OtoRhinoLaryngology News: Μαρτίου 2016

Τετάρτη 30 Μαρτίου 2016

Long-term observation of lateral medullary infarction due to vertebral artery dissection assessed with multimodal neuroimaging.

Long-term observation of lateral medullary infarction due to vertebral artery dissection assessed with multimodal neuroimaging.

J Nippon Med Sch. 2015;82(1):68-72

Authors: Nomura K, Mishina M, Okubo S, Suda S, Katsura K, Katayama Y

Abstract
A 33-year-old man presented with a lateral medullary infarction, vertigo, and nausea. At the time of hospital admission, he had Wallenberg syndrome. Although initial magnetic resonance imaging showed no abnormalities, subsequent diffusion-weighted magnetic resonance imaging showed a high-intensity area in the right lateral medulla oblongata. The right vertebral artery was shown to be dilated on basi-parallel anatomical scanning but to be stenosed on magnetic resonance angiography (MRA). Cerebral angiography 7 days after onset showed the "pearl and string sign" in the right vertebral artery. Follow-up MRA showed gradual improvement of the stenosis in the right vertebral artery. Multiple neuroimaging studies, such as MRA, basi-parallel anatomical scanning, 3-dimensional computed tomographic angiography, and cerebral angiography, should be performed soon after onset in suspected cases of cerebral artery dissection. In addition, serial imaging examinations increase diagnostic accuracy, and the medical history and neurological examination are important.

PMID: 25797880 [PubMed - indexed for MEDLINE]

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A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy.

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy.

Sensors (Basel). 2016;16(4)

Authors: Martín-Ruiz ML, Máximo-Bocanegra N, Luna-Oliva L

Abstract
The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children's oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.

PMID: 27023561 [PubMed - as supplied by publisher]

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[Satisfaction of patients with tracheostomal epithesis].

[Satisfaction of patients with tracheostomal epithesis].

HNO. 2016 Mar 29;

Authors: Bozzato V, Bumm K, Gärtner H, Schneider MH, Schwerdtfeger P, Sittel C, Schick B

Abstract
BACKGROUND: The utilization of craniofacial prosthesis has proven to be very successful for craniofacial defects. However, there is a lack of knowledge about the value of an epithesis for voice rehabilitation in patients with tracheostomy. The aim of this study was to describe application of the tracheostomy epithesis and to present a systematic analysis of the functional results of this prosthetic technique.
MATERIALS AND METHODS: This retrospective analysis included 48 patients on follow-up being treated in three different centers after laryngectomy and/or tracheostomy between 2008 and 2014. Subjects were given a questionnaire with items such as speech quality, quality of life, free hand speech ability, respiratory quality and sufficient tracheostomal sealing comparing values before and after application of an individually custom-made tracheostomy epithesis. Twenty-eight answered the questionnaire and could be reported.
RESULTS: Twenty-eight of 48 patients were consistently being included in follow-up. The statistical analysis revealed a significant improvement of tracheostoma occlusion (p < 0.05) and improvement in free hand speech ability (p < 0.05). A leakage of air during voice production could be prevented in 59.3 % after application of an epithesis. Quality of life correlated directly with successful utilization of an epithesis.
CONCLUSION: In the literature, different industrialized products are described to realize occlusion of the tracheostoma for sufficient speech production without using the hands. In numerous cases commercial solutions fail and the patients need individual modifications. Our study first describes the evaluation of custom-made tracheostomal epithesis. From our observed results we advocate the individual tracheostomal epithesis as a durable solution for voice rehabilitation.

PMID: 27023379 [PubMed - as supplied by publisher]

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Τρίτη 29 Μαρτίου 2016

Relationship between pharyngitis and peri-odontoid pannus: A new etiology for some Chiari I malformations?

Relationship between pharyngitis and peri-odontoid pannus: A new etiology for some Chiari I malformations?

Clin Anat. 2015 Jul;28(5):602-7

Authors: Tubbs RS, Griessenauer CJ, Hendrix P, Oakes P, Loukas M, Chern JJ, Rozzelle CJ, Oakes WJ

Abstract
The pathophysiology underlying Chiari I malformations (CIMs) provides room for debate with several theories attempting to address this issue. We retrospectively reviewed many of our past patients with pediatric CIMs (specifically, those with peri-odontoid pannus), and present a hypothesis for the development of the malformation in some of said patients. Our experience with the pediatric CIM has shown that almost 1 in 20 patients who present with symptoms is found to have a peri-odontoid pannus. These masses ranged in size from 4 to 11 mm in diameter. Forty percent had a history of clinically significant pharyngitis or pharyngeal abscess. Pannus formation around the dens (odontoid) resulted in ventral compression of the craniocervical junction in each of these patients. Highlighting the hypermobility that causes such lesions, following fusion, the pannus and symptoms in several patients were diminished. Impairment of normal cerebrospinal fluid circulation out of the fourth ventricle and across the craniocervical junction appears to be a plausible endpoint in this discussion and a suitable explanation for some patients with CIM. Still, the mechanisms by which cerebrospinal fluid circulation is compromised may be variable and are not well understood. This is the first study dedicated to the evaluation of pannus formation in the CIM population. We hypothesize that pharyngeal inflammatory conditions contribute to the formation and progression of hindbrain herniation in a small subset of patients with CIMs.

PMID: 25974330 [PubMed - indexed for MEDLINE]

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THE ROLE OF TILT-TABLE TEST IN DIFFERENTIAL DIAGNOSIS OF UNEXPLAINED SYNCOPE.

THE ROLE OF TILT-TABLE TEST IN DIFFERENTIAL DIAGNOSIS OF UNEXPLAINED SYNCOPE.

Acta Clin Croat. 2015 Dec;54(4):417-23

Authors: Jelavić MM, Babić Z, Hećimović H, Erceg V, Pintarić H

Abstract
The aim of this retrospective study (February 2012-September 2014) was to assess the role of head-up tilt-table test in patients with unexplained syncope. It was performed on 235 patients at Clinical Department of Cardiology, Sestre milosrdnice University Hospital Center. Patients were classified according to test indications: group A (convulsive syncope, n = 30), group B (suspected vasovagal syncope, n = 180), and group C (paroxysmal vertigo, n = 25). The groups were analyzed and compared according to demographic data (age and gender), referral specialist (cardiologist, neurologist, and others), and test results (positive/negative) with specific response (cardioinhibitory, vasodepressor, or mixed). Groups A and B were referred most frequently by neurologists and cardiologists (p < 0.05). The test was positive in 34 (14.5%) of all evaluated patients (5 in group A and 29 in group B), of which 13 (38.2%) had cardioinhibitory, 11 (32.4%) mixed and 10 (29.4%) vasodepressor response. In the cardioinhibitory subgroup, three patients (23.1%, 2 males/1 female, mean age 28.5 years) with normal electroencephalography were on antiepileptics. During head-up tilt-table testing, they had bradycardia (heart rate 30.0 ± 5.0 beats/min) and prolonged asystole (13.7 ± 11.0 seconds) with development of typical convulsions. These three subjects got a permanent pacemaker (atrial/ventricular stimulation, heart rate control) and anticonvulsive therapy was slowly withdrawn with no syncope recurrence during 24-month follow up. In conclusion, head-up tilt-table test has an important role in the evaluation of patients with unexplained syncope and in differential diagnosis of vasovagal syncope. The indication for pacemaker implantation, strictly following the European Society of Cardiology guidelines, proved to be effective in preventing syncope relapses in patients with cardioinhibitory convulsive syncope.

PMID: 27017714 [PubMed - in process]

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[Abdominal pain, vomiting, vertigo...this is unlike a migraine...although!].

http:--linkinghub.elsevier.com-ihub-imag

[Abdominal pain, vomiting, vertigo...this is unlike a migraine...although!].

Arch Pediatr. 2015 May;22(5 Suppl 1):19-20

Authors: Andreu-Gallien J, Tourniaire B

PMID: 26112502 [PubMed - indexed for MEDLINE]

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[Management of benign paroxysmal positional vertigo in first care centers].

[Management of benign paroxysmal positional vertigo in first care centers].

Semergen. 2014 Jul-Aug;40(5):254-60

Authors: Carnevale C, Muñoz-Proto F, Rama-López J, Ferrán-de la Cierva L, Rodríguez-Villalba R, Sarría-Echegaray P, Mas-Mercant S, Tomás-Barberán M

Abstract
The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers.

PMID: 24717672 [PubMed - indexed for MEDLINE]

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Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications.

Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications.

J Neurosurg Pediatr. 2015 Dec;16(6):752-7

Authors: Reisner A, Hayes LL, Holland CM, Wrubel DM, Kebriaei MA, Geller RJ, Baum GR, Chern JJ

Abstract
In environments in which opioids are increasingly abused for recreation, children are becoming more at risk for both accidental and nonaccidental intoxication. In toxic doses, opioids can cause potentially lethal acute leukoencephalopathy, which has a predilection for the cerebellum in young children. The authors present the case of a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status requiring cardiorespiratory support. She required emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle. To the authors' knowledge, this is the first report of surgical decompression used to treat cerebellar edema associated with opioid overdose in a child.

