[A Case of Combined Modality Therapy for a Cervical Lymph Node Recurrence after Surgery for Esophageal Cancer].

[A Case of Combined Modality Therapy for a Cervical Lymph Node Recurrence after Surgery for Esophageal Cancer].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1626-8

Authors: Murakami H, Nishikawa K, Hirao M, Yamamoto K, Maeda S, Uemura M, Miyake M, Hama N, Ohmiya H, Miyamoto A, Miyazaki M, Ikeda M, Takami K, Nakamori S, Sekimoto M

Abstract
Inthe present report, we describe a manwith type 2 progressive squamous cell carcinoma(cT3N1M0, cStage Ⅲ)that was detected inthe esophago-gastric junction during follow-up after ESD for early gastric cancer. We performed a middle inferior part esophagectomy, a 2-region dissection, and a posterior mediastinum gastric tube reconstruction after preoperative chemotherapy( docetaxel plus cisplatinplus 5-FU). The patient only received 1 course of preoperative chemotherapy because of neutropenia. The pathology results were pT3N2M0, pStage Ⅲ. Six months later, we started chemotherapy(nedaplatin plus adriamycinplus 5-FU)owing to an abdominal lymph node recurrence. We administered 3 courses, but then switched to radiotherapy because of AEs. After receiving a radiation dose of 50.4 Gy, the patient experienced a para-aortic lymph node recurrence and was administered 50.4 Gy for the new lesion, resulting in a CR. Six months later, we identified lymph node recurrences under the left superficialis neck muscle and performed left cervical lymph node resection. All 3 of the enlarged lymph nodes that we resected were found to contain a metastasis of esophageal cancer. Currently(after 6 months), there are no signs of recurrence.

PMID: 26805118 [PubMed - in process]

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A rash starting on the palms and soles.

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A rash starting on the palms and soles.

BMJ. 2015;351:h5452

Authors: Nambudiri VE, Nambudiri NS, Nazarian RM, Tsao SS

PMID: 26481515 [PubMed - indexed for MEDLINE]

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[Abnormal percentage of memory B cells in tonsils and peripheral blood in clinical progression of IgA nephropathy].

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[Abnormal percentage of memory B cells in tonsils and peripheral blood in clinical progression of IgA nephropathy].

Beijing Da Xue Xue Bao. 2015 Oct 18;47(5):749-53

Authors: Wu G, Peng YM, Xu DL, Liu CH

Abstract
OBJECTIVE: To observe an abnormal expression of humoral immune response induced by memory B cells in tonsils and peripheral blood of patients with IgA nephropathy (IgAN), the variation of memory B cells after tonsillectomy, and to discover the role of tonsillectomy in IgAN.
METHODS: In the study, 28 patients were diagnosed as IgAN via renal biopsy, and 27 patients suffering from chronic tonsillitis without nephritis and 10 normal human beings were selected as controls. The expression of memory B cells in the tonsils and peripheral blood was tested by flow cytometry, and the same method was used to test the variation of the expression of memory B cells in peripheral blood of patients with IgAN after tonsillectomy.
RESULTS: In this study, higher percentages of memory B cells were observed in tonsil and peripheral blood of IgAN patients, which were 5.72%±5.26%, 4.92%±5.10%. After tonsillectomy, the percentage of memory B cells was 1.10%±0.65%, lower than that before tonsillectomy (P<0.05). Meanwhile, in tonsils and peripheral blood, the percentage of memory B cells varied with the variation of the urinary findings of the IgAN patients.
CONCLUSION: The percentage of memory B cell in tonsils and peripheral blood could predict disease progression of IgAN to a certain extent.

PMID: 26474610 [PubMed - indexed for MEDLINE]

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Impact of Prolonged Exacerbation Recovery in Chronic Obstructive Pulmonary Disease.

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Impact of Prolonged Exacerbation Recovery in Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2015 Oct 15;192(8):943-50

Authors: Donaldson GC, Law M, Kowlessar B, Singh R, Brill SE, Allinson JP, Wedzicha JA

Abstract
RATIONALE: Exacerbations are important and heterogeneous events in the natural history of chronic obstructive pulmonary disease (COPD).
OBJECTIVES: To examine the consequences of prolonged exacerbation recovery in patients with COPD.
METHODS: A cohort of 384 patients with COPD (FEV1 % predicted 45.8 [SD, 16.6] and a median exacerbation rate of 2.13 per year [interquartile range, 1.0-3.2]) were followed for 1,039 days (interquartile range, 660-1,814) between October 1995 and January 2013. Patients recorded daily worsening of respiratory symptoms and peak expiratory flow (PEF), and when stable underwent spirometry every 3 months, and completed the St. George's Respiratory Questionnaire annually. Exacerbations were diagnosed as 2 consecutive days with one major symptom plus another respiratory symptom. Exacerbation duration was defined as the time from onset to the day preceding 2 consecutive symptom-free days and recovery in PEF as return to preexacerbation levels.
MEASUREMENTS AND MAIN RESULTS: A total of 351 patients had one or more exacerbations. Patients with a longer symptom duration (mean, 14.5 d) had a worse St. George's Respiratory Questionnaire total score (0.2 units per 1 day; P = 0.040). A longer symptomatic duration was associated with a shorter interval between exacerbation recovery and onset of the next exacerbation (hazard ratio, 1.004; P = 0.013). For 257 (7.3%) exacerbations, PEF did not recover within 99 days. These exacerbations were associated with symptoms of a viral infection (cold and sore throat). Patients with these nonrecovered exacerbations showed a 10.8 ml/yr (P < 0.001) faster decline in FEV1.
CONCLUSIONS: Prolonged exacerbation symptomatic duration is associated with poorer health status and a greater risk of a new event. Exacerbations where lung function does not recover are associated with symptoms of viral infections and accelerated decline in FEV1.

