Detecting Residual/Recurrent Head Neck Squamous Cell Carcinomas Using PET or PET/CT: Systematic Review and Meta-analysis.

Detecting Residual/Recurrent Head Neck Squamous Cell Carcinomas Using PET or PET/CT: Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg. 2015 Dec 29;

Authors: Cheung PK, Chin RY, Eslick GD

Abstract
OBJECTIVE: To evaluate the diagnostic accuracy of positron emission tomography (PET) and PET/computed tomography (CT) for detecting residual and/or recurrent local and regional disease and distant metastases in patients with head and neck squamous cell carcinomas (HNSCCs) following radiotherapy with or without chemotherapy.
DATA SOURCES: A systematic review with no language restrictions was conducted using PREMEDLINE, MEDLINE, EMBASE, and Google Scholar.
REVIEW METHODS: Only prospective studies with histopathological and/or clinical follow-up that assessed the diagnostic accuracy of PET and PET/CT in detecting residual and/or recurrent disease following radiotherapy with or without chemotherapy in patients with HNSCCs were included.
RESULTS: Twenty-seven studies were identified. The pooled sensitivity and specificity of PET and PET/CT for detecting residual or recurrent disease at the primary site was 86.2% and 82.3%, respectively. For residual and recurrent neck disease, the sensitivity and specificity were 72.3% and 88.3%, while for distant metastases, the values were 84.6% and 94.9%.
CONCLUSIONS: PET and PET/CT are highly accurate in detecting residual and/or recurrent HNSCC. PET/CT is more specific than PET alone. Specificity is also greater for scans performed more than 12 weeks after radiotherapy with or without chemotherapy. The authors support the use of PET/CT after 12 weeks posttreatment for the assessment of residual or recurrent disease.

PMID: 26715675 [PubMed - as supplied by publisher]

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Nasal angiosarcoma metastatic to the larynx: Case report and systematic review of the literature.

Nasal angiosarcoma metastatic to the larynx: Case report and systematic review of the literature.

Head Neck. 2015 Dec 30;

Authors: Qualls HE, Mitchell RM, Deubner H, Moe KS, Sardesai M

Abstract
BACKGROUND: Laryngeal angiosarcoma is rare and the prognosis is poor. The purpose of this study was to describe the first case of cutaneous angiosarcoma metastatic to the larynx and systematically review all cases of laryngeal angiosarcoma.
METHODS: A 61-year-old man presented with an alar lesion diagnosed as angiosarcoma and was treated with wide local resection and radiation. Six years later, he presented with a laryngeal mass histologically similar to the initial tumor. A systematic review of reported cases of angiosarcoma of the larynx was performed.
RESULTS: Eighteen cases were identified. Mean age of presentation was 64.3 years. Men represented 66.7%. Mean follow-up was 34.1 months. Forty-seven percent died with disseminated disease at a mean of 18.4 months. Our patient did well with serial resection.
CONCLUSION: To the best of our knowledge, this case represents the first documented case of cutaneous angiosarcoma metastatic to the larynx and suggests that serial resection with long-term surveillance may be of benefit in some cases. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26717551 [PubMed - as supplied by publisher]

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Merkel cell carcinoma: Do you know your guidelines?

Merkel cell carcinoma: Do you know your guidelines?

Head Neck. 2015 Dec 30;

Authors: Miles BA, Goldenberg D, Education Committee of the American Head and Neck Society (AHNS)

Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine malignancy that exhibits clinically aggressive features and is associated with a poor prognosis. The incidence of MCC seems to be increasing for reasons unknown, and is estimated to be 0.32/100,000 in the United States.
METHODS: This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of MCC.
RESULTS: Resection of MCC with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy. High-risk patients should undergo adjuvant radiotherapy, which improves oncologic outcomes. The role of chemotherapy is less clear and is currently reserved for advanced-stage MCC and palliative therapy.
CONCLUSION: The pathogenesis of MCC has recently been impacted with the discovery of the Merkel cell polyomavirus (MCPyV). Research to establish targeted and immunologic therapeutic options are ongoing. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26716756 [PubMed - as supplied by publisher]

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External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society.

External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society.

Head Neck. 2015 Dec 30;

Authors: Kiess AP, Agrawal N, Brierley JD, Duvvuri U, Ferris RL, Genden E, Wong RJ, Tuttle RM, Lee NY, Randolph GW

Abstract
The use of external-beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) is debated because of a lack of prospective clinical data, but recent retrospective studies have reported benefits in selected patients. The Endocrine Surgery Committee of the American Head and Neck Society provides 4 recommendations regarding EBRT for locoregional control in DTC, based on review of literature and expert opinion of the authors. (1) EBRT is recommended for patients with gross residual or unresectable locoregional disease, except for patients <45 years old with limited gross disease that is radioactive iodine (RAI)-avid. (2) EBRT should not be routinely used as adjuvant therapy after complete resection of gross disease. (3) After complete resection, EBRT may be considered in select patients >45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. (4) Cervical lymph node involvement alone should not be an indication for adjuvant EBRT. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26716601 [PubMed - as supplied by publisher]

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Recurrent giant mandibular ameloblastoma in young adults.

Recurrent giant mandibular ameloblastoma in young adults.

Head Neck. 2015 Dec 30;

Authors: Gravvanis A, Koumoullis HD, Anterriotis D, Tsoutsos D, Katsikeris N

Abstract
BACKGROUND: The purpose of the study was to define the most appropriate management of the giant mandibular ameloblastoma (GMA) in young adults.
METHODS: A retrospective study was performed on patients with GMA <30 years old. The data collected included initial treatment, tumor margins, reconstruction, and follow-up. Patients evaluated speech, chewing, swallowing, and facial appearance after definitive treatment.
RESULTS: Thirteen patients were identified with recurrent solid/multicystic disease requiring further treatment. Definitive treatment involved segmental mandibulectomy and reconstruction with free fibular flap in all patients. Seven patients had immediate reconstruction (group A) and 6 had secondary (group B). Mandibular resection was planned at least 2 cm beyond the radiological limit, free margins were achieved in all patients, and all flaps were transplanted successfully. In group A, functional score was 13.7 ± 0.45 and facial appearance score was 4.5 ± 0.49, whereas in group B were 11.16 ± 0.37 and 3.3 ± 0.5, respectively (both p < .05).
CONCLUSION: Aggressive resection of the GMA and immediate reconstruction is strongly advised. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26716398 [PubMed - as supplied by publisher]

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Microsurgery with or without Neuroendoscopy in Petroclival Meningiomas.

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Microsurgery with or without Neuroendoscopy in Petroclival Meningiomas.

Turk Neurosurg. 2015;25(2):231-8

Authors: Zhou QJ, Liu B, Geng DJ, Fu Q, Cheng XJ, Kadeer K, DU GJ, Wang YX, Luan XP

Abstract
AIM: This study aimed to investigate the operative procedure for neuroendoscope-assisted microscopic resection of petroclival meningioma to improve prognosis.
MATERIAL AND METHODS: Twelve patients with petroclival meningioma who had undergone neuroendoscope-assisted microscopic resection at the Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University were selected. In addition, 12 patients with petroclival meningioma who had undergone microscopic surgery were used as control. Clinical data from the 24 cases of petroclival meningioma were analyzed.
RESULTS: For the neuroendoscope-assisted group, six, five, and one cases were respectively subjected to total resection, subtotal resection, and most resection. For the microscopic surgery group, two, three, and seven cases were respectively subjected to total resection, subtotal resection, and most resection. Both the total and subtotal resection rates of petroclival meningioma in the neuroendoscope-assisted group were significantly higher than those in the microscopic surgery group (p < 0.05). No difference was observed for short-term and long-term complications (p > 0.05) between the two groups.
CONCLUSION: Neuroendoscope-assisted microscopic resection for petroclival meningioma can improve the total and subtotal resection rates of the tumor. Moreover, this method does not increase postoperative short-term and long-term complications.

PMID: 26014005 [PubMed - indexed for MEDLINE]

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Intracranial plasmacytoma with hypoglossal nerve palsy in multiple myeloma.

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Intracranial plasmacytoma with hypoglossal nerve palsy in multiple myeloma.

Postgrad Med J. 2015 Mar;91(1073):174-5

Authors: Sin WY, Grant I

PMID: 25740318 [PubMed - indexed for MEDLINE]

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Comparison of lateral microsurgical preauricular and anterior endoscopic approaches to the jugular foramen.

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Comparison of lateral microsurgical preauricular and anterior endoscopic approaches to the jugular foramen.

J Laryngol Otol. 2015 Mar;129 Suppl 2:S12-20

Authors: Komune N, Komune S, Matsushima K, Rhoton AL

Abstract
INTRODUCTION: This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach.
STUDY DESIGN: Cadaveric study.
RESULTS: The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach.
CONCLUSIONS: The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.

PMID: 25706154 [PubMed - indexed for MEDLINE]

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Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

Eur Arch Otorhinolaryngol. 2015 Dec 29;

Authors: Gungor V, Baklaci D, Kum RO, Yilmaz YF, Ozcan M, Unal A

Abstract
The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

PMID: 26714803 [PubMed - as supplied by publisher]

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The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery.

