- An estimate of the prevalence of developmental phonagnosiaPublication date: August 2016
Source:Brain and Language, Volume 159
Author(s): Bryan E. Shilowich, Irving Biederman
A web-based survey estimated the distribution of voice recognition abilities with a focus on determining the prevalence of developmental phonagnosia, the inability to identify a familiar person based on their voice. Participants matched clips of 50 celebrity voices to 1–4 named headshots of celebrities whose voices they had previously rated for familiarity. Given a strong correlation between rated familiarity and recognition performance, a residual was calculated based on the average familiarity rating on each trial, which thus constituted each respondent’s voice recognition ability that could not be accounted for by familiarity. 3.2% of the respondents (23 of 730 participants) had residual recognition scores 2.28 SDs below the mean (whereas 8 or 1.1% would have been expected from a normal distribution). They also judged whether they could imagine the voice of five familiar celebrities. Individuals who had difficulty in imagining voices were also generally below average in their accuracy of recognition.
- High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus.High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus.AJNR Am J Neuroradiol. 2016 Jun 30;Authors: Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, Iwasaki M, Tominaga T, Mori EAbstract
BACKGROUND AND PURPOSE: Although neuroimaging plays an important role in the diagnosis of idiopathic normal pressure hydrocephalus, its predictive value for response to shunt surgery has not been established. The purpose of the current study was to identify neuroimaging markers that predict the shunt response of idiopathic normal pressure hydrocephalus.
MATERIALS AND METHODS: Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The assessed MR imaging features included the Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. The idiopathic normal pressure hydrocephalus grading scale total score was used as a primary clinical outcome measure. We used measures for individual symptoms (ie, the idiopathic normal pressure hydrocephalus grading scale subdomain scores, such as gait, cognitive, and urinary scores), the Timed Up and Go test, and the Mini-Mental State Examination as secondary clinical outcome measures. The relationships between presurgical neuroimaging features and postoperative clinical changes were investigated by using simple linear regression analysis. To identify the set of presurgical MR imaging features that best predict surgical outcomes, we performed multiple linear regression analysis by using a bidirectional stepwise method.
RESULTS: Simple linear regression analyses demonstrated that presurgical high-convexity tightness, callosal angle, and Sylvian fissure dilation were significantly associated with the 1-year changes in the clinical symptoms. A multiple linear regression analysis demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.
CONCLUSIONS: High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.PMID: 27365329 [PubMed – as supplied by publisher]from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29jSBd0
via IFTTT - The use of intracranial recordings to decode human language: Challenges and opportunitiesPublication date: Available online 1 July 2016
Source:Brain and Language
Author(s): Stephanie Martin, José del R. Millán, Robert T. Knight, Brian N. Pasley
Decoding speech from intracranial recordings serves two main purposes: understanding the neural correlates of speech processing and decoding speech features for targeting speech neuroprosthetic devices. Intracranial recordings have high spatial and temporal resolution, and thus offer a unique opportunity to investigate and decode the electrophysiological dynamics underlying speech processing. In this review article, we describe current approaches to decoding different features of speech perception and production – such as spectrotemporal, phonetic, phonotactic, semantic, and articulatory components – using intracranial recordings. A specific section is devoted to the decoding of imagined speech, and potential applications to speech prosthetic devices. We outline the challenges in decoding human language, as well as the opportunities in scientific and neuroengineering applications.
- Analysis of iodine-131-induced early thyroid hormone variations in Graves’ disease.Analysis of iodine-131-induced early thyroid hormone variations in Graves’ disease.Nucl Med Commun. 2016 Jun 30;Authors: Xu F, Gu A, Pan Y, Yang L, Ma YAbstract
OBJECTIVE: This prospective study aimed to assess iodine-131 (I)-induced early thyroid hormone variations in Graves’ disease (GD) and determine the associated factors.
MATERIALS AND METHODS: One hundred and seventy-one GD patients treated with I were evaluated (47 men, 124 women). I was administered at 9.0±4.9 mCi on average. Serum free triiodothyronine and free thyroxin were measured within 24 h before treatment and 8 (3-14) days after treatment. Patients were divided into increase, no change, and decrease groups, respectively, on the basis of hormone variations after treatment. χ-Test, analysis of variance, and the Kruskal-Wallis test were used to compare groups in terms of sex, age, course of disease, thyroid stimulating hormone receptor antibodies, antithyroid drug (ATD) pretreatment time, time of ATD discontinuation before I treatment, 24 h thyroid I uptake, thyroid weight, I activity, and I activity/thyroid weight (μCi/g). The Spearman method was used for correlation analyses.
RESULTS: Twenty-seven, 20, and 124 cases were assigned to increase, no change, and decrease groups, respectively. Significant differences were found among groups in the time of ATD discontinuation before I treatment [the median duration for methimazole was 11 (5-26), 16 (10-30), and 21 (1-30) days, P=0.000, the median duration for propylthiouracil was 12.5 (5-24), 22 (11-26), and 26 (21-30) days, P=0.000], thyroid weight (93.5±33.6, 90.3±48.8, and 74.1±26.0 g, P=0.003), and μCi/g (84.8±11.8, 100.4±24.9, and 121.1±44.0 μCi/g, P=0.000). Interestingly, μCi/g was negatively and positively correlated to the possibility of hormone increase and decrease, respectively. No significant differences were found in the other parameters assessed.
CONCLUSION: At the early stage of I treatment for GD, few patients showed increased thyroid hormone levels. Key factors may include time of ATD discontinuation before I treatment and μCi/g. High μCi/g might decrease thyroid hormone levels in early treatment, making it safe.PMID: 27366942 [PubMed – as supplied by publisher]from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29dHgrV
via IFTTT - Lymph node ratio predicts survival in hypopharyngeal cancer with positive lymph node metastasis
Abstract
The lymph node density (LND) has been reported to be a significant prognostic factor in various types of carcinoma. This study investigated whether the LND is associated with survival in patients with hypopharyngeal squamous cell carcinoma (HPSCC) who have positive lymph nodes without distant metastasis. Forty-six patients who were pathologically diagnosed with HPSCC with positive lymph nodes and without distant metastasis were enrolled in this study. The LND was defined as the ratio of positive lymph nodes to the total number of lymph nodes. An LND of ≥0.09 was found to be significantly correlated with a shorter overall (p = 0.044) and disease-specific (p = 0.019) survival according to a log-rank test. In a multivariate survival analysis using a Cox proportional hazards model adjusted for the pathological T category (pT3–4/pT1–2), pathological N category (pN2/pN1) and positive surgical margin and/or extracapsular spread (presence/absence), both an LND of ≥0.09 and pT3–4 category were associated with significantly shorter overall survival (p < 0.01) and disease-specific survival (p < 0.01). These results suggest that the LND functions as a prognostic factor for HPSCC patients with positive lymph nodes who do not have distant metastasis.
- Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sasieta HC, Iyer VN, Orbelo DM, Patton C, Pittelko R, Keogh K, Lim KG, Ekbom DCAbstract
Importance: Refractory chronic cough is a debilitating condition with limited therapeutic options. Laryngeal botulinum toxin type A (BtxA) has been anecdotally reported to benefit patients with chronic cough. We report on our experience with the use of BtxA for the treatment of patients with refractory chronic cough.
Objective: To describe the effects of electromyography (EMG)-guided thyroarytenoid (TA) BtxA injection for the treatment of refractory chronic cough.
Design, Setting, and Participants: For this single tertiary referral center retrospective case series, we included all patients with refractory chronic cough who received bilateral EMG-guided TA BtxA injections (n = 22) between July 1, 2013, and July 31, 2014, at the Mayo Clinic in Rochester, Minnesota.
Intervention: Bilateral TA BtxA injection.
Main Outcomes and Measures: The primary outcome is a self-reported improvement of 50% or more in cough severity and/or symptoms by a 2-month follow-up telephone call. Adverse events and patient-reported quality measures were also assessed.
Results: A total of 22 patients (median [interquartile range] age 61 [57.5-85] years; 19 of 22 women) underwent 31 distinct laryngeal BtxA treatment sessions. The primary outcome of self-reported improvement of 50% or more of cough severity and/or symptoms was achieved in 16 of 31 (52%) treatment sessions. Eleven patients (50%) reported greater than 50% improvement after the first BtxA injection. No major complications occurred. Postprocedural liquid dysphagia had a positive predictive value of 84% and negative predictive value of 100% for response to therapy.
Conclusions and Relevance: In this case series, laryngeal BtxA injection was well tolerated in patients with refractory chronic cough with half of participants experiencing at least short-term improvement in their cough. The occurrence of liquid dysphagia after a BtxA injection appeared to be predictive of a beneficial response. The durability of response, patient selection criteria, and optimal BtxA dosage remains to be determined.PMID: 27367917 [PubMed – as supplied by publisher]
- A very unusual cause of dysphagia: mantle cell lymphoma.A very unusual cause of dysphagia: mantle cell lymphoma.Ann Gastroenterol. 2016 Jul-Sep;29(3):383-5Authors: Zullo A, Cerro P, Chios A, Andriani A, Balsamo G, Francesco VD, Bruzzese VAbstract
Dysphagia is an alarm symptom requiring a prompt investigation. Different benign and malignant diseases may present such a symptom. We describe a case of a 79-year-old patient who complained of fluctuating dysphagia episodes following solid food ingestion in the previous 5 months with mild weight loss. No other gastrointestinal symptoms were present. The patient was referred by the General Practitioner for a videofluoroscopic swallow examination which revealed nodularity of mucosa surface in the oropharynx, esophagus, fundus, and gastric body. Upper endoscopy confirmed the feature, also showing a normal mucosa of the antrum and duodenum. The histological examination revealed a mantle cell lymphoma (MCL). A stage III, MCL involving the esophagus and proximal stomach was eventually diagnosed. Esophageal MCL localization is extremely rare, and this is the first report showing a clinical onset with dysphagia.PMID: 27366047 [PubMed]
- Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture.Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):153-6Authors: Kandpal DK, Bhargava DK, Jerath N, Darr LA, Chowdhary SKAbstract
Esophageal substitution in children is a rare and challenging surgery. The minimally invasive approach for esophageal substitution is novel and reported from a few centers worldwide. While detailed report on the various complications of this approach has been discussed in adult literature, the pediatric experience is rather limited. We report the laparoscopic management of a rare complication which developed after laparoscopic esophagectomy and esophageal substitution. The timely recognition and management by the minimally invasive approach have been highlighted.PMID: 27365913 [PubMed]
- Management of long segment congenital esophageal stenosis: A novel technique.Management of long segment congenital esophageal stenosis: A novel technique.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):150-2Authors: Jain V, Yadav DK, Sharma S, Jana M, Gupta DKAbstract
Congenital esophageal stenosis (CES) is a rare cause of dysphagia in children. Diagnosis is often apparent on esophagogram. Surgical treatment for the subtype with tracheobronchial remnants (TBR) includes resection and anastomosis of the stenosed segment, myectomy, enucleation of cartilage, etc., These procedures are not suitable if the stenosed segment is long. We present a case of a 5-year-old boy who was diagnosed as CES and was successfully managed with stricturoplasty with some innovative modifications.PMID: 27365912 [PubMed]
- Review of esophageal injuries and stenosis: Lessons learn and current concepts of management.Review of esophageal injuries and stenosis: Lessons learn and current concepts of management.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):139-43Authors: Ramareddy RS, Alladi AAbstract
AIM: To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.
MATERIALS AND METHODS: Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.
RESULTS: Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.
CONCLUSION: Esophageal injuries though rare can be potentially devastating and life-threatening.PMID: 27365909 [PubMed]
- Patterns of Care and Comparative Effectiveness of Intensified Adjuvant Therapy for Resected Oropharyngeal Squamous Cell Carcinoma in the Human Papillomavirus Era.Patterns of Care and Comparative Effectiveness of Intensified Adjuvant Therapy for Resected Oropharyngeal Squamous Cell Carcinoma in the Human Papillomavirus Era.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sher DJ, Nedzi L, Khan S, Hughes R, Sumer BD, Myers LL, Truelson JM, Koshy MAbstract
Importance: There is a growing debate on the relative benefits of adjuvant chemoradiotherapy (CRT) and boost doses of postoperative radiotherapy (B-PORT) in oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery, especially for patients with human papillomavirus (HPV)-driven disease.
Objective: To characterize the recent patterns of care in and overall survival (OS) outcomes following the use of adjuvant CRT and B-PORT after primary surgery for OPSCC.
Design, Setting, and Participants: Retrospective analysis of patients in the National Cancer Database with stage III to IVA-B OPSCC treated with surgery and adjuvant radiotherapy between 2010 and 2012 at Commission on Cancer-accredited facilities. The data analysis was performed between June 15, 2015, and May 4, 2016.