PMID: 26151174 [PubMed - indexed for MEDLINE]

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Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer.

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Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer.

J Laryngol Otol. 2015 Apr;129(4):372-6

Authors: Amir I, Vernham GA

Abstract
OBJECTIVE: This study aimed to report our current practice of transoral laser microsurgery for early glottic cancer against the standards outlined by the ENT UK Head and Neck Group and assess the oncological outcome.
METHOD: A retrospective review of case notes of patients diagnosed with early glottic cancer (tumour stages Tis, T1 and T2) who underwent transoral laser microsurgery as a primary curative treatment. The minimum follow-up period was two years.
RESULTS: Thirty-one patients had transoral laser microsurgery for early glottic cancer during the study period. Eighty-four per cent of cases were discussed by a multidisciplinary team prior to transoral laser microsurgery. Complete circumferential excision was achieved in 77 per cent of cases. Sixty-five per cent of specimens were subjected to histological analysis; they complied with standard pathology reporting for margins. Within 12 months of transoral laser microsurgery, there were 10 residual cases and 2 recurrences. Kaplan-Meier survival analysis gave disease-free survival rates of 96.8 per cent at 18 months and 93.5 per cent at 24 months. The laryngectomy-free survival rate was 96.8 per cent at two years.
CONCLUSION: The findings of this audit are encouraging and have highlighted areas for further discussions, recommendations, training and education.

PMID: 25804366 [PubMed - indexed for MEDLINE]

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Neuralgic amyotrophy associated with temporary vocal fold paralysis: successful treatment by vocal fold augmentation with hyaluronic acid.

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Neuralgic amyotrophy associated with temporary vocal fold paralysis: successful treatment by vocal fold augmentation with hyaluronic acid.

J Laryngol Otol. 2015 Apr;129(4):e1

Authors: Geißler K, Klingner CM, Guntinas-Lichius O, Bitter T

Abstract
BACKGROUND: Neuralgic amyotrophy is a polyneuropathy that classically involves the brachial plexus. This paper reports an unusual clinical manifestation associated with vocal fold paralysis.
CASE REPORT: A 36-year-old male presented with hoarseness and progressive weakness of the right shoulder and upper arm muscles. Laryngoscopy revealed a limited adduction of the right vocal fold.
RESULTS: Subsequent speech therapy did not improve the symptoms. Therefore, vocal fold augmentation by application of hyaluronic acid in the right vocal fold was performed.
CONCLUSION: Vocal fold augmentation with resorbable material seems to be a more effective transient treatment than speech therapy alone for patients with neuralgic amyotrophy and laryngeal involvement.

PMID: 25776098 [PubMed - indexed for MEDLINE]

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Clinical significance of granulation tissue after transoral laser microsurgery for glottic cancer.

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Clinical significance of granulation tissue after transoral laser microsurgery for glottic cancer.

J Laryngol Otol. 2015 Apr;129(4):377-82

Authors: Rioja E, Blanch JL, Borés A, Bernal-Sprekelsen M, Vilaseca I

Abstract
BACKGROUND: Granulation tissue after transoral laser microsurgery can make it difficult to distinguish between normal healing and tumour recurrence.
MATERIALS AND METHODS: We carried out a retrospective analysis of 316 consecutive glottic carcinomas (Tis-T3). Presence of granulation tissue at one and six months was correlated with demographic and clinical data, tumour and surgical characteristics, and tumour relapse.
RESULTS: Granulation tissue appeared in 53.8 per cent of patients at month 1, resolving spontaneously in 41.8 per cent. Revision surgery was performed in 60.1 per cent and was effective in 41.1 per cent. At month 6, 14.9 per cent of patients presented with granulation tissue. In 74.5 per cent the tissue was surgically removed and was positive for malignancy in 62.9 per cent. Tumour relapse presented in 29.4 per cent with granulation tissue at month 1 and in 61.7 per cent at month 6 (p = 0.000). Granulation tissue at month 1 correlated with thyroid cartilage exposure and continued smoking. At month 6, granulation tissue correlated with thyroid cartilage exposure, the affected surgical margins and diabetes.
CONCLUSION: Granulation tissue after transoral laser microsurgery is frequent. When it persists at six months, revision surgery is formally recommended.

PMID: 25731713 [PubMed - indexed for MEDLINE]

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Sialolithiasis is associated with nephrolithiasis: a case-control study.