The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery.

Eur Arch Otorhinolaryngol. 2015 Dec 29;

Authors: Azbay S, Bostanci A, Aysun Y, Turhan M

Abstract
The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI) >15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4 %) patients had septoplasty plus mUPPP and 50 (74.6 %) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00 ± 19.76 vs. 36.60 ± 18.34), Epworth sleepiness scale (ESS) score (18.00 ± 4.45 vs. 13.00 ± 4.72), oxygen desaturation index (ODI) (48.98 ± 16.73 vs. 37.81 ± 17.03), and optimal CPAP level (11.80 ± 1.40 vs. 8.96 ± 1.20) were decreased (p < 0.001 for all parameters). Fifty-nine percent of patients reported that they fairly satisfied with the surgery and 49.2 % reported that their symptoms were completely resolved. While none of the cases could tolerate CPAP before surgery, almost half (47.8 %) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p = 0.001), supine AHI (p = 0.009), ESS (p = 0.019), and ODI (p = 0.014), and significantly lower postoperative minimum O2 saturation (p = 0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.

PMID: 26714802 [PubMed - as supplied by publisher]

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Vestibular functions of hereditary hearing loss patients with GJB2 mutations.

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Vestibular functions of hereditary hearing loss patients with GJB2 mutations.

Audiol Neurootol. 2015;20(3):147-52

Authors: Tsukada K, Fukuoka H, Usami S

Abstract
OBJECTIVES: Mutations in the GJB2 gene have been of particular interest as it is the most common causative gene for congenital deafness in all populations. Detailed audiological features, including genotype-phenotype correlations, have been well documented. However, in spite of abundant gene as well as protein expression in the vestibular end organs, neither vestibular symptoms nor vestibular functions have yet been elucidated. In the present study, vestibular functions were evaluated in patients diagnosed with GJB2-related deafness.
SUBJECTS AND METHODS: Vestibular functions were evaluated by caloric test and cervical vestibular evoked myogenic potential (cVEMP) testing in 24 patients with biallelic GJB2 mutations.
RESULTS AND DISCUSSION: Twenty-one of 23 patients (91.3%) had normal caloric responses and significantly lower cVEMP amplitudes than the control subjects. In the patients who were able to undergo vestibular testing, the mostly normal reactions to caloric testing indicated that the lateral semicircular canal was intact. However, the majority of GJB2 patients showed low cVEMP reactions, indicating a saccular defect.

PMID: 25824904 [PubMed - indexed for MEDLINE]

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Selective otolith dysfunctions objectively verified.

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Selective otolith dysfunctions objectively verified.

J Vestib Res. 2014;24(5-6):365-73

Authors: Manzari L, MacDougall HG, Burgess AM, Curthoys IS

Abstract
Vertigo and vigorous horizontal spontaneous nystagmus in a presenting patient is usually taken to indicate unilaterally reduced horizontal canal function. However here we report results which question that presumption. In three such patients with an acute vestibular syndrome, complete testing of all peripheral vestibular sense organs using new tests of canal and otolith function (vHIT and VEMPs) showed that semicircular canal function was normal, but that there were unilateral otolithic deficits which probably caused their acute syndrome.

PMID: 25564079 [PubMed - indexed for MEDLINE]

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Thyroid hormone receptors are differentially expressed in granulosa and cervical cells of infertile women.

Thyroid hormone receptors are differentially expressed in granulosa and cervical cells of infertile women.

Thyroid. 2015 Dec 30;

Authors: López E, Ortega FJ, Francisco-Busquets E, Sabater-Masdeu M, Álvarez E, Ricart W, Fernández-Real JM

Abstract
BACKGROUND: Thyroid hormones are known to exert an important role in reproduction. The objective of this study is to evaluate the expression of thyroid hormone receptors (TR) in granulosa (GC) and cervical cells (CC) of infertile euthyroid women.
METHODS: In a cross-sectional study, we investigated 31 consecutive infertile and 18 fertile women undergoing oocyte retrieval procedures. The expression of TRα1, TRα2 and TRβ was evaluated in GCs and uterine CC from infertile and fertile euthyroid women. β2 adrenergic receptor (ADRβ2) mRNA levels and the expression of genes linked to fertility such as gremlin-1 (GREM1), hyaluronan synthase 2 (HAS2), and prostaglandin-endoperoxide synthase 2 (PTGS2) were also evaluated.
RESULTS: In GCs, the expression of the thyroid hormone receptor TRα2, which exerts a dominant negative effect, increased with age in all women tested. TRα2 mRNA was increased in infertile vs. fertile women, in parallel to decreased ADRβ2 mRNA. As expected, the expression of genes associated with fertility (i.e. GREM1 and PTGS2) was downregulated in infertile women, in parallel to decreased ADRβ2 mRNA and increased TRα2 mRNA. In uterine CCs, a positive association of ADRβ2 mRNA with TRα1:TRα2 ratio was observed. Importantly, GCs from infertile women whose oocytes did not result in pregnancy had increased expression of TRα2 (p=0.017), and lower ADRβ2 (p=0.008), GREM1 (p=0.003) and PTGS2 (p=0.002) mRNAs than fertile women whose oocytes resulted in pregnancy. Infertile women also showed more TRα2 (p=0.033) mRNA in CCs than fertile women whose oocytes resulted in pregnancy.
CONCLUSIONS: The expression of different markers of intracellular thyroid function is linked to fertility status.

PMID: 26715425 [PubMed - as supplied by publisher]

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Cost-Effectiveness of Diagnostic Lobectomy Versus Observation for Thyroid Nodules Greater than 4 cm.

Cost-Effectiveness of Diagnostic Lobectomy Versus Observation for Thyroid Nodules Greater than 4 cm.

Thyroid. 2015 Dec 30;

Authors: Lee L, Mitmaker EJ, Chabot JA, Lee JA, Kuo JH

Abstract
BACKGROUND: The management of thyroid nodules >4 cm with benign cytology after fine-needle aspiration (FNA) is controversial. FNA is associated with a high false-negative rate in this setting and may result in a delayed diagnosis and management of thyroid cancer. However, the majority of these nodules are benign. Therefore the objective was to determine the cost-utility of observation versus surgical management for thyroid nodules >4 cm with benign cytology after FNA.
METHODS: A microsimulation model comparing routine thyroid lobectomy versus observation for low-risk patients with >4cm thyroid nodules with benign FNA cytology was constructed. Costs, quality-adjusted life years (QALYs), and life-years gained were calculated over a lifetime time horizon from a US Medicare perspective.
RESULTS: The proportion of patients undergoing thyroid lobectomy for benign final pathology was 40% in the observation strategy versus 66% in the surgical strategy (p<0.001). Overall, the surgical strategy was associated with higher lifetime costs compared to the observation strategy (incremental difference: +12992 US$; 95% CI 13042, 13524), but also more QALYs (+0.12 QALYs; 95% CI 0.02, 0.24) and longer life expectancy (+1.67 years; 95% CI 1.00, 2.41). Incremental lifetime costs were lower for patients <55 years versus those >=55 years (+11181 vs +14811, p<0.001). The probability of cost-effectiveness of the surgical strategy was 49% at a $100k/QALY threshold or 65% at a $100k/life-year gained threshold.
CONCLUSIONS: Routine thyroid lobectomy is associated with improved outcomes at an acceptable cost compared to observation for thyroid nodules >4cm with benign cytology after FNA. Surgical resection may be a cost-effective strategy to rule out malignancy in these nodules.

PMID: 26715288 [PubMed - as supplied by publisher]

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Nasal angiosarcoma metastatic to the larynx: Case report and systematic review of the literature.

Nasal angiosarcoma metastatic to the larynx: Case report and systematic review of the literature.

Head Neck. 2015 Dec 30;

Authors: Qualls HE, Mitchell RM, Deubner H, Moe KS, Sardesai M

Abstract
BACKGROUND: Laryngeal angiosarcoma is rare and the prognosis is poor. The purpose of this study was to describe the first case of cutaneous angiosarcoma metastatic to the larynx and systematically review all cases of laryngeal angiosarcoma.
METHODS: A 61-year-old man presented with an alar lesion diagnosed as angiosarcoma and was treated with wide local resection and radiation. Six years later, he presented with a laryngeal mass histologically similar to the initial tumor. A systematic review of reported cases of angiosarcoma of the larynx was performed.
RESULTS: Eighteen cases were identified. Mean age of presentation was 64.3 years. Men represented 66.7%. Mean follow-up was 34.1 months. Forty-seven percent died with disseminated disease at a mean of 18.4 months. Our patient did well with serial resection.
CONCLUSION: To the best of our knowledge, this case represents the first documented case of cutaneous angiosarcoma metastatic to the larynx and suggests that serial resection with long-term surveillance may be of benefit in some cases. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26717551 [PubMed - as supplied by publisher]

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Mast cell tryptase and carboxypeptidase A expression in body fluid and gastrointestinal tract associated with drug-related fatal anaphylaxis.