Main Outcomes and Measures: The primary outcomes were prevalence of CRT and B-PORT, and OS. The primary predictors were HPV positivity and high-risk pathologic features (HRPFs) (extracapsular extension and positive surgical margins).
Results: Of the 1409 patients (1153 [82%] male; median age, 57 [interquartile range {IQR}, 51-63] years), 873 (62%) and 789 (56%) patients received CRT and B-PORT, respectively; most patients (n = 583 [79%]) with HRPFs received CRT, and many patients (n = 227 [40%]) without HRPFs received CRT. Multivariable predictors of CRT included adverse pathologic features (extracapsular extension [OR, 6.99; 95% CI, 5.22-9.35], positive surgical margins [OR, 2.07; 95% CI, 1.50-2.87], ≥6 involved nodes [OR, 2.34; 95% CI, 1.39-3.92], or low-neck disease [OR, 1.52; 95% CI, 1.01-2.28]), and treatment at a nonacademic institution (OR, 1.59 [95% CI, 1.21-2.10] for comprehensive community cancer center vs academic program). Patients with HPV-positive disease (OR, 0.47; 95% CI, 0.33-0.68) were less likely to receive CRT; this decrease was limited to absent HRPF treated at academic institutions (n = 173, 44 [25%] received CRT). With a median follow-up of surviving patients of 27 (IQR, 21-33) months, the 2-year OS probability was 92% (95% CI, 90%-94%). Multivariable analysis including age, sex, pathologic T stage, 6 or more positive nodes, and educational status confirmed the prognostic impact of HPV positivity (hazard ratio [HR], 0.41; 95% CI, 0.21-0.80) and HRPFs (positive surgical margins [HR, 2.15; 95% CI, 1.27-3.66] and ≥6 involved nodes [HR, 2.11; 95% CI, 1.13-3.93]), but neither CRT (HR, 1.27; 95% CI, 0.70-2.30) nor B-PORT (HR, 1.04; 95% CI, 0.63-1.73) was associated with improved OS.
Conclusions and Relevance: Postoperative CRT and B-PORT following resection of OPSCC were dependent on factors beyond HRPFs, including HPV status and treatment at an academic institution. No benefit was seen with intensified adjuvant therapy, supporting enrollment of the HPV-positive population into deintensification trials.PMID: 27368076 [PubMed – as supplied by publisher]
- The use of ileocolic segment for esophageal replacement in children.The use of ileocolic segment for esophageal replacement in children.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):116-9Authors: Bal HS, Sen SAbstract
AIMS: To evaluate and describe the procedure and outcome of ileocolic replacement of esophagus.
MATERIALS AND METHODS: We review 7 children with esophageal injuries, who underwent esophageal replacement using ileocolic segment in Christian Medical College, Vellore, India between 2006 and 2014.
RESULTS: The ileocolic segment was used in 7 children with scarred or inadequate esophagus. There were 4 girls and 3 boys, who underwent esophageal replacement using isoperistaltic ileocolic segment in this period. Age at presentation varied from 1 month to 14 years with an average of 4.6 years. The indications for ileocolic replacements were corrosive strictures in 5, failed esophageal atresia repair in one and gastric volvulus related esophageal stricture in another. The average follow-up duration was 37 months. One child with corrosive stricture lost to follow-up and died 2 years later in another center. Other 6 children were free of dysphagia till the last follow-up.
CONCLUSIONS: Although the ileocolic segment is not commonly used for esophageal substitution, it can be useful in special situations where the substitution needs to reach the high cervical esophagus and also where the stomach is scarred and not suitable for gastric pull-up.PMID: 27365904 [PubMed]
- Postdeglutitive residue in vagus nerve paralysis and its association with feeding style.Postdeglutitive residue in vagus nerve paralysis and its association with feeding style.Eur Arch Otorhinolaryngol. 2016 Jun 30;Authors: Kumai Y, Samejima Y, Yumoto EAbstract
The objective of this study is to compare the postdeglutitive pharyngeal residues between Xth cranial nerve paralysis (XNP) and isolated recurrent laryngeal nerve paralysis (RLNP) to elucidate the association with feeding style. This study enrolled 15 XNP patients with injuries at the brainstem level (Group I) and 26 patients with RLNP (Group II). All subjects underwent videofluoroscopic swallowing studies (VFSS). The pyriform sinus (PS) and vallecula residues were quantified. The symmetry of the affected versus non-affected sides was compared in both groups. Feeding style at the time of VFSS was also examined. The intra-rater correlation coefficients for all of the data, including the areas of both the vallecula and pyriform sinus on the affected and non-affected sides, were 0.88-0.92 (p < 0.001), reflecting high consistency of the evaluation. In Group I, there was significantly (p < 0.01) more residue in the PS, but not vallecula, compared to the respective non-affected sides, while in Group II there were no significant differences in residue between the affected and non-affected sides for either the vallecula or PS. Comparing Groups I and II, there was significant (p < 0.01) residue on the affected side in the PS but not the vallecula. There was a significant correlation between dependency on a feeding tube and XNP (p < 0.01, Chi-square test). XNP at the brainstem level may cause significantly increased residue in the PS compared to RLNP. This might increase the dependency on a feeding tube with XNP.PMID: 27363405 [PubMed – as supplied by publisher]
- The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer.The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Cabrera RN, Chone CT, Zantut-Wittmann DE, Matos PS, Ferreira DM, Pereira PS, Ribeiro MP, Santos AO, Ramos CD, Crespo AN, Etchebehere ECAbstract
Importance: Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC). Evidence suggests that these novel techniques lead to substantial changes in PTC management by reducing understaging and of occult lymph node (LN) metastases and optimizing neck surgery by increasing the necessity of lateral lymphadenectomy and decreasing central lymphadenectomy.
Objectives: To correlate the presence of LN metastases in PTC with clinical and pathological features using SPECT/CT and rSLNB.
Design, Setting, and Participants: For this prospective cohort study from June 2010 to November 2013, 42 patients with thyroid nodules suspicious for papillary carcinoma or classified as malignant on cytology examination without suspicion of lymph node metastases by clinical and ultrasound examinations were recruited from a single public medical institution.
Interventions: All 42 patients underwent preoperative lymphoscintigraphy after an ultrasound-guided peritumoral injection of Technetium Tc 99m nanocolloid. Cervical images were acquired with a SPECT/CT scanner 15 minutes after radiotracer injection. Approximately 2 hours after lymphoscintigraphy, the patients were submitted to intraoperative rSLNB using a handheld gamma probe. All SLNs identified were removed alongside with non-SLNs from the same compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted for histopathology and immunohistochemical analyses.
Results: Of the 42 patients initially enrolled, 37 were included in analysis, including 6 men and 31 women with a mean (range) age of 47 (22-83) years. Overall, T stage was as follows: T1, 23 patients (62.2%); T2, 8 patients (21.6%); and T3, 6 patients (16.2%). Sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 17 patients (46%). The SLNs were false-negative in 3 patients. Metastases in the lateral compartment ocurred in 7 patients (18%). There was a significant association between LN metastases and tumor size (odds ratio, 1.06; 95% CI, 1.00-1.13; P = .02), with a Cohen d effect of 0.683 (medium to large effect). Overall, 17 patients (46%) with LN metastases had management changed because they were submitted to higher radioiodine ablation doses and closer clinical surveillance.
Conclusions And Relevance: Radioguided SLNB is able to detect occult cervical lymph node metastases in patients with papillary thyroid carcinoma, and in 7 patients (18%) rSLNB detected lymph node metastases in the lateral compartments. The rSLNB technique lead to management change in 14 patients (37.8%).PMID: 27366869 [PubMed – as supplied by publisher]
- Diabolical Coughing-Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients.Diabolical Coughing-Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Bastian RWPMID: 27367790 [PubMed – as supplied by publisher]
- Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sasieta HC, Iyer VN, Orbelo DM, Patton C, Pittelko R, Keogh K, Lim KG, Ekbom DCAbstract
Importance: Refractory chronic cough is a debilitating condition with limited therapeutic options. Laryngeal botulinum toxin type A (BtxA) has been anecdotally reported to benefit patients with chronic cough. We report on our experience with the use of BtxA for the treatment of patients with refractory chronic cough.
Objective: To describe the effects of electromyography (EMG)-guided thyroarytenoid (TA) BtxA injection for the treatment of refractory chronic cough.
Design, Setting, and Participants: For this single tertiary referral center retrospective case series, we included all patients with refractory chronic cough who received bilateral EMG-guided TA BtxA injections (n = 22) between July 1, 2013, and July 31, 2014, at the Mayo Clinic in Rochester, Minnesota.
Intervention: Bilateral TA BtxA injection.
Main Outcomes and Measures: The primary outcome is a self-reported improvement of 50% or more in cough severity and/or symptoms by a 2-month follow-up telephone call. Adverse events and patient-reported quality measures were also assessed.
Results: A total of 22 patients (median [interquartile range] age 61 [57.5-85] years; 19 of 22 women) underwent 31 distinct laryngeal BtxA treatment sessions. The primary outcome of self-reported improvement of 50% or more of cough severity and/or symptoms was achieved in 16 of 31 (52%) treatment sessions. Eleven patients (50%) reported greater than 50% improvement after the first BtxA injection. No major complications occurred. Postprocedural liquid dysphagia had a positive predictive value of 84% and negative predictive value of 100% for response to therapy.
Conclusions and Relevance: In this case series, laryngeal BtxA injection was well tolerated in patients with refractory chronic cough with half of participants experiencing at least short-term improvement in their cough. The occurrence of liquid dysphagia after a BtxA injection appeared to be predictive of a beneficial response. The durability of response, patient selection criteria, and optimal BtxA dosage remains to be determined.PMID: 27367917 [PubMed – as supplied by publisher]
- The clinical manifestation of the neurovascular conflict of the vestibulocochlear nerve.[The clinical manifestation of the neurovascular conflict of the vestibulocochlear nerve].Vestn Otorinolaringol. 2016;81(3):67-68Authors: Redaktsiia, Kryukov AI, Kunel’skaya NL, Garov EV, Mishchenko VVPMID: 27367356 [PubMed – as supplied by publisher]
- Spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.Nonrandom spatial clustering of spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.:
J Neurosurg. 2016 Jul 1;:1-5
Authors: Murray RD, Friedlander R, Hanz S, Singh H, Anand VK, Schwartz TH
Abstract
OBJECTIVE The anterior skull base is a common site for the spontaneous development of meningoceles, encephaloceles, and meningoencephaloceles that can lead to cerebrospinal fluid (CSF) fistula formation, particularly in association with idiopathic intracranial hypertension. In some circumstances the lesions are difficult to localize. Whether all sites in the anterior skull base are equally prone to fistula formation or whether they are distributed randomly throughout the anterior skull base is unknown, although the anterior cribriform plate has been proposed as the most frequent location. The purpose of this study was to identify sites of predilection in order to provide assistance for clinicians in finding occult leaks and increase the understanding of the etiology of this pathology. METHODS The authors performed a retrospective review of a prospectively acquired surgical database of all endonasal endoscopic surgeries performed at Weill Cornell Medical College by the senior authors. Spontaneous CSF fistulas of the anterior skull base were identified. The anatomical sites of the defects were located on radiographic images and normalized to a theoretical 4 × 2 grid representing the anterior midline skull base. Data from the left and right skull base were combined to increase statistical power. This grid was then used to analyze the distribution of defects. Frequency analysis was performed by means of a chi-square test, with a subsequent Monte Carlo simulation to further strengthen the statistical support of the conclusions. RESULTS Nineteen cases of spontaneous CSF fistulas were identified. Frequency analysis using chi-square indicated a nonrandom distribution of sites (p = 0.035). Monte Carlo simulation supported this conclusion (p = 0.034). Seventy-four percent of cases occurred in the cribriform plate (p = 0.086). Moreover, 37% of all defects occurred in the posterior third of the cribriform plate. CONCLUSIONS Anterior skull base spontaneous CSF leaks are distributed in a nonrandom fashion. The most likely site of origin of the spontaneous CSF leaks of the anterior midline skull base is the cribriform plate, particularly the posterior third of the plate, likely because of the lack of significant thick bony buttressing. Clinicians searching for occult spontaneous leaks of the anterior skull base should examine the cribriform plate, especially the posterior third with particularly close scrutiny.