Sialolithiasis is associated with nephrolithiasis: a case-control study.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Wu CC, Hung SH, Lin HC, Lee CZ, Lee HC, Chung SD

Abstract
Conclusions This study demonstrates an association between sialolithiasis and nephrolithiasis. The results call for more awareness of this association among physicians and patients with nephrolithiasis. Objective Very few empirical studies have been conducted to explore the potential association between sialolithiasis and nephrolithiasis. As such, the association between sialolithiasis and nephrolithiasis still remains unclear. This study aimed to explore the possible association between sialolithiasis and nephrolithiasis using a population-based dataset. Methods Using data from the Taiwan Longitudinal Health Insurance Database 2005, this case-control study identified 966 patients with sialolithiasis as cases and 2898 sex- and age-matched subjects without sialolithiasis as controls. Conditional logistic regressions were conducted to examine the association of sialolithiasis with previously diagnosed nephrolithiasis. Results Out of 3864 sampled patients, 165 (4.27%) had prior nephrolithiasis. Using Chi-square test, it was found that there was a significant difference in the prevalence of prior nephrolithiasis between the cases and controls (10.25% vs 2.28%, p < 0.001). Moreover, by conditional logistic regression analysis, the odds ratio of prior nephrolithiasis for cases was 4.74 (95% CI = 3.41-6.58, p < 0.001) when compared to controls after adjusting for monthly income, geographic location, urbanization level of residence, diabetes, hypertension, heart failure, chronic renal disease, and tobacco use.

PMID: 26808906 [PubMed - as supplied by publisher]

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A causal relationship between hearing loss and cognitive impairment.

A causal relationship between hearing loss and cognitive impairment.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Park SY, Kim MJ, Sikandaner H, Kim DK, Yeo SW, Park SN

Abstract
Conclusion Moderate hearing loss in young mice caused decreases in cognition associated with spatial working and recognition memories in 6 months. These results provide evidence for a causal relationship between hearing loss and cognitive impairment. Objectives Hypothesized mechanisms to connect sensory and cognitive functions include the sensory-deprivation, information-degradation, and common-cause hypotheses. This study intended to investigate the effect of hearing loss on cognitive function, as estimated by radial arm maze (RAM) and novel object recognition (NOR) tasks in mice through age- and hearing-matched longitudinal work during a 6-month period. Methods Twenty-four male C57BL/6 mice aged 1 month with normal ABR thresholds were used. Twelve mice in the hearing loss (HL) group were exposed to white noise at 110 dB SPL for 60 min every day for 20 days. At post-noise 6 months, all mice underwent RAM and one-trial NOR test. RAM performance measures and NOR discrimination index were compared between two groups. Results At 6 months after noise exposure, all mice in the experimental group had moderate hearing loss. Most of the RAM performances improved gradually within each group across five trials, probably due to learning effect. The HL group showed lower performance scores than the control group in several trial points in the RAM task. The contact time with the novel object was shorter in the HL group than in the control group.

PMID: 26808715 [PubMed - as supplied by publisher]

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Correlation of climbing perception and eye movements during daytime and nighttime takeoffs using a flight simulator.

Correlation of climbing perception and eye movements during daytime and nighttime takeoffs using a flight simulator.

Acta Otolaryngol. 2016 Jan 25;:1-6

Authors: Tamura A, Wada Y, Shimizu N, Inui T, Shiotani A

Abstract
Conclusion This study suggests that the subjective climbing perception can be quantitatively evaluated using values calculated from induced eye movements, and the findings may aid in the detection of pilots who are susceptible to spatial disorientation in a screening test. Objective The climbing perception experienced by a pilot during takeoff at night is stronger than that experienced during the day. To investigate this illusion, this study assessed eye movements and analyzed their correlation with subjective climbing perception during daytime and nighttime takeoffs. Methods Eight male volunteers participated in this study. A simulated aircraft takeoff environment was created using a flight simulator and the maximum slow-phase velocities and vestibulo-ocular reflex gain of vertical eye movements were calculated during takeoff simulation. Results Four of the eight participants reported that their perception of climbing at night was stronger, while the other four reported that there was no difference between day and night. These perceptions were correlated with eye movements; participants with a small difference in the maximum slow-phase velocities of their downward eye movements between daytime and nighttime takeoffs indicated that their perception of climbing was the same under the two conditions.

PMID: 26808614 [PubMed - as supplied by publisher]

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Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Minami K, Haji T

Abstract
Conclusion Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis. Objective HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT. Methods Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy. Results Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.

PMID: 26808464 [PubMed - as supplied by publisher]

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Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge.

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Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge.

J Laryngol Otol. 2015 Apr;129(4):358-64

Authors: Martínez-Capoccioni G, Serramito-García R, Huertas-Pardo B, García-Allut A, Martín-Martín C

Abstract
OBJECTIVE: This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy.
METHOD: A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected.
RESULTS: Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy.
CONCLUSION: Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

PMID: 25907278 [PubMed - indexed for MEDLINE]

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Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series.

Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series.

Surg Obes Relat Dis. 2015 Oct 1;

Authors: Casella G, Soricelli E, Giannotti D, Collalti M, Maselli R, Genco A, Redler A, Basso N

Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) has gained great popularity as a stand-alone bariatric procedure because short- and mid-term outcomes in terms of weight loss and resolution of co-morbidities have been very positive. However, long-term results from large series still are sparse.
OBJECTIVES: To evaluate the long-term clinical outcomes of SG in a large series of patients undergoing SG as a stand-alone procedure.
SETTING: University hospital in Italy.
METHODS: A retrospective analysis of prospectively collected data from 182 patients undergoing SG between 2006 and 2008 in the authors' institution. Long-term outcomes at 6 and 7 years were analyzed in terms of weight loss and co-morbidities resolution.
RESULTS: Mean initial body mass index (BMI) was 45.9±7.3 kg/m(2). Major postoperative complications occurred in 8 patients (5.4%): 4 leaks, 2 bleeding, 1 abdominal collection, and 1 dysphagia. All complications were managed conservatively. One hundred forty-eight patients (81.4%) completed the 72-month (6-year) follow-up. Thirty-seven patients (25%) reached a follow-up of 84 months. At year 6 follow-up the mean BMI and the mean percentage of excess weight loss (%EWL) were 30.2 kg/m(2) and 67.3%, respectively. Mean total body weight loss was 44.9 kg, while a %EWL >50 was registered in 123 patients (83.1%). Preoperative BMI did not significantly influence postoperative %EWL. Remission of type 2 diabetes mellitus, arterial hypertension, obstructive sleep apnea syndrome, and gastroesophageal reflux disease symptoms occurred in 83.8%, 59.7%, 75.6%, and 64.7% of patients, respectively.
CONCLUSION: %EWL and resolution of co-morbidities appear to be sustained 6 and 7 years after SG. Preoperative BMI is not predictive for weight loss outcomes.