Mast cell tryptase and carboxypeptidase A expression in body fluid and gastrointestinal tract associated with drug-related fatal anaphylaxis.

World J Gastroenterol. 2015 Dec 21;21(47):13288-93

Authors: Guo XJ, Wang YY, Zhang HY, Jin QQ, Gao CR

Abstract
AIM: To investigate the expression of mast cell tryptase and carboxypeptidase A in drug-related fatal anaphylaxis.
METHODS: The expression of mast cell tryptase and carboxypeptidase A in 15 autopsy cases of drug-related fatal anaphylaxis and 20 normal autopsy cases were detected. First, the expression of mast cell tryptase was determined in stomach, jejunum, lung, heart, and larynx by immunofluorescence. Different tissues were removed and fixed in paraformaldehyde solution, then paraffin sections were prepared for immunofluorescence. Using specific mast cell tryptase and carboxypeptidase A antibodies, the expression of tryptase and carboxypeptidase A in gastroenterology tract and other tissues were observed using fluorescent microscopy. The postmortem serum and pericardial fluid were collected from drug-related fatal anaphylaxis and normal autopsy cases. The level of mast cell tryptase and carboxypeptidase A in postmortem serum and pericardial fluid were measured using fluor enzyme linked immunosorbent assay (FEIA) and enzyme linked immunosorbent assay (ELISA) assay. The expression of mast cell tryptase and carboxypeptidase A was analyzed in drug-related fatal anaphylaxis cases and compared to normal autopsy cases.
RESULTS: The expression of carboxypeptidase A was less in the gastroenterology tract and other tissues from anaphylaxis-related death cadavers than normal controls. Immunofluorescence revealed that tryptase expression was significantly increased in multiple organs, especially the gastrointestinal tract, from anaphylaxis-related death cadavers compared to normal autopsy cases (46.67 ± 11.11 vs 4.88 ± 1.56 in stomach, 48.89 ± 11.02 vs 5.21 ± 1.34 in jejunum, 33.72 ± 5.76 vs 1.30 ± 1.02 in lung, 40.08 ± 7.56 vs 1.67 ± 1.03 in larynx, 7.11 ± 5.67 vs 1.10 ± 0.77 in heart, P < 0.05). Tryptase levels, as measured with FEIA, were significantly increased in both sera (43.50 ± 0.48 μg/L vs 5.40 ± 0.36 μg/L, P < 0.05) and pericardial fluid (28.64 ± 0.32 μg/L vs 4.60 ± 0.48 μg/L, P < 0.05) from the anaphylaxis group in comparison with the control group. As measured by ELISA, the concentration of carboxypeptidase A was also increased more than 2-fold in the anaphylaxis group compared to control (8.99 ± 3.91 ng/mL vs 3.25 ± 2.30 ng/mL in serum, 4.34 ± 2.41 ng/mL vs 1.43 ± 0.58 ng/mL in pericardial fluid, P < 0.05).
CONCLUSION: Detection of both mast cell tryptase and carboxypeptidase A could improve the forensic identification of drug-related fatal anaphylaxis.

PMID: 26715811 [PubMed - in process]

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Does airway intervention before primary nonsurgical therapy for T3/T4 laryngeal squamous cell carcinoma impact on oncological or functional outcomes?

Does airway intervention before primary nonsurgical therapy for T3/T4 laryngeal squamous cell carcinoma impact on oncological or functional outcomes?

Swiss Med Wkly. 2015;145:w14213

Authors: Schariatzadeh R, Pezier T, Studer G, Schmid S, Huber G

Abstract
QUESTIONS UNDER STUDY: Even today, some patients with laryngeal cancer present with airway obstruction necessitating an intervention in the form of either a tracheostomy or transoral laser debulking (TOL). Controversy exists as to whether such an intervention is a risk factor for poor oncological or functional outcome in patients who then undergo primary (chemo)radiotherapy.
METHODS: Retrospective chart review of all patients undergoing primary curative nonsurgical treatment for T3/T4 laryngeal squamous cell cancer at the University Hospital Zurich between 1981 and 2011.
RESULTS: A total of 29/114 patients had an airway intervention before initiation of (chemo)radiotherapy (21/29 tracheostomies, 8/29 TOL). Kaplan-Meier analysis showed no statistical difference in oncological outcomes between the groups with and without intervention (5 year overall survival: 52% vs 70%, disease specific survival: 73% vs 79%, recurrence free survival: 53% vs 63%). In functional terms, we report an overall functional larynx rate of 60%.
CONCLUSIONS: Airway intervention was not found to be a risk factor for poor oncological or functional outcome in this patient group.

PMID: 26715377 [PubMed - in process]

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Automated tracking of quantitative parameters from single line scanning of vocal folds: a case study of the 'messa di voce' exercise.

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Automated tracking of quantitative parameters from single line scanning of vocal folds: a case study of the 'messa di voce' exercise.

Logoped Phoniatr Vocol. 2015 Apr;40(1):44-54

Authors: Dejonckere PH, Lebacq J, Bocchi L, Orlandi S, Manfredi C

Abstract
This article presents a novel application of the 'single line scanning' of the vocal fold vibrations (kymography) in singing pedagogy, particularly in a specific technical voice exercise: the 'messa di voce'. It aims at giving the singer relevant and valid short-term feedback. A user-friendly automatic analysis program makes possible a precise, immediate quantification of the essential physiological parameters characterizing the changes in glottal impedance, concomitant with the progressive increase and decrease of the lung pressure. The data provided by the program show a strong correlation with the hand-made measurements. Additional measurements such as subglottic pressure and flow glottography by inverse filtering can be meaningfully correlated with the data obtained from the kymographic images.

PMID: 24456119 [PubMed - indexed for MEDLINE]

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Human vocal tract resonances and the corresponding mode shapes investigated by three-dimensional finite-element modelling based on CT measurement.

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Human vocal tract resonances and the corresponding mode shapes investigated by three-dimensional finite-element modelling based on CT measurement.

Logoped Phoniatr Vocol. 2015 Apr;40(1):14-23

Authors: Vampola T, Horáček J, Laukkanen AM, Švec JG

Abstract
Resonance frequencies of the vocal tract have traditionally been modelled using one-dimensional models. These cannot accurately represent the events in the frequency region of the formant cluster around 2.5-4.5 kHz, however. Here, the vocal tract resonance frequencies and their mode shapes are studied using a three-dimensional finite element model obtained from computed tomography measurements of a subject phonating on vowel [a:]. Instead of the traditional five, up to eight resonance frequencies of the vocal tract were found below the prominent antiresonance around 4.7 kHz. The three extra resonances were found to correspond to modes which were axially asymmetric and involved the piriform sinuses, valleculae, and transverse vibrations in the oral cavity. The results therefore suggest that the phenomenon of speaker's and singer's formant clustering may be more complex than originally thought.

PMID: 23517635 [PubMed - indexed for MEDLINE]

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The Intensive Dysphagia Rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study.

The Intensive Dysphagia Rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study.

Arch Phys Med Rehabil. 2015 Dec 19;

Authors: Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K

Abstract
OBJECTIVE: To examine the effects of the Intensive Dysphagia Rehabilitation (IDR) approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.
DESIGN: Intervention study; before-after trial with 4-week follow-up through an online survey.
SETTING: Outpatient university clinics.
PARTICIPANTS: A consecutive sample of 10 subjects recruited from outpatient university clinics. All were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subject withdrew from the study.
INTERVENTIONS: Participants completed the 4-week Intensive Dysphagia Rehabilitation, including: two oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice/week, and home practice for ∼45 minutes/day.
MAIN OUTCOME MEASURE(S): Outcome measures assessed pre- and post-IDR were: (1) airway safety using an 8-point Penetration Aspiration scale; (2) lingual isometric pressures; (3) self-reported swallowing-related quality of life (QOL), and (4) level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).
RESULTS: IDR was effective in improving maximum and mean Penetration Aspiration scale scores (p<0.05, η(2)=0.8146; p<0.05, η(2)=0.799708); and level of oral intake (p<0.005, Cohen's d=-1.387). Of 5 patients who were feeding tube dependent initially, two progressed to total, and two to partial oral nutrition. One remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% CI [6.38, 14.5], p<0.00), but not at the post-IDR assessment. No adverse effects were observed/reported.
CONCLUSION(S): We conclude that IDR was safe and improved physiological and some functional swallowing outcomes in our sample, however further investigation is needed before it can be widely applied.

PMID: 26711168 [PubMed - as supplied by publisher]

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Incidence of severe dysphagia after brain surgery in pediatric traumatic brain injury: a nationwide population-based retrospective study.

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Incidence of severe dysphagia after brain surgery in pediatric traumatic brain injury: a nationwide population-based retrospective study.

