angio-oedema is swelling of deep dermis, subcutaneous, or submucosal tissue, often affecting the face (lips, tongue, and eyelids), genitalia, hands, or feet. Less commonly, submucosal swelling affects the bowel and airway. Angio-oedema most commonly occurs with urticaria (a superficial swelling of the epidermis

2018 NICE Clinical Knowledge Summaries

1634. Gingivitis and periodontitis

clinical judgement and consider referring urgently using a local suspected cancer referral pathway (to be seen within 2 weeks) or seek immediate advice from an oral medicine or oral and maxillofacial specialist. Advise routine regular review by a dentist or hygienist. Review interval will depend on the advice of the dentist. People with predisposing risk factors may require frequent professional cleaning. For people with diabetes, explain that they are at increased risk of periodontal (gum) disease (...) Effectiveness Programme on Prevention and treatment of periodontal diseases in primary care which state that this can be a sign of undiagnosed leukaemia in adults and children and urgent referral to a physician should be considered if the clinical picture is inconsistent with the person's level of oral hygiene [ ]. The recommendation to consider underlying conditions such as aggressive periodontitis, malignancy, and immunosuppression in young people with periodontitis, or people in whom periodontitis

2018 NICE Clinical Knowledge Summaries

1635. Blackouts

beats) or sustained atrial arrhythmia may be seen on ECG. Pulmonary embolism — suggested by dizziness, shortness of breath, pleuritic chest pain, thromboembolic (TE) risk factors, such as previous TE disease, prolonged immobilisation (e.g. flight > 4 hours), smoking, contraceptive pill or HRT use, known malignancy, or family history of thromboembolism. Be aware that syncope is a relatively common finding in older people with a PE (24% of people aged over 65 years). For more information, see the CKS (...) underlying cause being vasovagal syncope. Diagnosing the underlying cause of a blackout will usually include: Assessment of vital signs, measurement of lying and standing blood pressure, and recording an ECG. Documenting details of the event (from a witness if possible). Determining whether there have been any previous blackouts, considering the person's medical and family history of cardiac disease/sudden cardiac death, reviewing whether any current medication may have contributed to the blackout

2018 NICE Clinical Knowledge Summaries

1636. HIV infection and AIDS

HIV infection is associated with an increased risk of malignancies many of which are associated with advanced HIV disease such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and invasive cervical cancer. Lymphoma Lymphomas can present with weight loss, fevers, night sweats, lymphadenopathy, and abdominal masses (lymph nodes, liver or spleen) — see the CKS topic on for further information. Primary cerebral lymphoma may also occur. Kaposi's sarcoma Kaposi's sarcoma is the most common tumour in people (...) than 10 years later ('slow progressors') [ ]. AIDS or 'advanced HIV disease' occurs when the number of CD4 cells is very low (less than 200 cells/uL). Opportunistic infections and malignancies (AIDS-defining illnesses) such as Pneumocystis jiroveci pneumonia (formerly known as PCP) and Kaposi’s sarcoma can develop [ ]. Prevalence How common is it? Prevalence In 2013, there were an estimated 107,800 people living with HIV in the UK. About 1 in 4 were unaware of their infection. HIV prevalence among

2018 NICE Clinical Knowledge Summaries

1637. Mastitis and breast abscess

breast pain that are not associated with lactation include: Breast cancer — this includes ductal cancer (characterized by breast pain and/or bloody discharge), inflammatory breast cancer (characterized by rapid onset of warmth of the breast, diffuse redness, and oedema causing an orange skin [peau d'orange] appearance), and Paget's disease of the nipple (characterized by an itchy, red rash on the nipple, burning sensation in the breast, and bleeding from the nipple). For more information, see the CKS (...) central/subareolar or peripheral. Central/subareolar infection is usually secondary to periductal mastitis (a condition where the subareolar ducts are damaged and become infected). Peripheral infection (less common) is associated with diabetes mellitus, rheumatoid arthritis, trauma, corticosteroid treatment, and granulomatous lobular mastitis (a rare inflammatory disease of the breast), but often there is no underlying cause. The most common organisms associated with infectious mastitis in non

2018 NICE Clinical Knowledge Summaries

1638. Bacterial vaginosis

and gonorrhoea, a 9-fold risk of trichomoniasis, and a 2-fold risk of herpes simplex virus (HSV)-1 compared with women without BV [ ]. A prospective study of women with clinically suspected pelvic inflammatory disease (PID) reported significant association between the presence of BV-associated bacteria and the presence of endometritis and recurrent PID [ ; ]. BV is also associated with several obstetric and gynaecologic complications, including [ ; ; ; ; ; ] : Late miscarriage. Pre-term labour and delivery (...) notification (if necessary). Palpate the abdomen (if appropriate) to assess for tenderness or a mass (which may indicate malignancy). Inspect the vulva for lesions, discharge, vulvitis, ulcers, and any other changes. Perform a speculum examination (except in a pregnant woman with a low-lying placenta) to visualize the cervix and vagina to look for characteristic signs of BV. BV is characterized by a thin, white/grey, homogeneous coating of the vaginal walls and vulva that has a fishy odour

2018 NICE Clinical Knowledge Summaries

1639. Nausea/vomiting in pregnancy

examination. Goitre. Conditions causing nausea and vomiting in pregnancy: Genito-urinary conditions — urinary tract infection, uraemia, pyelonephritis, ovarian torsion, renal stones. Metabolic disorders and endocrine conditions — hypercalcaemia, thyrotoxicosis, diabetic ketoacidosis, Addison's disease. Gastrointestinal conditions — gastritis, gastroenteritis, peptic ulcer, pancreatitis, cholecystitis, bowel obstruction, hepatitis, cholelithiasis, appendicitis. Neurological disorders — vestibular disease (...) , migraine, central nervous system tumours. Other pregnancy-related conditions — acute fatty liver of pregnancy, pre-eclampsia. Drug-induced vomiting — for example iron or opioids. Psychological disorders — for example eating disorders. Basis for recommendation Basis for recommendation Findings suggesting an alternative diagnosis This information is based on a Royal College of Obstetricians and Gynaecologists (RCOG) guideline: The management of nausea and vomiting of pregnancy and hyperemesis gravidarum

2018 NICE Clinical Knowledge Summaries

1640. Dyspepsia - proven functional

. pylori re-testing. Consider offering re-testing for H. pylori , using clinical judgement, if: There has been poor compliance to first-line eradication therapy, or the initial test was performed within 2 weeks of proton pump inhibitor (PPI) or 4 weeks of antibiotic therapy. Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) is indicated, especially if there is a history of peptic ulcer disease. See the CKS topic on for more information. There is a family history of gastric malignancy (...) of malignancy or peptic ulcer disease, a maintenance PPI may be appropriate. This is supported by a subsequent Cochrane systematic review of 23 randomized controlled trials (RCTs, n = 8759) of the use of PPIs for functional dyspepsia, which found moderate-quality evidence that 2–8 weeks of PPI therapy was slightly more effective than placebo at relieving functional dyspepsia symptoms. It also found low-quality evidence that PPIs may be slightly more effective than H 2 RAs at relieving symptoms. Low-dose

2018 NICE Clinical Knowledge Summaries

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