PMID: 26806727 [PubMed - as supplied by publisher]

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Radiofrequency thermotherapy in the treatment of tongue base lymphoid hyperplasia: case report.

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Radiofrequency thermotherapy in the treatment of tongue base lymphoid hyperplasia: case report.

J Laryngol Otol. 2015 Apr;129(4):398-402

Authors: Nicoli TK, Gupta S, Kotecha B

Abstract
OBJECTIVE: This paper describes a case where a patient diagnosed with tongue base lymphoid hyperplasia was successfully treated with radiofrequency excision and interstitial radiofrequency-induced thermotherapy.
CASE REPORT: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot potato voice' dysphonia. On flexible nasendoscopy, a visible tongue mass was seen to obstruct the posterior oropharynx. On magnetic resonance imaging scans, this mass looked suspicious of lymphoma, but on histology was confirmed to be benign reactive lymphoid hyperplasia. Sleep study findings indicated moderate obstructive sleep apnoea, with an apnoea-hypopnoea index of 18.1 events per hour. She was treated with radiofrequency-induced thermotherapy on three separate occasions.
RESULTS: A post-operative sleep study showed a dramatic improvement in the patient's apnoea-hypopnoea index (3.8 events per hour). This correlated well with the improvement in her sleep quality and reduction of snoring. Over the follow-up period, there has been sustained resolution of dyspnoea, with almost total restoration of voice quality.

PMID: 25744781 [PubMed - indexed for MEDLINE]

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Defining Zone I of Penetrating Neck Trauma. A Surgical controversy in the light of Clinical Anatomy.

Defining Zone I of Penetrating Neck Trauma. A Surgical controversy in the light of Clinical Anatomy.

J Trauma Acute Care Surg. 2016 Jan 21;

Authors: Rodríguez-Luna MR, Guarneros-Zárate JE, Hérnandez-Méndez JR, Tueme-Izaguirre J, Noriega-Usi V, Fenig-Rodríguez J

Abstract
In 1969, Monson proposed a classification for triage purposes in penetrating neck trauma based in zones in a paper addressing carotid and vertebral injuries. Zone I below the jugular notch, even though it is not located in the neck itself, but in the superior mediastinum; Zone II from the latter point to the mandible angle and Zone III above mandible angle to the base of the skull. Ten years later, Roon published an alternate classification, considering a Low Zone extending from the clavicles to the cricoid cartilage, a more anatomical correct classification considering that its location at the base of the neck. Current publications take one of the two classifications either, despite making the mistake of defining the anatomical superior mediastinum and axilla as part of the neck region. Many authors have considered this differences as not clinically relevant, but the two classifications are still in use in the clinical research and decision-making process for treatment of penetrating neck injuries. What is a fact is that this anatomical region is complex on itself and surgical management of penetrating injuries to the vital elements crossing the superior thoracic aperture often requires a high anterior thoracotomy, median sternotomy or supraclavicular incision with claviculectomy in the search of vascular control for the carotid, vertebral, subclavian and axillary vessels. In the present paper, we consider to be appropriate to define the Zone I bellow the cricoid cartilage extending to the sternal angle encompassing a "thoracocervicoaxiallary" zone. The acute-care surgeon must master this region for the treatment of penetrating injuries located in such a complex anatomical region. We present a historical review of the evolution in the surgical care of these wounds. Until now, we have no standardized classification leading to confusion among surgical students, and acute-care surgeons making it impossible for future systematic reviews and meta-analysis.

PMID: 26808025 [PubMed - as supplied by publisher]

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Intraoperative supratentorial extradural haematoma complicating excision of a giant vestibular schwannoma.

Intraoperative supratentorial extradural haematoma complicating excision of a giant vestibular schwannoma.

World Neurosurg. 2016 Jan 21;

Authors: Lewis DG, Lloyd S, Pathmanaban ON, Ward C, Rutherford SA, King AT

Abstract
BACKGROUND: Here we present the case of a man, who developed a rare and unexpected contralateral intraoperative complication during a translabyrinthine resection of a large cystic vestibular schwannoma.
CASE DESCRIPTION: A 29 year old gentleman, presented with progressive low-level right sided tinnitus and hearing loss. Subsequent MR imaging displayed a large multi-cystic lesion suggestive of a vestibular schwannoma extending into the right cerebellopontine angle and distorting the midbrain. The patient subsequently underwent translabyrinthine excision of this lesion. The operation was, however, complicated by brain swelling that obscured the operative field. CSF drainage failed to improve operative conditions, therefore an urgent CT scan was perfomed, which showed a large supratentorial extradural haematoma as the cause. This extradural collection was promptly evacuated, and the patient made a good postoperative neurological recovery.
CONCLUSIONS: Whilst the development of postoperative extradural haematomas due to CSF overdrainage, is reported in the literature, this case is unique in that infratentorial surgery led to the development of a supratentorial haematoma.

