Publication date: Available online 25 November 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Raquel Harumi Uejima Satto Sakai, Fernando Augusto Lima Marson, Emerson Taro Inoue Sakuma, José Dirceu Ribeiro, Eulália Sakano
IntroductionTo provide clinical information and diagnosis in mouth breathers with transverse maxillary deficiency (MBTMD) with posterior crossbite. Numerous exams can be performed; however, the correlation among these exams remains unclear.ObjectiveTo evaluate the correlation between acoustic rhinometry (AR), computed rhinomanometry (CR), and cone-beam computed tomography (CBCT) in MBTMD.MethodsA cross-sectional study was conducted in 30 MBTMD (7–13 y.o.) patients with posterior crossbite. The examinations assessed: (i) AR: nasal volumes (0–5cm and 2–5cm) and minimum cross-sectional areas (MCA1 and MCA2) of nasal cavity; (ii) CR: flow (F) and average inspiratory (AIR) and expiratory (AER) resistance; (iii) CBCT: coronal section on the head of inferior turbinate (Widths 1 and 2), middle turbinate (Widths 3 and 4) and maxilla levels (Width 5). AR and CR were evaluated before (WVC) and after administration of vasoconstrictor. Results were compared by Spearman's correlation and Mann–Whitney tests (α=0.05).ResultsPositive correlation was observed between: (i) F/WVC and Width 4 (Rho=0.380) and Width 5 (Rho=0.371); (ii) Width 2 and MCA1/WVC (Rho=0.380); (iii) F/WVC and nasal volumes of 0–5cm (Rho=0.421), 2–5cm (Rho=0.393) and MCA1 (Rho=0.375); (iv) Width 4 and nasal volumes of 0–5cm/WVC (Rho=0.376), 2–5cm/WVC (Rho=0.376), MCA1/WVC (Rho=0.410) and MCA1 after administration of vasoconstrictor (Rho=0.426); (v) Width 5 and Width 1 (Rho=0.542), Width 2 (Rho=0.411), and Width 4 (Rho=0.429). Negative correlation was observed between: (i) Width 4 and AIR (Rho=−0.385); (ii) AIR/WVC and volume of 0–5cm (Rho=−0.382), and AER/WVC and MCA1 (Rho=−0.362).ConclusionThere was correlation between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency.
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Παρασκευή 25 Νοεμβρίου 2016
Correlation between acoustic rhinometry, computed rhinomanometry and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency
Evaluation of peripheral auditory pathways and brainstem in obstructive sleep apnea
Publication date: Available online 25 November 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Erika Matsumura, Carla Gentile Matas, Fernanda Cristina Leite Magliaro, Raquel Meirelles Pedreño, Geraldo Lorenzi-Filho, Seisse Gabriela Gandolfi Sanches, Renata Mota Mamede Carvallo
IntroductionObstructive sleep apnea (OSA) causes changes in normal sleep architecture, fragmenting it chronically with intermittent hypoxia, leading to serious health consequences in the long term. It is believed that the occurrence of respiratory events during sleep, such as apnea and hypopnea, can impair the transmission of nerve impulses along the auditory pathway that are highly dependent on the supply of oxygen. However, this association is not well established in the literature.ObjectiveTo compare the evaluation of peripheral auditory pathway and brainstem among individuals with and without OSA.MethodsThe sample consisted of 38 adult males, mean age of 35.8 (±7.2), divided into four groups matched for age and Body Mass Index. The groups were classified based on polysomnography in: control (n=10), mild OSA (n=11) moderate OSA (n=8) and severe OSA (n=9). All study subjects denied a history of risk for hearing loss and underwent audiometry, tympanometry, acoustic reflex and Brainstem Auditory Evoked Response (BAER). Statistical analyses were performed using three-factor ANOVA, 2-factor ANOVA, chi-square test, and Fisher's exact test. The significance level for all tests was 5%.ResultsThere was no difference between the groups for hearing thresholds, tympanometry and evaluated BAER parameters. An association was observed between the presence of OSA and changes in absolute latency of wave V (p=0.03). There was an association between moderate OSA and change of the latency of wave V (p=0.01).ConclusionThe presence of OSA is associated with changes in nerve conduction of acoustic stimuli in the auditory pathway in the brainstem. The increase in OSA severity does not promote worsening of responses assessed by audiometry, tympanometry and BAER.