PMID: 27367237 [PubMed - as supplied by publisher]
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29B7WC6
via IFTTT - The role of prosodic boundaries in word discoveryThis study aims to quantify the role of prosodic boundaries in early language acquisition using a computational modeling approach. A spoken term discovery system that models early word learning was used with and without a prosodic component on speech corpora of English, Spanish, and Japanese. The results showed that prosodic information induces a consistent improvement both in the alignment of the terms to actual word boundaries and in the phonemic homogeneity of the discovered clusters of terms. This benefit was found also when automatically discovered prosodic boundaries were used, boundaries which did not perfectly match the linguistically defined ones.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29ezwFB
via IFTTT - Spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.Nonrandom spatial clustering of spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.:
J Neurosurg. 2016 Jul 1;:1-5
Authors: Murray RD, Friedlander R, Hanz S, Singh H, Anand VK, Schwartz TH
Abstract
OBJECTIVE The anterior skull base is a common site for the spontaneous development of meningoceles, encephaloceles, and meningoencephaloceles that can lead to cerebrospinal fluid (CSF) fistula formation, particularly in association with idiopathic intracranial hypertension. In some circumstances the lesions are difficult to localize. Whether all sites in the anterior skull base are equally prone to fistula formation or whether they are distributed randomly throughout the anterior skull base is unknown, although the anterior cribriform plate has been proposed as the most frequent location. The purpose of this study was to identify sites of predilection in order to provide assistance for clinicians in finding occult leaks and increase the understanding of the etiology of this pathology. METHODS The authors performed a retrospective review of a prospectively acquired surgical database of all endonasal endoscopic surgeries performed at Weill Cornell Medical College by the senior authors. Spontaneous CSF fistulas of the anterior skull base were identified. The anatomical sites of the defects were located on radiographic images and normalized to a theoretical 4 × 2 grid representing the anterior midline skull base. Data from the left and right skull base were combined to increase statistical power. This grid was then used to analyze the distribution of defects. Frequency analysis was performed by means of a chi-square test, with a subsequent Monte Carlo simulation to further strengthen the statistical support of the conclusions. RESULTS Nineteen cases of spontaneous CSF fistulas were identified. Frequency analysis using chi-square indicated a nonrandom distribution of sites (p = 0.035). Monte Carlo simulation supported this conclusion (p = 0.034). Seventy-four percent of cases occurred in the cribriform plate (p = 0.086). Moreover, 37% of all defects occurred in the posterior third of the cribriform plate. CONCLUSIONS Anterior skull base spontaneous CSF leaks are distributed in a nonrandom fashion. The most likely site of origin of the spontaneous CSF leaks of the anterior midline skull base is the cribriform plate, particularly the posterior third of the plate, likely because of the lack of significant thick bony buttressing. Clinicians searching for occult spontaneous leaks of the anterior skull base should examine the cribriform plate, especially the posterior third with particularly close scrutiny.
PMID: 27367237 [PubMed - as supplied by publisher]
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29B7WC6
via IFTTT - The role of prosodic boundaries in word discoveryThis study aims to quantify the role of prosodic boundaries in early language acquisition using a computational modeling approach. A spoken term discovery system that models early word learning was used with and without a prosodic component on speech corpora of English, Spanish, and Japanese. The results showed that prosodic information induces a consistent improvement both in the alignment of the terms to actual word boundaries and in the phonemic homogeneity of the discovered clusters of terms. This benefit was found also when automatically discovered prosodic boundaries were used, boundaries which did not perfectly match the linguistically defined ones.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29ezwFB
via IFTTT - Rhino-septal splints in endoscopic transsphenoidal skull base surgery.Evaluation of the application of
Eur Arch Otorhinolaryngol. 2016 Jun 30;
Authors: Schlüter A, Ahmadipour Y, Vogelsang T, Kreitschmann-Andermahr I, Kleist B, Weller P, Holtmann L, Mattheis S, Lang S, Bergmann C, Mueller O
Abstract
The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10 days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2 months postoperatively. Patients’ subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n = 15; 50 %) than without (n = 16; 84.2 %). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n = 10 vs. n = 2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p = 0.039 and p = 0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9 % of patients without splints, but only 56 % of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.
PMID: 27363406 [PubMed - as supplied by publisher]
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29ezL3m
via IFTTT - Acute exercise caused significant reduction in salivary flow rateEffects of acute exercise on salivary free insulin-like growth factor 1 and interleukin 10 in sportsmen:
Background: Saliva analysis is rapidly developing as a tool for the assessment of biomarkers of sports training. It remains poorly understood whether a short bout of sport training can alter some salivary immune biomarkers.
Aim: To investigate the effect of acute exercise using football training session on salivary flow rate, salivary free Insulin-like Growth Factor-1 (IGF-1) and Interleukin 10 (IL-10).
Methods: Saliva samples were collected before and immediately after a football session. Salivary flow rates, salivary levels of free IGF-1 and IL-10 (using ELISA) were determined. Data was analyzed and compared using Related Samples Wilcoxon Signed Rank test (non-parametric test). Relationships between salivary flow rate and levels of free IGF-1 and IL-10 were determined using Spearman correlation test.
Results: There were 22 male footballers with a mean age of 20.46 years. Salivary flow rate reduced significantly (p = 0.01) after the training session while salivary levels of free IGF-1 and IL-10 did not show any significant change. Also, there were no correlations between salivary flow rates and salivary levels of free IGF-1 and IL-10 before and after exercise.
Conclusion: These findings suggest that acute exercise caused significant reduction in salivary flow rate but no change in the levels of salivary free IGF-1 and IL-10.
Keywords: Saliva, exercise, Insulin-like Growth Factor, interleukin 10,salivary flow rate
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29lPIsA
via IFTTT - Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma.Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma
Laryngoscope. 2016 Jul 1;
Authors: Rovó L, Bach Á, Sztanó B, Matievics V, Szegesdi I, Castellanos PF
Abstract
OBJECTIVES: The complex laryngeal functions are fundamentally defined by the cricoid cartilage. Thus, lesions requiring subtotal or total resection of the cricoid cartilage commonly warrant total laryngectomy. However, from an oncological perspective, the resection of the cricoid cartilage would be an optimal solution in these cases. The poor functional results of the few reported cases of total and subtotal cricoidectomy with different reconstruction techniques confirm the need for new approaches to reconstruct the infrastructure of the larynx post cricoidectomy.
STUDY DESIGN: Retrospective case series review.
METHODS: Four consecutive patients with low-grade chondrosarcoma were treated by cricoidectomy with rotational thyrotracheopexy reconstruction to enable the functional creation of a complete cartilaginous ring that can substitute the functions of the cricoid cartilage. The glottic structures were stabilized with endoscopic arytenoid abduction lateropexy. Patients were evaluated with objective and subjective function tests.
RESULTS: Tumor-free margins were proven; patients were successfully decannulated within 3 weeks. Voice outcomes were adequate for social conversation in all cases. Oral feeding was possible in three patients.
CONCLUSION: Total and subtotal cricoidectomy can be a surgical option to avoid total laryngectomy in cases of large chondrosarcomas destroying the cricoid cartilage. The thyrotracheopexy rotational advancement technique enables the effective reconstruction of the structural deficit of the resected cricoid cartilage in cases of total and subtotal cricoidectomy. An adequate airway for breathing, swallowing, and voice production can be reconstructed with good oncological control. In cases where the pharynx is not involved, good swallowing function can also be achieved.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.
PMID: 27364085 [PubMed - as supplied by publisher]
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29lPq4T
via IFTTT - Upper Airway Stimulation for OSAEarly Adherence and Outcome Results of One Center: Objective
To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA).
Study Design
Case series with chart review.
Setting
Academic sleep medicine center.
Subjects and Methods
The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system. Data included demographics, body mass index (BMI), apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), nightly hours of device usage, and procedure- and therapy-related complications.
Results
Mean age was 64.8 ± 12.0 years, with 50% female. Mean BMI was unchanged postoperatively (26.5 ± 4.2 to 26.8 ± 4.5 kg/m2; P > .05). Mean AHI (33.3 ± 13.0 to 5.1 ± 4.3; P < .0001) and mean ESS (10.3 ± 5.2 to 6.0 ± 4.4; P < .01) decreased significantly. Seventy percent (14/20) of patients achieved a treatment AHI <5, 85% (17/20) an AHI <10, and 95% (19/20) an AHI <15. Average stimulation amplitude was 1.89 ± 0.50 V after titration. Adherence monitoring via device interrogation showed high rates of voluntary device use (mean 7.0 ± 2.2 h/night).
Conclusion
For a clinical and anatomical subset of patients with OSA, HNS therapy is associated with good objective adherence, low morbidity, and improved OSA outcome measures. Early results at one institution suggest that HNS therapy can be implemented successfully into routine clinical practice, outside of a trial setting.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29a7D0g
via IFTTT - Recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinomaHuman Papillomavirus Vaccination Counseling in Pediatric Training: Are We Discussing Otolaryngology-Related Manifestations?: Objective
Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling.
Study Design
Survey.
Setting
Tertiary care academic children’s hospital.
Subjects
Pediatric residents, fellows, and staff.
Methods
An online survey was made available regarding HPV education and vaccination.
Results
Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported “never” discussing recurrent respiratory papillomatosis and 52.9% “never” discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma.
Conclusions
Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dmdaO
via IFTTT - Human Papillomavirus Vaccination Counselingin Pediatric Training: Are We Discussing Otolaryngology-Related Manifestations?: Objective
Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling.
Study Design
Survey.
Setting
Tertiary care academic children’s hospital.
Subjects
Pediatric residents, fellows, and staff.
Methods
An online survey was made available regarding HPV education and vaccination.
Results
Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported “never” discussing recurrent respiratory papillomatosis and 52.9% “never” discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma.
Conclusions
Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29a7Dxj
via IFTTT - Sudden-Onset Sensorineural Hearing Loss after ImmunizationA Case-Centered Analysis: Objective
Case reports of sudden sensorineural hearing loss (SSHL) following vaccines have led to concerns that vaccines may rarely cause hearing loss. Because of this concern, we analyzed for an association between SSHL and vaccinations.
Study Design
We used a case-centered method, equivalent to a case control design using immunization dates from all matched members of the population to calculate exposure to vaccines, rather than sampling.
Setting
Kaiser Permanente Northern California (KPNC), 2007 to 2013.
Subjects and Methods
We searched KPNC databases from 2007 to 2013 for all first-time diagnoses of SSHL. We used the date of any hearing- or ear-related visit in the 60 days prior to the first SSHL diagnosis as the onset date. Using only SSHL cases immunized in the prior 9 months, we compared the vaccine exposure in several risk intervals prior to onset with the exposure to the same vaccine during the same time period in all KPNC membership, matched to sex and age.
Results
During the study period, >20 million vaccines were administered at KPNC. In all risk intervals prior to onset of SSHL, we found no evidence of increased risk of immunization compared with matched controls. The odds ratios for vaccination 1 week prior to SSHL were 0.965 (95% confidence interval, 0.61-1.50) for trivalent inactivated influenza vaccine (TIV); 0.842 (0.39-1.62) for tetanus, reduced diphtheria, and reduced acellular pertussis; and 0.454 (0.08-1.53) for zoster vaccine.
Conclusion
A large-scale analysis applying a case-centered method did not detect any association between SSHL and previous receipt of TIV or other vaccines.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29a7D0e
via IFTTT - Management Strategies for Skull Base Inverted PapillomaManagement Strategies for Skull Base Inverted Papilloma: Objective
Inverted papilloma attached to the ventral skull base presents a surgical dilemma because surgical removal of the bony pedicle is critical to decrease risk of recurrence. The objective of this study is to evaluate the effectiveness of endoscopic management of skull base inverted papilloma.
Study Design
Case series with planned data collection.
Setting
Tertiary medical center.
Subjects
Patients with skull base inverted papilloma.
Methods
Over 7 years, 49 patients with skull base inverted papilloma were referred for surgical resection. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated.
Results
Average age at presentation was 57 years. Twenty-six patients (53%) had prior attempts at resection elsewhere, and 5 had squamous cell carcinoma (SCCA) arising in an inverted papilloma. Six patients (12%) suffered major complications, including skull base osteomyelitis in 2 previously irradiated patients, cerebrospinal fluid leak with pneumocephalus (n = 1), meningitis (n = 1), invasive fungal sinusitis (n = 1), and cerebrovascular accident (n = 1). The mean disease-free interval was 29 months (range, 10-78 months). One patient with SCCA recurred in the nasopharynx (overall 2% recurrence rate). He is disease-free 3 years following endoscopic nasopharyngectomy. Three patients with SCCA had endoscopic resection of the skull base, while 1 subject with inverted papilloma pedicled on the superior orbital roof had an osteoplastic flap in conjunction with a Draf III procedure. All others received endoscopic resection.