PMID: 26805692 [PubMed - as supplied by publisher]

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Utility of neuronavigation in intracranial meningioma resection: A single center retrospective study.

Utility of neuronavigation in intracranial meningioma resection: A single center retrospective study.

World Neurosurg. 2016 Jan 21;

Authors: Bir SC, Konar SK, Maiti TK, Thakur JD, Guthikonda B, Nanda A

Abstract
OBJECTIVE: In this study, we validate the utility of navigation in intracranial meningioma excision and evaluate the effectiveness of image guidance surgery based on clinical outcome, extent of resection, and recurrence-free survival (RFS).
METHODS: Information related to clinical history, use of neuronavigation, neuroimaging, microsurgical dissection, and outcomes of 517 consecutive cases with meningiomas between January 1995 and June 2015 was collected retrospectively. A Cox proportional hazards regression model was used to determine independent predictor of RFS.
RESULTS: In this study, overall recurrence rate after tumor excision with or without neuronavigation was17.7% and 31.2% respectively (p=0.03). Based on neuronavigation use, RFS of the patients with meningiomas in different locations also varied significantly (skull base; with 110 months vs. without, 157 months, p=0.02). The median RFS for patients operated on with or without use of neuronavigation during resection of tumors was 167 and 97 months, respectively, (log-rank p =0.0001). In Cox regression multivariate analysis, use of neuronavigation (p=0.0001), gross total resection (Simpson grade I-II, p=0.001), and WHO grade I tumor (p=0.0001) were revealed as significant predictors of RFS. In addition, mean blood loss (p=0.005) and average length of stay (LOS, p=0.008) in the hospital were significantly reduced and performance status was improved using neuronavigation during resection of meningiomas.
CONCLUSION: Interactive surgical navigation is a useful tool in the operative management of intracranial meningiomas to decrease recurrence rate, blood loss, and LOS, and to improve RFS and performance status. Therefore, use of neuronavigation should be ensured during resection of intracranial meningiomas.

PMID: 26805681 [PubMed - as supplied by publisher]

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Sinonasal malignancies: A population-based analysis of site-specific incidence and survival.

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Sinonasal malignancies: A population-based analysis of site-specific incidence and survival.

Laryngoscope. 2015 Nov;125(11):2491-7

Authors: Dutta R, Dubal PM, Svider PF, Liu JK, Baredes S, Eloy JA

Abstract
OBJECTIVES/HYPOTHESIS: Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in various cases. Our objective was to utilize a national population-based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities.
STUDY DESIGN: Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry.
METHODS: The SEER database was examined for patients diagnosed with sinonasal malignancies between 1973 and 2011. Data were stratified according to anatomical site, incidence, survival, histology, staging, and patient demographics. Therapy-based outcomes were analyzed for cases from 1983 to 2011.
RESULTS: A total of 13,295 patients were identified, with an incidence of 0.83 per 100,000 people. Males comprised 58.6% of cases. Whites represented 81.5% of cases, while blacks comprised 8.7%. Squamous cell carcinoma was the most common histology (41.9%) across all sites of the sinonasal tract. The most common anatomical site of malignancy was the nasal cavity (45.7%), and least common was the frontal sinus (1.2%). For single sites, 5-year disease-specific survival (DSS) was highest for nasal cavity tumors (67.1%) and lowest for overlapping sinus malignancies (37.6%). The overall 5-year DSS for all sinonasal malignancies was 53.7%.
CONCLUSION: Sinonasal malignancies are rare entities with poor overall prognosis. By anatomical site, prognosis is best for nasal cavity cancers and worst for overlapping lesions.
LEVEL OF EVIDENCE: 4.

PMID: 26228792 [PubMed - indexed for MEDLINE]

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Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study.

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Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study.

Acta Neurochir (Wien). 2015 Jul;157(7):1229-37

Authors: Hermann EJ, Petrakakis I, Polemikos M, Raab P, Cinibulak Z, Nakamura M, Krauss JK

Abstract
BACKGROUND: Electromagnetic (EM)-guided neuronavigation is an innovative technique and a viable alternative to opto-electric navigation. We have performed a safety and feasibility study using EM-guided neuronavigation for posterior fossa surgery in the semi-sitting position in a selected subset of patients.
METHODS: Out of 284 patients with posterior fossa tumours operated upon over a period of 40 months, a subset of 15 patients was thought to possibly benefit from EM navigational guidance and was included in this study. There were six children and nine adults (aged between 8 and 84 years; mean age, 34.6 years) with different neoplasms in the brainstem or close to the midline. All patients had contrast-enhanced three-dimensional (3D) magnetic resonance imaging (MRI) of the head preoperatively. EM-guided navigation was used to identify and preserve the venous sinuses during craniotomy and to determine the trajectory to the lesion using various approaches. Neuronavigation accuracy was repeatedly checked for deviations measured in millimetres on screen shots during surgery before and after dural opening in the coronal (z = vertical), axial (x = mediolateral) and sagittal (y = anteroposterior) plane.
RESULTS: Referencing of the patient in the supine position was fast and easy. There was no loss of navigation accuracy after repositioning of the patient in the semi-sitting position (mean, 2.5 mm ± 0.92 mm). Identification of the pathological structure using EM navigation was achieved in all instances. Optimal angulation of the neck was selected individually to permit a comfortable position for the surgeon with full access to the lesion avoiding over-flexion. Deviation of accuracy at the surface of the target lesion ranged between 2.5 and 5.8 mm (mean, 3.9 mm ± 1.1 mm).
CONCLUSIONS: EM-guided neuronavigation in the semi-sitting position was safe and technically feasible. It enabled fast and accurate referencing without loss of navigation accuracy despite repositioning of the patient. In contrast to conventional opto-electric neuronavigation there were no line of sight problems.

