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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].
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]
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]
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]
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.
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]
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]
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.
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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Animal models of chronic tympanic membrane perforation: a 'time-out' to review evidence and standardize design.
Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2048-55
Authors: Wang AY, Shen Y, Wang JT, Friedland PL, Atlas MD, Dilley RJ
Abstract
OBJECTIVE: To review the literature on techniques for creation of chronic tympanic membrane perforations (TMP) in animal models. Establishing such models in a laboratory setting will have value if they replicate many of the properties of the human clinical condition and can thus be used for investigation of novel grafting materials or other interventions.
METHODS: A literature search of the PubMed database (1950-August 2014) was performed. The search included all English-language literature published attempts on chronic or delayed TMP in animal models. Studies of non English-language or acute TMP were excluded.
RESULTS: Thirty-seven studies were identified. Various methods to create TMP in animals have been used including infolding technique, thermal injury, re-myringotomy, and topical agents including chemicals and growth factor receptor inhibitors. The most common type of animal utilized was chinchilla, followed by rat and guinea pig. Twenty three of the 37 studies reported success in achieving chronic TMP animal model while 14 studies solely delayed the healing of TMP. Numerous experimental limitations were identified including TMP patency duration of <8 weeks, lack of documentation of total number of animals attempted and absence of proof for chronicity with otoscopic and histologic evidence.
CONCLUSION: The existing literature demonstrates the need for an ideal chronic TMP animal model to allow the development of new treatments and evaluate the risk of their clinical application. Various identified techniques seem promising, however, a need was identified for standardization of experimental design and evidence to address multiple limitations.
PMID: 25455522 [PubMed - indexed for MEDLINE]
Trans-oesophageal ultrasound and computer tomographic assessment of the Equine Cricoarytenoid Dorsalis Muscle: Relationship between muscle geometry and exercising laryngeal function.
Equine Vet J. 2015 Dec 28;
Authors: Kenny M, Cercone M, Rawlinson JJ, Ducharme NG, Bookbinder L, Thompson M, Cheetham J
Abstract
REASONS FOR PERFORMING STUDY: Early detection of recurrent laryngeal neuropathy is of considerable interest to the equine industry.
OBJECTIVES: To describe two imaging modalities, transoesophageal ultrasound (TEU) and computed tomography (CT) with multiplanar reconstruction to assess laryngeal muscle geometry, and determine the relationship between Cricoarytenoid Dorsalis (CAD) geometry and function.
STUDY DESIGN: Two phase study evaluating CAD geometry in experimental horses and horses with naturally occurring Recurrent Laryngeal Neuropathy (RLN).
METHODS: Equine CAD muscle volume was determined from computed tomography (CT) scan sets using volumetric reconstruction with Livewire(™) . The midbody and caudal dorsal-ventral thickness of the CAD muscle was determined using a transoesophageal ultrasound in the same horses; and in horses with a range of severity of RLN (n = 112).
RESULTS: TEU was able to readily image the CAD muscles and lower left:right CAD thickness ratios were observed with increasing disease severity. CT based muscle volume correlated very closely with ex vivo muscle volume (R(2) = 0.77).
CONCLUSION: CT reconstruction can accurately determine intrinsic laryngeal muscle geometry. A relationship between TEU measurements of CAD geometry and laryngeal function was established. These imaging techniques could be used to track the response of the CAD muscle to restorative surgical treatments such as nerve muscle pedicle graft, nerve anastomosis and functional electrical stimulation. This article is protected by copyright. All rights reserved.
PMID: 26709115 [PubMed - as supplied by publisher]
Angioedema Triggered by Medication Blocking the Renin/Angiotensin System: Retrospective Study Using the French National Pharmacovigilance Database.
J Clin Immunol. 2015 Dec 28;
Authors: Faisant C, Armengol G, Bouillet L, Boccon-Gibod I, Villier C, Lévesque H, Cottin J, Massy N, Benhamou Y
Abstract
INTRODUCTION: Bradykinin-mediated angioedema (AE) is a rare side effect of some medications, including angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). In France, side-effects to treatments are reported to the national pharmacovigilance database.