PMID: 26339960 [PubMed - indexed for MEDLINE]

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Content analysis of the professional journal of the College of Speech Therapists II: coming of age and growing maturity, 1946-65.

Content analysis of the professional journal of the College of Speech Therapists II: coming of age and growing maturity, 1946-65.

Int J Lang Commun Disord. 2016 Mar 27;

Authors: Stansfield J, Armstrong L

Abstract
BACKGROUND: Following a content analysis of the first 10 years of the UK professional journal Speech, this study was conducted to survey the published work of the speech (and language) therapy profession in the 20 years following the unification of two separate professional bodies into the College of Speech Therapists.
AIM: To understand better the development of the speech (and language) therapy profession in the UK in order to support the development of an online history of the speech and language therapy profession in the UK.
METHODS & PROCEDURES: The 40 issues of the professional journal of the College of Speech Therapists published between 1946 and 1965 (Speech and later Speech Pathology and Therapy) were examined using content analysis and the content compared with that of the same journal as it appeared from 1935 to the end of the Second World War (1945).
OUTCOMES & RESULTS: Many aspects of the journal and its authored papers were retained from the earlier years, for example, the range of authors' professions, their location mainly in the UK, their number of contributions and the length of papers. Changes and developments included the balance of original to republished papers, the description and discussion of new professional issues, and an extended range of client groups/disorders.
CONCLUSIONS & IMPLICATIONS: The journal and its articles reflect the growing maturity of the newly unified profession of speech therapy and give an indication both of the expanding depth of knowledge available to speech therapists and of the rapidly increasing breadth of their work over this period.

PMID: 27018211 [PubMed - as supplied by publisher]

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DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

Acta Clin Croat. 2015 Dec;54(4):541-6

Authors: Kovacić M, Kovacić I, Dželalija B

Abstract
Descending necrotizing mediastinitis secondary to a nontraumatic retropharyngeal abscess is very rare. This form of mediastinitis in the era of potent antibiotics often ends up with lethal outcome. It usually occurs in immunocompromised patients and requires intensive multidisciplinary treatment approach. We report a case of nontraumatic retropharyngeal abscess complicated by descending necrotizing mediastinitis in a 70-year-old man with insulin dependent diabetes mellitus. The patient was admitted to our hospital after clinical and radiological diagnosis of retropharyngeal abscess. During treatment for retropharyngeal abscess with antibiotic therapy and transoral incision, the patient showed mild clinical improvement but his condition suddenly aggravated on day 4 of hospital stay. He had high fever, chest pain with tachypnea, tachycardia, hypotension, and showed signs of occasional disorientation. Emergency computed tomography (CT) scan of the neck and thorax showed inflammation in the retropharyngeal space, as well as thickening of the upper posterior mediastinum fascia with the presence of air. Emergency surgery including cervicotomy and drainage of the retropharyngeal space and posterior mediastinum was performed. The patient promptly recovered with improvement of the clinical status and laboratory findings. After 16 days of treatment he was discharged from the hospital in good condition. Descending necrotizing mediastinitis can be a serious and life threatening complication of deep neck infection if the diagnosis is not quickly established. Besides inevitable application of antimicrobial drugs, good drainage of the mediastinum is necessary. We believe that transcervical approach can achieve high-quality drainage of the upper mediastinum, especially if it is done timely as in this case. Its efficacy can be verified by intensive monitoring of the patient clinical condition, by CT scan of the thorax, and by laboratory tests. In the case of inefficacy of this type of drainage, subsequently some other, more aggressive transthoracic methods of drainage can be done.

PMID: 27017733 [PubMed - in process]

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High-Resolution, Non-Invasive Imaging of Upper Vocal Tract Articulators Compatible with Human Brain Recordings.

High-Resolution, Non-Invasive Imaging of Upper Vocal Tract Articulators Compatible with Human Brain Recordings.

PLoS One. 2016;11(3):e0151327

Authors: Bouchard KE, Conant DF, Anumanchipalli GK, Dichter B, Chaisanguanthum KS, Johnson K, Chang EF

Abstract
A complete neurobiological understanding of speech motor control requires determination of the relationship between simultaneously recorded neural activity and the kinematics of the lips, jaw, tongue, and larynx. Many speech articulators are internal to the vocal tract, and therefore simultaneously tracking the kinematics of all articulators is nontrivial-especially in the context of human electrophysiology recordings. Here, we describe a noninvasive, multi-modal imaging system to monitor vocal tract kinematics, demonstrate this system in six speakers during production of nine American English vowels, and provide new analysis of such data. Classification and regression analysis revealed considerable variability in the articulator-to-acoustic relationship across speakers. Non-negative matrix factorization extracted basis sets capturing vocal tract shapes allowing for higher vowel classification accuracy than traditional methods. Statistical speech synthesis generated speech from vocal tract measurements, and we demonstrate perceptual identification. We demonstrate the capacity to predict lip kinematics from ventral sensorimotor cortical activity. These results demonstrate a multi-modal system to non-invasively monitor articulator kinematics during speech production, describe novel analytic methods for relating kinematic data to speech acoustics, and provide the first decoding of speech kinematics from electrocorticography. These advances will be critical for understanding the cortical basis of speech production and the creation of vocal prosthetics.

PMID: 27019106 [PubMed - as supplied by publisher]

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Feasibility of comfortable and secure intubation achieved with the Disposcope endoscope or Macintosh laryngoscope for patients in whom glottis viewing is difficult.

Feasibility of comfortable and secure intubation achieved with the Disposcope endoscope or Macintosh laryngoscope for patients in whom glottis viewing is difficult.

Genet Mol Res. 2015;14(2):3694-701

Authors: Li XH, Sun Z, He LL

Abstract
We aimed to study the feasibility of a comfortable and secure intubation achieved with the Disposcope endoscope or Macintosh laryngoscope when glottis viewing is difficult. Forty adults scheduled for elective surgery under general anesthesia, in whom glottis viewing was difficult with the Macintosh laryngoscope (classified as Cormack-Lehane Grade III or IV), were randomized into 2 groups (N = 20 each): Disposcope endoscope (Group D) and Macintosh laryngoscope (Group M). We recorded the successful glottis viewing rate; intubation time; successful intubation rate; incidence of systolic blood pressure (SBP) ≥140 mmHg and heart rate (HR) ≥90 bpm from the beginning of intubation to 5 min after intubation; and postoperative sore throat and hoarseness. Successful glottis viewing rate and successful first intubation rate were higher in Group D than in Group M (P < 0.05); the number of intubations taking >3 min and with SBP ≥140 mmHg and HR ≥90 bpm were less in Group D (P < 0.05). The visual analogue scale of postoperative sore throat 1 day after extubation was higher in Group M than in Group D (P < 0.05). No significant differences were found in other indices (P > 0.05). Better stability of hemodynamics, less intubation time, higher successful first intubation rate, and fewer incidences of postoperative sore throat were achieved in Group D than in Group M. Thus, comfortable and secure intubation can be achieved using the Disposcope endoscope in patients in whom glottis viewing is difficult.

PMID: 25966138 [PubMed - indexed for MEDLINE]

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Formant frequencies and bandwidths of the vocal tract transfer function are affected by the mechanical impedance of the vocal tract wall.

http:--production.springer.de-OnlineReso

Formant frequencies and bandwidths of the vocal tract transfer function are affected by the mechanical impedance of the vocal tract wall.

Biomech Model Mechanobiol. 2015 Aug;14(4):719-33

Authors: Fleischer M, Pinkert S, Mattheus W, Mainka A, Mürbe D

Abstract
The acoustical properties of the vocal tract, the air-filled cavity between the vocal folds and the mouth opening, are determined by its individual geometry, the physical properties of the air and of its boundaries. In this article, we address the necessity of complex impedance boundary conditions at the mouth opening and at the border of the acoustical domain inside the human vocal tract. Using finite element models based on MRI data for spoken and sung vowels /a/, /i/ and /Ω(-1)/ and comparison of the transfer characteristics by analysis of acoustical data using an inverse filtering method, the global wall impedance showed a frequency-dependent behaviour and depends on the produced vowel and therefore on the individual vocal tract geometry. The values of the normalised inertial component (represented by the imaginary part of the impedance) ranged from 250 g/m(2) at frequencies higher than about 3 kHz up to about 2.5 × 10(5) g/m(2)in the mid-frequency range around 1.5-3 kHz. In contrast, the normalised dissipation (represented by the real part of the impedance) ranged from 65 to 4.5 × 10(5) Ns/m(3). These results indicate that structures enclosing the vocal tract (e.g. oral and pharyngeal mucosa and muscle tissues), especially their mechanical properties, influence the transfer of the acoustical energy and the position and bandwidth of the formant frequencies. It implies that the timbre characteristics of vowel sounds are likely to be tuned by specific control of relaxation and strain of the surrounding structures of the vocal tract.

PMID: 25416844 [PubMed - indexed for MEDLINE]

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Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases.

Secondary Neck Lift and the Importance of Midline Platysmaplasty: Review of 101 Cases.