Conclusions
Removal of the bony pedicle resulted in excellent local control of skull base inverted papillomas. Our experience demonstrates that disease eradication with limited morbidity is attainable with this approach.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dlTcp
via IFTTT - Oral Flurbiprofen Spray for Posttonsillectomy PainOral Flurbiprofen Spray for Posttonsillectomy Pain: Objective
Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy.
Study Design
Prospective, double-blind, randomized, placebo controlled.
Setting
Patients at Ataturk Training and Research Hospital, Ankara, Turkey.
Subjects and Methods
This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected.
Results
There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups.
Conclusion
In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dmfzu
via IFTTT - Pediatric Descending MediastinitisRetrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis: Objectives
To review the management and outcomes of pediatric patients treated for descending mediastinitis at a single institution and contribute to an updated mortality rate.
Study Design
Case series with chart review.
Setting
Tertiary care pediatric hospital.
Subjects and Methods
This study is a 19-patient case series of all patients treated for descending mediastinitis at a tertiary pediatric hospital from 1997 to 2015, and it serves as an update to the case series published from this institution in 2008. Review of management included time to diagnosis, time to surgery, surgical procedures performed, and antibiotics administered. The primary outcomes measured were length of hospitalization and mortality.
Results
In addition to 8 previously reported patients, we identified 11 pediatric patients treated for descending mediastinitis in the period of review. All 19 patients were <18 months old, and all survived their hospitalization. Fourteen patients underwent surgical drainage at least twice. The median length of hospital stay was 15 days. Retropharyngeal abscess was the source of infection in 16 of 19 patients, and methicillin-resistantStaphylococcus aureus (MRSA) was the isolated organism in 14 of 15 positive cultures.
Conclusion
This review represents the largest reported series of pediatric patients with descending mediastinitis. With 100% survival, our results suggest that pediatric descending mediastinitis can be safely managed by prompt surgical drainage. Broad-spectrum antibiotics covering MRSA and a low threshold for repeat surgical intervention have been an important part of our successful approach and may decrease length of stay.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dmESq
via IFTTT - Effects of a Fibrin Sealant on Skin Graft Tissue Adhesionin a Rodent Model: Objective
To establish a rodent model for skin grafting with fibrin glue and examine the effects of fibrin glue on the adhesive strength of skin grafts without bolsters.
Study Design
Animal cohort.
Setting
Academic hospital laboratory.
Subjects and Methods
Three skin grafts were created using a pneumatic microtome on the dorsum of 12 rats. Rats were evenly divided into experimental (n = 6) and control (n = 6) groups. The experimental group received a thin layer of fibrin glue between the graft and wound bed, and the control group was secured with standard bolsters. Adherence strength of the skin graft was tested by measurement of force required to sheer the graft from the recipient wound. Adhesion strength measurements were taken on postoperative days (PODs) 1, 2, and 3.
Results
The experimental group required an average force of 719 g on POD1, 895 g on POD2, and 676 g on POD3, while the average force in the control group was 161 g on POD1, 257 g on POD2, and 267 g on POD3. On each of the 3 PODs, there was a significant difference in adherence strength between the experimental and control groups (P = .036, P = .029, P = .024).
Conclusion
There is a significant difference in the adhesion strength of skin grafts to the wound bed in the early postoperative period of the 2 groups. In areas of high mobility, using the fibrin sealant can keep the graft immobile during the critical phases of early healing.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29a7rOl
via IFTTT - How different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortalityAssociations of Volume and Thyroidectomy Outcomes: A Nationwide Study with Systematic Review and Meta-Analysis: Objective
This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality.
Data Sources
MEDLINE and EMBASE databases.
Review Methods
This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed.
Results
The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts (P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals.
Conclusions
This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29a7w4O
via IFTTT - Oral Steroid Usage forfor Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction: Objectives
Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement.
Study Design
Cross-sectional analysis of a national database.
Setting
Ambulatory visits in the United States.
Subjects
Children and adults in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2005-2010).
Methods
Data were coded for patient demographic information, potential confounders (eg, concurrent conditions managed by oral steroids), and diagnosis of OME, ETD, or TMR (OME/ETD/TMR). The latter 2 diagnoses were included to meet minimum numbers for reliability of weighted estimates, but OME constituted the majority of cases. Multivariate regression was used to determine the variables associated with oral steroid use.
Results
Among 590,772 observations representing 7,191,711,480 visits for OME/ETD/TMR, 3.2% resulted in a new prescription for oral steroid medication (2.3% for children, 7.0% for adults). Adults were more likely to receive steroids (odds ratio = 3.50, P < .001) than those with other diagnoses, but a similar association was not found for children. Patients seen by an otolaryngologist or in the emergency department were less likely to receive steroids than those seen in other settings.
Conclusions
OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29ohlOw
via IFTTT - The National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases,The otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) databaseDoes an Otolaryngology-Specific Database Have Added Value? A Comparative Feasibility Analysis: Objectives
There are multiple nationally representative databases that support epidemiologic and outcomes research, and it is unknown whether an otolaryngology-specific resource would prove indispensable or superfluous. Therefore, our objective was to determine the feasibility of analyses in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases as compared with the otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) database.
Study Design
Parallel analyses in 2 data sets.
Setting
Ambulatory visits in the United States.
Subjects and Methods
To test a fixed hypothesis that could be directly compared between data sets, we focused on a condition with expected prevalence high enough to substantiate availability in both. This query also encompassed a broad span of diagnoses to sample the breadth of available information. Specifically, we compared an assessment of suspected risk factors for sensorineural hearing loss in subjects 0 to 21 years of age, according to a predetermined protocol. We also assessed the feasibility of 6 additional diagnostic queries among all age groups.
Results
In the NAMCS/NHAMCS data set, the number of measured observations was not sufficient to support reliable numeric conclusions (percentage standard error among risk factors: 38.6-92.1). Analysis of the CHEER database demonstrated that age, sex, meningitis, and cytomegalovirus were statistically significant factors associated with pediatric sensorineural hearing loss (P < .01). Among the 6 additional diagnostic queries assessed, NAMCS/NHAMCS usage was also infeasible; the CHEER database contained 1585 to 212,521 more observations per annum.
Conclusion
An otolaryngology-specific database has added utility when compared with already available national ambulatory databases.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29cZPzX
via IFTTT - Ciprofloxacin Decreases Collagen in Tympanic Membrane Fibroblastsin Mouse
Objectives
To determine how collagen production by tympanic membrane fibroblasts is affected by ciprofloxacin at levels found in eardrops.
Study Design
Prospective, controlled, and blinded cell culture study.
Setting
Academic tertiary medical center.
Subjects
Cell culture of mouse fibroblasts.
Methods
A primary fibroblast culture was established from mouse tympanic membranes. Fibroblasts were cultured until they were 75% confluent, then treated with dilute hydrochloric acid (control) or ciprofloxacin (0.01% or 0.3%) for 24 or 72 hours for Western blotting and for 24 or 48 hours for cytotoxicity assay. Cells were observed with phase-contrast microscope. Western blotting was performed for collagen type 1 α1 (collagen 1A1) and α-tubulin.
Results
Fibroblasts treated with 0.01% and 0.3% ciprofloxacin for 24 hours had lower levels of collagen 1A1 (P = .0005 and P < .0001, respectively) and α-tubulin (both P < .0001) than control fibroblasts. Collagen 1A1 and α-tubulin levels were lower in fibroblasts treated with 0.3% than with 0.01% ciprofloxacin (P = .02 and P = .014). After 72 hours, 0.3% ciprofloxacin completely eliminated collagen 1A1 and α-tubulin (P < .001). Cells treated with 0.01% ciprofloxacin for 72 hours also had lower collagen 1A1 (P < .0001) and α-tubulin (P = .005) as compared with the control. Seventy-two-hour incubation in 0.01% or 0.3% ciprofloxacin resulted in lower levels of collagen 1A1 (P = .009 and P < .0001, respectively) and α-tubulin (P = .007 and P < .0001, respectively) than 24-hour incubation. Cytotoxicity assay and phase-contrast microscopy mirrored these findings.
Conclusions
Treatment of tympanic membrane fibroblasts with 0.3% ciprofloxacin, as found in eardrops, reduces fibroblast viability and collagen and α-tubulin protein levels. These findings could explain tympanic membrane healing problems associated with quinolone eardrops.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29ogZYo
via IFTTT - Treatment of Sudden Hearing LossEvaluation of Compliance for Treatment of Sudden Hearing Loss: A CHEER Network Study: Objective
The objective of this study is to describe the presentation and management of sudden sensorineural hearing loss for patients seen in academic and community-based practices within the context of the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s “Clinical Practice Guideline: Sudden Hearing Loss.” The intention is to use these findings to guide implementation strategies and quality improvement initiatives and as pilot data for the development of clinical research initiatives.
Study Design
A cross-sectional study of patients with sudden hearing loss.
Setting
Patients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) network. The CHEER network is an National Institutes of Health–funded network of 30 otolaryngology sites across the country, half of which are community based and half of which are academic practices.
Subjects and Methods
A total of 173 patients were recruited. Data were gathered via custom questionnaires collected by study site coordinators and entered into a secure online platform. Descriptive analyses and correlation statistics were run with SAS 9.3.1.
Results
Of the 13 guideline statements in the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s clinical practice guideline on sudden hearing loss, 11 statements were evaluable through this study. Compliance for otolaryngologists was >95% for key action statements (KASs) 1, 3, and 6; 90% to 95% for KASs 5 and 10; and <90% for KASs 7 and 13. Compliance was <45% for nonotolaryngologists for KASs 3 and 5-7.
Conclusions
There is opportunity for nonotolaryngologists to improve for statements 3 and 5-7. Otolaryngologists are compliant with many of the KASs overall, but there is significant room for improvement.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29jRaLx
via IFTTT - Laryngopharyngeal Reflux on Taste and Smell FunctionsLaryngopharyngeal Reflux Has Negative Effects on Taste and Smell Functions: Objective
We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR).
Study Design
Prospective clinical study.
Setting
Multicenter tertiary care hospital.
Methods
Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin’ Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test.
Results
A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups (P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group (P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites (P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control (P = .001).
Conclusion
Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dG9s4
via IFTTT - Vestibular Diagnostic Testing for Patients with DizzinessVariation in the Use of Vestibular Diagnostic Testing for Patients Presenting to Otolaryngology Clinics with Dizziness: Objective
We used a national otolaryngology practice–based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder.
Study Design
Database review.
Setting
The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers
Subjects and Methods
Dizzy patients in the CHEER retrospective database were identified throughICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit.
Results
A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics.
Conclusion
There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing.
from OtoRhinoLaryngology - Alexandros G. Sfakianakis http://ift.tt/29dG1Jm
via IFTTT - SonoTip Pro EBUS-TBNA needle – the need for comparative studies with the Vizishot 21 guage needle.SonoTip Pro EBUS-TBNA needle – the need for comparative studies with the Vizishot 21 guage needle.Jpn J Clin Oncol. 2016 Jun 30;Authors: Izumo TPMID: 27365522 [PubMed – as supplied by publisher]from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29dHFul
via IFTTT - An estimate of the prevalence of developmental phonagnosiaPublication date: August 2016
Source:Brain and Language, Volume 159
Author(s): Bryan E. Shilowich, Irving Biederman
A web-based survey estimated the distribution of voice recognition abilities with a focus on determining the prevalence of developmental phonagnosia, the inability to identify a familiar person based on their voice. Participants matched clips of 50 celebrity voices to 1–4 named headshots of celebrities whose voices they had previously rated for familiarity. Given a strong correlation between rated familiarity and recognition performance, a residual was calculated based on the average familiarity rating on each trial, which thus constituted each respondent’s voice recognition ability that could not be accounted for by familiarity. 3.2% of the respondents (23 of 730 participants) had residual recognition scores 2.28 SDs below the mean (whereas 8 or 1.1% would have been expected from a normal distribution). They also judged whether they could imagine the voice of five familiar celebrities. Individuals who had difficulty in imagining voices were also generally below average in their accuracy of recognition. - High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus.High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus.AJNR Am J Neuroradiol. 2016 Jun 30;Authors: Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, Iwasaki M, Tominaga T, Mori EAbstract
BACKGROUND AND PURPOSE: Although neuroimaging plays an important role in the diagnosis of idiopathic normal pressure hydrocephalus, its predictive value for response to shunt surgery has not been established. The purpose of the current study was to identify neuroimaging markers that predict the shunt response of idiopathic normal pressure hydrocephalus.
