Daniel Miller

Two patients with squamous cell carcinoma of the head and neck are reported in whom the syndrome of inappropriate antidiuretic hormone (SIADH) secretion occurred transiently during the rapid cytolytic phase of tumor destruction after chemotherapy with cis‐platinum diamminedi‐chloride and bleomycin. Immunoperoxidase staining for ADH of the original biopsy specimens from both patients was negative. Possible mechanisms for and the implications of the production of SIADH in this setting are discussed.

At the Dann‐Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis‐platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: 1. predictability of, and conversion to, resectability during induction chemotherapy; 2. ease of surgical technique and intraoperative assessment; 3. patterns of pre‐op and postop risks and complications; 4. gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; 5. patterns of locoregional control or failure related to treatment variables.The issues subsequently addressed include: how does chemotherapy affect the operati...

Abstract: Provides information about current brain research. Explains that some of the basic tenets that have guided research are outlined in R. Shore's" Rethinking the Brain: New Insights into Early Development." Offers five hypotheses:(1) nature/nurture;(2) effects of ...

ACADEMIC EMERGENCY MEDICINE 2012; 19: 608–612 © 2012 by the Society for Academic Emergency MedicineObjectives:  Teamwork and communication often play a role in adverse clinical events. Due to the multidisciplinary and time‐sensitive nature of trauma care, the effects of teamwork and communication can be especially pronounced in the treatment of the acutely injured patient. Our hypothesis was that an in situ trauma simulation (ISTS) program (simulating traumas in the trauma bay with all members of the trauma team) could be implemented in an emergency department (ED) and that this would improve teamwork and communication measured in the clinical setting.Methods:  This was an observational study of the effect of an ISTS program on teamwork and communication during trauma care. The authors observed a convenience sample of 39 trauma activations. Cases were selected by their presenting to the resuscitation bay of a Level I trauma center between 09:00 and 16:00, Monday through Thursday, du...

Screening programs can be designed to be useful for data collection to study effectiveness of screening. High-risk populations may be identified, and screening techniques applied to a randomly selected subgroup with another subgroup serving as controls. This raises the ethical question of not applying helpful surveillance to individuals known to be at high-risk. Attention should be paid to management of controls, for example, to screen them less frequently, or at least to inform them of their increased risk and advise periodic exams. Against such recommendations is that differences between test and control groups would be minimized and the study less conclusive. Another approach is to use adaptive design, selecting the study group for a large population which is being subject to medical surveillance for some other reason. As in other clinical trails, studies of screening programs must include appropriate surveillance for controls to properly safeguard their rights and medical needs.

Purpose To investigate the clinical characteristics of the syndrome of inappropriate antidiuretic hormone (SIADH) associated with nasal and paranasal malignant tumors. Methods Patients with locally advanced or recurrence/metastatic malignant tumors of the nasal and paranasal sinuses were included. The SIADH was diagnosed according to the diagnostic criteria. The clinical characteristics of SIADH patients were retrospectively analyzed. Results Six patients (6/188, 3.2%) met the diagnostic criteria of SIADH, including four olfactory neuroblastoma (4/26, 15.4%), one neuroendocrine carcinoma (1/9, 11.1%), and one squamous cell carcinoma (1/63, 1.6%). Five patients (83.3%) had severe hyponatremia; however, the hyponatremia could be improved by fluid restriction or tolvaptan. Three patients' SIADH were recovered during the chemotherapy and the other three were recovered after the surgery. Conclusion The incidence of SIADH associated with nasal and paranasal malignant tumors is relatively more common in olfactory neuroblastoma and neuroendocrine carcinoma. The hyponatremia caused by SIADH may be corrected by fluid restriction or tolvaptan, and the SIADH may be recovered through anti-tumor therapy. Keywords Syndrome of inappropriate secretion of antidiuretic hormone • Nasal and paranasal tumors • Olfactory neuroblastoma • Hyponatremia

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Supreme excellence consists in breaking the enemy's resistance without fighting.” “The worst strategy of all is to besiege walled cities.” “There are five essentials for victory: He will win who knows when to fight and when not to fight. He will win who knows how to handle both superior and inferior forces.