Plast Reconstr Surg. 2016 Apr;137(4):667e-675e

Authors: Narasimhan K, Ramanadham S, O'Reilly E, Rohrich RJ

Abstract
BACKGROUND: The authors believe that open access to the submental region, platysmaplasty, and wide skin undermining provide the most long-lasting results in neck rejuvenation, and sought to evaluate this hypothesis by reviewing their neck-lift patients.
METHODS: The authors performed a retrospective chart review of their experience with neck-lift procedures and patients who underwent a secondary procedure. Patient age, sex, initial technique, visible neck deformities, and reasons for revision were assessed. Photographs were used to assess the features of persistent or recurrent neck-lift deformity and techniques to correct them.
RESULTS: Of 1089 neck lifts reviewed, 101 patients underwent secondary or revision procedures (approximately 10 percent of total). The average patient age was 57.4 years, 95 percent were women, and secondary procedures were performed 10.3 years after the first procedure. Seventy percent of the revisions were of the authors' own primary neck lifts, and all of these after 10 years. The most common aesthetic deformities-recurrent platysmal bands (87 percent), persistent/recurrent jowling (48 percent), fat malposition/irregularities (10 percent), and vertical band deformity (8 percent)-were most often corrected with open platysmaplasty and medial or lateral plication and skin redraping. All patients had their submental region opened in the secondary procedure. All secondary operations were performed at least 10 years after primary surgery.
CONCLUSIONS: The authors believe their technique of open submental neck access and platysmal approximation in patients with medial bands provides long-lasting results. The authors use precise preoperative evaluation, recontouring of neck fat irregularities, opening of the submental region with platysmaplasty, drains, and strict hemostasis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PMID: 27018694 [PubMed - as supplied by publisher]

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Retrograde intra-arterial chemotherapy and daily concurrent proton beam therapy for recurrent oral cavity squamous cell carcinoma: Analysis of therapeutic results in 46 cases.

Retrograde intra-arterial chemotherapy and daily concurrent proton beam therapy for recurrent oral cavity squamous cell carcinoma: Analysis of therapeutic results in 46 cases.

Head Neck. 2016 Mar 28;

Authors: Hayashi Y, Nakamura T, Mitsudo K, Yamaguchi H, Ono T, Azami Y, Takayama K, Suzuki M, Hatayama Y, Tsukiyama I, Hareyama M, Kikuchi Y, Fuwa N, Tohnai I

Abstract
BACKGROUND: The purpose of this study was to evaluate the efficacy and toxicities of proton beam therapy combined with intra-arterial infusion chemotherapy via superficial temporal and occipital arteries for recurrent oral cavity squamous cell carcinoma (SCC).
METHODS: Between October 2009 and June 2013, 46 patients with recurrent oral cavity SCC were treated by proton beam therapy combined with intra-arterial infusion chemotherapy of cisplatin (CDDP) and docetaxel. Treatment consisted of proton beam therapy (28.6-74.8 GyE in 13-34 fractions) and intra-arterial infusion chemotherapy (CDDP, 30-50 mg/body/week; docetaxel, 5-25 mg/body/week).
RESULTS: One-year and 2-year overall survival (OS) rates were 65% and 46%, respectively. One-year and 2-year local control rates were 81% and 70%, respectively.
CONCLUSION: These findings suggest that proton beam therapy combined with intra-arterial infusion chemotherapy could be applied effectively and safely for patients with recurrent oral cavity SCC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27018982 [PubMed - as supplied by publisher]

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Δευτέρα 28 Μαρτίου 2016

A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Deng YF, Lei BX, Zheng MG, Zheng YQ, Chen WL, Lan YQ

Abstract
Cranial-nasal-orbital communicating tumors involving the anterior and middle skull base are among the most challenging to treat surgically, with high rates of incomplete resection and surgical complications. Currently, there is no recognized classification of tumors with regard to the choice of surgical approaches. From January 2004 to January 2014, we classified 32 cranial-nasal-orbital communicating tumors treated in our center into three types according to the tumor body location, scope of extension and direction of invasion: lateral (type I), central (type II) and extensive (type III). This classification considerably facilitated the choice of surgical routes and significantly influenced the surgical time and amount of hemorrhage during operation. In addition, we emphasized the use of transnasal endoscopy for large and extensive tumors, individualized treatment strategies drafted by a group of multidisciplinary collaborators, and careful reconstruction of the skull base defects. Our treatment strategies achieved good surgical outcomes, with a high ratio of total resection (87.5 %, 28/32, including 16 cases of benign tumors and 12 cases of malignant tumors) and a low percentage of surgical complications (18.8 %, 6/32). Original symptoms were alleviated in 29 patients. The average KPS score improved from 81.25 % preoperatively to 91.25 % at 3 months after surgery. No serious perioperative complications occurred. During the follow-up of 3 years on average, four patients with malignant tumors died, including three who had subtotal resections. The 3-year survival rate of patients with malignant tumors was 78.6 %, and the overall 3-year survival rate was 87.5 %. Our data indicate that the simple classification method has practical significance in guiding the choice of surgical approaches for cranial-nasal-orbital communicating tumors and may be extended to other types of skull base tumors.

PMID: 27016919 [PubMed - as supplied by publisher]

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Treatment Efficacy of Voice Therapy for Vocal Fold Polyps and Factors Predictive of Its Efficacy.

Treatment Efficacy of Voice Therapy for Vocal Fold Polyps and Factors Predictive of Its Efficacy.

J Voice. 2016 Mar 23;

Authors: Lee YS, Lee DH, Jeong GE, Kim JW, Roh JL, Choi SH, Kim SY, Nam SY

Abstract
OBJECTIVES: Vocal fold polyps can be treated with either surgical resection or conservative therapy based on voice therapy. This study was designed to analyze the success rate of voice therapy and identify factors that are predictive of the response to this treatment for vocal fold polyps.
METHODS: This was a retrospective cohort study of 92 consecutive patients who were diagnosed with vocal fold polyp(s) and received voice therapy. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results.
RESULTS: After voice therapy, 40 patients showed improved findings and did not undergo surgical treatment. By univariate analysis, female patients (54.9%) and small polyps (56.1%) showed a good response to voice therapy. In multivariate analysis, female sex (odds ratio [OR] = 0.34; confidence interval [CI]: 0.14-0.81, P = 0.01) and small size (OR = 0.15; CI: 0.05-0.47, P <0.01) were significantly related to a successful voice response. In small polyps, the sessile type of polyp was found to be related to a good response rate (OR = 0.24; CI: 0.11-0.95, P = 0.04).
CONCLUSIONS: Voice therapy is more effective for small vocal polyps, particularly the sessile type, in female patients.

PMID: 27017066 [PubMed - as supplied by publisher]

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Enhanced salivary secretion by interferential current stimulation in patients with dry mouth: a pilot study.

Enhanced salivary secretion by interferential current stimulation in patients with dry mouth: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Hasegawa Y, Sugahara K, Sano S, Sakuramoto A, Kishimoto H, Oku Y

Abstract
OBJECTIVE: This pilot study tested the effects of submandibular and sublingual gland stimulation by interferential current stimulation (IFCS), a noninvasive mode of electrical stimulation.
STUDY DESIGN: Three groups were enrolled in this study: 20 young adults, 19 older adults, and 21 patients with dry mouth. Four electrodes were attached to the submandibular area, and the secreted saliva was collected by using Salivette cotton rolls (Sarstedt K. K., Tokyo, Japan) for 15 minutes, either with or without IFCS. Patients were randomly chosen to receive IFCS. Each subject rated pain and discomfort on the Visual Analogue Scale (VAS) after each experiment. Saliva chromogranin A levels were measured as a stress marker. To compare data between conditions with and without IFCS, a two-sample Student t test analysis was performed.
RESULTS: Saliva flow was slightly increased in those in the dry mouth group receiving IFCS compared with those who did not receive IFCS (approximately 130%). However, no such difference was found in the young and older adult groups. There was no significant difference in the VAS values of pain and discomfort or in the stress marker levels between patients who received or did not receive IFCS in the three groups.
CONCLUSIONS: IFCS delivered to submandibular and sublingual glands may promote saliva secretion in persons who suffer from dry mouth in a manner that does not induce pain or physical stress.

PMID: 27017403 [PubMed - as supplied by publisher]

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Iron-labeled adipose stem cells and neovascularization in rabbit calvarial critical-sized defects.

Iron-labeled adipose stem cells and neovascularization in rabbit calvarial critical-sized defects.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 14;

Authors: Lappalainen OP, Haapea M, Serpi R, Lehtonen S, Ylikontiola L, Korpi J, Serlo W, Sándor GK

Abstract
OBJECTIVE: The aim of this study was to evaluate the presence of iron-labeled adipose stem cells at the 2-week time point and vascular changes at the 2-week and 6-week time points using two different types of scaffolds.
STUDY DESIGN: This study included 22 White New Zealand adult male rabbits. In six rabbits, full-thickness calvarial critical-sized defects were filled with autogenous adipose stem cells labeled with iron oxide seeded onto two scaffolds, namely, solid bioactive glass (BAG) or porous tricalcium phosphate granules (TCP) used on reciprocal sides of the skull. Eleven rabbits were implanted with adipose stem cell-seeded scaffolds without iron labeling for analysis of vascular changes. Five defects were left empty as negative control defects. The specimens were analyzed histologically at the 2-week and 6-week time points.
RESULTS: The TCP group showed significantly more vascularity compared with the BAG group. A greater number of labeled stem cells were identified in the TCP group compared with the BAG group, but the difference was not statistically significant.
CONCLUSIONS: This study revealed the differences in stem cell distribution and revascularization of the calvarial defect, which may be biomaterial dependent.