J Head Trauma Rehabil. 2014 Nov-Dec;29(6):E31-6

Authors: Huang CT, Lin WC, Ho CH, Tung LC, Chu CC, Chou W, Wang CH

Abstract
OBJECTIVES: To investigate the incidence of dysphagia and medical resource utilization in a nationwide population of pediatric patients with traumatic brain injury (TBI).
SETTING: Subjects' data were obtained from the Taiwan National Health Insurance Research Database.
PARTICIPANTS: Between 2000 and 2008, 6290 children less than 18 years old who had received surgery post-TBI were included in the study.
DESIGN: Retrospective study.
MAIN OUTCOME MEASURE: Biographic data and medical utilization results.
RESULTS: Of all the children postsurgery after TBI, 12.3% were categorized as having severe dysphagia. The occurrence of severe dysphagia was not related to sex but was statistically and significantly related to a younger mean age. The relationship between age and dysphagia also showed an interestingly biphasic distribution, mostly in the subgroups of 1 to 3 and 16 to 18 years of age. The medical resource utilization was higher in severely dysphagia patients, but only 8.4% received intervention by a speech language pathologist.
CONCLUSIONS: Severe dysphagia among postsurgical pediatric patients after TBI is relatively common, and those with severe dysphagia have a greater need for medical services. However, the ratio of such patients who receive swallowing treatment is still low in Taiwan. Clinicians are prompted to pay more attention to the impairment in functional oral intake of children postsurgery after TBI.

PMID: 24590154 [PubMed - indexed for MEDLINE]

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Transoral robotic medial hypopharyngectomy: Surgical technique.

Transoral robotic medial hypopharyngectomy: Surgical technique.

Head Neck. 2015 Dec 29;

Authors: Sims JR, Robinson NL, Moore EJ, Janus JR

Abstract
BACKGROUND: Transoral robotic surgery (TORS) has been shown to be both feasible and oncologically sound for use in early T classification hypopharyngeal cancers. The purpose of this study was to present our surgical technique for performing a transoral robotic hypopharyngectomy.
METHODS: A 48-year-old man with a T2, N2a, M0 squamous cell carcinoma of the hypopharynx underwent a transoral robotic hypopharyngectomy and a left select neck dissection of levels II to IV.
RESULTS: The hypopharyngeal tumor was removed en bloc after circumferential cuts were made until the tumor was finally amputated from the apex of the piriform sinus. Negative margins were achieved. A left select neck dissection was performed. The patient was tolerating an oral diet and his tracheostomy tube was decannulated before discharge.
CONCLUSION: TORS offers improved manual dexterity and tumor manipulation over conventional transoral approaches to hypopharyngeal cancers. It is both a feasible and effective method for certain early-stage hypopharyngeal cancers. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26714289 [PubMed - as supplied by publisher]

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Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports.

Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports.

Head Neck. 2015 Dec 29;

Authors: Wang CC, Liu SA, Wu SH, Lin WJ, Jiang RS, Wang L

Abstract
BACKGROUND: Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity.
METHODS: Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed.
RESULTS: TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence.
CONCLUSION: TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26714200 [PubMed - as supplied by publisher]

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The relationship between communicative participation and postlaryngectomy speech outcomes.

The relationship between communicative participation and postlaryngectomy speech outcomes.

Head Neck. 2015 Dec 29;

Authors: Eadie TL, Otero D, Cox S, Johnson J, Baylor CR, Yorkston KM, Doyle PC

Abstract
BACKGROUND: The purpose of this study was to examine relationships between communicative participation and postlaryngectomy speech outcomes, including listener-rated speech intelligibility and acceptability, and patient-rated speech acceptability and voice handicap.
METHODS: Thirty-six laryngectomized individuals completed the Communicative Participation Item Bank (CPIB) short form and the Voice Handicap Index-10 (VHI-10). They provided recordings from the Sentence Intelligibility Test (SIT) and a reading passage, and rated their own speech acceptability. Forty-eight inexperienced listeners transcribed the SIT sentences to derive intelligibility scores. Eighteen additional listeners judged the speech acceptability using the rating scales.
RESULTS: Listeners judged tracheoesophageal speakers as significantly more intelligible and acceptable than electrolaryngeal speakers (p < .05). Speech acceptability was significantly more acceptable to speakers than listeners (p < .05). Weak, nonsignificant relationships were found between communicative participation and listener-rated outcomes. Stronger, significant relationships were found between communicative participation and self-rated speech acceptability and voice handicap (p < .05).
CONCLUSION: Patient-reported communication outcomes are complementary to listener-rated outcomes. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26714043 [PubMed - as supplied by publisher]

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Evaluation of Polo-like kinase 1 as a potential therapeutic target in Merkel cell carcinoma.

Evaluation of Polo-like kinase 1 as a potential therapeutic target in Merkel cell carcinoma.

Head Neck. 2015 Dec 29;

Authors: Kadletz L, Bigenzahn J, Thurnher D, Stanisz I, Erovic BM, Schneider S, Schmid R, Seemann R, Birner P, Heiduschka G

Abstract
BACKGROUND: Merkel cell carcinoma (MCC) is a rare and aggressive malignancy of the skin. Treatment options for MCC include surgery, radiotherapy, and chemotherapy. The purpose of this study was to assess the expression of Polo-like kinase 1 (PLK1) in MCC and the role of the inhibitor, BI2536, as a potential therapeutic option in MCC.
METHODS: PLK1 expression was assessed in tissue samples from 28 patients with MCC and 5 healthy skin samples via immunohistochemistry and furthermore in the 2 MCC cell lines, MCC13 and MCC26, via immunoblotting. The impact of increasing doses of BI2536 alone and in combination with cisplatin or irradiation on cell viability was measured using the CCK-8 assay. Colony forming assays were performed to evaluate long-term effects of combination treatments. Additionally, the induction of apoptotic cell death was measured via flow cytometry.
RESULTS: PLK1 is moderately to strongly expressed in 75% of the patients with MCC. The PLK1 inhibitor, BI2536, demonstrated marked inhibition of cell proliferation with IC50 in the low nM range (from 10.07-12.39 nM). Furthermore, BI2536 induces apoptosis in MCC cell lines and acts synergistically in combination with irradiation and cisplatin.
CONCLUSION: Because of the marked upregulation of PLK1 in MCC tumor samples and potent inhibition of cell proliferation using a specific clinically available inhibitor, targeting of PLK1 qualifies as a potential novel therapeutic strategy in MCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26713885 [PubMed - as supplied by publisher]

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Effect of β-catenin silencing in overcoming radioresistance of head and neck cancer cells by antagonizing the effects of AMPK on Ku70/Ku80.

Effect of β-catenin silencing in overcoming radioresistance of head and neck cancer cells by antagonizing the effects of AMPK on Ku70/Ku80.

Head Neck. 2015 Dec 29;

Authors: Chang HW, Nam HY, Kim HJ, Moon SY, Kim MR, Lee M, Kim GC, Kim SW, Kim SY

Abstract
BACKGROUND: We attempted to elucidate the mechanism of cell death after radiation by studying how β-catenin silencing controls the radiation sensitivity of radioresistant head and neck cancer cells.
METHODS: The most radioresistant cancer cell line (AMC-HN-9) was selected for study. Targeted silencing of β-catenin was used on siRNAs. Sensitivity to radiation was examined using clonogenic and methylthiazol tetrazolium (MTT) assays.
RESULTS: A combination of irradiation plus β-catenin silencing led to a significant reduction in the inherent radioresistance of AMC-HN-9 cells. Although expression of Ku70/80 was upregulated in AMC-HN-9 cells after irradiation, Ku70/80 was dramatically decreased in a combination of irradiation and β-catenin silencing. Interestingly, irradiation-induced Ku70/80 was completely prevented by β-catenin silencing-induced LKB1/AMP-activated protein kinase (LKB1/AMPK) signal.
CONCLUSION: The LKB1/AMPK pathway might relay the signal between the Wnt/β-catenin pathway and the Ku70/Ku80 DNA repair machinery, and play a decisive role in fine-tuning the responses of cancer cells to irradiation. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26713771 [PubMed - as supplied by publisher]

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Cervical lymph node metastases from remote primary tumor sites.

Cervical lymph node metastases from remote primary tumor sites.

Head Neck. 2015 Dec 29;

Authors: López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A

Abstract
Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26713674 [PubMed - as supplied by publisher]

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Regional variation in head and neck cancer mortality: Role of patient and hospital characteristics.

Regional variation in head and neck cancer mortality: Role of patient and hospital characteristics.

Head Neck. 2015 Dec 29;

Authors: Divi V, Ma Y, Rhoads KF

Abstract
BACKGROUND: The purpose of this study was to determine whether outcomes in head and neck cancer would vary based on geographic location of patients.
METHODS: A dataset from the California Cancer Registry was linked to publicly available discharge abstracts. Patients were separated into geographic areas based on health service areas (HSAs). Multilevel logistic regression models were constructed to include geographic, patient, and hospital-level characteristics.
RESULTS: There was significant variation in 5-year survival hazard ratios (HRs) among the majority of the 14 HSAs in the unadjusted model. After adjusting for patient and hospital characteristics, the differences between regions were not significant except for Orange County (HR = 0.75). Commission on Cancer certification (HR = 0.82; p < .01) and hospital volume (HR = 0.975; p < .01) were each independently associated with differences in survival.
CONCLUSION: Geographic variation in 5-year survival outcomes is seen in head and neck cancer. Patient characteristics and treating hospitals explain much of this variation. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26713544 [PubMed - as supplied by publisher]

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Anesthetic considerations and airway management in professional singers: an "orphan disease"?