METHODS: The national MedDRA database was searched using the term "angioedema". Patients were included if they met the clinical criteria corresponding to bradykinin-mediated AE, if their C1-inhibitor levels were normal, and if they were treated with an ACEi or an ARB.
RESULTS: 7998 cases of AE were reported between 1994 and 2013. Among these, 112 met the criteria for bradykinin-mediated AE with normal C1-inhibitor levels. On the 112 drug-AE, patients were treated with an ARB in 21 % of cases (24 patients), or an ACEi in 77 % of cases (88 patients), in combination with another treatment in 17 cases (mTORi for 3 patients, iDPP-4 for 1 patient, hormonal treatment for 7 patients). ENT involvement was reported in 90 % of cases (tongue: 48.2 %, larynx: 23.2 %). The median duration of treatment before the first attack was 720 days, and the mean duration of attacks was 36.6 h. Forty-one percent (19/46) of patients relapsed after discontinuing treatment.
CONCLUSION: Angioedema triggered by medication blocking the renin/angiotensin system is rare but potentially severe, with a high risk of recurrence despite cessation of the causative drug.
PMID: 26707788 [PubMed - as supplied by publisher]
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Comparison of three methods for the confirmation of laryngeal mask airway placement in female patients undergoing gynecologic surgery.
Ultrasound Med Biol. 2015 May;41(5):1212-20
Authors: Zhou ZF, Xia CZ, Wu M, Yu LN, Yan GZ, Ren QS, Hu CX, Yan M
Abstract
The laryngeal mask airway (LMA) is a supraglottic device that is commonly used to provide lung ventilation during general anesthesia. LMA placement needs to be confirmed to provide adequate lung ventilation. To investigate the feasibility of using ultrasound examination, compared with clinical tests and fiberoptic laryngoscopy, to confirm LMA placement, we performed a clinical study of 64 female patients classified as American Society of Anesthesiologists Physical Status I or II who were scheduled for gynecologic surgery with LMA insertion for airway management. After insertion, placement of the LMA was confirmed by clinical tests, ultrasound examination and fiberoptic laryngoscopy. Of the 64 women, placement was confirmed as acceptable in 89.1% by clinical tests, in 59.4% by fiberoptic laryngoscope assessment and in 67.2% by ultrasound examination. With respect to patients with oropharyngeal leaks classified as high, there were no differences in confirmation of acceptable placement between clinical tests and ultrasound examinations (p = 0.092), but the number of patients determined to have acceptable placement by ultrasound examination was greater than that determined by fiberoptic laryngoscopy (p = 0.034). Thus, ultrasound examination is a superior technique for confirming the seal on the LMA.
PMID: 25748523 [PubMed - indexed for MEDLINE]
Does the continuation of warfarin change management outcomes in epistaxis patients?
J Laryngol Otol. 2015 Dec 28;:1-5
Authors: Bola S, Marsh R, Braggins S, Potter C, Hickey S
Abstract
OBJECTIVE: This study aimed to compare management, readmission rates and length of in-patient stay amongst warfarinised and non-warfarinised patients to ascertain future treatment protocols.
METHODS: A 12-month retrospective review was conducted of ENT epistaxis admissions. Admission details such as length of in-patient stay, clotting profile and management plan were recorded. Comparisons of management and outcome for warfarinised and non-warfarinised patients were made using the Fisher's exact paired t-test.
RESULTS: Of 176 epistaxis patients admitted, 31 per cent were warfarinised, 18 per cent were on another form of anticoagulation or antiplatelet therapy, and 51 per cent were not on any medication that might impose a bleeding risk. The international normalised ratio at admission was high in 13 per cent of warfarinised patients; the remaining patients had therapeutic or sub-therapeutic international normalised ratios and so warfarin was continued. The mean in-patient stay was similar for all cohorts; however, warfarinised patients had a higher readmission rate.