PMID: 27017402 [PubMed - as supplied by publisher]

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High-grade transformation of acinic cell carcinoma: an inadequately treated entity?

High-grade transformation of acinic cell carcinoma: an inadequately treated entity?

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 21;

Authors: Chintakuntlawar AV, Shon W, Erickson-Johnson M, Bilodeau E, Jenkins SM, Davidson JA, Keeney MG, Rivera M, Price DL, Moore EJ, Olsen KD, Kasperbauer JL, Foote RL, Price KA, García JJ

Abstract
OBJECTIVE: Acinic cell carcinoma (AcCC) is an uncommon salivary gland malignancy. We aim to characterize the clinical and pathologic characteristics of AcCC with and without high-grade transformation (HGT). Importantly, cases of mammary analogue secretory carcinoma, a recently described histologic mimic of AcCC, have been excluded by using cytogenetics and molecular studies.
STUDY DESIGN: Archival surgical pathology material was obtained for patients diagnosed with AcCC at Mayo Clinic Rochester between 1990 and 2010. Tumors harboring the ETV6-NTRK3 fusion transcript were excluded from analysis by using cytogenetics and molecular studies. Tumors with HGT were characterized by areas with an infiltrative growth pattern, nuclear anaplasia, prominent nucleoli, brisk mitotic activity, geographic necrosis, and stromal desmoplasia. Demographic and clinical data were extracted from the medical records.
RESULTS: AcCC with HGT was seen in 8 of 48 cases (17%). Patients with AcCC with HGT were significantly older than patients without HGT (median 69 vs 54 years; P = .04). Angiolymphatic invasion was more common in AcCC with HGT (P = .02). Relapse-free survival and overall survival were significantly worse for cases of AcCC with HGT (hazard ratio 10.4 and 9.3, respectively; P < .0001 for both comparisons). Locoregional recurrence-free survival was not significantly different (P = .12), but distant metastases-free survival was significantly worse in patients with HGT compared with non-HGT patients (P < .0001).
CONCLUSIONS: Prognosis for overall survival and distant relapse for AcCC patients with HGT is significantly worse than that for patients without HGT.

PMID: 27017401 [PubMed - as supplied by publisher]

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[Craniofacial fibrous dysplasia].

[Craniofacial fibrous dysplasia].

Rev Med Interne. 2016 Mar 23;

Authors: Couturier A, Aumaître O, Mom T, Gilain L, André M

Abstract
Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, café au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies.

PMID: 27017329 [PubMed - as supplied by publisher]

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Hyperbaric oxygen therapy as an alternative to surgery for non-healing pharyngocutaneous fistula.

Hyperbaric oxygen therapy as an alternative to surgery for non-healing pharyngocutaneous fistula.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Abu Eta R, Eviatar E, Gavriel H

Abstract
The aim of the study is to examine the utilization of hyperbaric oxygen treatment (HBOT) as an alternative to surgical treatment for non-healing postoperative phayngocutaneous fistula (POPCF). A retrospective study was conducted between 2012 and 2014 of referred patients who had failed conservative treatment for POPCF at other medical centers. Reevaluation at our department was followed by therapeutic management including daily HBOT. Eight male patients with a mean age of 62.3 years were included. The average period of conservative treatment was 1 month before admittance to our department. All patients were managed with HBOT and local debridement. Closure of the POPCF was proved by a barium swallow test in seven patients (87.5 %). HBOT is recommended for patients who have failed conservative treatment for POPCF post-laryngectomy, due to a high rate of successful (87.5 %) closure and should be considered as an alternative to surgical treatment.

PMID: 27016920 [PubMed - as supplied by publisher]

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A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Deng YF, Lei BX, Zheng MG, Zheng YQ, Chen WL, Lan YQ

PMID: 27016919 [PubMed - as supplied by publisher]

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Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.

Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.

Auris Nasus Larynx. 2016 Mar 23;

Authors: Suárez C, Barnes L, Silver CE, Rodrigo JP, Shah JP, Triantafyllou A, Rinaldo A, Cardesa A, Pitman KT, Kowalski LP, Robbins KT, Hellquist H, Medina JE, de Bree R, Takes RP, Coca-Pelaz A, Bradley PJ, Gnepp DR, Teymoortash A, Strojan P, Mendenhall WM, Eloy JA, Bishop JA, Devaney KO, Thompson LD, Hamoir M, Slootweg PJ, Vander Poorten V, Williams MD, Wenig BM, Skálová A, Ferlito A

Abstract
The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.

PMID: 27017314 [PubMed - as supplied by publisher]

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Κυριακή 27 Μαρτίου 2016

Role of sex hormones produced during menstrual cycle on brainstem encoding of speech stimulus.

Role of sex hormones produced during menstrual cycle on brainstem encoding of speech stimulus.

Eur Arch Otorhinolaryngol. 2016 Mar 25;

Authors: Prabhu P, Banerjee N, Anil A, Abdulla A

Abstract
There are no studies attempted to determine the effects of different phases of menstrual cycle on frequency following response (FFR) for speech stimuli. The aim of the study was to determine the differences in latencies and amplitude of FFR waves recorded at four phases of menstrual cycle. In addition, it was also attempted to determine if there is any ear effect on latency and amplitude measures across the phases of menstrual cycle. FFR was recorded in 20 females in the age range of 18-25 years in the four menstrual cycles [Phase I-menses (day 1-3), Phase II-proliferative phase (day 11-14), Phase III-mid-luteal phase (day 17-22) and Phase IV-pre-menstrual phase (day 25-27)]. The results of the study showed that there was significant reduction in latencies and slight increase in amplitude during menses and mid-luteal phase compared to mid-cycle and pre-menstruation cycles. The present study supports the hypothesis that difference in the levels of sex hormones in women during menstrual cycle can affect brainstem encoding of speech stimuli.

PMID: 27015668 [PubMed - as supplied by publisher]

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Optimal time for intranasal splint removal after septoplasty: a prospective clinical study.

Optimal time for intranasal splint removal after septoplasty: a prospective clinical study.

Eur Arch Otorhinolaryngol. 2016 Mar 25;

Authors: Ozdogan F, Ozel HE, Esen E, Yuce T, Eyisarac S, Genc S, Selcuk A

Abstract
To investigate the effect of intranasal splint removal time on patient comfort and possible complications after septoplasty. One hundred and nine patients who had septoplasty operations were included in this study. The patients were divided into three groups. In the 1st group (n = 36), splints were removed on the 3rd day after septoplasty; in the 2nd group (n = 36), splints were removed on the 5th day; and in the 3rd group (n = 37), splints were removed on the 7th day. Pain and nasal fullness were evaluated with visual analog scale. Synechia, perforation, hematoma, infection and hemorrhage were recorded after the removal of the splints (postoperative 1, 8 and 24 weeks). For the 1st, 2nd, and 3rd groups, respectively, pain score was 1.96, 2.67, and 2.67; and nasal fullness score was 6.23, 6.04, and 5.48. Nasal synechia was detected in two patients in the 1st group and in one patient in the 2nd group. Early hemorrhage was detected in two patients in the 1st group and one patient in the 3rd group. Infection, septal perforation and hematoma were detected in three patients in the 1st group. There was no difference in hemorrhage, hematoma, synechia and perforation rates between the three groups. There are various opinions in the literature about the ideal removal time of intranasal tampons after septoplasty, but there is no consensus on this topic. Our study shows that removal time of intranasal splints has no effect on patient comfort or possible complications.

PMID: 27015667 [PubMed - as supplied by publisher]

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Tumors of the sublingual gland: a national clinicopathologic study of 29 cases.

Tumors of the sublingual gland: a national clinicopathologic study of 29 cases.

Eur Arch Otorhinolaryngol. 2016 Mar 25;

Authors: Andreasen S, Bjørndal K, Agander TK, Wessel I, Homøe P

Abstract
Tumors of the salivary glands are a heterogeneous group of diseases most often originating in the major salivary glands. Only a minor proportion of mainly malignant tumors arise in the sublingual gland. Due to the rarity of sublingual gland tumors (SGTs), little is known about the clinicopathologic characteristics, prognostic factors, and clinical course. We present a large national series of histopathologically revised SGTs from the past 35 years in Denmark with clinicopathologic correlation. Twenty nine cases were identified, of which 96.6 % were malignant and 16/28 (57.1 %) were adenoid cystic carcinomas (ACC). Patient demography was similar to salivary gland tumors in other locations. All fine needle aspiration cytologies (FNACs) interpreted as benign were from ACCs. Metastatic disease was found in 12.5 % of ACCs at diagnosis with one third of all ACC patients having metastases at the end of follow-up. Stage >II and T-stage >2 were significantly associated with shortened disease-specific survival (DSS) (p = 0.005 and <0.001, respectively), whereas perineural invasion and involved margins was not. No parameters were associated with disease-free survival. In conclusion, the majority of SGTs are malignant, most frequently ACC with a high rate of metastatic spread. The diagnostic value of FNAC in SGTs seems inferior to what is found for other major salivary glands. DSS is determined by stage and T-stage and not by histopathological parameters. International collaboration is warranted to confirm and elaborate these findings in larger materials.