Related Articles

Anesthetic considerations and airway management in professional singers: an "orphan disease"?

Can J Anaesth. 2015 Aug;62(8):928-9

Authors: Errando CL

PMID: 25894907 [PubMed - indexed for MEDLINE]

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Gorham-Stout Disease of the Skull Base With Hearing Loss: Dramatic Recovery and Antiangiogenic Therapy.

Gorham-Stout Disease of the Skull Base With Hearing Loss: Dramatic Recovery and Antiangiogenic Therapy.

Pediatr Blood Cancer. 2015 Dec 29;

Authors: Nozawa A, Ozeki M, Kuze B, Asano T, Matsuoka K, Fukao T

Abstract
Gorham-Stout disease (GSD) is a rare disorder of unknown etiology. We present a 6-year-old male with GSD involving the skull base who presented with recurrent cerebrospinal fluid (CSF) rhinorrhea, severe hearing loss, and facial palsy secondary to cerebellar herniation into the internal auditory canal. After 2 months of treatment with pegylated interferon (IFN) α-2b (50 μg/week), his hearing recovered dramatically. Two years later, new bone formation appeared radiologically and IFN was switched to sirolimus. One year after the switch, CSF rhinorrhea disappeared. Antiangiogenic therapy might inhibit proliferation of vascular endothelial cells in osteolytic lesions and lead to new bone formation.

PMID: 26713883 [PubMed - as supplied by publisher]

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Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases.

Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases.

N Am J Med Sci. 2015 Nov;7(11):494-502

Authors: Karmacharya P, Pathak R, Ghimire S, Shrestha P, Ghimire S, Poudel DR, Khanal R, Shah S, Aryal MR, Alweis RL

Abstract
Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.

PMID: 26713297 [PubMed]

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Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports.

Transoral robotic surgery for early glottic carcinoma involving anterior commissure: Preliminary reports.

Head Neck. 2015 Dec 29;

Authors: Wang CC, Liu SA, Wu SH, Lin WJ, Jiang RS, Wang L

Abstract
BACKGROUND: Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity.
METHODS: Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed.
RESULTS: TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence.
CONCLUSION: TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26714200 [PubMed - as supplied by publisher]

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Laryngoscopy evaluation protocol for the differentiation of essential and dystonic voice tremor.

Laryngoscopy evaluation protocol for the differentiation of essential and dystonic voice tremor.

Braz J Otorhinolaryngol. 2015 Dec 3;

Authors: de Moraes BT, de Biase NG

Abstract
INTRODUCTION: Although syndromes that cause voice tremor have singular characteristics, the differential diagnosis of these diseases is a challenge because of the overlap of the existing signs and symptoms.
OBJECTIVE: To develop a task-specific protocol to assess voice tremor by means of nasofibrolaryngoscopy and to identify those tasks that can distinguish between essential and dystonic tremor syndromes.
METHODS: Cross-sectional study. The transnasal fiberoptic laryngoscopy protocol, which consisted of the assessment of palate, pharynx and larynx tremor during the performance of several vocal and non-vocal tasks with distinct phenomenological characteristics, was applied to 19 patients with voice tremor. Patients were diagnosed with essential or dystonic tremor according to the phenomenological characterization of each group. Once they were classified, the tasks associated with the presence of tremor in each syndrome were identified.
RESULTS: The tasks that significantly contributed to the differential diagnosis between essential and dystonic tremor were /s/ production, continuous whistling and reduction of tremor in falsetto. These tasks were phenomenologically different with respect to the presence of tremor in the two syndromes.
CONCLUSION: The protocol of specific tasks by means of transnasal fiberoptic laryngoscopy is a viable method to differentiate between essential and dystonic voice tremor syndromes through the following tasks: /s/ production, continuous whistling and reduction of tremor in falsetto.

PMID: 26712633 [PubMed - as supplied by publisher]

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Upper airway endoscopy to optimize obstructive sleep apnea treatment in Apert and Crouzon syndromes.

Upper airway endoscopy to optimize obstructive sleep apnea treatment in Apert and Crouzon syndromes.

J Craniomaxillofac Surg. 2015 Nov 17;

Authors: Doerga PN, Spruijt B, Mathijssen IM, Wolvius EB, Joosten KF, van der Schroeff MP

Abstract
INTRODUCTION: Obstructive sleep apnea (OSA) is highly prevalent in children with Apert and Crouzon syndromes. Although often related to midface hypoplasia, it is a multi-level problem for which routine midface advancement might be a suboptimal treatment choice. We therefore wished to: 1.) use upper airway endoscopy to examine the level of obstruction in children with OSA; 2.) determine the relationship between endoscopic assessment and OSA severity; and 3.) evaluate the effect of surgery on endoscopic assessment and OSA severity.
METHODS: Prospective observational cohort study of patients considered for midface advancement, underwent upper airway endoscopy. Endoscopy findings were scored according to the system of Bachar, based on level (nose, uvulopalatine plane, tongue base, hypopharynx and larynx); and severity (no, partial or complete obstruction). Polysomnography was used to diagnose OSA.
RESULTS: We included 22 children (Apert N = 10, Crouzon N = 12), 17 had OSA, 14 of whom had multilevel obstruction and 3 single-level obstruction. The endoscopy findings were correlated with OSA severity: R = 0.56, P = 0.01. Midface advancement (N = 8) reduced Bachar's severity index in 7 of 8 patients, and OSA in all patients.
CONCLUSIONS: OSA in children with Apert or Crouzon syndrome is often a multi-level problem. Upper airway endoscopy is essential to optimizing OSA treatment.

PMID: 26712482 [PubMed - as supplied by publisher]

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[BIOFILM FORMATION BY STREPTOCOCCUS PNEUMONIAE].

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[BIOFILM FORMATION BY STREPTOCOCCUS PNEUMONIAE].

Mol Gen Mikrobiol Virusol. 2015;33(3):16-22

Authors: Mayanskiy AN, Chebotar IV, Lazareva AV, Mayanskiy NA

Abstract
The biofilm process in Streptococcus pneumoniae (pneumococcus) is described. Virtually all wild-type pneumococci are capable of the biofilm formation. The pneumococcal capsule may reduce the biofilm production, and the propensity to form biofilms has a reverse correlation with the amount of the capsule material. Invasive pneumococcal isolates and noninvasive strains that persist in the nasopharynx have different biofilm potential. A number of issues related to effector and regulatory factors in the pneumococcal biofilms are discussed in this review. In the summary, a biofilm may be essential only for the persistent pneumococcal infection.

PMID: 26665737 [PubMed - indexed for MEDLINE]

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Vocal fold hyalinosis in Urbach-Wiethe disease, a rare cause of hoarseness.

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Vocal fold hyalinosis in Urbach-Wiethe disease, a rare cause of hoarseness.

B-ENT. 2015;11(2):151-5

Authors: Honings J, van Rossum MM, van den Hoogen FJ

Abstract
BACKGROUND: Lipoid proteinosis is an autosomal recessive disorder characterized by hyalin deposits in the skin and mucosa of the upper aerodigestive tract; currently, no treatment exists. Nearly all patients experience hoarseness and speech difficulties, due to hyalin deposition in the vocal folds and diminished mobility in infiltrated lips, tongue, and palate.
METHODS: We describe a patient with extensive hyalin plaques on the vocal folds, which resulted in near-aphonic hoarseness. Hyalin deposits in the vocal folds and skin were treated with laser resection.
RESULTS: Both the vocal folds and skin improved in appearance, with smoother surface epithelium. However, the patient's speech remained impaired, due to extensive hyalin plaques in the mouth, tongue, and lips. The voice improved only temporarily.
CONCLUSIONS: Laser resection of hyalin plaques in the vocal folds and skin is a feasible treatment for lipoid proteinosis. However, speech may remain severely limited, due to impaired tongue and lip movement.

PMID: 26563017 [PubMed - indexed for MEDLINE]

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Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution.

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Accuracy of identifying the cricothyroid membrane by anesthesia trainees and staff in a Canadian institution.