CONCLUSION: Warfarinised epistaxis patients may be safely managed without stopping their anticoagulation therapy, provided their international normalised ratio is at therapeutic or sub-therapeutic levels. By continuing regular anticoagulation therapy, warfarinised patients may be discharged without delay.
PMID: 26707504 [PubMed - as supplied by publisher]
Single cannula versus double cannula tracheostomy tubes in major oral and oropharyngeal resections.
J Laryngol Otol. 2015 Dec 28;:1-5
Authors: Dhiwakar M, Nambi GI, Ramanikanth TV, Kale SM, Sivakumar MN
Abstract
OBJECTIVE: To compare the outcomes of two types of tracheostomy tubes used in major head and neck surgery.
METHODS: A retrospective study was conducted of prospectively collected data. The post-operative safety and adequacy of a single cannula tracheostomy tube was compared to a double cannula tracheostomy tube in patients undergoing tracheostomy during major oral and oropharyngeal resections.
RESULTS: Out of 46 patients with the single cannula tube, 7 (15 per cent) experienced significant obstruction warranting immediate tube removal, while another 9 (20 per cent) needed a change of tube or tube re-insertion for continued airway protection. In contrast, out of 50 patients with the double cannula tube, the corresponding numbers were 0 (p = 0.004) and 1 (2 per cent; p = 0.007) respectively.
CONCLUSION: Insertion of a double cannula (instead of a single cannula) tracheostomy tube in the course of major oral and oropharyngeal resections offers better airway protection during the post-operative period.
PMID: 26707289 [PubMed - as supplied by publisher]
Optimizing Successful Outcomes in Complex Spine Reconstruction Using Local Muscle Flaps.
Plast Reconstr Surg. 2016 Jan;137(1):295-301
Authors: Cohen LE, Fullerton N, Mundy LR, Weinstein AL, Fu KM, Ketner JJ, Härtl R, Spector JA
Abstract
BACKGROUND: Postoperative wound complications in patients undergoing complex spinal surgery can have devastating sequelae, including hardware exposure, meningitis, and unplanned reoperation. The literature shows that wound complication rates in this patient population approach 19 percent and, in very high-risk patients (i.e., prior spinal surgery, existing spinal wound infection, cerebrospinal fluid leak, malignancy, or history of radiation therapy), as high as 40 percent and with reoperation rates as high as 12 percent. The authors investigated whether prophylactic closure of spinal wounds with muscle flaps improves outcomes.
METHODS: A retrospective review was performed of 102 reconstructions (in 96 patients) in which spinal wound closure was performed by means of paraspinous, trapezius, or latissimus muscle advancement flaps by a single plastic surgeon (J.A.S.) from 2006 to 2014. Data regarding presurgical diagnosis, patient demographics, and incidence of postoperative complications were recorded.
RESULTS: One hundred two reconstructions were included, with follow-up ranging from 2 to 60 months. Eighty-eight reconstructions were classified as very high-risk for wound complications, defined as those having prior spinal surgery, existing spinal wound infection, cerebrospinal fluid leak, malignancy, or prior radiation therapy. Within the very high-risk group, there were six wound complications (6.8 percent), three of which (3.4 percent) required reoperation.
CONCLUSIONS: In this study, there is a markedly lower rate (6.8 percent) of postoperative wound complications compared with historical controls after closure of spinal wounds with local muscle flaps in very high-risk patients. These data encourage safe and routine use of muscle flaps for closure in this cohort of patients undergoing spinal surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
PMID: 26710033 [PubMed - as supplied by publisher]
Fiberoptic Endoscopic Evaluation of Swallowing: A Multidisciplinary Alternative for Assessment of Infants With Dysphagia in the Neonatal Intensive Care Unit.
