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

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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.

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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].

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[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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Cerebral venous sinus thrombosis and dural arteriovenous fistula in a 75-year-old man primarily presenting with repeated transient visual obscurations.

Cerebral venous sinus thrombosis and dural arteriovenous fistula in a 75-year-old man primarily presenting with repeated transient visual obscurations.

Rinsho Shinkeigaku. 2016 Mar 24;

Authors: Sato T, Matsuno H, Omoto S, Sakuta K, Terasawa Y, Iguchi Y

Abstract
A 75-year-old man was admitted to our hospital because of repeated transient visual obscurations of greying vision. The transient visual obscurations were caused by rotating his neck or the Valsalva manoeuver, and they recovered in about 30 seconds. A few weeks later, pulsatile tinnitus of the right ear and a dull headache developed. Both ocular fundi showed papilledema, and there was significant intracranial hypertension on cerebrospinal fluid examination. He was diagnosed as having right sigmoid sinus thrombosis and a dural arteriovenous fistula with a rapid arteriovenous shunt from the right ascending pharyngeal artery and the right occipital artery to the right transverse sinus. Anticoagulant therapy was started, and coil embolization was performed. The transient visual obscurations, headache, and tinnitus improved dramatically after the procedure. We hypothesized that the transient visual obscurations were triggered by rotating the neck or performing the Valsalva manoeuver as they both increase the pressure of cerebrospinal fluid, inducing transient optic nerve ischemia and visual obscurations under mild intracranial hypertension. Transient visual obscurations are an important initial symptom of intracranial hypertension.

PMID: 27010097 [PubMed - as supplied by publisher]

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Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Process Evaluation Protocol.

Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Process Evaluation Protocol.

JMIR Res Protoc. 2016;5(1):e49

Authors: Greenwell K, Sereda M, Coulson N, Hoare DJ

Abstract
BACKGROUND: Tinnitus is a common medical symptom that can affect an individual's emotional and functional quality of life. Psychological therapies are acknowledged as beneficial to people with tinnitus; however, such therapies are not always readily accessible. With their global reach, automated Internet-based interventions have the potential to reduce the disparity in access to psychological support that people with tinnitus currently experience. However, the evidence on the acceptability and efficacy of these interventions is lacking. Process evaluations that develop an in-depth understanding of how users experience these interventions provide an essential first step when evaluating complex psychological interventions.
OBJECTIVE: To describe the protocol for a study that will explore past, current, and new users' reactions to and interactions with the Tinnitus E-Programme, an Internet-based intervention for the self-management of tinnitus.
METHODS: Two parallel mixed-methods studies will be carried out with 2 different populations. Study 1 will use an online survey to gather past and current users' views of the program. Study 2 will recruit new program users to take part in an interview and complete a relaxation log to explore how well they were able to implement the skills they learned during the program in their everyday lives. The findings from both studies will be triangulated to develop an in-depth understanding of the program's mechanisms of impact and identify any implementation or contextual factors that strengthen or impede its delivery and functioning.
RESULTS: Study 1 is open for recruitment with a projected completion in June 2016 and Study 2 was completed November 2015. At the time of submission, 36 participants have been recruited to Study 1 and 12 participants have taken part in Study 2.
CONCLUSIONS: Findings will inform the optimization of the Tinnitus E-Programme and guide future evaluation work to assess the program's effectiveness as a therapy for people with tinnitus.

PMID: 27009548 [PubMed]

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Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes.

Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes.

Orphanet J Rare Dis. 2016;11(1):29

Authors: Lavezzo MM, Sakata VM, Morita C, Rodriguez EE, Abdallah SF, da Silva FT, Hirata CE, Yamamoto JH

Abstract
Vogt-Koyanagi-Harada disease (VKHD) is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin and hair. This disease is mainly a Th1 lymphocyte mediated aggression to melanocytes after a viral trigger in the presence of HLA-DRB1*0405 allele. The absence of ocular trauma or previous intraocular surgery sets VKHD appart from sympathetic ophthalmia, its main differential diagnosis. The disease has an acute onset of bilateral blurred vision with hyperemia preceded by flu-like symptoms. The acute uveitic stage is characterized by a diffuse choroiditis with serous retinal detachment and optic disc hyperemia and edema. Fluorescein angiography in this phase demonstrates multiple early hyperfluorescent points. After the acute uveitic stage, ocular and integumentary system pigmentary changes may appear. Ocular findings may be accompanied by lymphocytic meningitis, hearing impairment and/or tinnitus in a variable proportion of patients. Prompt diagnosis followed by early, aggressive and long-term treatment with high-dose corticosteroids is most often ensued by good visual outcomes. However, some patients may experience chronic uveal inflammation with functional eye deterioration. The current review discusses the general features of VKHD, including epidemiology, classification into categories, differential diagnosis and current therapeutic approaches.

PMID: 27008848 [PubMed - in process]

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Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

Eur Radiol. 2016 Mar 24;

Authors: Torres C, Hogan M, Patro S, Chakraborty S, Nguyen T, Thornhill R, Freedman M, Bussiere M, Dabirzadeh H, Schwarz BA, Belanger S, Legault-Kingstone L, Schweitzer M, Lum C

Abstract
OBJECTIVE: To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population.
MATERIALS AND METHODS: We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins.
RESULTS: Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon.
CONCLUSION: It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients.
KEY POINTS: • The venous anatomy of the neck in patients without MS demonstrates multiple variants • Asymmetry and stenoses of the internal jugular veins are common • Collateral neck veins are not uncommon in patients without MS • These findings do not support the theory of chronic cerebrospinal venous insufficiency • MR venography is a useful imaging modality for assessing venous anatomy.