MATERIALS AND METHODS: Sixty patients with idiopathic normal pressure hydrocephalus underwent presurgical brain MR imaging and clinical evaluation before and 1 year after shunt surgery. The assessed MR imaging features included the Evans index, high-convexity tightness, Sylvian fissure dilation, callosal angle, focal enlargement of the cortical sulci, bumps in the lateral ventricular roof, and deep white matter and periventricular hyperintensities. The idiopathic normal pressure hydrocephalus grading scale total score was used as a primary clinical outcome measure. We used measures for individual symptoms (ie, the idiopathic normal pressure hydrocephalus grading scale subdomain scores, such as gait, cognitive, and urinary scores), the Timed Up and Go test, and the Mini-Mental State Examination as secondary clinical outcome measures. The relationships between presurgical neuroimaging features and postoperative clinical changes were investigated by using simple linear regression analysis. To identify the set of presurgical MR imaging features that best predict surgical outcomes, we performed multiple linear regression analysis by using a bidirectional stepwise method.
RESULTS: Simple linear regression analyses demonstrated that presurgical high-convexity tightness, callosal angle, and Sylvian fissure dilation were significantly associated with the 1-year changes in the clinical symptoms. A multiple linear regression analysis demonstrated that presurgical high-convexity tightness alone predicted the improvement of the clinical symptoms 1 year after surgery.
CONCLUSIONS: High-convexity tightness is a neuroimaging feature predictive of shunt response in idiopathic normal pressure hydrocephalus.PMID: 27365329 [PubMed – as supplied by publisher]from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29jSBd0
via IFTTT - The use of intracranial recordings to decode human language: Challenges and opportunitiesPublication date: Available online 1 July 2016
Source:Brain and Language
Author(s): Stephanie Martin, José del R. Millán, Robert T. Knight, Brian N. Pasley
Decoding speech from intracranial recordings serves two main purposes: understanding the neural correlates of speech processing and decoding speech features for targeting speech neuroprosthetic devices. Intracranial recordings have high spatial and temporal resolution, and thus offer a unique opportunity to investigate and decode the electrophysiological dynamics underlying speech processing. In this review article, we describe current approaches to decoding different features of speech perception and production – such as spectrotemporal, phonetic, phonotactic, semantic, and articulatory components – using intracranial recordings. A specific section is devoted to the decoding of imagined speech, and potential applications to speech prosthetic devices. We outline the challenges in decoding human language, as well as the opportunities in scientific and neuroengineering applications. - Analysis of iodine-131-induced early thyroid hormone variations in Graves’ disease.Analysis of iodine-131-induced early thyroid hormone variations in Graves’ disease.Nucl Med Commun. 2016 Jun 30;Authors: Xu F, Gu A, Pan Y, Yang L, Ma YAbstract
OBJECTIVE: This prospective study aimed to assess iodine-131 (I)-induced early thyroid hormone variations in Graves’ disease (GD) and determine the associated factors.
MATERIALS AND METHODS: One hundred and seventy-one GD patients treated with I were evaluated (47 men, 124 women). I was administered at 9.0±4.9 mCi on average. Serum free triiodothyronine and free thyroxin were measured within 24 h before treatment and 8 (3-14) days after treatment. Patients were divided into increase, no change, and decrease groups, respectively, on the basis of hormone variations after treatment. χ-Test, analysis of variance, and the Kruskal-Wallis test were used to compare groups in terms of sex, age, course of disease, thyroid stimulating hormone receptor antibodies, antithyroid drug (ATD) pretreatment time, time of ATD discontinuation before I treatment, 24 h thyroid I uptake, thyroid weight, I activity, and I activity/thyroid weight (μCi/g). The Spearman method was used for correlation analyses.
RESULTS: Twenty-seven, 20, and 124 cases were assigned to increase, no change, and decrease groups, respectively. Significant differences were found among groups in the time of ATD discontinuation before I treatment [the median duration for methimazole was 11 (5-26), 16 (10-30), and 21 (1-30) days, P=0.000, the median duration for propylthiouracil was 12.5 (5-24), 22 (11-26), and 26 (21-30) days, P=0.000], thyroid weight (93.5±33.6, 90.3±48.8, and 74.1±26.0 g, P=0.003), and μCi/g (84.8±11.8, 100.4±24.9, and 121.1±44.0 μCi/g, P=0.000). Interestingly, μCi/g was negatively and positively correlated to the possibility of hormone increase and decrease, respectively. No significant differences were found in the other parameters assessed.
CONCLUSION: At the early stage of I treatment for GD, few patients showed increased thyroid hormone levels. Key factors may include time of ATD discontinuation before I treatment and μCi/g. High μCi/g might decrease thyroid hormone levels in early treatment, making it safe.PMID: 27366942 [PubMed – as supplied by publisher]from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29dHgrV
via IFTTT - Lymph node ratio predicts survival in hypopharyngeal cancer with positive lymph node metastasis
Abstract
The lymph node density (LND) has been reported to be a significant prognostic factor in various types of carcinoma. This study investigated whether the LND is associated with survival in patients with hypopharyngeal squamous cell carcinoma (HPSCC) who have positive lymph nodes without distant metastasis. Forty-six patients who were pathologically diagnosed with HPSCC with positive lymph nodes and without distant metastasis were enrolled in this study. The LND was defined as the ratio of positive lymph nodes to the total number of lymph nodes. An LND of ≥0.09 was found to be significantly correlated with a shorter overall (p = 0.044) and disease-specific (p = 0.019) survival according to a log-rank test. In a multivariate survival analysis using a Cox proportional hazards model adjusted for the pathological T category (pT3–4/pT1–2), pathological N category (pN2/pN1) and positive surgical margin and/or extracapsular spread (presence/absence), both an LND of ≥0.09 and pT3–4 category were associated with significantly shorter overall survival (p < 0.01) and disease-specific survival (p < 0.01). These results suggest that the LND functions as a prognostic factor for HPSCC patients with positive lymph nodes who do not have distant metastasis. - Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sasieta HC, Iyer VN, Orbelo DM, Patton C, Pittelko R, Keogh K, Lim KG, Ekbom DCAbstract
Importance: Refractory chronic cough is a debilitating condition with limited therapeutic options. Laryngeal botulinum toxin type A (BtxA) has been anecdotally reported to benefit patients with chronic cough. We report on our experience with the use of BtxA for the treatment of patients with refractory chronic cough.
Objective: To describe the effects of electromyography (EMG)-guided thyroarytenoid (TA) BtxA injection for the treatment of refractory chronic cough.
Design, Setting, and Participants: For this single tertiary referral center retrospective case series, we included all patients with refractory chronic cough who received bilateral EMG-guided TA BtxA injections (n = 22) between July 1, 2013, and July 31, 2014, at the Mayo Clinic in Rochester, Minnesota.
Intervention: Bilateral TA BtxA injection.
Main Outcomes and Measures: The primary outcome is a self-reported improvement of 50% or more in cough severity and/or symptoms by a 2-month follow-up telephone call. Adverse events and patient-reported quality measures were also assessed.
Results: A total of 22 patients (median [interquartile range] age 61 [57.5-85] years; 19 of 22 women) underwent 31 distinct laryngeal BtxA treatment sessions. The primary outcome of self-reported improvement of 50% or more of cough severity and/or symptoms was achieved in 16 of 31 (52%) treatment sessions. Eleven patients (50%) reported greater than 50% improvement after the first BtxA injection. No major complications occurred. Postprocedural liquid dysphagia had a positive predictive value of 84% and negative predictive value of 100% for response to therapy.
Conclusions and Relevance: In this case series, laryngeal BtxA injection was well tolerated in patients with refractory chronic cough with half of participants experiencing at least short-term improvement in their cough. The occurrence of liquid dysphagia after a BtxA injection appeared to be predictive of a beneficial response. The durability of response, patient selection criteria, and optimal BtxA dosage remains to be determined.PMID: 27367917 [PubMed – as supplied by publisher] - A very unusual cause of dysphagia: mantle cell lymphoma.A very unusual cause of dysphagia: mantle cell lymphoma.Ann Gastroenterol. 2016 Jul-Sep;29(3):383-5Authors: Zullo A, Cerro P, Chios A, Andriani A, Balsamo G, Francesco VD, Bruzzese VAbstract
Dysphagia is an alarm symptom requiring a prompt investigation. Different benign and malignant diseases may present such a symptom. We describe a case of a 79-year-old patient who complained of fluctuating dysphagia episodes following solid food ingestion in the previous 5 months with mild weight loss. No other gastrointestinal symptoms were present. The patient was referred by the General Practitioner for a videofluoroscopic swallow examination which revealed nodularity of mucosa surface in the oropharynx, esophagus, fundus, and gastric body. Upper endoscopy confirmed the feature, also showing a normal mucosa of the antrum and duodenum. The histological examination revealed a mantle cell lymphoma (MCL). A stage III, MCL involving the esophagus and proximal stomach was eventually diagnosed. Esophageal MCL localization is extremely rare, and this is the first report showing a clinical onset with dysphagia.PMID: 27366047 [PubMed] - Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture.Unusual postoperative complication of minimally invasive transhiatal esophagectomy and esophageal substitution for absolute dysphagia in a child with corrosive esophageal stricture.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):153-6Authors: Kandpal DK, Bhargava DK, Jerath N, Darr LA, Chowdhary SKAbstract
Esophageal substitution in children is a rare and challenging surgery. The minimally invasive approach for esophageal substitution is novel and reported from a few centers worldwide. While detailed report on the various complications of this approach has been discussed in adult literature, the pediatric experience is rather limited. We report the laparoscopic management of a rare complication which developed after laparoscopic esophagectomy and esophageal substitution. The timely recognition and management by the minimally invasive approach have been highlighted.PMID: 27365913 [PubMed] - Management of long segment congenital esophageal stenosis: A novel technique.Management of long segment congenital esophageal stenosis: A novel technique.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):150-2Authors: Jain V, Yadav DK, Sharma S, Jana M, Gupta DKAbstract
Congenital esophageal stenosis (CES) is a rare cause of dysphagia in children. Diagnosis is often apparent on esophagogram. Surgical treatment for the subtype with tracheobronchial remnants (TBR) includes resection and anastomosis of the stenosed segment, myectomy, enucleation of cartilage, etc., These procedures are not suitable if the stenosed segment is long. We present a case of a 5-year-old boy who was diagnosed as CES and was successfully managed with stricturoplasty with some innovative modifications.PMID: 27365912 [PubMed] - Review of esophageal injuries and stenosis: Lessons learn and current concepts of management.Review of esophageal injuries and stenosis: Lessons learn and current concepts of management.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):139-43Authors: Ramareddy RS, Alladi AAbstract
AIM: To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.
MATERIALS AND METHODS: Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.
RESULTS: Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.
CONCLUSION: Esophageal injuries though rare can be potentially devastating and life-threatening.PMID: 27365909 [PubMed] - Endoscopic and external resections for sinonasal instestinal-type adenocarcinoma.Comparison of
Eur Arch Otorhinolaryngol. 2016 Jun 30;
Authors: Mortuaire G, Leroy X, Vandenhende-Szymanski C, Chevalier D, Thisse AS
Abstract
Endoscopic sinus surgery (ESS) is considered as a valid option in the management of nasal adenocarcinoma (ADC). Comparative studies with open approaches are still required. A monocentric retrospective study was carried out from May 2002 to December 2013, including 43 patients with intestinal-type adenocarcinoma of the ethmoid sinus. Non-resectable tumours or recurrences were excluded. Before 2008, open approach with lateral rhinotomy (LR) was performed as the gold standard of treatment. From 2008, ESS was systematically used as a first-line option as long as a complete resection was achievable. Adjuvant radiation therapy was delivered (RT) for all the patients. LR and ESS were performed in, respectively, 23 and 20 patients. The two groups were comparable in terms of age, occupational dust exposure, histopathological subtypes, and T stage based on the pathological assessment of the specimen (10 pT2, 26 pT3, 2 pT4a, and 5 pT4b). The tumour origin was mainly located in the olfactory cleft with the involvement of the cribriform plate in 60 % of patients. No major complication was observed in ESS group with a reduced hospital stay (5.6 vs 7.6 days). The disease-free survival was not different between LR and ESS groups over a mean follow-up period of 6.6 years. Even for local advanced stages with skull base involvement, we confirm the reliability and the advantages of ESS in terms of oncological outcomes and morbidity. We advocate complete excision of the olfactory cleft to ensure an appropriate control of the tumoral origin.
PMID: 27363404 [PubMed - as supplied by publisher] - Bioabsorbable steroid-releasing implant in the frontal sinus openingRandomized controlled trial of a bioabsorbable steroid-releasing implant in the frontal sinus opening.:
Laryngoscope. 2016 Jul 1;
Authors: Smith TL, Singh A, Luong A, Ow RA, Shotts SD, Sautter NB, Han JK, Stambaugh J, Raman A
Abstract
OBJECTIVES/HYPOTHESIS: To assess safety and efficacy of a steroid-releasing implant in improving surgical outcomes when placed in the frontal sinus opening (FSO) following endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS).