PMID: 27015666 [PubMed - as supplied by publisher]

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Impact of the surgical wound closure technique on the revision surgery rate after subtotal petrosectomy.

Impact of the surgical wound closure technique on the revision surgery rate after subtotal petrosectomy.

Eur Arch Otorhinolaryngol. 2016 Mar 25;

Authors: Lyutenski S, Schwab B, Lenarz T, Salcher R, Majdani O

Abstract
The objective of the study was to examine the impact of the surgical wound closure technique as protection of the obliterated tympanomastoid cavity on the revision surgery rate after subtotal petrosectomy (SP). This is a retrospective case series conducted in a tertiary care referral center. 199 patients (212 ears) with recurrent chronic otitis media underwent SP followed by tympanomastoid obliteration with abdominal fat at a single tertiary referral center between 2005 and 2015. 124 SP were carried out without (group A), 74 with temporalis muscle flap (group B) and 14 with reinforcing material like polydioxanone foil or bovine pericardium or allogenic fascia lata (group C) for wound closure. The evaluated follow-up was either until the scheduled device implantation or 6 months postoperatively. We assessed the rate of postoperative wound healing disorder with revision surgery according to the surgical technique for closure of the obliterated cleft. Revision surgery due to impaired wound healing was necessary in 16 % of the total cases (group A: 18.5 %, group B: 10.8 %, group C: 21.4 %). Further analysis concerning the dehiscent area in both sites (retroauricular and blind sac of the external auditory canal) was conducted and discussed. There was no significant difference observed in the rate of revision surgery between the three groups. The wound healing process after SP is determined by many factors and cannot be significantly influenced solely by reinforcing tissue like the temporalis muscle flap or supporting materials.

PMID: 27015665 [PubMed - as supplied by publisher]

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Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder.

Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder.

Gen Thorac Cardiovasc Surg. 2016 Mar 25;

Authors: Liew YT, Lim EY, Zulkiflee AB, Prepageran N

Abstract
Descending necrotizing mediastinitis (DNM) is a rapidly progressive disease from the spread of cervical infection. Transcervical and transthoracic drainage was the recognized traditional surgical approach to achieve adequate clearance of infection. Non-invasive vacuum-assisted dressing is a new technique where applied negative pressure can help remove infective fluid and to promote wound healing. A 60-year-old man presented with odynophagia, fever and anterior neck swelling for 2 weeks. He was diagnosed to have anterior neck abscess and underwent surgical drainage. However, it did not respond well, but progressed to involve superior and inferior mediastinum. Vacuum-assisted dressing was applied for total of 2 weeks and the patient recovered without going through usual traditional transthoracic drainage. Vacuum drainage is a simple, safe and non-invasive method of managing DNM, in well selected group with small abscess cavity without airway obstruction and septicemia. This potential technique can lead to paradigm shift in treating life-threatening DNM.

PMID: 27016203 [PubMed - as supplied by publisher]

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The neural correlates of cognitive dysfunction in phantom sounds.

The neural correlates of cognitive dysfunction in phantom sounds.

Brain Res. 2016 Mar 22;

Authors: Vanneste S, Faber M, Langguth B, De Ridder D

Abstract
Tinnitus is an auditory phantom percept with a tone, hissing or buzzing sound in the absence of an objective physical sound source. It has been shown that tinnitus can lead to emotional and cognitive impairment and people with tinnitus perform worse than a control group on different cognitive tasks. The hippocampus is known to play an important role in cognitive performance, and also in the pathophysiology of tinnitus. Hippocampal deficits have been described in animal models of tinnitus and in tinnitus patients a decrease in grey matter in the hippocampus has been demonstrated. Nineteen patients with tinnitus and fifteen healthy controls performed different cognitive processing tasks and underwent an EEG with source analysis to investigate the relationship between tinnitus loudness, tinnitus distress and tinnitus duration, cognitive impairment and neurophysiological changes in the hippocampus. Results show that both tinnitus loudness, tinnitus distress and tinnitus duration correlated positively with different cognitive measures (trail making test, Montreal cognitive assessment, mini mental state examination). It was also shown that these cognitive measures correlate with beta activity in the hippocampus, the pregenual and subgenual anterior cingulate cortex extending into the right insula. A region of interest analysis further confirms that beta activity in the left and right hippocampal area correlated with the trail making performance. In conclusion, these results support for the first time the notion that cognitive changes in tinnitus patients are associated with changes in hippocampal activity as well as the anterior cingulate and insula.

PMID: 27016059 [PubMed - as supplied by publisher]

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Σάββατο 26 Μαρτίου 2016

Cerebral infarction after intraarterial and intravenous chemoradiotherapy for head and neck cancer: A retrospective analysis using a Japanese inpatient database.

Cerebral infarction after intraarterial and intravenous chemoradiotherapy for head and neck cancer: A retrospective analysis using a Japanese inpatient database.

Head Neck. 2016 Mar 25;

Authors: Suzuki S, Yasunaga H, Matsui H, Fushimi K, Saito Y, Yamasoba T

Abstract
BACKGROUND: The occurrence of cerebral infarction after intraarterial chemoradiotherapy (CRT) remains uncertain.
METHODS: We conducted a retrospective cohort study using the Diagnosis Procedure Combination (DPC) database from 2010 to 2013. We performed a 1:4 propensity score-matched analysis between patients undergoing intraarterial or intravenous CRT, and determined the association between cerebral infarction and intraarterial CRT.
RESULTS: Among patients with head and neck cancer receiving platinum-based chemotherapy and concurrent radiotherapy, we identified 776 patients with intraarterial CRT and 7157 with intravenous CRT. The occurrence of cerebral infarction was significantly higher in the intraarterial CRT group than in the intravenous CRT group: 1.4% (11 of 775) versus 0.4% (12 of 3100; p = .002). There was no significant difference in mucosal toxicity or febrile neutropenia.
CONCLUSION: About 10% of patients received intraarterial CRT. Intraarterial CRT was associated with a higher incidence of cerebral infarction than was intravenous CRT. This result is useful when considering the procedure-related risks and the potential benefits of intraarterial CRT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27015638 [PubMed - as supplied by publisher]

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AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines.

AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines.

Head Neck. 2016 Mar 25;

Authors: Gooi Z, Fakhry C, Goldenberg D, Richmon J, Kiess AP, Education Committee of the American Head and Neck Society (AHNS)

Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, an initiative of the American Head and Neck Society's Education Committee to increase awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network guidelines for radiotherapy in the treatment for head and neck cancers are reviewed here in a systematic fashion according to site and stage. These guidelines outline indications for primary and adjuvant treatment, as well as general principles of radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27015108 [PubMed - as supplied by publisher]

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Excision margins and sentinel lymph node status as prognostic factors in thick melanoma of the head and neck: A retrospective analysis.

Excision margins and sentinel lymph node status as prognostic factors in thick melanoma of the head and neck: A retrospective analysis.

Head Neck. 2016 Mar 25;

Authors: Ruskin O, Sanelli A, Herschtal A, Webb A, Dixon B, Pohl M, Donahoe S, Spillane J, Henderson MA, Gyorki DE

Abstract
BACKGROUND: Recommended margins for thick cutaneous melanoma (Breslow thickness >4 mm; T4) have decreased over recent decades. Optimal margins and the role of sentinel node biopsy (SNB) in thick head and neck melanoma remain controversial.
METHODS: A single-center review was conducted of patients treated between 2002 and 2012 assessing the impact of excision margins and sentinel lymph node status on locoregional recurrence and melanoma-specific survival (MSS).
RESULTS: One hundred eight patients were identified. Median age was 71.1 years and median Breslow thickness was 6.0 mm. Median follow-up was 40 months. Locoregional recurrence occurred in 27% and there was no significant reduction in recurrence with margins ≥2 cm (p = .17). Increasing margins did not improve survival (p = .58). Fifty-nine patients (55%) underwent SNB, of which 27% were positive. There was a trend toward longer survival for patients who were sentinel lymph node-negative (p = .097).
CONCLUSION: Wider margins do not significantly improve locoregional recurrence or MSS. Sentinel lymph node involvement reflects a poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27014970 [PubMed - as supplied by publisher]

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Primary surgery for advanced-stage laryngeal cancer: A stage and subsite-specific survival analysis.

Primary surgery for advanced-stage laryngeal cancer: A stage and subsite-specific survival analysis.

