Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study.

Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study.

Paediatr Anaesth. 2016 Jan 7;

Authors: Choudhry DK, Brenn BR, Lutwin-Kawalec M, Sacks K, Nesargi S, He Z

Abstract
BACKGROUND: Resistance to the passage of the endotracheal tube (ETT) is frequently encountered in children as it is advanced over the fiberoptic scope for placement into the trachea because it gets hung up at the laryngeal inlet. Literature in adults indicates that a 90° counterclockwise rotation (CCR) of the ETT before advancing results in smooth passage. We found no literature in children.
OBJECTIVES: Our aim was to study if a 90° counterclockwise rotation (CCR) of the ETT before advancement leads to smooth passage of the ETT into the larynx in children.
METHODS: Following IRB approval, we performed this study in two parts: Part 1: An unblinded, observational, pilot study on 20 children scheduled for oral rehabilitation where we concurrently used a fiberoptic scope nasally and GlideScope orally. We visualized the ETT path and observed that 90° CCR allowed smooth passage without hang up. Part 2: A blinded and randomized study on 40 children to confirm if 90° CCR from the outset would improve passage of the ETT during nasal intubation with a fiberoptic scope in children. All children were divided into two groups: group S, ETT bevel facing left; group R, ETT bevel facing down.
RESULTS: In Part 1, we observed that the ETT got hung up in 57% of children with standard bevel direction (facing left) and in 0% of children when prerotated. In Part 2, efficacy of prerotation was confirmed; the ETT got hung up in 50% of children in group S but in only 10.5% of children in group R.
CONCLUSION: A change in ETT tip orientation from bevel facing left to facing down by 90° CCR, leads to a significantly higher first-attempt success rate by nasal approach in children. We believe the ETT should be rotated before insertion into the nostril to ensure that full 90° CCR of the tip has been accomplished.

PMID: 26749187 [PubMed - as supplied by publisher]

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Therapeutic antibodies reveal Notch control of transdifferentiation in the adult lung.

Related Articles

Therapeutic antibodies reveal Notch control of transdifferentiation in the adult lung.

Nature. 2015 Dec 3;528(7580):127-31

Authors: Lafkas D, Shelton A, Chiu C, de Leon Boenig G, Chen Y, Stawicki SS, Siltanen C, Reichelt M, Zhou M, Wu X, Eastham-Anderson J, Moore H, Roose-Girma M, Chinn Y, Hang JQ, Warming S, Egen J, Lee WP, Austin C, Wu Y, Payandeh J, Lowe JB, Siebel CW

Abstract
Prevailing dogma holds that cell-cell communication through Notch ligands and receptors determines binary cell fate decisions during progenitor cell divisions, with differentiated lineages remaining fixed. Mucociliary clearance in mammalian respiratory airways depends on secretory cells (club and goblet) and ciliated cells to produce and transport mucus. During development or repair, the closely related Jagged ligands (JAG1 and JAG2) induce Notch signalling to determine the fate of these lineages as they descend from a common proliferating progenitor. In contrast to such situations in which cell fate decisions are made in rapidly dividing populations, cells of the homeostatic adult airway epithelium are long-lived, and little is known about the role of active Notch signalling under such conditions. To disrupt Jagged signalling acutely in adult mammals, here we generate antibody antagonists that selectively target each Jagged paralogue, and determine a crystal structure that explains selectivity. We show that acute Jagged blockade induces a rapid and near-complete loss of club cells, with a concomitant gain in ciliated cells, under homeostatic conditions without increased cell death or division. Fate analyses demonstrate a direct conversion of club cells to ciliated cells without proliferation, meeting a conservative definition of direct transdifferentiation. Jagged inhibition also reversed goblet cell metaplasia in a preclinical asthma model, providing a therapeutic foundation. Our discovery that Jagged antagonism relieves a blockade of cell-to-cell conversion unveils unexpected plasticity, and establishes a model for Notch regulation of transdifferentiation.