Can J Anaesth. 2015 May;62(5):495-503

Authors: Lamb A, Zhang J, Hung O, Flemming B, Mullen T, Bissell MB, Arseneau I

Abstract
PURPOSE: We sought to determine the rate of successful identification of the cricothyroid membrane by anesthesia residents and staff at a Canadian institution.
METHODS: In this prospective study, healthy adult volunteer subjects were positioned supine with their necks placed in neutral position. There were 12 subjects, half of whom were non-obese (body mass index < 30.0 kg·m(2)) and half of whom were obese. There were equal numbers of male and female subjects in each of the obese and non-obese groups. Anesthesia staff and resident participants were allowed to palpate multiple subjects but with only one attempt per subject. For each subject, ultrasonography was used to identify the superior and inferior borders of the cricothyroid membrane, which were then marked with "invisible" ink that could be made visible with ultraviolet light. The midline was also marked with invisible ink. Identification of the cricothyroid membrane was considered correct if the mark was between the superior and inferior borders and within 0.5 cm of the midline.
RESULTS: Altogether, 61 participants palpated 12 subjects, resulting in 186 identifications. The success rates for the subgroups were as follows: non-obese men 72% (95% confidence interval [CI] 59 to 85%); obese men 39% (95% CI 26 to 54%); non-obese women 24% (95% CI 12 to 36%); obese women 35% (95% CI 21 to 49%).
CONCLUSION: Success rates for correct identification of the cricothyroid membrane were poor in this Canadian institution.

PMID: 25637060 [PubMed - indexed for MEDLINE]

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Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial.

Related Articles

Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial.

Can J Anaesth. 2015 May;62(5):485-94

Authors: You-Ten KE, Bould MD, Friedman Z, Riem N, Sydor D, Boet S

Abstract
PURPOSE: Non-adherence to airway guidelines in a 'cannot intubate-cannot oxygenate' (CICO) crisis situation is associated with adverse patient outcomes. This study investigated the effects of hands-on training in cricothyrotomy on adherence to the American Society of Anesthesiologists difficult airway algorithm (ASA-DAA) during a simulated CICO scenario.
METHODS: A total of 21 postgraduate second-year anesthesia residents completed a pre-test teaching session during which they reviewed the ASA-DAA, became familiarized with the Melker cricothyrotomy kit, and watched a video on cricothyrotomy. Participants were randomized to either the intervention 'Trained' group (n = 10) (taught and practiced cricothyrotomy) or the control 'Non-Trained' group (n = 11) (no extra training). After two to three weeks, performances of the groups were assessed in a simulated CICO scenario. The primary outcome measure was major deviation from the ASA-DAA. Secondary outcome measures were (1) performance of the four categories of non-technical behaviours using the validated Anaesthetists' Non-Technical Skills scale (ANTS) and (2) time to perform specific tasks.
RESULTS: Significantly more non-trained than trained participants (6/11 vs 0/10, P = 0.012) committed at least one major ASA-DAA deviation, including failure to insert an oral airway, failure to call for help, bypassing the laryngeal mask airway, and attempting fibreoptic intubation. ANTS scores for all four categories of behaviours, however, were similar between the groups. Trained participants called for help faster [26 (2) vs 63 (48) sec, P = 0.012] but delayed opening of the cricothyrotomy kit [130 (50) vs 74 (36) sec, P = 0.014].
CONCLUSION: Hands-on training in cricothyrotomy resulted in fewer major ASA-DAA deviations in a simulated CICO scenario. Training in cricothyrotomy may play an important role in complying with the ASA-DAA in a CICO situation but does not appear to affect non-technical behaviours such as decision-making.

PMID: 25547068 [PubMed - indexed for MEDLINE]

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The impact of the cochlear-carotid interval on tinnitus perception.

The impact of the cochlear-carotid interval on tinnitus perception.

Surg Radiol Anat. 2015 Dec 29;

Authors: Gunbey HP, Gunbey E, Sayit AT, Aslan K, Unal A, Incesu L

Abstract
PURPOSE: We hypothesized that the cochlear-carotid interval (CCI), which is defined as the smallest distance along the petrous segment of the internal carotid artery and basal turn of cochlea, may be associated with direct stimulation of hair cells, thereby affecting tinnitus perception. The aim of this study was to investigate the relationships between the CCI, tinnitus perception, and accompanying hearing loss in patients with tinnitus.
METHODS: The CCI on both sides was measured independently by two observers from the temporal 3D b-FFE MR images of 25 patients with tinnitus and 20 age/gender matched control subjects. The relationships between CCI, tinnitus visual analog scale (VAS), and tinnitus handicap inventory (THI) were investigated.
RESULTS: CCI ranged 0.2-5.6 mm (1.9 ± 1.5) on the right and 0.1-5.4 mm (2.2 ± 1.6) on the left side in the patient group and 0.5-5.4 (1.9 ± 1.4) mm on the right and 0.3-6.7 (2.3 ± 1.7) on the left side in the control group. The differences between the two groups were not statistically significant (p > 0.05). CCI showed a strong negative correlation with THI and VAS scores on both sides. Correlation of audiologic findings with CCI revealed a significant negative correlation with pure tone average of the ipsilateral ear most affectedly at high frequencies.
CONCLUSION: The strong negative correlation of CCI with tinnitus-related distress and accompanying sensorineural hearing loss predominantly at high frequencies suggests that further studies on patients with tinnitus that focus on this small area may help to improve the knowledge of tinnitus pathophysiology.

PMID: 26711900 [PubMed - as supplied by publisher]

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The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study.

The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study.

Rhinology. 2015 Dec 29;

Authors: Kayiran O, Calli C

Abstract
INTRODUCTION: Success and satisfactory results in rhinoplasty are established not only with flawless surgery but also with meticulous perioperative care. Pain stays at the centre of these circumstances. Besides, several contributing perioperative factors such as periorbital edema and ecchymosis play key role on the patients' comfort.
METHODS: Septorhinoplasty was carried out in 50 patients between February and May 2014 under general anesthesia. Local anesthesia with lidocaine and adrenaline combination was done prior to incision. Following the procedure, silicone gel packs were applied. One periorbital region was cooled after surgery whereas the opposite site was left uncooled. Periorbital edema-ecchmosis and pain intensity were graded and noted 1 hour, 1 day, 3 days, 1 week and 1 month after surgery.
RESULTS: Cold application seriously reduced postoperative edema and ecchymosis at the first week (p=0.001 for the first 3 days and p=0.006 at first week). Pain was reduced with cooling not on the first hour (p>0.05), but on the forthcoming days throughout the first week (p<0.005). Operation time revealed that primary cases were carried out quicker than revisional surgery. Moreover, pain scores were found lower in primary cases than revisions, especially in the first 3 days. These finding were approved statistically.
CONCLUSION: Cooling of the periorbital region reduces edema and ecchymosis as well as pain; however 3 days of use is enough after rhinoplasty. One hour after surgery, cooling does not affect the pain but reduce edema and ecchymosis.

PMID: 26713321 [PubMed - as supplied by publisher]

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Uncommon TERT Promoter Mutations in Pediatric Thyroid Cancer.

Uncommon TERT Promoter Mutations in Pediatric Thyroid Cancer.

Thyroid. 2015 Dec 29;

Authors: Alzahrani AS, Qasem E, Murugan AK, Al-Hindi HN, Alkhafaji DM, Almohanna M, Xing M, Alhomaidah D, Alswailem M

Abstract
PURPOSE: To determine the rate and significance of TERT promoter mutations which have been recently described in adult thyroid cancer (TC) but not yet in the uncommonly occurring pediatric TC. Also, the role of BRAFV600E mutation in the clinical outcome of pediatric TC is unknown.
EXPERIMENTAL DESIGN: The study included 55 pediatric [median age 16 years (range 9-18), female:male 46:9] and 210 adult TC patients [median age 40 years (range 20-75), female:male 155:55] seen during the same time period. DNA was isolated from TC tissues and subjected to direct sequencing. Genetic-clinicopathological correlations were analyzed.
RESULTS: Only one case of pediatric TC was found to harbor the C228T TERT promoter mutation (1.8%). C250T mutation was never detected in any of the 55 pediatric TC. In contrast, there was a significantly higher rate of TERT promoter mutations in the adult patients (15.7%, 33/210) compared with the pediatric patients (P=0.003). In addition, persistent/recurrent TC was seen in 8/12 (66.7%) pediatric patients harboring the BRAFV600E mutation versus 14/41 (34.1%) patients harboring the wild-type BRAF (P = 0.05) and, when only conventional papillary TC was examined, in 7/9 (77.8%) cases harboring BRAFV600E mutation versus 11/33 (33.3%) cases harboring wild type BRAF (P = 0.025).
CONCLUSIONS: This is the first study on TERT promoter mutations in pediatric TC, which revealed an exceedingly low prevalence, suggesting a limited role of these mutations in pediatric TC. This study also for the first time demonstrates an association of BRAFV600E mutation with TC recurrence in the pediatric patients.

PMID: 26711586 [PubMed - as supplied by publisher]

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Parity and 11-year serum thyrotropin and thyroid autoantibody change: A longitudinal population-based study.

Parity and 11-year serum thyrotropin and thyroid autoantibody change: A longitudinal population-based study.