STUDY DESIGN: Prospective, multicenter, randomized, blinded trial using an intrapatient control design.
METHODS: Eighty adult (≥ 18 years) CRS patients who underwent successful bilateral frontal sinusotomy were randomized to receive a steroid-releasing implant in one FSO, whereas the contralateral control side received no implant. All patients received standard postoperative care. Endoscopic evaluations recorded at 30-days postendoscopic sinus surgery (ESS) were graded real time by clinical investigators and by an independent, blinded sinus surgeon to assess the need for postoperative interventions in the FSO.
RESULTS: Implants were successfully placed in all 80 frontal sinuses, resulting in 100% implant delivery success. At 30-days post-ESS, steroid-releasing implants provided a statistically significant (P = 0.0070) reduction in the need for postoperative interventions compared to surgery alone by an independent reviewer, representing 38% relative reduction. Clinical investigators reported statistically significant reduction in this measure at 30 days (P < 0.0001) and 90 days (P = 0.0129). Clinical investigators also reported a 55.6% reduction in the need for oral steroid interventions (P = 0.0015), 75% reduction in the need for surgical interventions (P = 0.0225), 16.7% reduction in inflammation score, 54.3% reduction in restenosis rate (P = 0.0002), and 32.2% greater diameter of FSO (P < 0.0001) on treated sides compared to control at 30 days. No implant-related adverse events were reported.
CONCLUSION: This study demonstrates the efficacy of steroid-releasing implants in improving outcomes of frontal sinus surgery.
LEVEL OF EVIDENCE: 1b. Laryngoscope, 2016.
PMID: 27363723 [PubMed - as supplied by publisher] - The gross tumor volume (GTV) on dose distribution in organs at risk (OARs) and healthy brain tissueIntensity-modulated radiotherapy for gliomas:dosimetric effects of changes in gross tumor volume on organs at risk and healthy brain tissue.
Onco Targets Ther. 2016;9:3545-54
Authors: Yang Z, Zhang Z, Wang X, Hu Y, Lyu Z, Huo L, Wei R, Fu J, Hong J
Abstract
AIM: The aim of this study was to explore the effects of changes in the gross tumor volume (GTV) on dose distribution in organs at risk (OARs) and healthy brain tissue in patients with gliomas.
METHODS: Eleven patients suffering from gliomas with intensity-modulated radiotherapy (IMRT) plans treated with a simultaneous integrated boost technique planned before therapy (initial plans) were prospectively enrolled. At the end of radiotherapy, patients underwent repeat computed tomography and magnetic resonance imaging, and IMRT was replanned. The GTV and dosimetric parameters between the initial and replanned IMRT were compared using the Wilcoxon two-related-sample test, and correlations between the initial GTV and the replanned target volumes were assessed using the bivariate correlation test.
RESULTS: The volume of the residual tumor did not change significantly (P>0.05), the volume of the surgical cavity decreased significantly (P<0.05), and the GTV and target volumes decreased significantly at the end of IMRT (all P<0.05). The near-maximum dose to OARs and volumes of healthy brain tissue receiving total doses of 10-50 Gy were lower in the replanned IMRT than in the initial IMRT (all P<0.05). The GTV in the initial plan was significantly positively correlated with the changes in the GTV and planning target volume 1 that occurred during IMRT (all P<0.05).
CONCLUSION: The reduction in the GTV in patients with gliomas resulted from shrinkage of the surgical cavity during IMRT, leading to decreased doses to the OARs and healthy brain tissue. Such changes appeared to be most meaningful in patients with large initial GTV values.
PMID: 27366091 [PubMed] - Endoscopic management of cerebrospinal fluid rhinorrhea.Endoscopic management of cerebrospinal fluid rhinorrhea
Asian J Neurosurg. 2016 Jul-Sep;11(3):183-93
Authors: Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H
Abstract
Cerebrospinal fluid (CSF) rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa. It could be due to trauma, raised intracranial pressure (ICP), tumors, erosive diseases, and congenital skull defects. Some leaks could be spontaneous without any specific etiology. The potential leak sites include the cribriform plate, ethmoid, sphenoid, and frontal sinus. Glucose estimation, although non-specific, is the most popular and readily available method of diagnosis. Glucose concentration of > 30 mg/dl without any blood contamination strongly suggests presence and the absence of glucose rules out CSF in the fluid. Beta-2 transferrin test confirms the diagnosis. High-resolution computed tomography and magnetic resonance cisternography are complementary to each other and are the investigation of choice. Surgical intervention is indicated, when conservative management fails to prevent risk of meningitis. Endoscopic closure has revolutionized the management of CSF rhinorrhea due to its less morbidity and better closure rate. It is usually best suited for small defects in cribriform plate, sphenoid, and ethmoid sinus. Large defects can be repaired when sufficient experience is acquired. Most frontal sinus leaks, although difficult, can be successfully closed by modified Lothrop procedure. Factors associated with increased recurrences are middle age, obese female, raised ICP, diabetes mellitus, lateral sphenoid leaks, superior and lateral extension in frontal sinus, multiple leaks, and extensive skull base defects. Appropriate treatment for raised ICP, in addition to proper repair, should be done to prevent recurrence. Long follow-up is required before leveling successful repair as recurrences may occur very late.
PMID: 27366243 [PubMed] - Spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.Nonrandom spatial clustering of spontaneous anterior fossa cerebrospinal fluid fistulas and predilection for the posterior cribriform plate.:
J Neurosurg. 2016 Jul 1;:1-5
Authors: Murray RD, Friedlander R, Hanz S, Singh H, Anand VK, Schwartz TH
Abstract
OBJECTIVE The anterior skull base is a common site for the spontaneous development of meningoceles, encephaloceles, and meningoencephaloceles that can lead to cerebrospinal fluid (CSF) fistula formation, particularly in association with idiopathic intracranial hypertension. In some circumstances the lesions are difficult to localize. Whether all sites in the anterior skull base are equally prone to fistula formation or whether they are distributed randomly throughout the anterior skull base is unknown, although the anterior cribriform plate has been proposed as the most frequent location. The purpose of this study was to identify sites of predilection in order to provide assistance for clinicians in finding occult leaks and increase the understanding of the etiology of this pathology. METHODS The authors performed a retrospective review of a prospectively acquired surgical database of all endonasal endoscopic surgeries performed at Weill Cornell Medical College by the senior authors. Spontaneous CSF fistulas of the anterior skull base were identified. The anatomical sites of the defects were located on radiographic images and normalized to a theoretical 4 × 2 grid representing the anterior midline skull base. Data from the left and right skull base were combined to increase statistical power. This grid was then used to analyze the distribution of defects. Frequency analysis was performed by means of a chi-square test, with a subsequent Monte Carlo simulation to further strengthen the statistical support of the conclusions. RESULTS Nineteen cases of spontaneous CSF fistulas were identified. Frequency analysis using chi-square indicated a nonrandom distribution of sites (p = 0.035). Monte Carlo simulation supported this conclusion (p = 0.034). Seventy-four percent of cases occurred in the cribriform plate (p = 0.086). Moreover, 37% of all defects occurred in the posterior third of the cribriform plate. CONCLUSIONS Anterior skull base spontaneous CSF leaks are distributed in a nonrandom fashion. The most likely site of origin of the spontaneous CSF leaks of the anterior midline skull base is the cribriform plate, particularly the posterior third of the plate, likely because of the lack of significant thick bony buttressing. Clinicians searching for occult spontaneous leaks of the anterior skull base should examine the cribriform plate, especially the posterior third with particularly close scrutiny.
PMID: 27367237 [PubMed - as supplied by publisher] - The role of prosodic boundaries in word discoveryEvidence from a computational model:This study aims to quantify the role of prosodic boundaries in early language acquisition using a computational modeling approach. A spoken term discovery system that models early word learning was used with and without a prosodic component on speech corpora of English, Spanish, and Japanese. The results showed that prosodic information induces a consistent improvement both in the alignment of the terms to actual word boundaries and in the phonemic homogeneity of the discovered clusters of terms. This benefit was found also when automatically discovered prosodic boundaries were used, boundaries which did not perfectly match the linguistically defined ones.
- Acute exercise caused significant reduction in salivary flow rateEffects of acute exercise on salivary free insulin-like growth factor 1 and interleukin 10 in sportsmen:
Background: Saliva analysis is rapidly developing as a tool for the assessment of biomarkers of sports training. It remains poorly understood whether a short bout of sport training can alter some salivary immune biomarkers.
Aim: To investigate the effect of acute exercise using football training session on salivary flow rate, salivary free Insulin-like Growth Factor-1 (IGF-1) and Interleukin 10 (IL-10).
Methods: Saliva samples were collected before and immediately after a football session. Salivary flow rates, salivary levels of free IGF-1 and IL-10 (using ELISA) were determined. Data was analyzed and compared using Related Samples Wilcoxon Signed Rank test (non-parametric test). Relationships between salivary flow rate and levels of free IGF-1 and IL-10 were determined using Spearman correlation test.
Results: There were 22 male footballers with a mean age of 20.46 years. Salivary flow rate reduced significantly (p = 0.01) after the training session while salivary levels of free IGF-1 and IL-10 did not show any significant change. Also, there were no correlations between salivary flow rates and salivary levels of free IGF-1 and IL-10 before and after exercise.
Conclusion: These findings suggest that acute exercise caused significant reduction in salivary flow rate but no change in the levels of salivary free IGF-1 and IL-10.
Keywords: Saliva, exercise, Insulin-like Growth Factor, interleukin 10,salivary flow rate - Rhino-septal splints in endoscopic transsphenoidal skull base surgery.Evaluation of the application of
Eur Arch Otorhinolaryngol. 2016 Jun 30;
Authors: Schlüter A, Ahmadipour Y, Vogelsang T, Kreitschmann-Andermahr I, Kleist B, Weller P, Holtmann L, Mattheis S, Lang S, Bergmann C, Mueller O
Abstract
The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10 days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2 months postoperatively. Patients' subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n = 15; 50 %) than without (n = 16; 84.2 %). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n = 10 vs. n = 2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p = 0.039 and p = 0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9 % of patients without splints, but only 56 % of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.
PMID: 27363406 [PubMed - as supplied by publisher] - Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma.Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma
Laryngoscope. 2016 Jul 1;
Authors: Rovó L, Bach Á, Sztanó B, Matievics V, Szegesdi I, Castellanos PF
Abstract
OBJECTIVES: The complex laryngeal functions are fundamentally defined by the cricoid cartilage. Thus, lesions requiring subtotal or total resection of the cricoid cartilage commonly warrant total laryngectomy. However, from an oncological perspective, the resection of the cricoid cartilage would be an optimal solution in these cases. The poor functional results of the few reported cases of total and subtotal cricoidectomy with different reconstruction techniques confirm the need for new approaches to reconstruct the infrastructure of the larynx post cricoidectomy.
STUDY DESIGN: Retrospective case series review.
METHODS: Four consecutive patients with low-grade chondrosarcoma were treated by cricoidectomy with rotational thyrotracheopexy reconstruction to enable the functional creation of a complete cartilaginous ring that can substitute the functions of the cricoid cartilage. The glottic structures were stabilized with endoscopic arytenoid abduction lateropexy. Patients were evaluated with objective and subjective function tests.
RESULTS: Tumor-free margins were proven; patients were successfully decannulated within 3 weeks. Voice outcomes were adequate for social conversation in all cases. Oral feeding was possible in three patients.
CONCLUSION: Total and subtotal cricoidectomy can be a surgical option to avoid total laryngectomy in cases of large chondrosarcomas destroying the cricoid cartilage. The thyrotracheopexy rotational advancement technique enables the effective reconstruction of the structural deficit of the resected cricoid cartilage in cases of total and subtotal cricoidectomy. An adequate airway for breathing, swallowing, and voice production can be reconstructed with good oncological control. In cases where the pharynx is not involved, good swallowing function can also be achieved.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.
PMID: 27364085 [PubMed - as supplied by publisher] - Upper Airway Stimulation for OSAEarly Adherence and Outcome Results of One Center: Objective
To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA).
Study Design
Case series with chart review.
Setting
Academic sleep medicine center.
Subjects and Methods
The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system. Data included demographics, body mass index (BMI), apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), nightly hours of device usage, and procedure- and therapy-related complications.