Adv Neonatal Care. 2015 Dec 24;
Authors: Reynolds J, Carroll S, Sturdivant C
Abstract
BACKGROUND: The standard procedure to assess an infant in the neonatal intensive care unit (NICU) who is suspected of aspirating on oral feedings is a videofluoroscopic swallowing study (VFSS). The VFSS has been used for more than 30 years to assess dysphagia and is considered the gold standard. However, there are challenges to the VFSS, including radiation exposure, transport to radiology, usage of barium, limited positioning options, and cost. An alternative approach is fiberoptic endoscopic evaluation of swallowing (FEES), which uses a flexible endoscope passed transnasally into the pharynx to assess anatomy, movement/sensation of structures, swallow function, and response to therapeutic interventions. Fiberoptic endoscopic evaluation of swallowing has been established as a valid tool for evaluating dysphagia and utilized as an alternative or supplement to the VFSS in both adults and children.
PURPOSE: This article provides an overview of the current challenges in the NICU with assessing aspiration and introduces a multidisciplinary FEES program for bottle and breastfeeding.
METHODS/SEARCH STRATEGY: A review of the literature of dysphagia, VFSS, and FEES in the adult, pediatric, infant, and neonatal populations was performed. Clinical competency standards were researched and then implemented through an internal process of validation. Finally, a best practice protocol was designed as it relates to FEES in the NICU.
FINDINGS/RESULTS: Fiberoptic endoscopic evaluation of swallowing is a safe alternative to the VFSS. It can be utilized at the infant's bedside in a NICU for the diagnosis and treatment of swallowing disorders by allowing the clinician the ability to replicate a more accurate feeding experience, therefore, determining a safe feeding plan.
IMPLICATIONS FOR PRACTICE: Competency and training are essential to establishing a multidisciplinary FEES program in the NICU.
IMPLICATIONS FOR RESEARCH: Further research is needed to compare the efficacy and validity of FEES versus VFSS for infants in the NICU. Furthermore, evaluating the efficacy of FEES during breastfeeding is warranted.
PMID: 26709466 [PubMed - as supplied by publisher]
Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children with Cerebral Palsy.
Arch Phys Med Rehabil. 2015 Dec 18;
Authors: Benfer KA, Weir KA, Bell KL, Ware RS, Davies PS, Boyd RN
Abstract
OBJECTIVE: To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and relationship to health outcomes.
DESIGN: Longitudinal cohort study.
SETTING: Community and tertiary institutions.
PARTICIPANTS: 53 children with confirmed CP diagnosis assessed first at 18-24 months (Ax1 mean age 22.9 months c.a. (SD=2.9), 33 males, Gross Motor Function Classification System (GMFCS) I=22, II=7, III=11, IV=5, V=8) and at 36 months (Ax2).
INTERVENTIONS: none MAIN OUTCOME MEASURES: OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z-scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/ distribution.
RESULTS: Prevalence of OPD reduced from 62% to 59% between ages. 30% of children had an improvement in severity of OPD (>smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Ax1 OR=20.3, p=0.011; Ax2 OR=28.9, p=0.002), pharyngeal signs (Ax 1 OR=10.6, p=0.007; Ax2 OR=15.8, p=0.003), and OPD severity (Ax1 β=6.1, p<0.001; Ax2 β=5.5 p<0.001). OPD at 18-24 months was related to health outcomes at 36 months: low Z-scores for weight (adj β=1.2, p=0.03) and BMI (adj β=1.1, p=0.048), increased parent stress (adj OR=1.1, p=0.049).
CONCLUSIONS: Classification and severity of OPD remained relatively stable between 18-24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes which consider critical developmental transitions which are anticipated to present challenges for children from each of the GMFCS levels.
PMID: 26707458 [PubMed - as supplied by publisher]
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Anesthetic considerations and airway management in a professional singer: case report and brief review.
Can J Anaesth. 2015 Mar;62(3):323-4
Authors: Tiwari AK, Wong DT, Venkatraghaven L
PMID: 25351978 [PubMed - indexed for MEDLINE]