Head Neck. 2016 Mar 25;

Authors: Harris BN, Bhuskute AA, Rao S, Farwell DG, Bewley AF

Abstract
BACKGROUND: Treatment recommendations for advanced-stage laryngeal squamous cell carcinoma (SCC) have evolved significantly over the last 2 decades.
METHODS: We retrospectively analyzed patients in the Surveillance, Epidemiology, and End Results (SEER) database with advanced-stage laryngeal SCC treated between 2004 and 2012.
RESULTS: A total of 6797 patients were identified in the SEER database who met inclusion criteria, with 2051 patients undergoing primary surgery and 4746 patients undergoing primary radiotherapy (RT) or chemoradiotherapy (CRT). Disease-specific survival (DSS) and overall survival (OS) were significantly better for patients treated with primary surgery when compared using Kaplan-Meier curves and a Cox multivariate regression. When survival analysis was repeated for patients stratified by T classification, N classification, and subsite, OS and DSS benefits from primary surgery were observed for patients with T3 and T4a tumors, N0 neck disease, or supraglottic primaries.
CONCLUSION: Patients with advanced-stage laryngeal SCC with T3 and T4a tumors, N0 neck disease, or supraglottic primaries have the greatest chance of survival when treated with primary surgery. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27014858 [PubMed - as supplied by publisher]

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Early diagnosis and management of esophageal leakage after peroral endoscopic myotomy for achalasia.

Early diagnosis and management of esophageal leakage after peroral endoscopic myotomy for achalasia.

Turk J Gastroenterol. 2016 Mar;27(2):97-102

Authors: Zhang YQ, Yao LQ, Xu MD, Li QL, Chen WF, Hu JW, Cai MY, Qin WZ, Zhou PH

Abstract
BACKGROUND/AIMS: To improve the understanding of esophageal leakage after peroral endoscopic myotomy (POEM).
MATERIALS AND METHODS: From August 2010 to April 2013, patients with postoperative esophageal leakage were identified from the database of cases with achalasia who had undergone POEM and their medical records were reviewed.
RESULTS: Three patients (0.4%, 3/679) developed esophageal leakage after POEM. All three patients had non-severe chest or upper abdominal pain within 3 days after the procedure. Infections were observed, and computed tomography scans showed pleural effusion in all three patients. Pneumonia occurred in two of the three patients. Esophageal leakage was confirmed by gastroscopy. Incision rupture due to an early breaking-off of the clips at the tunnel entry was revealed in two cases. When detected, the entry was immediately closed using metal clips. A thoracic drain was placed in all cases. An enteric feeding tube was also placed to help correct nutrition deficiencies. Successful leakage closure was achieved in all three cases and no surgical intervention was needed.
CONCLUSION: Early diagnosis and treatment can improve the status of patients with esophageal leakage after POEM and can shorten the recovery time.

PMID: 27015615 [PubMed - as supplied by publisher]

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Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique.

Surgical Treatment of Iatrogenic Ventral Glottic Stenosis Using a Mucosal Flap Technique.

Vet Surg. 2016 Mar 25;

Authors: Kane-Smyth J, Barnett TP, Mark O'Leary J, Dixon PM

Abstract
OBJECTIVE: To describe a novel surgical technique for correcting postoperative ventral glottic stenosis (cicatrix or web formation) and the outcome in 2 Thoroughbred racehorses.
STUDY DESIGN: Retrospective case report.
ANIMALS: Thoroughbreds diagnosed with ventral glottic stenosis (n=2).
METHODS: Horses presenting with iatrogenic ventral glottic stenosis and resultant exercise intolerance and abnormal exercise-related noise were anesthetized and a midline sagittal skin incision was made over the ventral larynx and between the sternohyoideus muscles overlying the cricothyroid notch. The cricothyroid ligament, attached laryngeal cicatrix, and overlying mucosa were sagittally sectioned at the dorsal aspect of the cicatrix on the left side. The laryngeal mucosa, cicatrix, and underlying cricothyroid ligament immediately rostral and caudal to the cicatrix were sectioned in a medial (axial) direction as far as the right side of the cricothyroid notch. After resection of the majority of the attached cicatrix tissue, the residual mucosal flap (attached to the right side of the larynx) was reflected ventrally and sutured to the attachment of the cricothyroid ligament on the right side of the cricothyroid notch, creating an intact mucosal layer on the right side of the ventral larynx.
RESULTS: Both horses had good intralaryngeal wound healing with minimal redevelopment of ventral glottic stenosis at 5 and 9 months postoperatively and were successfully returned to racing with complete absence of abnormal respiratory noise.
CONCLUSION: The unique laryngeal anatomy of horses, with a cartilage-free ventral laryngeal area (cricothyroid notch), allowed the use of this novel surgical technique to successfully treat ventral glottic stenosis.

PMID: 27013024 [PubMed - as supplied by publisher]

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Mouthwash use and associated head and neck cancer risk.

Mouthwash use and associated head and neck cancer risk.

Evid Based Dent. 2016 Mar;17(1):8-9

Authors: Wilson G, Conway DI

Abstract
Data sourcesAll studies with questionnaire items on mouthwash use in the International Head and Neck Cancer Epidemiology Consortium (INHANCE).Data extraction and synthesisPooled analysis data from case controlled studies using Individual Patient Data (IPD) meta-analysis methods. Logistic regression was used to assess the association of mouthwash use with cancers of the oral cavity, oropharynx, hypopharynx and larynx, adjusting for study, age, sex, pack-years of tobacco smoking, number of alcoholic drinks/day and education.ResultsEight thousand, nine hundred and eighty-one cases of head and neck cancer and 10,090 controls from 12 case-control studies with comparable information on mouthwash use were included in the analysis. Compared with never users of mouthwash, the odds ratio (OR) of all head and neck cancers was 1.01 [95% confidence interval (CI): 0.94-1.08] for ever users, based on 12 studies. The corresponding ORs of cancer of the oral cavity and oropharynx were 1.11 (95% CI: 1.00-1.23) and 1.28 (95% CI: 1.06-1.56), respectively.ConclusionsAlthough limited by the retrospective nature of the study and the limited ability to assess risks of mouthwash use in nonusers of tobacco and alcohol, this large investigation shows potential risks for head and neck cancer subsites and in long-term and frequent users of mouthwash.

PMID: 27012566 [PubMed - in process]

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[Safety and efficacy of surgical closure of the larynx for recurrent aspiration pneumonia in persons with severe motor and intellectual disabilities: a comparative study with tracheoesophageal diversion].

[Safety and efficacy of surgical closure of the larynx for recurrent aspiration pneumonia in persons with severe motor and intellectual disabilities: a comparative study with tracheoesophageal diversion].

No To Hattatsu. 2016 Jan;48(1):20-4

Authors: Oshima S, Ochiai Y, Ariga M, Hayakawa M, Kanno M, Takeuchi C, Saigusa H, Imai M, Hamano S

Abstract
OBJECTIVE: We retrospectively investigated the efficacy and complications of surgical closure of the larynx (SCL) for recurrent aspiration pneumonia in comparison with tracheoesophageal diversion.
METHODS: The subjects were persons with severe motor and intellectual disabilities (SMID) who had undergone surgery for recurrent aspiration pneumonia between 1994 and 2011: A 8 SCL patients group and a 16 tracheoesophageal diversion patients group. We investigated two groups the lower respiratory infection incidence, length of hospital stay for the surgery, postoperative complications, and rate of cannula withdrawal, by reviewing medical records.
RESULTS: Both the SCL and the tracheoesophageal diversion group showed a reduction in the incidence of infection after surgery, indicating that the efficacy of SCL was equivalent to that of tracheoesophageal diversion in preventing aspiration pneumonea. The SCL group showed a reduction in the length of hospital stay and an increased rate of cannula withdrawal as compared with the tracheoesophageal diversion group.
CONCLUSION: The efficacy of SCL was equivalent to that of tracheoesophageal diversion in preventing aspiration for SMID. We consider SLC to have potential for reducing the burden on patients.

PMID: 27012105 [PubMed - in process]

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Spinal Cord Lesion by Minor Trauma as an Early Sign of Multiple System Atrophy.

Spinal Cord Lesion by Minor Trauma as an Early Sign of Multiple System Atrophy.

Front Neurol. 2016;7:33

Authors: Brum M, Reimão S, Sousa D, de Carvalho R, Ferreira JJ

Abstract
Multiple system atrophy (MSA) is characterized clinically by parkinsonism, cerebellar, autonomic, and corticospinal features of variable severity. When the presentation is only parkinsonism, the disease might be difficult to differentiate from Parkinson's disease (PD). We present a case of an 80-year-old man with previous diagnosis of PD. One year after the diagnosis, he had a whiplash cervical trauma due to a tricycle accident caused by a hole in the road. This low-energy trauma caused an unstable C4-C5 cervical fracture with spinal cord injury, which required surgical decompression and stabilization. Neurological examination showed marked postural instability, no rest and postural tremor, finger tapping slowed on the right, spastic tetraparesis (ASIA D) - predominantly on the left side, brisk deep tendon reflexes in the upper and lower extremities, and bilateral extensor plantar response. He also presented with vertical gaze restriction, mild hypometria in horizontal saccades, moderate dysphagia, and dysphonia. As atypical parkinsonism was suspected, he underwent an MRI that revealed conjunction of findings suggestive of parkinsonian-type MSA. In our case, we hypothesize that the loss of postural reflexes, as an early manifestation of MSA, did not allow the patient to have an effective reaction response to a low-energy trauma, resulting in a more severe injury. With this case report, we speculate that the severe spinal lesions caused by minor accidents can be an early sign of postural instability, which may lead to clinical suspicion of neurodegenerative disorder manifested by postural reflexes impairment.