Results
Mean age was 64.8 ± 12.0 years, with 50% female. Mean BMI was unchanged postoperatively (26.5 ± 4.2 to 26.8 ± 4.5 kg/m2; P > .05). Mean AHI (33.3 ± 13.0 to 5.1 ± 4.3; P < .0001) and mean ESS (10.3 ± 5.2 to 6.0 ± 4.4; P < .01) decreased significantly. Seventy percent (14/20) of patients achieved a treatment AHI <5, 85% (17/20) an AHI <10, and 95% (19/20) an AHI <15. Average stimulation amplitude was 1.89 ± 0.50 V after titration. Adherence monitoring via device interrogation showed high rates of voluntary device use (mean 7.0 ± 2.2 h/night).
Conclusion
For a clinical and anatomical subset of patients with OSA, HNS therapy is associated with good objective adherence, low morbidity, and improved OSA outcome measures. Early results at one institution suggest that HNS therapy can be implemented successfully into routine clinical practice, outside of a trial setting. - Recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinomaHuman Papillomavirus Vaccination Counseling in Pediatric Training: Are We Discussing Otolaryngology-Related Manifestations?: Objective
Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling.
Study Design
Survey.
Setting
Tertiary care academic children’s hospital.
Subjects
Pediatric residents, fellows, and staff.
Methods
An online survey was made available regarding HPV education and vaccination.
Results
Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported "never" discussing recurrent respiratory papillomatosis and 52.9% "never" discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma.
Conclusions
Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling. - Human Papillomavirus Vaccination Counselingin Pediatric Training: Are We Discussing Otolaryngology-Related Manifestations?: Objective
Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling.
Study Design
Survey.
Setting
Tertiary care academic children’s hospital.
Subjects
Pediatric residents, fellows, and staff.
Methods
An online survey was made available regarding HPV education and vaccination.
Results
Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported "never" discussing recurrent respiratory papillomatosis and 52.9% "never" discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma.
Conclusions
Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling. - Management Strategies for Skull Base Inverted PapillomaManagement Strategies for Skull Base Inverted Papilloma: Objective
Inverted papilloma attached to the ventral skull base presents a surgical dilemma because surgical removal of the bony pedicle is critical to decrease risk of recurrence. The objective of this study is to evaluate the effectiveness of endoscopic management of skull base inverted papilloma.
Study Design
Case series with planned data collection.
Setting
Tertiary medical center.
Subjects
Patients with skull base inverted papilloma.
Methods
Over 7 years, 49 patients with skull base inverted papilloma were referred for surgical resection. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated.
Results
Average age at presentation was 57 years. Twenty-six patients (53%) had prior attempts at resection elsewhere, and 5 had squamous cell carcinoma (SCCA) arising in an inverted papilloma. Six patients (12%) suffered major complications, including skull base osteomyelitis in 2 previously irradiated patients, cerebrospinal fluid leak with pneumocephalus (n = 1), meningitis (n = 1), invasive fungal sinusitis (n = 1), and cerebrovascular accident (n = 1). The mean disease-free interval was 29 months (range, 10-78 months). One patient with SCCA recurred in the nasopharynx (overall 2% recurrence rate). He is disease-free 3 years following endoscopic nasopharyngectomy. Three patients with SCCA had endoscopic resection of the skull base, while 1 subject with inverted papilloma pedicled on the superior orbital roof had an osteoplastic flap in conjunction with a Draf III procedure. All others received endoscopic resection.
Conclusions
Removal of the bony pedicle resulted in excellent local control of skull base inverted papillomas. Our experience demonstrates that disease eradication with limited morbidity is attainable with this approach. - Sudden-Onset Sensorineural Hearing Loss after ImmunizationA Case-Centered Analysis: Objective
Case reports of sudden sensorineural hearing loss (SSHL) following vaccines have led to concerns that vaccines may rarely cause hearing loss. Because of this concern, we analyzed for an association between SSHL and vaccinations.
Study Design
We used a case-centered method, equivalent to a case control design using immunization dates from all matched members of the population to calculate exposure to vaccines, rather than sampling.
Setting
Kaiser Permanente Northern California (KPNC), 2007 to 2013.
Subjects and Methods
We searched KPNC databases from 2007 to 2013 for all first-time diagnoses of SSHL. We used the date of any hearing- or ear-related visit in the 60 days prior to the first SSHL diagnosis as the onset date. Using only SSHL cases immunized in the prior 9 months, we compared the vaccine exposure in several risk intervals prior to onset with the exposure to the same vaccine during the same time period in all KPNC membership, matched to sex and age.
Results
During the study period, >20 million vaccines were administered at KPNC. In all risk intervals prior to onset of SSHL, we found no evidence of increased risk of immunization compared with matched controls. The odds ratios for vaccination 1 week prior to SSHL were 0.965 (95% confidence interval, 0.61-1.50) for trivalent inactivated influenza vaccine (TIV); 0.842 (0.39-1.62) for tetanus, reduced diphtheria, and reduced acellular pertussis; and 0.454 (0.08-1.53) for zoster vaccine.
Conclusion
A large-scale analysis applying a case-centered method did not detect any association between SSHL and previous receipt of TIV or other vaccines. - Oral Flurbiprofen Spray for Posttonsillectomy PainOral Flurbiprofen Spray for Posttonsillectomy Pain: Objective
Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy.
Study Design
Prospective, double-blind, randomized, placebo controlled.
Setting
Patients at Ataturk Training and Research Hospital, Ankara, Turkey.
Subjects and Methods
This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected.
Results
There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups.
Conclusion
In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications. - Effects of a Fibrin Sealant on Skin Graft Tissue Adhesionin a Rodent Model: Objective
To establish a rodent model for skin grafting with fibrin glue and examine the effects of fibrin glue on the adhesive strength of skin grafts without bolsters.
Study Design
Animal cohort.
Setting
Academic hospital laboratory.
Subjects and Methods
Three skin grafts were created using a pneumatic microtome on the dorsum of 12 rats. Rats were evenly divided into experimental (n = 6) and control (n = 6) groups. The experimental group received a thin layer of fibrin glue between the graft and wound bed, and the control group was secured with standard bolsters. Adherence strength of the skin graft was tested by measurement of force required to sheer the graft from the recipient wound. Adhesion strength measurements were taken on postoperative days (PODs) 1, 2, and 3.
Results
The experimental group required an average force of 719 g on POD1, 895 g on POD2, and 676 g on POD3, while the average force in the control group was 161 g on POD1, 257 g on POD2, and 267 g on POD3. On each of the 3 PODs, there was a significant difference in adherence strength between the experimental and control groups (P = .036, P = .029, P = .024).
Conclusion
There is a significant difference in the adhesion strength of skin grafts to the wound bed in the early postoperative period of the 2 groups. In areas of high mobility, using the fibrin sealant can keep the graft immobile during the critical phases of early healing. - Pediatric Descending MediastinitisRetrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis: Objectives
To review the management and outcomes of pediatric patients treated for descending mediastinitis at a single institution and contribute to an updated mortality rate.
Study Design
Case series with chart review.
Setting
Tertiary care pediatric hospital.
Subjects and Methods
This study is a 19-patient case series of all patients treated for descending mediastinitis at a tertiary pediatric hospital from 1997 to 2015, and it serves as an update to the case series published from this institution in 2008. Review of management included time to diagnosis, time to surgery, surgical procedures performed, and antibiotics administered. The primary outcomes measured were length of hospitalization and mortality.
Results
In addition to 8 previously reported patients, we identified 11 pediatric patients treated for descending mediastinitis in the period of review. All 19 patients were <18 months old, and all survived their hospitalization. Fourteen patients underwent surgical drainage at least twice. The median length of hospital stay was 15 days. Retropharyngeal abscess was the source of infection in 16 of 19 patients, and methicillin-resistantStaphylococcus aureus (MRSA) was the isolated organism in 14 of 15 positive cultures.
Conclusion
This review represents the largest reported series of pediatric patients with descending mediastinitis. With 100% survival, our results suggest that pediatric descending mediastinitis can be safely managed by prompt surgical drainage. Broad-spectrum antibiotics covering MRSA and a low threshold for repeat surgical intervention have been an important part of our successful approach and may decrease length of stay. - How different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortalityAssociations of Volume and Thyroidectomy Outcomes: A Nationwide Study with Systematic Review and Meta-Analysis: Objective
This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality.
Data Sources
MEDLINE and EMBASE databases.
Review Methods
This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed.
Results
The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts (P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals.
Conclusions
This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate. - Oral Steroid Usage forfor Otitis Media with Effusion, Eustachian Tube Dysfunction, and Tympanic Membrane Retraction: Objectives
Avoiding oral steroids for otitis media with effusion (OME) is endorsed as a performance measure by the National Quality Foundation, but data regarding current gaps and practice patterns are lacking. Our objectives were to evaluate oral steroid use for OME and the related diagnoses of eustachian tube dysfunction (ETD) and tympanic membrane retraction (TMR), to assess variations by visit setting, and to identify opportunities for measurable performance improvement.
Study Design
Cross-sectional analysis of a national database.
Setting
Ambulatory visits in the United States.
Subjects
Children and adults in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2005-2010).
Methods
Data were coded for patient demographic information, potential confounders (eg, concurrent conditions managed by oral steroids), and diagnosis of OME, ETD, or TMR (OME/ETD/TMR). The latter 2 diagnoses were included to meet minimum numbers for reliability of weighted estimates, but OME constituted the majority of cases. Multivariate regression was used to determine the variables associated with oral steroid use.
Results
Among 590,772 observations representing 7,191,711,480 visits for OME/ETD/TMR, 3.2% resulted in a new prescription for oral steroid medication (2.3% for children, 7.0% for adults). Adults were more likely to receive steroids (odds ratio = 3.50, P < .001) than those with other diagnoses, but a similar association was not found for children. Patients seen by an otolaryngologist or in the emergency department were less likely to receive steroids than those seen in other settings.
Conclusions
OME/ETD/TMR is infrequently treated with oral steroids, particularly in children. Opportunities for performance improvement are limited. - Extended bandwidth real-ear measurement accuracy and repeatability to 10 kHz10.1080/14992027.2016.1197427<br/>Jonathan M. Vaisberg
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- Patterns of Care and Comparative Effectiveness of Intensified Adjuvant Therapy for Resected Oropharyngeal Squamous Cell Carcinoma in the Human Papillomavirus Era.Patterns of Care and Comparative Effectiveness of Intensified Adjuvant Therapy for Resected Oropharyngeal Squamous Cell Carcinoma in the Human Papillomavirus Era.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sher DJ, Nedzi L, Khan S, Hughes R, Sumer BD, Myers LL, Truelson JM, Koshy MAbstract
Importance: There is a growing debate on the relative benefits of adjuvant chemoradiotherapy (CRT) and boost doses of postoperative radiotherapy (B-PORT) in oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery, especially for patients with human papillomavirus (HPV)-driven disease.
Objective: To characterize the recent patterns of care in and overall survival (OS) outcomes following the use of adjuvant CRT and B-PORT after primary surgery for OPSCC.
Design, Setting, and Participants: Retrospective analysis of patients in the National Cancer Database with stage III to IVA-B OPSCC treated with surgery and adjuvant radiotherapy between 2010 and 2012 at Commission on Cancer-accredited facilities. The data analysis was performed between June 15, 2015, and May 4, 2016.
Main Outcomes and Measures: The primary outcomes were prevalence of CRT and B-PORT, and OS. The primary predictors were HPV positivity and high-risk pathologic features (HRPFs) (extracapsular extension and positive surgical margins).
Results: Of the 1409 patients (1153 [82%] male; median age, 57 [interquartile range {IQR}, 51-63] years), 873 (62%) and 789 (56%) patients received CRT and B-PORT, respectively; most patients (n = 583 [79%]) with HRPFs received CRT, and many patients (n = 227 [40%]) without HRPFs received CRT. Multivariable predictors of CRT included adverse pathologic features (extracapsular extension [OR, 6.99; 95% CI, 5.22-9.35], positive surgical margins [OR, 2.07; 95% CI, 1.50-2.87], ≥6 involved nodes [OR, 2.34; 95% CI, 1.39-3.92], or low-neck disease [OR, 1.52; 95% CI, 1.01-2.28]), and treatment at a nonacademic institution (OR, 1.59 [95% CI, 1.21-2.10] for comprehensive community cancer center vs academic program). Patients with HPV-positive disease (OR, 0.47; 95% CI, 0.33-0.68) were less likely to receive CRT; this decrease was limited to absent HRPF treated at academic institutions (n = 173, 44 [25%] received CRT). With a median follow-up of surviving patients of 27 (IQR, 21-33) months, the 2-year OS probability was 92% (95% CI, 90%-94%). Multivariable analysis including age, sex, pathologic T stage, 6 or more positive nodes, and educational status confirmed the prognostic impact of HPV positivity (hazard ratio [HR], 0.41; 95% CI, 0.21-0.80) and HRPFs (positive surgical margins [HR, 2.15; 95% CI, 1.27-3.66] and ≥6 involved nodes [HR, 2.11; 95% CI, 1.13-3.93]), but neither CRT (HR, 1.27; 95% CI, 0.70-2.30) nor B-PORT (HR, 1.04; 95% CI, 0.63-1.73) was associated with improved OS.