PMID: 25990847 [PubMed - indexed for MEDLINE]

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Posterior fossa surgery in sitting position in patient with severe mitral regurgitation.

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Posterior fossa surgery in sitting position in patient with severe mitral regurgitation.

J Neurosurg Anesthesiol. 2015 Jan;27(1):82

Authors: Jain R, Shetty A, Oak S, Wajekar A

PMID: 25000148 [PubMed - indexed for MEDLINE]

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Sialolithiasis is associated with nephrolithiasis: a case-control study.

Sialolithiasis is associated with nephrolithiasis: a case-control study.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Wu CC, Hung SH, Lin HC, Lee CZ, Lee HC, Chung SD

Abstract
Conclusions This study demonstrates an association between sialolithiasis and nephrolithiasis. The results call for more awareness of this association among physicians and patients with nephrolithiasis. Objective Very few empirical studies have been conducted to explore the potential association between sialolithiasis and nephrolithiasis. As such, the association between sialolithiasis and nephrolithiasis still remains unclear. This study aimed to explore the possible association between sialolithiasis and nephrolithiasis using a population-based dataset. Methods Using data from the Taiwan Longitudinal Health Insurance Database 2005, this case-control study identified 966 patients with sialolithiasis as cases and 2898 sex- and age-matched subjects without sialolithiasis as controls. Conditional logistic regressions were conducted to examine the association of sialolithiasis with previously diagnosed nephrolithiasis. Results Out of 3864 sampled patients, 165 (4.27%) had prior nephrolithiasis. Using Chi-square test, it was found that there was a significant difference in the prevalence of prior nephrolithiasis between the cases and controls (10.25% vs 2.28%, p < 0.001). Moreover, by conditional logistic regression analysis, the odds ratio of prior nephrolithiasis for cases was 4.74 (95% CI = 3.41-6.58, p < 0.001) when compared to controls after adjusting for monthly income, geographic location, urbanization level of residence, diabetes, hypertension, heart failure, chronic renal disease, and tobacco use.

PMID: 26808906 [PubMed - as supplied by publisher]

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A causal relationship between hearing loss and cognitive impairment.

A causal relationship between hearing loss and cognitive impairment.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Park SY, Kim MJ, Sikandaner H, Kim DK, Yeo SW, Park SN

Abstract
Conclusion Moderate hearing loss in young mice caused decreases in cognition associated with spatial working and recognition memories in 6 months. These results provide evidence for a causal relationship between hearing loss and cognitive impairment. Objectives Hypothesized mechanisms to connect sensory and cognitive functions include the sensory-deprivation, information-degradation, and common-cause hypotheses. This study intended to investigate the effect of hearing loss on cognitive function, as estimated by radial arm maze (RAM) and novel object recognition (NOR) tasks in mice through age- and hearing-matched longitudinal work during a 6-month period. Methods Twenty-four male C57BL/6 mice aged 1 month with normal ABR thresholds were used. Twelve mice in the hearing loss (HL) group were exposed to white noise at 110 dB SPL for 60 min every day for 20 days. At post-noise 6 months, all mice underwent RAM and one-trial NOR test. RAM performance measures and NOR discrimination index were compared between two groups. Results At 6 months after noise exposure, all mice in the experimental group had moderate hearing loss. Most of the RAM performances improved gradually within each group across five trials, probably due to learning effect. The HL group showed lower performance scores than the control group in several trial points in the RAM task. The contact time with the novel object was shorter in the HL group than in the control group.

PMID: 26808715 [PubMed - as supplied by publisher]

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Correlation of climbing perception and eye movements during daytime and nighttime takeoffs using a flight simulator.

Correlation of climbing perception and eye movements during daytime and nighttime takeoffs using a flight simulator.

Acta Otolaryngol. 2016 Jan 25;:1-6

Authors: Tamura A, Wada Y, Shimizu N, Inui T, Shiotani A

Abstract
Conclusion This study suggests that the subjective climbing perception can be quantitatively evaluated using values calculated from induced eye movements, and the findings may aid in the detection of pilots who are susceptible to spatial disorientation in a screening test. Objective The climbing perception experienced by a pilot during takeoff at night is stronger than that experienced during the day. To investigate this illusion, this study assessed eye movements and analyzed their correlation with subjective climbing perception during daytime and nighttime takeoffs. Methods Eight male volunteers participated in this study. A simulated aircraft takeoff environment was created using a flight simulator and the maximum slow-phase velocities and vestibulo-ocular reflex gain of vertical eye movements were calculated during takeoff simulation. Results Four of the eight participants reported that their perception of climbing at night was stronger, while the other four reported that there was no difference between day and night. These perceptions were correlated with eye movements; participants with a small difference in the maximum slow-phase velocities of their downward eye movements between daytime and nighttime takeoffs indicated that their perception of climbing was the same under the two conditions.