http://ift.tt/2gqhWAE
Kutane Nebenwirkungen zielgerichteter onkologischer Arzneimittel
Zusammenfassung
In den letzten Jahren erhielten zahlreiche neue Pharmaka ihre Zulassung zur Behandlung onkologischer Erkrankungen und sind mittlerweile fester Bestandteil der Therapieregime. Bewähren konnten sich insbesondere zielgerichtete und immunmodulierende Wirkstoffe, die in spezifische Signalwege von Tumoren bzw. Tumorzellen eingreifen oder die Tumorimmunantwort modulieren. Trotz ihrer zielgerichteten Wirkweise führen sie zu diversen Arzneimittelreaktionen, unter denen die kutanen Nebenwirkungen eine besondere Stellung einnehmen, nicht zuletzt aufgrund ihres großen Einflusses auf die Lebensqualität der Patienten. Während eine Basistherapie mittlerweile zumeist durch die betreuenden Onkologen geleistet wird, stellen insbesondere höhergradige Hautreaktionen eine fachliche Herausforderung dar und erfordern die Expertise des Dermatologen. In dieser Übersicht beschreiben wir kutane Nebenwirkungen verschiedener neuer Substanzklassen wie den epidermalen Wachstumsfaktorinhibitoren (EGFR-I), Multikinaseinhibitoren (MKI), BRAF-Inhibitoren, MEK-Inhibitoren sowie Immun-Checkpoint-Inhibitoren (Anti-CTLA-4-, Anti-PD-1-Antikörper) und geben Empfehlungen zu Prävention und Management.
http://ift.tt/2gq4AUK
Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature
Abstract
Aim
The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used.
Case report
A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps.
Conclusion
Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.
http://ift.tt/2g19ScA
Delayed retrieval of a displaced maxillary third molar from infratemporal space via trans-sinusoidal approach: a case report and the review of the literature
Abstract
Aim
The aim of this case report is to present the trans-sinusoidal pathway used to remove a displaced maxillary third molar from the infratemporal fossa and review the English literature regarding the techniques used.
Case report
A 21-year-old male patient was referred with the findings of an oroantral fistula on the left maxillary vestibular first molar region and slight restriction of mouth opening. The patient underwent a maxillary sinus surgery in order to remove a sinus retention cyst via Caldwell-Luc access in a dental clinic 4 years ago. A computerized tomography scan showed the inverted third molar to be located in the infratemporal fossa, just between zygomatic arch and lateral pterygoid plate. The tooth was accessed through the remaining lateral bone defect from the Caldwell-Luc approach of the lateral sinus wall. The bone defect was extended. The posterior bony wall of the maxillary sinus was removed via a surgical burr. After that, the displaced tooth was exposed. The tooth was mobilized via Warwick James elevator downwards and removed with a forceps.
Conclusion
Access for surgical removal of the tooth from the infratemporal fossa is not only difficult but also has potential for morbidity due to the structures running through it. Wide incision in the maxillary sulcus and blunt dissection are reported with lower success rates and usually necessitate a second intervention via extraoral route. Trans-sinusoidal approach might be an old fashioned but relatively successfully attempt in the removal of the upper third molars from the infratemporal fossa. Considering the time of removal, if no symptoms were present, it is beneficial to wait for a couple of weeks thus facilitating development of fibrous surrounding around the tooth.
http://ift.tt/2g19ScA
Use of Internal Limiting Membrane Autograft in Primary Vitrectomy for Rhegmatogenous Retinal Detachment
During a pars plana vitrectomy, an unplanned retinotomy in the raphe was performed in a 55-year-old female patient with rhegmatogenous retinal detachment and proliferative vitreoretinopathy. Since diathermy and laser therapy were not available at that moment, it was decided to peel off a small graft of the internal limiting membrane adjacent to the retinotomy site which had been previously stained with Brilliant Blue G. The graft was displaced under perfluorocarbon fluids and placed inside the retinotomy. Three weeks after surgery, the apparent closure of the retinotomy was observed clinically.