PMID: 26580007 [PubMed - indexed for MEDLINE]

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Geographic variation in human papillomavirus-related oropharyngeal cancer: Data from four multinational randomized trials.

Geographic variation in human papillomavirus-related oropharyngeal cancer: Data from four multinational randomized trials.

Head Neck. 2016 Jan 8;

Authors: Mehanna H, Franklin N, Compton N, Robinson M, Powell N, Biswas-Baldwin N, Paleri V, Hartley A, Fresco L, Al-Booz H, Junor E, El-Hariry I, Roberts S, Harrington K, Ang KK, Dunn J, Woodman C

Abstract
BACKGROUND: There are variations in the proportions of head and neck cancers caused by the human papillomavirus (HPV) between countries and regions. It is unclear if these are true variations or due to different study designs and assays.
METHODS: We tested formalin-fixed paraffin-embedded diagnostic biopsies for p16 immunohistochemistry and HPV-DNA (by polymerase chain reaction [PCR] and in situ hybridization [ISH]) using validated protocols on samples from 801 patients with head and neck cancer recruited prospectively between 2006 and 2011 in 4 randomized controlled trials (RCTs).
RESULTS: Twenty-one percent of patients (170 of 801) showed both HPV-DNA and p16-positivity, detected almost exclusively in oropharyngeal cancer (55%; 15 of 302); and only 1% of the patients (5 of 499) with nonoropharyngeal cancer were HPV positive. HPV-positive oropharyngeal cancer differed between Western and Eastern Europe (37%, 155 of 422 vs 6%, 8 of 144; p < .0001) and between Western Europe and Asia (37% vs 2%; 4 of 217; p < .0001). Other independent determinants of HPV positivity were tumor site and smoking.
CONCLUSION: This is the first study to establish geographic variability as an independent risk factor in HPV-positive oropharyngeal cancer prevalence, with higher prevalence in Western Europe. © 2016 The Authors Head & Neck Published by Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26749143 [PubMed - as supplied by publisher]

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Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach.

Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach.

Eur Arch Otorhinolaryngol. 2016 Jan 9;

Authors: Scheich M, Ginzkey C, Ehrmann-Müller D, Shehata-Dieler W, Hagen R

Abstract
Microsurgery is one of the primary current standard options for the treatment of vestibular schwannoma (VS). Especially the middle cranial fossa (MCF) approach is a safe and efficacious technique for the preservation of hearing and facial nerve function in small VS. Postoperative complications are rare, although a leakage of cerebrospinal fluid (CSF) is common. The aim of this study was to analyze postoperative CSF leaks and to describe strategies for postoperative treatment. Between October 2005 and May 2012, 148 patients suffering from VS and selected for microsurgery via the MCF approach were treated in our department. Postoperative CSF leakage occurred in 19 patients. We found a leakage via the Eustachian tube into the nasopharynx in 18 patients and one case of incisional leakage. In 13 cases leaking stopped within 5 days by conservative management including bed rest and intravenous (i.v) antibiotics. Five patients needed lumbar drainage (LD) and only two patients had to undergo revision surgery to seal and pack the mastoid. Analyzed risk factors were age, gender, tumor size and pneumatization of the mastoid. Only the latter showed a significant influence on CSF leakage. We could demonstrate that a stepwise strategy is needed for successful treatment of CSF leaks.

PMID: 26749560 [PubMed - as supplied by publisher]

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Modified facelift incision for partial parotidectomy versus bayonet-shaped incision: a comparison using visual analog scale.

Modified facelift incision for partial parotidectomy versus bayonet-shaped incision: a comparison using visual analog scale.