Thyroid. 2015 Dec 29;

Authors: Bjergved L, Carlé A, Jørgensen T, Perrild H, Laurberg P, Krejbjerg A, Ovesen L, Bülow Pedersen I, Rasmussen LB, Knudsen N

Abstract
Background A role for female reproductive factors in the pathogenesis of thyroid autoimmunity has been suggested. We investigated the prospective association between parity, abortion, use of oral contraceptive pill (OCP), and use of hormone replacement therapy (HRT), and 11-year change in serum thyrotropin (TSH) as well as change in thyroid peroxidase autoantibody (TPO-Ab) status. Methods A random sample of 4,649 persons aged 18-65 years participated in a population-based study in the period 1997-1998. In the study presented here, we included 1,749 non-pregnant women with no history of thyroid disease who participated in the 11-year follow-up examination in the period 2008-2010. Gynecological exposures were reported in a self-administered questionnaire at baseline and follow-up. TSH and TPO-Ab were measured at baseline and follow-up. Increased TPO-Ab status during follow-up was defined as a TPO-Ab below assay cut-off (< 30 kU/L) at baseline and TPO-Ab ≥ 30 kU/L at follow-up. Multiple linear regression models were used, adjusted for age, smoking status, and urinary iodine excretion. Results An inverse association was found between the number of years on hormone replacement therapy and the risk (odds ratio) of increased TPO-Ab status during follow-up (0.735 (95% confidence interval, CI 0.558, 0.968), P=0.03). This association was however not statistically significant when applying the Bonferroni adjusted significance level. The remaining reproductive factors showed no statistically significant association with risk of increased TPO-Ab during follow-up. Also, parity, abortions, use of OCP, HRT use, age at menarche and being pre- or postmenopausal were not significantly associated with 11-year TSH change. Conclusions We found no statistically significant association between the studied female reproductive measures and 11-year risk of TSH or TPO-change. A possible protective role for hormone replacement therapy in the etiology of thyroid autoimmunity however deserves further research.

PMID: 26711373 [PubMed - as supplied by publisher]

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Congenital granular cell lesion of the tongue: a report of two cases and review of the literature.

Congenital granular cell lesion of the tongue: a report of two cases and review of the literature.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 21;

Authors: Yancoskie AE, Reebye UN, Segal JD, Aldape Barrios BC, Velasco AA, Fantasia JE

Abstract
The congenital granular cell lesion most commonly occurs on the maxillary or mandibular alveolus of neonates. Extra-alveolar congenital granular cell lesion is exceptionally rare, with only 10 cases reported. Two additional cases occurring on the tongue are presented with a description of the clinical, histopathologic, and immunohistochemical features. The differential diagnosis is discussed, and the literature reviewed.

PMID: 26712684 [PubMed - as supplied by publisher]

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Rapidly expanding mass of the maxilla and paranasal sinuses.

Rapidly expanding mass of the maxilla and paranasal sinuses.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 24;

Authors: Stojanov IJ, Woo SB

PMID: 26712683 [PubMed - as supplied by publisher]

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Clinical utility of myb rearrangement detection and p63/p40 immunophenotyping in the diagnosis of adenoid cystic carcinoma of minor salivary glands: a pilot study.

Clinical utility of myb rearrangement detection and p63/p40 immunophenotyping in the diagnosis of adenoid cystic carcinoma of minor salivary glands: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 19;

Authors: Argyris PP, Wetzel SL, Greipp P, Wehrs RN, Knutson DL, Kloft-Nelson SM, García JJ, Koutlas IG

Abstract
OBJECTIVES: MYB rearrangement is observed in approximately 28% to 86% of adenoid cystic carcinomas (ACCs). Also, ACC features a p63+/p40+ immunophenotype in greater than 90% of cases, compared with p63+/p40- polymorphous low-grade adenocarcinoma (PLGA). Our aim was to investigate the incidence of (1) MYB rearrangement and (2) p63/p40 immunoreactivity in ACC and PLGA of minor salivary glands (MSGs).
STUDY DESIGN: Seven cases of ACC as well as five of PLGA were evaluated by using a MYB (6 q23.3) break-apart fluorescence in situ hybridization (FISH) probe. In addition, all cases were immunohistochemically stained with p63 and p40 antibodies.
RESULTS: All five successfully hybridized ACCs featured MYB rearrangement, whereas PLGAs did not show MYB rearrangement. Interestingly, one case of PLGA demonstrated a single intact copy of MYB in greater than 88% of the neoplastic cells. All ACCs exhibited consistent p63+/p40+ staining, whereas PLGAs demonstrated a p63+/p40- immunophenotype.
CONCLUSIONS: (1) MYB rearrangement is encountered in ACCs but not PLGAs of MSGs; (2) MYB aberrations, for example, monosomy or deletion, can be seen in PLGAs; (3) combined p63/p40 immunostaining can be used to differentiate ACC from PLGA in incisionally biopsied specimens; and (4) performance of either FISH or p63/p40 immunohistochemistry is expected to be able to confirm the diagnosis of ACC or PLGA in small intraoral biopsies, since both techniques appeared to be diagnostically accurate in this pilot study.

PMID: 26711711 [PubMed - as supplied by publisher]

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Oral squamous cell carcinoma: the impact of stage-dependent therapy regimes on postoperative disease recurrence.

Oral squamous cell carcinoma: the impact of stage-dependent therapy regimes on postoperative disease recurrence.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Oct 22;

Authors: Unterhuber T, Duma MN, Rau A, Nieberler M, Wolff KD, Kesting MR

Abstract
OBJECTIVE: To investigate disease recurrence among patients with oral squamous cell carcinoma (OSCC) and positive lymph node lesions receiving different therapy for different stages of the disease.
STUDY DESIGN: One hundred sixty-one patients with biopsy-proven pN1 and pN2+ carcinomas were reviewed retrospectively. We investigated postoperative disease recurrence when using surgery alone (SA), adjuvant radiotherapy (RT), or adjuvant radiochemotherapy (RCT) and compared our results with the 2012 German guidelines.
RESULTS: Among the study population, 60 (37%) experienced postoperative disease recurrence, 38% with SA, 42% with adjuvant RT, and 39% with adjuvant RCT (P = .420). In the case of pN1, the recurrence rate was 14% with SA, 32% with RT, and 33% with RCT (P = .156); and in pN2+, 60%, 49%, and 29%, respectively (P = .012).
CONCLUSIONS: Surgery plus adjuvant therapy has benefits with respect to postoperative disease recurrence in pN2+ OSCC. In pN1, surgery alone might be as effective as adjuvant RT or RCT.

PMID: 26711710 [PubMed - as supplied by publisher]

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Associations between neurologic dysfunction and lesions in canine fucosidosis.

Associations between neurologic dysfunction and lesions in canine fucosidosis.

Genes Brain Behav. 2015 Dec 29;

Authors: Fletcher JL, Taylor RM

Abstract
Canine fucosidosis in English Springer spaniels is the only animal model of the neurovisceral lysosomal storage disease fucosidosis available for preclinical therapeutic trials. For this reason, it is crucial to identify critical time points in disease progression, and if there are particular lesions associated with specific aspects of neurologic dysfunction. Historical records of 53 canine fucosidosis cases from 1979-2009 containing a neurologic dysfunction score assessing motor, behavioral and sensory dysfunction were interrogated by statistical analysis. Motor and behavioral dysfunction scores assessing gait deficits and apprehensive behavior first significantly increased at 12-17 months, and increased at each six monthly interval thereafter. Sensory dysfunction scores, assessing hearing loss, balance and vision deterioration did not significantly increase until 18-23 months, and coincided with a rapid decline in neurologic function. Regression analysis incorporating published neuropathology data measured by image analysis, identified neuroinflammation and apoptotic cell death as significant informative predictors of increasing neurologic dysfunction. These findings indicate that the level of neuropathology required to induce consistent and conspicuous clinical signs in canine fucosidosis is reached by approximately 12 months of age in the absence of other disease processes. Significant association between neuroinflammation and apoptotic cell death also suggest that specifically targeting these lesions combined with enzyme replacement in future studies may reduce disease burden in fucosidosis. Overall, examining this historical clinical data to identify associations between the extent of neuropathology and degree of clinical dysfunction provides a useful reference tool for monitoring disease and evaluating therapeutic trials conducted in canine fucosidosis.

PMID: 26711085 [PubMed - as supplied by publisher]

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Submucosal carcinoma of the gastroesophageal junction diagnosed after peroral endoscopic myotomy.

Submucosal carcinoma of the gastroesophageal junction diagnosed after peroral endoscopic myotomy.

Endoscopy. 2015 0;47(S 01):E623-E624

Authors: Chan DY, Dolgunov D, Lee VK, Chiu PW, So JB

PMID: 26714153 [PubMed - as supplied by publisher]

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Acute gastric mucosal ischemic ulcer: a rare adverse result of peroral endoscopic myotomy.

Acute gastric mucosal ischemic ulcer: a rare adverse result of peroral endoscopic myotomy.

Endoscopy. 2015 0;47(S 01):E614-E615

Authors: Yang CW, Wang BY, Chou KC, Yen HH, Chen YY

PMID: 26714148 [PubMed - as supplied by publisher]

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[Destructive lesion of the middle ear].

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[Destructive lesion of the middle ear].