Case Rep Ophthalmol 2016;7:251–255
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Endophthalmitis following 27-Gauge Pars Plana Vitrectomy for Vitreous Floaters
Case Rep Ophthalmol 2016;7:245–250
http://ift.tt/2fv3uX2
Weekly versus every-three-weeks platinum-based chemoradiation regimens for head and neck cancer
The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the...
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An unusual presentation of a rare disease: posterior reversible encephalopathy syndrome following abdominal sepsis
Posterior reversible encephalopathy syndrome (PRES) is an unusual disease of unknown incidence and cause. There are a wide range of associated, predisposing medical causes to include pregnancy, renal failure, immunosuppressive medication administration and hypertension. The diagnosis is made following the radiographic identification of characteristic vasogenic edema in the setting of neurologic impairment. A significant portion of patients will have long-term, if not permanent, sequelae of the disease. We present a patient who developed PRES following a hemicolectomy that was complicated by an anastomotic leak. She went on to a complete recovery following surgical treatment of the leak and supportive care.
http://ift.tt/2gshIdf
Case report: successful open resection of a symptomatic giant liver haemangioma during the second trimester of pregnancy
Liver haemangiomas are consistently reported to be the commonest benign liver tumours and are most often incidental findings in asymptomatic individuals. Large lesions can become symptomatic, spontaneously rupture or result in a consumptive coagulopathy known as Kasabach–Merrit Syndrome. It is believed that the female sex hormones, particularly oestrogen, have an influence on haemangioma development and growth. The optimal management of large haemangiomas during the hyperoestrogenic state of pregnancy is poorly described in the current literature. To our knowledge, we describe only the second case of a giant hepatic haemangioma resection during pregnancy.
http://ift.tt/2gnB4m9
Case report: imaging the clinical course of FOPE--a cause of adolescent knee pain
Focal periphyseal oedema (FOPE) is a rare MRI finding associated with pain in adolescent patients with very few reported cases. We present a case of FOPE in a 13-year-old girl and the only follow-up imaging available for an isolated presentation of this condition.This article describes a clinical course that correlates well with the imaging obtained. This article describes a clinical course that correlates well with the imaging obtained.
http://ift.tt/2gsjxah
Massive seminoma presenting with inguinal lymph node metastases only
Seminomatous germ cell tumours characteristically affect men in their second-to-fourth decades, presenting as a testicular mass. Metastases when present are usually seen in para-aortic lymph nodes. These tumours are difficult to diagnose clinically and histologically when the presentation is unusual. We describe a seminoma presenting in a 61-year-old male as an inguinal mass with associated lymphadenopathy resembling lymphoma. Past medical history included ipsilateral cryptorchidism and orchidopexy. The tumour responded well to conventional chemotherapy.
This case illustrates a possible diagnostic pitfall and that germ cell tumours should be included in the differential diagnosis of tumours presenting in the groin.
http://ift.tt/2gnFs4G
Inferior vena caval filter strut perforation causing intramural duodenal haematoma
We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means. Causes of duodenal haematoma include blunt trauma, haematologic malignancy, coagulopathy, percutaneous or endoscopic procedures, pancreatic pathology, peptic ulcer disease and aortoenteric fistula. Duodenal haematoma is rare and is usually managed conservatively or by percutaneous drainage. While this patient had a typical presentation, IVC filter strut perforation has not been described in the literature as a cause for duodenal haematoma.