Eur Arch Otorhinolaryngol. 2016 Jan 9;

Authors: Bulut OC, Plinkert P, Federspil PA

Abstract
The aim of this study is to show differences between a modified facelift incision (MFI) for partial parotidectomy versus a bayonet-shaped incision (BSI). 24 patients presenting with a parotid tumor were surgically treated with a partial parotidectomy using a MFI. We generated a "matched pair control group" regarding age, tumor size and gender, who received a BSI. A questionnaire was sent to all patients and relevant data reviewed. The cosmetic satisfaction on a VAS with a MFI was 9.74 (±0.47) compared to BSI with 7.63 (±2.44, p = 0.004). The scoring in the two subgroups "visible scar" and "people noticed my surgery" was significantly better in the MFI group The postoperative skin numbness, skin depression, facial nerve function postoperatively showed no statistical differences. The MFI for parotid tumors has a better outcome than the BSI regarding cosmetic satisfaction and visible scarring.

PMID: 26749559 [PubMed - as supplied by publisher]

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Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.

Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.

Man Ther. 2015 Dec 18;

Authors: Oostendorp RA, Bakker I, Elvers H, Mikolajewska E, Michiels S, De Hertogh W, Samwel H

Abstract
Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements. The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus. To date only a handful of publications have focussed on (cervicogenic) somatosensory tinnitus and manual therapy. Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus. The conceptual phase of this study aims to uncover underlying mechanisms linking the auditory and somatosensory systems in relation to subjective tinnitus through (i) review of the literature (part 1) and (ii) through design of a that will explore characteristics of the study population and identify relevant components and outcomes of manual therapy in patients with cervicogenic somatosensory tinnitus (part 2). This manuscript focusses the theoretical concept of (cervicogenic) somatosensory tinnitus, either with or without secondary central tinnitus or tinnitus sensitization.

PMID: 26749460 [PubMed - as supplied by publisher]

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Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach.

Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach.

Eur Arch Otorhinolaryngol. 2016 Jan 9;

Authors: Scheich M, Ginzkey C, Ehrmann-Müller D, Shehata-Dieler W, Hagen R

Abstract
Microsurgery is one of the primary current standard options for the treatment of vestibular schwannoma (VS). Especially the middle cranial fossa (MCF) approach is a safe and efficacious technique for the preservation of hearing and facial nerve function in small VS. Postoperative complications are rare, although a leakage of cerebrospinal fluid (CSF) is common. The aim of this study was to analyze postoperative CSF leaks and to describe strategies for postoperative treatment. Between October 2005 and May 2012, 148 patients suffering from VS and selected for microsurgery via the MCF approach were treated in our department. Postoperative CSF leakage occurred in 19 patients. We found a leakage via the Eustachian tube into the nasopharynx in 18 patients and one case of incisional leakage. In 13 cases leaking stopped within 5 days by conservative management including bed rest and intravenous (i.v) antibiotics. Five patients needed lumbar drainage (LD) and only two patients had to undergo revision surgery to seal and pack the mastoid. Analyzed risk factors were age, gender, tumor size and pneumatization of the mastoid. Only the latter showed a significant influence on CSF leakage. We could demonstrate that a stepwise strategy is needed for successful treatment of CSF leaks.

PMID: 26749560 [PubMed - as supplied by publisher]

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Productivity outcomes following endoscopic sinus surgery for recurrent acute rhinosinusitis.

Productivity outcomes following endoscopic sinus surgery for recurrent acute rhinosinusitis.

Laryngoscope. 2016 Jan 9;