HNO. 2015 Apr;63(4):312-4

Authors: Jäger A, Herbeck R, Wagenblast J, Stöver T, Diensthuber M

PMID: 25527382 [PubMed - indexed for MEDLINE]

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[A rare case of lateral cervical mass in children].

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[A rare case of lateral cervical mass in children].

Arch Pediatr. 2015 Mar;22(3):309-10, 320-2

Authors: Eliezer M, Marie JP, Dacher JN, Vivier PH

PMID: 25636212 [PubMed - indexed for MEDLINE]

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How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies.

How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies.

Eur Arch Otorhinolaryngol. 2015 Dec 26;

Authors: Vlastarakos PV, Iacovou E, Fetta M, Tapis M, Nikolopoulos TP

Abstract
The present study aimed to assess the clinical effectiveness of absorbable packing alone, non-absorbable packing alone, and absorbable versus non-absorbable packing in the postoperative care of FESS patients, regarding bleeding control, adhesion formation, wound healing, and overall patient comfort. Systematic literature review in Medline and other database sources until July 2013, and critical analysis of pooled data were conducted. Blinded prospective randomized control trials, prospective, and retrospective comparative studies were included in study selection. The total number of analyzed studies was 19. Placing packs in the middle meatus after endoscopic procedures does not seem to be harmful for postoperative patient care. Regarding the postoperative bleeding rate, absorbable packing is not superior to no postoperative packing (strength of recommendation A). Comparing absorbable to non-absorbable packing, the former one seems slightly more effective than the latter in the aforementioned domain (strength of recommendation C). Absorbable packing was also found more effective than non-absorbable packing as a means of reducing the postoperative adhesion rate (strength of recommendation B), and more effective in comparison with not placing any packing material at all (strength of recommendation C). Non-absorbable packing also proves more effective than no postoperative packing in preventing the appearance of such adhesions (strength of recommendation A). Absorbable packing is also more comfortable compared to non-absorbable materials (strength of recommendation A), or no postoperative packing in FESS patients (strength of recommendation B). The comparative analysis between the different packing modalities performed in the present study may help surgeons design a more individualized postoperative patient care.

PMID: 26708011 [PubMed - as supplied by publisher]

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Traditional Chinese medicine targeting apoptotic mechanisms for esophageal cancer therapy.

Traditional Chinese medicine targeting apoptotic mechanisms for esophageal cancer therapy.

Acta Pharmacol Sin. 2015 Dec 28;

Authors: Zhang YS, Shen Q, Li J

Abstract
Esophageal cancer is one of the most common types of cancer in the world, and it demonstrates a distinct geographical distribution pattern in China. In the last decade, inducing apoptosis with traditional Chinese medicine (TCM) has become an active area in both fundamental and clinical research on cancer therapy. In this review, we summarize the molecular mechanisms by which TCM induces apoptosis in esophageal cancer cells. These mechanisms are generally related but not limited to targeting the extrinsic death receptor pathway, the intrinsic mitochondrial pathway, and the endoplasmic reticulum (ER) stress pathway. By using different monomers and composite prescriptions of TCM, it is possible to modulate the ratio of Bcl-2/Bax, regulate the expression of caspase proteases and mitochondrial transmembrane potential, increase the expression of Fas and p53, down-regulate NF-κB pathway and the expression of CHOP and survivin, and block cell cycle progression.

PMID: 26707140 [PubMed - as supplied by publisher]

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Deafferentation-based pathophysiological differences in phantom sound: Tinnitus with and without hearing loss.

Deafferentation-based pathophysiological differences in phantom sound: Tinnitus with and without hearing loss.

Neuroimage. 2015 Dec 18;

Authors: Vanneste S, De Ridder D

Abstract
Tinnitus has been considered an auditory phantom percept. Recently a theoretical multiphase compensation mechanism at a cortical level has been hypothesized linking auditory deafferentation to tinnitus. This Bayesian brain model predicts that two very different kinds of tinnitus should exist, depending on the amount of hearing loss: an auditory cortex related form of tinnitus not associated with hearing loss, and a (para)hippocampal form associated with hearing loss, in which the auditory cortex might be of little relevance. In order to verify this model, resting state source analyzed EEG recordings were made in 129 tinnitus patients, and correlated to the mean hearing loss, the range of the hearing loss and the hearing loss at the tinnitus frequency. Results demonstrate that tinnitus can be linked to 2 very different mechanisms. In patients with little or no hearing loss, the tinnitus seems to be more related to auditory cortex activity, but not to (para)hippocampal memory related activity, whereas in tinnitus patients with more severe hearing loss, tinnitus seems to be related to (para)hippocampal mechanisms. Furthermore hearing loss seems to drive the communication between the auditory cortex and the parahippocampus, as measured by functional and effective connectivity.

PMID: 26708013 [PubMed - as supplied by publisher]

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Vestibular evoked myogenic potential testing for the diagnosis of conductive hearing loss: survey of pediatric otolaryngologists' knowledge and beliefs.

Related Articles

Vestibular evoked myogenic potential testing for the diagnosis of conductive hearing loss: survey of pediatric otolaryngologists' knowledge and beliefs.

Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1937-9

Authors: Dargie JM, Zhou G, Dornan BK, Whittemore KR

Abstract
OBJECTIVES: To assess physicians' knowledge and beliefs regarding vestibular evoked myogenic potential (VEMP) testing in children.
METHODS: A survey was delivered via email in html format to 1069 members of the American Academy of Otolaryngology--Head and Neck Surgery who identified as pediatric otolaryngologists. Study data were collected and managed using the Research Electronic Data Capture (REDCap) tools.
RESULTS: 443 (41.4%) physicians opened the email. 190 (42.9% of opens) initiated the survey, of which 117 (61.9%) fully completed the survey of the physicians who responded to a question regarding knowledge of VEMP, 16% of respondents had never heard of the test. 16% of participants would use it in the setting of diagnosing pediatric conductive hearing loss. Responses regarding the youngest age at which VEMP is possible ranged from younger than 6 months through greater than 13 years of age. Beliefs regarding utility and reliability of VEMP varied, with 'unsure' as the most frequent response. Additionally, only 26% of pediatric otolaryngologists indicated some access to the test.
CONCLUSION: The knowledge and availability of VEMP testing in the pediatric otolaryngology community varies widely.

PMID: 25245257 [PubMed - indexed for MEDLINE]

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Peripheral facial palsy, the only presentation of a primitive neuroectodermal tumor of the skull base.

Peripheral facial palsy, the only presentation of a primitive neuroectodermal tumor of the skull base.

Int J Surg Case Rep. 2015 Dec 17;19:47-50

Authors: Kim HJ, Kang B, Joo EY, Kim EY, Kwon YS

Abstract
INTRODUCTION: Peripheral facial palsy is rarely caused by primary neoplasms, which are mostly constituted of tumors of the central nervous system, head and neck, and leukemia.
PRESENTATION OF CASE: A 2-month-old male infant presented with asymmetric facial expression for 3 weeks. Physical examination revealed suspicious findings of right peripheral facial palsy. Computed tomography of the temporal bone revealed a suspicious bone tumor centered in the right petrous bone involving surrounding bones with extension into the middle ear cavity and inner ear. Subtotal resection of the tumor was performed due to crucial structures adjacent the mass. Histopathology and immunohistochemistry of the resected tumor was consistent with primitive neuroectodermal tumor.
CONCLUSION: We report a rare case of a primitive neuroectodermal tumor located at the skull base presenting with only peripheral facial palsy.

PMID: 26710328 [PubMed - as supplied by publisher]

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Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery.

Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery.

Plast Reconstr Surg. 2016 Jan;137(1):267-278

Authors: Rozen SM, Harrison BL, Isaacson B, Kutz JW, Roland PS, Blau PA, Barnett SL, Mickey BE

Abstract
BACKGROUND: Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, final facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes.
METHODS: Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results.
RESULTS: Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and five men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Disability Index was 67.5 percent. Although not statistically significant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symmetry. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes.
CONCLUSIONS: Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; however, overall voluntary facial motion is poor.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PMID: 26710031 [PubMed - as supplied by publisher]

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Congenital abnormalities of the posterior fossa.

Related Articles

Congenital abnormalities of the posterior fossa.

Radiographics. 2015 Jan-Feb;35(1):200-20

Authors: Bosemani T, Orman G, Boltshauser E, Tekes A, Huisman TA, Poretti A

Abstract
The frequency and importance of the evaluation of the posterior fossa have increased significantly over the past 20 years owing to advances in neuroimaging. Nowadays, conventional and advanced neuroimaging techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa. A wide spectrum of congenital abnormalities has been demonstrated, including malformations (anomalies due to an alteration of the primary developmental program caused by a genetic defect) and disruptions (anomalies due to the breakdown of a structure that had a normal developmental potential). Familiarity with the spectrum of congenital posterior fossa anomalies and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counseling. The authors discuss the spectrum of posterior fossa malformations and disruptions, with emphasis on neuroimaging findings (including diagnostic criteria), neurologic presentation, systemic involvement, prognosis, and risk of recurrence.

PMID: 25590398 [PubMed - indexed for MEDLINE]

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