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Gastric glomus tumor
Gastric glomus tumors are rare, mesenchymal neoplasms, generally described as benign and account for nearly 1% of all gastrointestinal soft tissue tumors. The most common gastrointestinal site of involvement is the stomach, particularly the antrum. Gastric glomus tumors are submucosal tumors that lack specific clinical and endoscopic characteristics, and are often mistaken for the more common gastrointestinal stromal tumors. A 62-year-old Caucasian female presented with shortness of breath and a persistent cough. Clinical workup revealed a mass in the upper abdomen. After endoscopic ultrasound and fine needle aspiration raised concerns for cancer, the patient elected to proceed with exploratory laparotomy. A local resection was performed at the time of surgery. Pathologic and immunohistochemical findings following surgical resection were consistent with a gastric glomus tumor. Consideration of gastric glomus tumors in the differential diagnosis may optimize the chance for a more accurate preoperative diagnosis and targeted surgical intervention.
http://ift.tt/2gnxZTj
Uncommon cause for ileocolic fistulation and caecal perforation following multiple magnet ingestion in an adult
Non-accidental ingestion of foreign bodies rarely occurs in adults. We report a case of multiple magnet ingestion in an adult with learning difficulties to highlight the associated abdominal complications. Multiple magnets may not pass through the gastrointestinal tract spontaneously and approach considerations should differ from those who had ingested an isolated magnet or other foreign bodies.
http://ift.tt/2gsiXtf
First case of penile metastasis following abdominoperineal resection with VRAM flap reconstruction
Penile metastases are rare in colorectal cancer. We report the first case of such a recurrence in a patient who had undergone an extralevator abdominoperineal resection with vertical rectus abdominis myocutaneous flap perineal reconstruction. The patient was treated with curative intent by total penectomy.
http://ift.tt/2gnB31z
Intra-abdominal myositis ossificans in an asymptomatic patient during closure of a Hartmann's colostomy
Intra-abdominal myositis ossificans, also known as heterotopic mesenteric ossification, defines the formation of bone-like lesions inside the abdominal cavity. It is a rare medical condition, usually following abdominal surgery or trauma. A 55-year-old male presented for closure of a Hartmann's colostomy, created 6 months ago because of sigmoid adenocarcinoma. Intraoperative findings consisted of an elongated bone-like lesion attached on the peritoneum and protruding inside the abdominal cavity, while two more stiff calcified nodules were found in the mesocolon. All lesions were excised. The presence of a hard consistency sigmoid stump led to cancelation of the operation. Heterotopous bone formation constitutes a challenging surgical condition, since its clinical presentation is innocuous and repetitive surgery acts a stimuli for additional bone creation. Computed tomography scan plays a major role in its diagnosis, while nonsteroidal anti-inflammatory drugs and cimetidine are helpful in preventing further recurrence of the disease.
http://ift.tt/2gshkvA
A case of primary intracardiac yolk sac tumour with extracardiac extension
Primary cardiac tumour is a rare entity as secondaries in the heart are more common. A 2-year-old child was having repeated respiratory tract infection with poor oral intake and poor activity for 3 months. His symptoms progressed from New York Heart Association (NYHA) Class II to IV. On evaluation he had an intracardiac mass with extracardiac extension. Emergency tumour excision under deep hypothermic circulatory arrest was performed with provisional diagnosis of sarcoma. But Serum markers, histopathological examination and immunohistochemistry confirmed diagnosis of yolk sac tumour. Postoperative recovery was uneventful and the child was receiving adjuvant chemotherapy. Extensive literature review revealed only four cases of primary intracardiac yolk sac tumour published till date. Our case report is unique, in that intracardiac tumour had extracardiac extension by infiltration through right atrial wall. Previous four reports mention purely intracardiac mass.