Conclusions and Relevance: Postoperative CRT and B-PORT following resection of OPSCC were dependent on factors beyond HRPFs, including HPV status and treatment at an academic institution. No benefit was seen with intensified adjuvant therapy, supporting enrollment of the HPV-positive population into deintensification trials.PMID: 27368076 [PubMed – as supplied by publisher] - The use of ileocolic segment for esophageal replacement in children.The use of ileocolic segment for esophageal replacement in children.J Indian Assoc Pediatr Surg. 2016 Jul-Sep;21(3):116-9Authors: Bal HS, Sen SAbstract
AIMS: To evaluate and describe the procedure and outcome of ileocolic replacement of esophagus.
MATERIALS AND METHODS: We review 7 children with esophageal injuries, who underwent esophageal replacement using ileocolic segment in Christian Medical College, Vellore, India between 2006 and 2014.
RESULTS: The ileocolic segment was used in 7 children with scarred or inadequate esophagus. There were 4 girls and 3 boys, who underwent esophageal replacement using isoperistaltic ileocolic segment in this period. Age at presentation varied from 1 month to 14 years with an average of 4.6 years. The indications for ileocolic replacements were corrosive strictures in 5, failed esophageal atresia repair in one and gastric volvulus related esophageal stricture in another. The average follow-up duration was 37 months. One child with corrosive stricture lost to follow-up and died 2 years later in another center. Other 6 children were free of dysphagia till the last follow-up.
CONCLUSIONS: Although the ileocolic segment is not commonly used for esophageal substitution, it can be useful in special situations where the substitution needs to reach the high cervical esophagus and also where the stomach is scarred and not suitable for gastric pull-up.PMID: 27365904 [PubMed] - Postdeglutitive residue in vagus nerve paralysis and its association with feeding style.Postdeglutitive residue in vagus nerve paralysis and its association with feeding style.Eur Arch Otorhinolaryngol. 2016 Jun 30;Authors: Kumai Y, Samejima Y, Yumoto EAbstract
The objective of this study is to compare the postdeglutitive pharyngeal residues between Xth cranial nerve paralysis (XNP) and isolated recurrent laryngeal nerve paralysis (RLNP) to elucidate the association with feeding style. This study enrolled 15 XNP patients with injuries at the brainstem level (Group I) and 26 patients with RLNP (Group II). All subjects underwent videofluoroscopic swallowing studies (VFSS). The pyriform sinus (PS) and vallecula residues were quantified. The symmetry of the affected versus non-affected sides was compared in both groups. Feeding style at the time of VFSS was also examined. The intra-rater correlation coefficients for all of the data, including the areas of both the vallecula and pyriform sinus on the affected and non-affected sides, were 0.88-0.92 (p < 0.001), reflecting high consistency of the evaluation. In Group I, there was significantly (p < 0.01) more residue in the PS, but not vallecula, compared to the respective non-affected sides, while in Group II there were no significant differences in residue between the affected and non-affected sides for either the vallecula or PS. Comparing Groups I and II, there was significant (p < 0.01) residue on the affected side in the PS but not the vallecula. There was a significant correlation between dependency on a feeding tube and XNP (p < 0.01, Chi-square test). XNP at the brainstem level may cause significantly increased residue in the PS compared to RLNP. This might increase the dependency on a feeding tube with XNP.PMID: 27363405 [PubMed – as supplied by publisher] - The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer.The Role of SPECT/CT Lymphoscintigraphy and Radioguided Sentinel Lymph Node Biopsy in Managing Papillary Thyroid Cancer.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Cabrera RN, Chone CT, Zantut-Wittmann DE, Matos PS, Ferreira DM, Pereira PS, Ribeiro MP, Santos AO, Ramos CD, Crespo AN, Etchebehere ECAbstract
Importance: Single-photon emission computed tomography/computed tomography (SPECT/CT) and radioguided sentinel lymph node biopsy (rSLNB) are techniques that could potentially benefit surgeons and pathologists in the identification of sentinel lymph node (SLN) metastases in patients with papillary thyroid carcinoma (PTC). Evidence suggests that these novel techniques lead to substantial changes in PTC management by reducing understaging and of occult lymph node (LN) metastases and optimizing neck surgery by increasing the necessity of lateral lymphadenectomy and decreasing central lymphadenectomy.
Objectives: To correlate the presence of LN metastases in PTC with clinical and pathological features using SPECT/CT and rSLNB.
Design, Setting, and Participants: For this prospective cohort study from June 2010 to November 2013, 42 patients with thyroid nodules suspicious for papillary carcinoma or classified as malignant on cytology examination without suspicion of lymph node metastases by clinical and ultrasound examinations were recruited from a single public medical institution.
Interventions: All 42 patients underwent preoperative lymphoscintigraphy after an ultrasound-guided peritumoral injection of Technetium Tc 99m nanocolloid. Cervical images were acquired with a SPECT/CT scanner 15 minutes after radiotracer injection. Approximately 2 hours after lymphoscintigraphy, the patients were submitted to intraoperative rSLNB using a handheld gamma probe. All SLNs identified were removed alongside with non-SLNs from the same compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted for histopathology and immunohistochemical analyses.
Results: Of the 42 patients initially enrolled, 37 were included in analysis, including 6 men and 31 women with a mean (range) age of 47 (22-83) years. Overall, T stage was as follows: T1, 23 patients (62.2%); T2, 8 patients (21.6%); and T3, 6 patients (16.2%). Sentinel lymph nodes were identified in 92% of the patients, and among these metastases were present in 17 patients (46%). The SLNs were false-negative in 3 patients. Metastases in the lateral compartment ocurred in 7 patients (18%). There was a significant association between LN metastases and tumor size (odds ratio, 1.06; 95% CI, 1.00-1.13; P = .02), with a Cohen d effect of 0.683 (medium to large effect). Overall, 17 patients (46%) with LN metastases had management changed because they were submitted to higher radioiodine ablation doses and closer clinical surveillance.
Conclusions And Relevance: Radioguided SLNB is able to detect occult cervical lymph node metastases in patients with papillary thyroid carcinoma, and in 7 patients (18%) rSLNB detected lymph node metastases in the lateral compartments. The rSLNB technique lead to management change in 14 patients (37.8%).PMID: 27366869 [PubMed – as supplied by publisher] - Diabolical Coughing-Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients.Diabolical Coughing-Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Bastian RWPMID: 27367790 [PubMed – as supplied by publisher]
- Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.Bilateral Thyroarytenoid Botulinum Toxin Type A Injection for the Treatment of Refractory Chronic Cough.JAMA Otolaryngol Head Neck Surg. 2016 Jun 30;Authors: Sasieta HC, Iyer VN, Orbelo DM, Patton C, Pittelko R, Keogh K, Lim KG, Ekbom DCAbstract
Importance: Refractory chronic cough is a debilitating condition with limited therapeutic options. Laryngeal botulinum toxin type A (BtxA) has been anecdotally reported to benefit patients with chronic cough. We report on our experience with the use of BtxA for the treatment of patients with refractory chronic cough.
Objective: To describe the effects of electromyography (EMG)-guided thyroarytenoid (TA) BtxA injection for the treatment of refractory chronic cough.
Design, Setting, and Participants: For this single tertiary referral center retrospective case series, we included all patients with refractory chronic cough who received bilateral EMG-guided TA BtxA injections (n = 22) between July 1, 2013, and July 31, 2014, at the Mayo Clinic in Rochester, Minnesota.
Intervention: Bilateral TA BtxA injection.
Main Outcomes and Measures: The primary outcome is a self-reported improvement of 50% or more in cough severity and/or symptoms by a 2-month follow-up telephone call. Adverse events and patient-reported quality measures were also assessed.
Results: A total of 22 patients (median [interquartile range] age 61 [57.5-85] years; 19 of 22 women) underwent 31 distinct laryngeal BtxA treatment sessions. The primary outcome of self-reported improvement of 50% or more of cough severity and/or symptoms was achieved in 16 of 31 (52%) treatment sessions. Eleven patients (50%) reported greater than 50% improvement after the first BtxA injection. No major complications occurred. Postprocedural liquid dysphagia had a positive predictive value of 84% and negative predictive value of 100% for response to therapy.
Conclusions and Relevance: In this case series, laryngeal BtxA injection was well tolerated in patients with refractory chronic cough with half of participants experiencing at least short-term improvement in their cough. The occurrence of liquid dysphagia after a BtxA injection appeared to be predictive of a beneficial response. The durability of response, patient selection criteria, and optimal BtxA dosage remains to be determined.PMID: 27367917 [PubMed – as supplied by publisher] - The clinical manifestation of the neurovascular conflict of the vestibulocochlear nerve.[The clinical manifestation of the neurovascular conflict of the vestibulocochlear nerve].Vestn Otorinolaringol. 2016;81(3):67-68Authors: Redaktsiia, Kryukov AI, Kunel’skaya NL, Garov EV, Mishchenko VVPMID: 27367356 [PubMed – as supplied by publisher]
- The gross tumor volume (GTV) on dose distribution in organs at risk (OARs) and healthy brain tissueOnco Targets Ther. 2016;9:3545-54Authors: Yang Z, Zhang Z, Wang X, Hu Y, Lyu Z, Huo L, Wei R, Fu J, Hong JAbstractAIM: The aim of this study was to explore the effects of changes in the gross tumor volume (GTV) on dose distribution in organs at risk (OARs) and healthy brain tissue in patients with gliomas.METHODS: Eleven patients suffering from gliomas with intensity-modulated radiotherapy (IMRT) plans treated with a simultaneous integrated boost technique planned before therapy (initial plans) were prospectively enrolled. At the end of radiotherapy, patients underwent repeat computed tomography and magnetic resonance imaging, and IMRT was replanned. The GTV and dosimetric parameters between the initial and replanned IMRT were compared using the Wilcoxon two-related-sample test, and correlations between the initial GTV and the replanned target volumes were assessed using the bivariate correlation test.RESULTS: The volume of the residual tumor did not change significantly (P>0.05), the volume of the surgical cavity decreased significantly (P<0.05), and the GTV and target volumes decreased significantly at the end of IMRT (all P<0.05). The near-maximum dose to OARs and volumes of healthy brain tissue receiving total doses of 10-50 Gy were lower in the replanned IMRT than in the initial IMRT (all P<0.05). The GTV in the initial plan was significantly positively correlated with the changes in the GTV and planning target volume 1 that occurred during IMRT (all P<0.05).CONCLUSION: The reduction in the GTV in patients with gliomas resulted from shrinkage of the surgical cavity during IMRT, leading to decreased doses to the OARs and healthy brain tissue. Such changes appeared to be most meaningful in patients with large initial GTV values.PMID: 27366091 [PubMed]
- Endoscopic management of cerebrospinal fluid rhinorrhea.Asian J Neurosurg. 2016 Jul-Sep;11(3):183-93Authors: Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev HAbstractCerebrospinal fluid (CSF) rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa. It could be due to trauma, raised intracranial pressure (ICP), tumors, erosive diseases, and congenital skull defects. Some leaks could be spontaneous without any specific etiology. The potential leak sites include the cribriform plate, ethmoid, sphenoid, and frontal sinus. Glucose estimation, although non-specific, is the most popular and readily available method of diagnosis. Glucose concentration of > 30 mg/dl without any blood contamination strongly suggests presence and the absence of glucose rules out CSF in the fluid. Beta-2 transferrin test confirms the diagnosis. High-resolution computed tomography and magnetic resonance cisternography are complementary to each other and are the investigation of choice. Surgical intervention is indicated, when conservative management fails to prevent risk of meningitis. Endoscopic closure has revolutionized the management of CSF rhinorrhea due to its less morbidity and better closure rate. It is usually best suited for small defects in cribriform plate, sphenoid, and ethmoid sinus. Large defects can be repaired when sufficient experience is acquired. Most frontal sinus leaks, although difficult, can be successfully closed by modified Lothrop procedure. Factors associated with increased recurrences are middle age, obese female, raised ICP, diabetes mellitus, lateral sphenoid leaks, superior and lateral extension in frontal sinus, multiple leaks, and extensive skull base defects. Appropriate treatment for raised ICP, in addition to proper repair, should be done to prevent recurrence. Long follow-up is required before leveling successful repair as recurrences may occur very late.PMID: 27366243 [PubMed]