PMID: 27014185 [PubMed]

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Laryngocele: an unusual presentation.

Laryngocele: an unusual presentation.

Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Jun;132(3):177-8

Authors: Oukessou Y, Abada RL, Roubal M, Mahtar M

PMID: 25846117 [PubMed - indexed for MEDLINE]

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Auto-fluorescence as indicator for detecting the surgical margins of medication-related osteonecrosis of the jaws.

Auto-fluorescence as indicator for detecting the surgical margins of medication-related osteonecrosis of the jaws.

Minerva Stomatol. 2016 Mar 24;

Authors: Giovannacci I, Meleti M, Manfredi M, Merigo E, Fornaini C, Bonanini M, Vescovi P

PMID: 27012287 [PubMed - as supplied by publisher]

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Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.

Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.

World J Gastrointest Endosc. 2016 Mar 25;8(6):288-94

Authors: Sakamoto T, Horiuchi A, Makino T, Kajiyama M, Tanaka N, Hyodo M

Abstract
AIM: To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method.
METHODS: Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by "white-out" following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets.
RESULTS: One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91).
CONCLUSION: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

PMID: 27014424 [PubMed]

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Letter to the Editor: Repair of skull base defects.

Letter to the Editor: Repair of skull base defects.

J Neurosurg. 2016 Mar 25;:1

Authors: Goel A

PMID: 27015397 [PubMed - as supplied by publisher]

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Surgical Technique: Endoscopic Endonasal Transphenoidal Resection of a Large Suprasellar Mixed Germ Cell Tumor.

Surgical Technique: Endoscopic Endonasal Transphenoidal Resection of a Large Suprasellar Mixed Germ Cell Tumor.

Cureus. 2016;8(2):e503

Authors: Ajayi O, Chakravarthy V, Hanna G, DeLos Reyes K

Abstract
The endoscopic endonasal transphenoidal approach has proven to be a very versatile surgical approach for the resection of small midline skull base tumors. This is due to its minimally invasive nature, the potentially fewer neurological complications, and lower morbidity in comparison to traditional craniotomies. This surgical approach has been less commonly utilized for large midline tumors such as suprasellar germ cell tumors, due to numerous reasons including the surgeon's comfort with the surgical approach, a higher chance of postoperative cerebrospinal fluid (CSF) leak, limited visualization due to arterial/venous bleeding, and limited working space. We present our surgical technique in the case of a large suprasellar and third ventricular mixed germ cell tumor that was resected via an endoscopic endonasal approach with favorable neurological outcome and no postoperative CSF leak.

PMID: 27014537 [PubMed]

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Multi atlas-based attenuation correction for brain FDG-PET imaging using a TOF-PET/MR scanner- comparison with clinical single atlas- and CT-based attenuation correction.

Multi atlas-based attenuation correction for brain FDG-PET imaging using a TOF-PET/MR scanner- comparison with clinical single atlas- and CT-based attenuation correction.

J Nucl Med. 2016 Mar 24;

Authors: Sekine T, Burgos N, Warnock G, Huellner MW, Buck A, Ter Voert EE, Cardoso MJ, Hutton BF, Ourselin S, Veit-Haibach P, Delso G

Abstract
To assess the feasibility of attenuation correction (AC) based on a multi atlas-based method (m-Atlas) by comparing it with a clinical AC method (single atlas-based method (s-Atlas)), on a time of flight (TOF)-PET/MRI system.
METHODS: We enrolled 12 patients. The median patient age was 62 years [range 31 to 80]. All patients underwent a clinically indicated whole-body(18)F-FDG-PET/CT (GE Healthcare Discovery 690 PET/CT) for staging, re-staging or follow-up of malignant disease. All patients volunteered for an additional PET/MR scan of the head (GE Healthcare SIGNA PET/MR) (no additional tracer being injected). For each patient, 3 AC maps were generated. Both s-Atlas and m-Atlas AC maps were generated from the same patient-specific LAVA-FLEX T1-weighted (T1w) images, being acquired by default on the PET/MR scanner during the first 18s of the PET scan. S-Atlas AC map was extracted by the PET/MR scanner, and m-Atlas AC map was created using a web service which automatically generates m-Atlas pseudo-CT images. For comparison, the CT-AC map generated by PET/CT was registered and used as gold standard. Using each AC map, PET images were reconstructed from raw data on the TOF-PET/MRI scanner. All PET images were normalized to the SPM5 PET template, and FDG accumulation was quantified in 67 volumes-of-interest (VOIs; automated anatomical labeling (AAL), atlas). Relative (%diff) and absolute differences (|%diff|) between images based on each atlas AC and CT AC were calculated. FDG uptake in all VOIs and generalized merged VOIs were compared using paired t-test and Bland-Altman test.
RESULTS: The range of error on m-Atlas in all 804 VOIs was -4.98% ~ 4.09%. |%diff| on m-Atlas was improved by about 30% compared to s-Atlas (s-Atlas vs. m-Atlas; 1.5±1.1% vs. 1.2 ± 0.9%,P< 0.01). In generalized VOIs, %diff on m-Atlas in the temporal lobe and cerebellum were significantly smaller (s-Atlas vs. m-Atlas; temporal lobe, 1.31±1.38% vs. -0.38±1.46%,P< 0.01; cerebellum, 1.46±2.12% vs. -1.07±1.87%,P< 0.01) CONCLUSION: The errors introduced using m-Atlas did not exceed 5 % in any brain region investigated. When compared to the clinical s-Atlas, m-Atlas is more accurate especially in regions close to the skull base.

PMID: 27013697 [PubMed - as supplied by publisher]

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[Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned].

[Endoscopic endonasal surgery for sellar region pathology. An analysis of our first 200 patients. What we have learned].

Neurocirugia (Astur). 2016 Mar 21;

Authors: Reyes L, García S, Torales J, Halperín I, Alobid I, Hanzu F, Mora M, Valero R, Enseñat J

Abstract
INTRODUCTION: Pituitary and sellar region tumours account for 10-15% of intracranial benign tumours, with pituitary adenoma being the most common one. In this article, a review is presented on 9 years of experience in surgical treatment using an endoscopic approach of sellar region lesions. The main features of our surgical technique will be explained, as well as the results in clinical and hormonal terms.
MATERIAL AND METHODS: A retrospective analysis was conducted on 200 patients operated on due to sellar lesions by the same neurosurgeon (J.E.) using an endoscopic endonasal transsphenoidal approach between February 2006 and February 2015. The cases excluded were, those requiring extended approaches of the skull base, as well as craniopharyngiomas, inflammatory, metastatic, or malignant lesions.
RESULTS: Of the 200 patients treated (59.5% women, mean age of 51.7 years, range: 18-82 years old), there were: 7 Rathke cysts and 193 adenomas (26 micro-adenomas and 165 macro-adenomas). All of them sub-classified according to the degree of invasion of the cavernous sinus (Knosp 0, 1, and 2: 129 cases and Knosp 3 and 4: 71 cases). Total resection was achieved in 143 patients (71.5%), subtotal resection in 39 (19.5%), and partial resection in 18 (9%). In the group of higher occupancy of the cavernous sinus (Knosp 3 and 4) complete resection was achieved in 55.5% (40 of 71 patients). Hormonal remission was achieved in 34 patients with acromegaly (85%), 23 patients with prolactinomas (76%), and 30 patients with Cushing's disease (86%).
CONCLUSION: The results obtained in our series, due to the centralisation of pathology and experience, are comparable to those achieved in pituitary surgery reference centres. Early surgical exploration of cerebrospinal fluid leaks reduces the risk of post-surgical meningitis.

PMID: 27012678 [PubMed - as supplied by publisher]

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Meningiomas: An Update on Diagnostic and Therapeutic Approaches.

Meningiomas: An Update on Diagnostic and Therapeutic Approaches.

Neurosurg Clin N Am. 2016 Apr;27(2):xiii

Authors: Zada G, Jensen RL

PMID: 27012390 [PubMed - in process]

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Endoscopic Endonasal and Keyhole Surgery for the Management of Skull Base Meningiomas.

Endoscopic Endonasal and Keyhole Surgery for the Management of Skull Base Meningiomas.

Neurosurg Clin N Am. 2016 Apr;27(2):207-14

Authors: Lucas JW, Zada G

Abstract
The resection of anterior skull base meningiomas has traditionally been performed via pterional or unilateral/bilateral subfrontal craniotomies. The supraorbital keyhole approach and the endoscopic endonasal approach, techniques in which the endoscope is used to aid visualization, were developed to provide alternative, less-invasive approaches to aid the resection of these tumors. The individual characteristics of each tumor, such as location and size, are the main determinants guiding the choice of approach. In this article, the advantages and disadvantages of each approach are discussed, along with complications specific to each technique. Furthermore, a detailed procedural description of each surgical approach is described.

PMID: 27012385 [PubMed - in process]

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Effects of language experience on the discrimination of the Portuguese palatal lateral by nonnative listeners.

Effects of language experience on the discrimination of the Portuguese palatal lateral by nonnative listeners.