http://ift.tt/2gnCtct
Insulinoma or non-insulinoma pancreatogenous hypoglycemia? A diagnostic dilemma
Insulinoma is the most common cause of endogenous hyperinsulinemic hypoglycemia in adults. An alternate etiology, non-insulinoma pancreatogenous hypoglycemia (NIPH), is rare. Clinically, NIPH is characterized by postprandial hyperinsulinemic hypoglycemia, negative 72-h fasts, negative preoperative localization studies for insulinoma and positive selective arterial calcium infusion tests. Histologically, diffuse islet hyperplasia with increased number and size of islet cells is present and confirms the diagnosis. Differentiating NIPH from occult insulinoma preoperatively is challenging. Partial pancreatectomy is the procedure of choice; however, recurrence of symptoms, although less debilitating, occurs commonly. Medical management with diazoxide, verapamil and octreotide can be used for persistent symptoms. Ultimately, near-total or total pancreatectomy may be necessary. We report a case of a 67-year-old male with hypoglycemia in whom preoperative workup, including computerized tomography abdomen, suggested insulinoma, but whose final diagnosis on pathology was NIPH instead.
http://ift.tt/2gsgdfl
Technical note: rapid, large-volume resuscitation at resuscitative thoracotomy by intra-cardiac catheterization
An emergency thoracotomy may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery. We theorize that a new goal should be achieving rapid, large-volume fluid resuscitation and we describe a technique to achieve this.
http://ift.tt/2gnw0hV
Large primary leiomyoma causing progressive cervical deformity
Leiomyomas are benign smooth tumors that rarely affect the neck area. Complete surgical resection is the treatment of choice. Here, we describe a 13-year-old girl with a large leiomyoma of the neck, which increased in size after incomplete resection. The tumor caused progressive cervical kyphotic deformity, difficulty breathing and severe malnourishment. The tumor was resected successfully in a second surgery, and the patient is stable after 3 years of follow-up. Histopathologically, the tumor was consistent with leiomyoma and showed strong reactivity to specific smooth muscle markers, such as desmin and caldesmon. This is the second reported case demonstrating massive growth of a leiomyoma, with emphasis on complete resection from the beginning.
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Epididymal papillary cystadenocarcinoma metastasising to the testis in a patient with infertility managed with Onco-microTeSE
Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel–Lindau (VHL) disease. The development of a papillary cystadenocarcinoma, its malignant counterpart, is rare with only a few sporadic cases reported in the literature. Metastatic deposits are exceedingly uncommon; in fact, only a single case report has documented metastases to the paraureteral region, but metastases to the testis have never been reported. A 43-year-old gentleman with VHL disease presented with non-obstructive azoospermia, a right epididymal mass, and an atrophic surgically corrected undescended left testis. The epididymal mass was reported as a papillary cystadenocarcinoma on biopsy. The patient was managed with a radical inguinal orchidectomy and bench microTeSE with successful sperm retrieval. Metastatic papillary cystadenocarcinoma of the epididymis to the testis has never been previously reported. This case was managed by radical orchidectomy and subsequent onco-microTeSE, allowing safe oncological treatment and optimal fertility preservation.
http://ift.tt/2gnuaxA
Severe cervical spondylotic myelopathy with complete neurological and neuroradiological recovery within a month after surgery
Cervical spondylotic myelopathy is a complex syndrome evolving in the presence of degenerative changes. The choice of care and prognostic factors are controversial. The use of appropriate surgical technique is very important. Posterior approach may be chosen when pathology is present dorsally and/or in the presence of neutral to lordotic alignment. Anterior approach is the golden standard in patients with kyphosis and/or stenosis due to ventral lesions, even with three or more affected levels. A 67-year-old man presented with progressive weakness and clumsiness (mJOA: 5; Nurick: 4). An anterior discectomy, osteophytectomy and bilateral foraminotomy of the C4–C5; C5–C6; C6–C7 were performed. Polyether-Ether-Ketone spacers and a titanium plate were placed. The patient was mobilized 3-hour post-surgery and was released the following day. Medicament therapy and a neck-conditioning program were prescribed. Clinical examinations were normal within a month. Magnetic resonance imaging showed no traces of the preoperatively registered intramedullary focal T2 hyper-intensity.
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