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.

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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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