Clin Linguist Phon. 2016 Mar 25;:1-15

Authors: Santos Oliveira D, M Casenhiser D, Hedrick M, Teixeira A, Bunta F

Abstract
The purpose of this study was to investigate (1) whether manner or place takes precedence over the other during a phonological category discrimination task and (2) whether this pattern of precedence persists during the early stages of acquisition of the L2. In doing so, we investigated the Portuguese palatal lateral approximant /ʎ/ since it differs from English /l/ only by the place of articulation, and from English /j/ only by the manner of articulation. Our results indicate that monolinguals' perception of the non-native sound is dominated by manner while Portuguese learners show a different pattern of results. The results are interpreted as being consistent with evidence suggesting that manner may be neurophysiologically dominant over place of articulation. The study adds further details to the literature on the effects of experience on language acquisition, and has significant clinical implications for bilingualism in general, and foreign accent training, in particular.

PMID: 27015591 [PubMed - as supplied by publisher]

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Phonetic and phonological perspectives on the acquisition of voice onset time by French-speaking children.

Phonetic and phonological perspectives on the acquisition of voice onset time by French-speaking children.

Clin Linguist Phon. 2016 Mar 25;:1-15

Authors: A N MacLeod A

Abstract
The goal of the present article is to describe the acquisition of the phonetic details and phonological categories of stop consonants in French. To this end, the stop consonants produced by children aged 2-4 years were transcribed and acoustically analysed. Stop consonants provide an interesting window in phonetic and phonological development since they are among the first phonemes to be acquired in French (MacLeod, Sutton, Thordardottir & Trudeau, 2011), yet the mastery of the phonetic detail of these phonemes can be more drawn out (Allen, 1985). The results of the study indicate that these children are producing significant voicing contrasts between homorganic stops using voice onset time, but at the phonetic level their productions are not yet within adult ranges.

PMID: 27014796 [PubMed - as supplied by publisher]

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Metronidazole and tinnitus: A potential side effect?

Metronidazole and tinnitus: A potential side effect?

Br Dent J. 2016 Mar 25;220(6):289-91

Authors: O'Donnell KL, Barker D

Abstract
As a healthcare profession, dentists have a role in ensuring the safety of prescribed medicines by reporting adverse drug reactions using the Yellow Card Scheme. This article briefly describes a case where metronidazole, an antibiotic commonly prescribed by dentists, may have caused ototoxicity and explores the evidence around this. It also highlights the method for reporting such effects.

PMID: 27012341 [PubMed - in process]

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[Hashimoto's encephalopathy presenting with vertigo and muscle weakness in a male pediatric patient].

[Hashimoto's encephalopathy presenting with vertigo and muscle weakness in a male pediatric patient].

No To Hattatsu. 2016 Jan;48(1):45-7

Authors: Ueno H, Nishizato C, Shimazu T, Watanabe H, Mizukami T, Kosuge H, Ozasa S, Nomura K, Kimura S, Takahashi Y

Abstract
Hashimoto's encephalopathy is an anti-thyroid antibody-positive autoimmune encephalopathy. We herein report the case of a 13-year-old male patient with subacute vertigo, muscle weakness in the extremities and gait disturbance who was diagnosed with Hashimoto's encephalopathy. He showed no severe impairment of consciousness and no seizures, and there were no abnormalities on the brain MRI. However, epileptic spike and wave complexes were observed on an electroencephalogram, and a decline in blood flow was diffusely observed on brain SPECT (single photon emission computed tomography). His thyroid function was normal, but he was positive for anti-thyroid antibodies, such as anti-TPO (thyroid peroxidase) antibodies. He was also positive for serum anti-NAE (NH2-terminal alpha-enolase) antibodies. Systemic corticosteroid therapy and high-dose intravenous immunoglobulin therapy were effective, greatly improving his quality of life.

PMID: 27012111 [PubMed - in process]

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Παρασκευή 25 Μαρτίου 2016

Sex differences in GABA(B)R-GIRK signaling in layer 5/6 pyramidal neurons of the mouse prelimbic cortex.

Sex differences in GABA(B)R-GIRK signaling in layer 5/6 pyramidal neurons of the mouse prelimbic cortex.

Neuropharmacology. 2015 Aug;95:353-60

Authors: Marron Fernandez de Velasco E, Hearing M, Xia Z, Victoria NC, Luján R, Wickman K

Abstract
The medial prefrontal cortex (mPFC) has been implicated in multiple disorders characterized by clear sex differences, including schizophrenia, attention deficit hyperactivity disorder, post-traumatic stress disorder, depression, and drug addiction. These sex differences likely represent underlying differences in connectivity and/or the balance of neuronal excitability within the mPFC. Recently, we demonstrated that signaling via the metabotropic γ-aminobutyric acid receptor (GABABR) and G protein-gated inwardly-rectifying K(+) (GIRK/Kir3) channels modulates the excitability of the key output neurons of the mPFC, the layer 5/6 pyramidal neurons. Here, we report a sex difference in the GABABR-GIRK signaling pathway in these neurons. Specifically, GABABR-dependent GIRK currents recorded in the prelimbic region of the mPFC were larger in adolescent male mice than in female counterparts. Interestingly, this sex difference was not observed in layer 5/6 pyramidal neurons of the adjacent infralimbic cortex, nor was it seen in young adult mice. The sex difference in GABABR-GIRK signaling is not attributable to different expression levels of signaling pathway components, but rather to a phosphorylation-dependent trafficking mechanism. Thus, sex differences related to some diseases associated with altered mPFC function may be explained in part by sex differences in GIRK-dependent signaling in mPFC pyramidal neurons.

PMID: 25843643 [PubMed - indexed for MEDLINE]

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Surgical telementoring: A new model for surgical training.

Surgical telementoring: A new model for surgical training.

Laryngoscope. 2016 Mar 24;

Authors: Snyderman CH, Gardner PA, Lanisnik B, Ravnik J

Abstract
OBJECTIVES/HYPOTHESIS: To assess the efficacy of a surgical telementoring program for endoscopic skull base surgery.
STUDY DESIGN: Prospective case series with surveys of surgeons.
METHODS: A surgical telementoring program was established for mentoring of a skull base team at the University of Maribor in Slovenia by an experienced skull base team at the University of Pittsburgh Medical Center in Pennsylvania. Two-way video and audio streaming provided real-time communication with the surgical team. Over a period of 3 years, 10 endoscopic endonasal surgeries of the skull base were mentored preoperatively and during the key part of the procedure. Following each procedure, an evaluation form was used to document the mentoring interventions and rate the experience.
RESULTS: Procedures included endoscopic endonasal approaches to the sella, anterior cranial fossa, posterior cranial fossa, and orbit. Diagnoses included benign and malignant neoplasms, cerebrospinal fluid leak, and inflammatory disease. In nine of 10 cases, adequate audio and video communications were maintained. The most frequent mentoring interventions were for identification of anatomy, extent of exposure, extent of resection, and surgical technique. The median perceived value by the junior surgical team was 9.5 (range 8-10). A model for surgical telementoring is proposed.
CONCLUSION: Surgical telementoring provides the ability to help surgeons develop their surgical skills to a greater level of proficiency for complex surgeries when experienced mentors are not available locally. The technology is reliable and available at most institutions. Perceived benefits of surgical telementoring include improved surgical exposure, increased extent of tumor resection, and decreased duration of surgery.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.

PMID: 27010229 [PubMed - as supplied by publisher]

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Chronic CSF leak causing syringomyelia and pseudo-Arnold-Chiari malformation.

http:--highwire.stanford.edu-icons-exter

Chronic CSF leak causing syringomyelia and pseudo-Arnold-Chiari malformation.

Neurology. 2015 Dec 1;85(22):1994

Authors: Smith RM, Garza I, Robertson CE

PMID: 26628487 [PubMed - indexed for MEDLINE]

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[Acetazolamide in the resolution of cerebrospinal fluid cutaneous fistula after peridural analgesia: case report].

[Acetazolamide in the resolution of cerebrospinal fluid cutaneous fistula after peridural analgesia: case report].

Cir Cir. 2015 Jan-Feb;83(1):43-5

Authors: Juárez-Adame FM, Ruiz-Rubio Y, Zavalza-Gómez AB

Abstract
BACKGROUND: Cerebrospinal fluid cutaneous fistula following spinal anesthesia is a serious and rare complication which mandates prompt diagnosis, although the treatment modalities are not well codified.
CLINICAL CASE: Female aged 50 with a stage IIB cervical carcinoma; a peridural catheter was passed at lumbar level; three days after surgery, refers severe headache and to corroborate leakage cerebrospinal fluid through the puncture. The prescription was antibiotics and acetazolamide 250mg every 8hours for five days with favorable evolution.
CONCLUSION: In this case, management with acetazolamide and suture of the fistula inhibits cerebrospinal fluid leakage without blood patch.

PMID: 25982607 [PubMed - indexed for MEDLINE]

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Αρχειοθήκη ιστολογίου

Τετάρτη 30 Μαρτίου 2016

Τρίτη 29 Μαρτίου 2016

Δευτέρα 28 Μαρτίου 2016

Κυριακή 27 Μαρτίου 2016

Σάββατο 26 Μαρτίου 2016

Παρασκευή 25 Μαρτίου 2016