PMID: 26808614 [PubMed - as supplied by publisher]

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Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

Acta Otolaryngol. 2016 Jan 25;:1-4

Authors: Minami K, Haji T

Abstract
Conclusion Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis. Objective HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT. Methods Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy. Results Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.

PMID: 26808464 [PubMed - as supplied by publisher]

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The efficacy of tonsillectomy in chronic tonsillitis patients as demonstrated by the neutrophil-to-lymphocyte ratio.

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The efficacy of tonsillectomy in chronic tonsillitis patients as demonstrated by the neutrophil-to-lymphocyte ratio.

J Laryngol Otol. 2015 Apr;129(4):386-91

Authors: Yenigun A

Abstract
OBJECTIVES: Adenoidectomy and tonsillectomy are the oldest surgical procedures. The neutrophil-to-lymphocyte ratio is an inflammatory marker. This study aimed to investigate neutrophil-to-lymphocyte ratios in chronic tonsillitis patients and to determine whether this ratio reflects the pre- and post-operative inflammatory status in these patients.
METHODS: Patients and healthy individuals were assigned to four groups: the adenoid hypertrophy, adenotonsillar hypertrophy, chronic tonsillitis and control groups. The neutrophil-to-lymphocyte ratio was calculated for each patient before surgery and one month post-surgery. Pre- and post-operative white blood cell, neutrophil and lymphocyte counts and neutrophil-to-lymphocyte ratios were compared both within and between groups.
RESULTS: Pre- and post-operative neutrophil-to-lymphocyte ratios were significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy and adenotonsillar hypertrophy groups (p < 0.01 and p < 0.05, respectively). In the chronic tonsillitis group, post-operative neutrophil-to-lymphocyte ratios were significantly lower than pre-operative ratios (p = 0.045). The pre-operative neutrophil-to-lymphocyte ratio was significantly higher in the chronic tonsillitis group than in the adenoid hypertrophy, adenotonsillar hypertrophy and control groups (p = 0.000). In contrast, there was no significant difference in post-operative neutrophil-to-lymphocyte ratios among all groups (p = 0.584).
CONCLUSION: The neutrophil-to-lymphocyte ratio measurement can be used in chronic tonsillitis patients as an effective auxiliary method for determining the necessity and timing of tonsillectomy and post-operative follow up, thereby helping prevent complications due to delayed or inadequate treatment.

PMID: 25791868 [PubMed - indexed for MEDLINE]

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Differential effect of elevated intralabyrinthine pressure on ocular vestibular evoked myogenic potentials elicited by air conducted sound and bone conducted vibration.

Differential effect of elevated intralabyrinthine pressure on ocular vestibular evoked myogenic potentials elicited by air conducted sound and bone conducted vibration.

Clin Neurophysiol. 2016 Jan 7;

Authors: Gürkov R, Speierer G, Wittwer L, Muri R, Kalla R

PMID: 26806721 [PubMed - as supplied by publisher]

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Clinical Assessment of Glottal Insufficiency in Age-related Dysphonia.

Clinical Assessment of Glottal Insufficiency in Age-related Dysphonia.

J Voice. 2016 Jan 21;

Authors: Vaca M, Cobeta I, Mora E, Reyes P

Abstract
OBJECTIVES: Incomplete glottal closure is one of the key clinical aspects of presbylarynx. The objective of the present study is to determine the diagnostic yield of several tests for the assessment of glottal competence in age-related dysphonia.
STUDY DESIGN: Cross-sectional prospective.
METHODS: One hundred and four healthy patients 65 years and older with a maximum phonation time below 12 seconds for women and 15 seconds for men were included. The glottal closure was assessed with laryngostroboscopy, and this observation was used as gold standard. Continuous light endoscopy, s/z ratio, electroglottography, and aerodynamic analysis of voice were performed, and their accuracy parameters for the diagnosis of the glottal gap in this context were calculated.
RESULTS: A spindle-shaped gap was observed in 47 cases. Sensitivity of vocal fold bowing to predict glottal gap in phonation was 93.6% with a negative likelihood ratio of 0.15. Specificity of s/z ratio was 91.4% with a positive likelihood ratio of 6.17. Electroglottography and aerodynamic measurements of voice resulted to be inaccurate for the diagnosis of glottal insufficiency in phonation.
CONCLUSIONS: Conventional endoscopy and s/z ratio are good diagnostic tests for an initial assessment of glottal insufficiency in age-related dysphonia that would allow general otolaryngologists early identification and prompt treatment of this pathology.

PMID: 26804785 [PubMed - as supplied by publisher]

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HPV prevalence in HIV patients with head and neck squamous cell carcinoma.

HPV prevalence in HIV patients with head and neck squamous cell carcinoma.

AIDS. 2016 Jan 23;

Authors: Picard A, Badoual C, Hourseau M, Halimi C, Pere H, Dib F, Barry B, Albert S