Authors: Steele TO, Detwiller KY, Mace JC, Strong EB, Smith TL, Alt JA

Abstract
OBJECTIVES/HYPOTHESIS: We sought to evaluate preoperative and postoperative productivity losses and quality of life (QOL) impairment reported by patients with recurrent acute rhinosinusitis (RARS) as compared to patients with chronic rhinosinusitis without nasal polyposis (CRSsNP).
STUDY DESIGN: Prospective, multi-institutional, nested case-control.
METHODS: Participants with RARS (n = 20) and CRSsNP (n = 20) undergoing endoscopic sinus surgery (ESS) were enrolled as part of a prospective cohort study. For comparison, participants diagnosed with RARS cases were age/gender-matched to control participants diagnosed with CRSsNP using a 1:1 ratio.
RESULTS: RARS and CRSsNP participants were followed for ∼14 months postoperatively. Productivity losses were reported as the number of days missed from normal productive activities out of the previous 90 days. RARS participants reported similar baseline productivity losses (12.6 ± 27.1 [standard deviation]) as participants with CRSsNP (11.7 ± 20.9; P = .314). Postoperatively, improvement in productivity losses was similar between RARS participants and CRSsNP controls (-6.7 ± 20.0 vs. -9.8 ± 19.1; P = .253). Preoperative and postoperative disease-specific QOL measures (Sino-Nasal Outcomes Test-22 and Rhinosinusitis Disability Index) were similar between the two groups. RARS participants reported a significant decrease in days of previous antibiotic (P = .009) and nasal decongestant (P = .004) use following ESS, whereas participants with CRSsNP reported a significant decrease in antibiotic (P = .002) and oral corticosteroid use (P = .002).
CONCLUSIONS: RARS patients report baseline productivity losses and disease-specific QOL impairment to levels that parallel those with CRSsNP. Patients with RARS report improvement in QOL following ESS in all disease-specific QOL measures and in several medication measures. Productivity losses and postoperative improvements are similar between patients with RARS and CRSsNP.
LEVEL OF EVIDENCE: 3b Laryngoscope, 2015.

PMID: 26749066 [PubMed - as supplied by publisher]

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A novel approach to neoplasms medial to the condyle: a condylectomy with anterior displacement of the condyle.

A novel approach to neoplasms medial to the condyle: a condylectomy with anterior displacement of the condyle.

Int J Oral Maxillofac Surg. 2015 Dec 31;

Authors: Ye ZX, Yang C, Chen MJ, Abdelrehem A

Abstract
Resecting neoplasms involving the infratemporal space has a high risk of damaging critical nerves and vessels, in addition to joint form and function. The purpose of this study was to introduce a novel approach to lesions medial to the condyle, which comprises a condylectomy with anterior displacement of the condyle. The indications evaluated using digital surgical simulation, the critical surgical technique, and the preliminary clinical effects are presented here. Five cases underwent this approach between January 2006 and December 2014. The common characteristics of the five masses were (1) that they were non-malignant neoplasms involving the posterior-medial region of the condyle; (2) the upper and lower borders were between the skull base and the lingula, while the anterior border did not exceed the coronoid process. All masses were resected successfully with no damage to any critical nerves or vessels. The average follow-up period was 29.8 months (range 6-56 months). There was no recurrence, secondary deformity, or facial paralysis. The average mouth opening improved from an original 27mm to 34mm after surgery. The condyles were well fixed, with no resorption, as shown on computed tomography scans.

PMID: 26748864 [PubMed - as supplied by publisher]

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Review on clinical update of essential tremor.

Review on clinical update of essential tremor.

Neurol Sci. 2016 Jan 9;

Authors: Chunling W, Zheng X

Abstract
Essential tremor (ET) is considered a benign disease without any pathological changes. Nevertheless, this point of view has recently been challenged. In recent years, studies have shown that ET occurs with other non-motor symptoms, such as cognitive deficits, depression, anxiety, balance disorder, hearing impairment, olfactory dysfunction and sleep problems. Advancements in neuroimaging have revealed widespread alterations in the brain, and cerebellar involvement was the most consistent finding. In addition, studies have also shown that ET patients might experience poor quality of life, reflecting motor or non-motor symptoms. Both pharmacotherapy and non-pharmacotherapy have recently been suggested for the treatment of ET. This review briefly describes the current information on ET, including the non-movement symptoms, neuroimaging findings, the impact on daily life and ET therapy.

PMID: 26749268 [PubMed - as supplied by publisher]

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