Extra-ocular movement restriction and diplopia following orbital fracture repair

Publication date: Available online 25 August 2017
Source:American Journal of Otolaryngology
Author(s): H.A. Shah, Taha Shipchandler, Dominic Vernon, Maraya Baumanis, David Chan, William R. Nunery, Hui Bae Harold Lee
PurposeTo report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.MethodsA chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision.ResultsTen patients were identified with a mean time to primary orbital fracture repair at 9days (range 1–48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia.ConclusionsClinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.



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Comment on: “The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach”

Publication date: Available online 25 August 2017
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou




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A rapid LC-MS/MS method for the determination of moniliformin and occurrence of this mycotoxin in maize products from the Bavarian market

Abstract

A simple LC-MS/MS method was developed for the determination of moniliformin (MON) in maize and applied for the analysis of samples within the official food surveillance. The homogenized samples were extracted with acetonitrile/water 50/50 (v/v) which proved to have the highest extraction efficiency compared to other tested solvents. The centrifuged extracts were diluted with acetonitrile and were measured after chromatographic separation by HILIC (hydrophobic interaction liquid chromatography)-HPLC without any cleanup (dilute and shoot approach). The LOD and LOQ achieved by this procedure were 2.6 and 8.8 μg/kg, respectively. Thirty-nine samples of popcorn, maize meal, and semolina were collected in 2014 and 2015 at mills, cinemas, wholesale, and retail from the Bavarian market (Germany). The rate of contamination with MON was very high (97%) with levels ranging between the LOD and 847 μg/kg. The mean level was 118 μg/kg and the median, 39 μg/kg. The maximum value was detected in maize meal. The results are discussed with respect to possible health implications for the consumer.

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Management of High-Velocity Injuries of the Head and Neck

Trauma centers must prepare to manage high-velocity injuries resulting from a mass casualty incidents as global terrorism becomes a greater concern and an increasing risk. The most recent conflicts in Iraq and Afghanistan have significantly improved understanding of battlefield trauma and how to appropriately address these injures. This article applies combat surgery experience to civilian situations, outlines the physiology and kinetics of high-velocity injuries, and reviews applicable triage and management strategies.

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Role of S100A9 in the development of neutrophilic inflammation in asthmatics and in a murine model

Publication date: Available online 25 August 2017
Source:Clinical Immunology
Author(s): Tae-Hyeong Lee, Hun Soo Chang, Da-Jeong Bae, Hyun Ji Song, Myung-Sin Kim, Jong Sook Park, Ji Ae Jun, Si Young Lee, Soo Taek Uh, Soo Hyun Kim, Choon-Sik Park
S100A9 is an endogenous danger signal that promotes and exacerbates the neutrophilic inflammatory response. To investigate the role of S100A9 in neutrophilic asthma, S100A9 levels were measured in sputum from 101 steroid-naïve asthmatics using an ELISA kit and the levels were significantly correlated with percentages of neutrophils in sputum. Intranasal administration of recombinant S100A9 markedly increased neutrophil numbers at 8h and 24h later with concomitant elevation of IL-1β, IL-17, and IFN-γ levels. Treatment with an anti-S100A9 antibody restored the increased numbers of neutrophils and the increased airway resistance in OVA/CFA mice toward the levels of sham-treated mice. Concomitantly, the S100A9 and neutrophil elastase double positive cells were markedly reduced with attenuation of IL-1β, IL-17, and IFN-γ levels by the treatment with the anti-S100A9 antibody. Our data support a role of S100A9 to initiate and amplify the neutrophilic inflammation in asthma, possibly via inducing IL-1β, IL-17 and IFN-γ.



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Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis

Abstract

Purpose of Review

In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.

Recent Findings

The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17–29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer.

Summary

An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol's role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.

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A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015)

Background

Sinonasal fungus ball (FB) is a type of noninvasive fungal rhinosinusitis affecting immunocompetent hosts. FB, previously considered rare, has been reported with increasing frequency. We reviewed our experience of 538 cases over the past 20 years.

Methods

We retrospectively examined clinical records including clinical presentations, radiological findings, management, and outcomes of FB patients who have undergone surgery for treatment. The number of FB patients who underwent endoscopic sinus surgery (ESS) was calculated annually. Causal relationships between structural variations and FB were also investigated.

Results

The number of FB patients who underwent sinus surgery has increased. The mean age was 58.3 years, and the gender ratio was approximately 2 (female): 1 (male). While the most common presenting symptoms of maxillary sinus FB patients were nasal symptoms, such as postnasal drip and nasal obstruction, sphenoid sinus FB patients presented with headache mostly. On computed tomography (CT) scans, the most common finding was intralesional hyperdensity (77.3%). There was no significant correlation between the presence of FB and structural variations (nasal septal deviation, concha bullosa, Haller cell). Median follow-up period of the patients was 11 months. Recurrence or residual disease occurred in only 6 (1.1%) cases.

Conclusion

The number of FB patients who underwent surgery has increased steadily over the past 20 years. FB should be considered in patients with unilateral nasal symptoms and unexplained headaches. A preoperative CT scan is an essential tool in making diagnosis easier and faster. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

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