Abstract
OBJECTIVE: The implication of HPV in head and neck squamous cell carcinoma (HNSCC) is well established, especially in oropharyngeal SCC. HIV patients have a higher risk of persistent HPV infection. We investigated the role of HPV in HNSCC carcinogenesis in HIV population.
DESIGN: Retrospective monocentric study.
METHODS: We studied HIV patients who presented with HNSCC between 1994 and 2014. For each patient, tumor characteristics, HIV disease and survival information were collected. Tumor HPV testing was performed using p16 immunohistochemistry, in situ hybridation and PCR. We assessed the percentage of HPV in this population of HIV patients with HNSCC and compared HIV disease characteristics based on HPV status.
RESULTS: Forty seven patients were included: 11 women/36 men, the median age was 50 years. Tumor HPV testing was performed in 40 patients. Tumors were located in oropharynx (32%), oral cavity (32%), larynx (21%) and hypopharynx (11%). At the time of diagnosis, median CD4 level was 385/mm, 31% of the patients were stage CDC C. The percentage of HPV linked to HNSCC for all locations in HIV patients was 30% (n = 12). HPV16 accounted for 50% of all HPV genotypes. HPV positive status was associated with a CD4 nadir of less than 200 (p = 0.026), but not with CD4 level at time of diagnosis (p = 0.414). HPV negative tumors tend to be associated with poorer 5-year overall survival (HR = 2.9, p = 0.0711).
CONCLUSION: HPV plays a critical role in HNSCC development in HIV population. HIV immunodeficiency may increase HPV persistence and progression of HNSCC.

PMID: 26807970 [PubMed - as supplied by publisher]

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Safety of heat generated by endoscope light sources in simulated transcanal endoscopic ear surgery.

Safety of heat generated by endoscope light sources in simulated transcanal endoscopic ear surgery.

Auris Nasus Larynx. 2016 Jan 21;

Authors: Ito T, Kubota T, Takagi A, Watanabe T, Futai K, Furukawa T, Kakehata S

Abstract
OBJECTIVE: To determine whether heat generated by endoscope light sources during ear surgery is safe.
METHODS: Transcanal endoscopic ear surgery (TEES) was simulated using 2.7-mm or 4-mm endoscopes coupled to xenon or LED light sources and a 3D model of human temporal bone. The endoscope tip was fixed at the center of tympanic annulus. Light sources were tested at clinical (30% for xenon and 40% for LED) and 100% settings. Temperatures were measured using thermocouples attached to the endoscope tip and three points within the middle ear cavity: promontory, horizontal portion of the facial nerve and lateral semicircular canal.
RESULTS: Maximum temperatures measured within the middle ear cavity were below 31°C at clinical settings, while the temperatures rose to 44.1°C using a 4-mm endoscope with a xenon light source set at 100%. Temperatures measured at the tip were all safe at clinical settings, but rose dramatically to 110.1°C for the 4-mm endoscope with xenon at 100%.
CONCLUSION: Endoscopes can be safely used within the middle ear at clinical settings. However, operators should not exceed clinical settings, particularly with 4-mm endoscopes with a xenon light source, to ensure temperatures generated within the middle ear cavity are safe.

PMID: 26806025 [PubMed - as supplied by publisher]

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[A Case of Esophageal Carcinoma with an Aberrant Right Subclavian Artery].

[A Case of Esophageal Carcinoma with an Aberrant Right Subclavian Artery].

Gan To Kagaku Ryoho. 2015 Nov;42(12):1908-10

Authors: Tokunou K, Yamamoto T, Kamei R, Kitamura Y, Ando S

Abstract
We report a rare case of esophagealcarcinoma with an aberrant right subclavian artery. A 67-year-old woman was admitted to our hospital because of a sense of discomfort during swallowing. A detailed gastrointestinal examination revealed advanced carcinoma of the middle thoracic esophagus. Preoperative CT also revealed an aberrant right subclavian artery(AR SA). After the second course of neoadjuvant chemotherapy(FP therapy), we conducted a transthoracic esophagectomy with a 3-field lymphadenectomy. The right recurrent nerve was not identified at the right subclavian artery during mediastinal dissection, but the non-recurrent inferior laryngeal nerve(NRILN)was identified as going directly from the vagal nerve to the larynx during the neck lymphadenectomy. The thoracic duct ran between the esophagus and the azygos vein, terminating at the right venous angle. We were able to perform a #106recL lymphadenectomy as usual. She continues to do well without signs of recurrence 1 year later. Though ARSA is a relatively rare congenital anomaly, it must be identified preoperatively, and anatomical anomalies such as NRILN must be taken into consideration, in order that the operation can be performed safely.

PMID: 26805213 [PubMed - in process]

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Andreas Vesalius' 500th Anniversary: Initial Integral Understanding of Voice Production.

Andreas Vesalius' 500th Anniversary: Initial Integral Understanding of Voice Production.

J Voice. 2016 Jan 21;

Authors: Brinkman RJ, Hage JJ

Abstract
BACKGROUND: Voice production relies on the integrated functioning of a three-part system: respiration, phonation and resonance, and articulation. To commemorate the 500th anniversary of the great anatomist Andreas Vesalius (1515-1564), we report on his understanding of this integral system.
METHODS: The text of Vesalius' masterpiece De Humani Corporis Fabrica Libri Septum and an eyewitness report of the public dissection of three corpses by Vesalius in Bologna, Italy, in 1540, were searched for references to the voice-producing anatomical structures and their function. We clustered the traced, separate parts for the first time.
RESULTS: We found that Vesalius recognized the importance for voice production of many details of the respiratory system, the voice box, and various structures of resonance and articulation. He stressed that voice production was a cerebral function and extensively recorded the innervation of the voice-producing organs by the cranial nerves.
CONCLUSIONS: Vesalius was the first to publicly record the concept of voice production as an integrated and cerebrally directed function of respiration, phonation and resonance, and articulation. In doing so nearly 500 years ago, he laid a firm basis for the understanding of the physiology of voice production and speech and its management as we know it today.

PMID: 26804787 [PubMed - as supplied by publisher]

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