PMID: 27011374 [PubMed - as supplied by publisher]

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Intranasal Volume Changes Caused by the Endoscopic Endonasal Transsphenoidal Approach and Their Effects on Nasal Functions.

Intranasal Volume Changes Caused by the Endoscopic Endonasal Transsphenoidal Approach and Their Effects on Nasal Functions.

PLoS One. 2016;11(3):e0151531

Authors: Kim DH, Hong YK, Jeun SS, Park YJ, Kim SW, Cho JH, Kim BY, Han S, Lee YJ, Hwang JH, Kim SW

Abstract
OBJECTIVE: We evaluated postoperative changes in nasal cavity volume and their effects on nasal function and symptoms after endoscopic endonasal transsphenoidal approach for antero-central skull base surgery.
STUDY DESIGN: Retrospective chart review at a tertiary referral center.
METHODS: We studied 92 patients who underwent binostril, four-hand, endoscopic endonasal transsphenoidal approach surgery using the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography and the Mimics® program were used to assess nasal cavity volume changes at three sections. We also performed several pre- and postoperative tests, including the Connecticut Chemosensory Clinical Research Center test, Cross-Cultural Smell Identification Test, Nasal Obstruction Symptoms Evaluation, and Sino-Nasal Outcome Test-20. In addition, a visual analog scale was used to record subjective symptoms. We compared these data with the pre- and postoperative nasal cavity volumes.
RESULTS: Three-dimensional, objective increases in nasal passage volumes were evident between the inferior and middle turbinates (p<0.001) and between the superior turbinate and choana (p = 0.006) postoperatively. However, these did not correlate with subjectively assessed symptoms (NOSE, SNOT-20 and VAS; all nasal cavity areas; p≥0.05) or olfactory dysfunction (CCCRC and CCSIT test; all nasal cavity areas; p≥0.05).
CONCLUSION: Skull base tumor surgery via an endoscopic endonasal transsphenoidal approach altered the patients' nasal anatomy, but the changes in nasal cavity volumes did not affect nasal function or symptoms. These results will help surgeons to appropriately expose the surgical field during an endoscopic endonasal transsphenoidal approach.

PMID: 27010730 [PubMed - as supplied by publisher]

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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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The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study.

The cavernous sinus in cluster headache - a quantitative structural magnetic resonance imaging study.

Cephalalgia. 2016 Mar 22;

Authors: Arkink EB, Schoonman GG, van Vliet JA, Bakels HS, Sneeboer MA, Haan J, van Buchem MA, Ferrari MD, Kruit MC

Abstract
BACKGROUND: It has been hypothesized that a constitutionally narrow cavernous sinus might predispose individuals to cluster headache. Cavernous sinus dimensions, however, have never been assessed.
METHODS: In this case-control study, we measured the dimensions of the cavernous sinus, skull base, internal carotid and pituitary gland with high-resolution T2-weighted magnetic resonance imaging in 25 episodic, 24 chronic and 13 probable cluster headache patients, 8 chronic paroxysmal hemicrania patients and 22 headache-free controls. Dimensions were compared between groups, correcting for age, sex and transcranial diameter.
RESULTS: On qualitative inspection, no relevant pathology or anatomic variants that were previously associated with cluster headache or chronic paroxysmal hemicranias were observed in the cavernous sinus or paracavernous structures. The left-to-right transcranial diameter at the temporal fossa level (mean ± SD) was larger in the headache groups (episodic cluster headache: 147.5 ± 7.3 mm, p = 0.044; chronic cluster headache: 150.2 ± 7.3 mm, p < 0.001; probable cluster headache: 146.0 ± 5.3 mm, p = 0.012; and chronic paroxysmal hemicrania: 145.2 ± 9.4 mm, p = 0.044) compared with controls (140.2 ± 8.0 mm). After adjusting for transcranial diameter and correcting for multiple comparisons, there were no differences in the dimensions of the cavernous sinus and surrounding structures between headache patients and controls.
CONCLUSION: Patients with cluster headache or chronic paroxysmal hemicrania had wider skulls than headache-free controls, but the proportional dimensions of the cavernous sinus were similar.

PMID: 27009562 [PubMed - as supplied by publisher]

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Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction.

Related Articles

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction.

JAMA Facial Plast Surg. 2015 Sep-Oct;17(5):340-5

Authors: Barham HP, Knisely A, Christensen J, Sacks R, Marcells GN, Harvey RJ

Abstract
IMPORTANCE: External nasal valve dysfunction (EVD) is a common cause of nasal obstruction.
OBJECTIVE: To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD.
DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty.
MAIN OUTCOMES AND MEASURES: Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area.
RESULTS: Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02).
CONCLUSIONS AND RELEVANCE: Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD.
LEVEL OF EVIDENCE: 2.

PMID: 26247619 [PubMed - indexed for MEDLINE]

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Photodynamic therapy in the upper aerodigestive tract. Overview and outlook.

Photodynamic therapy in the upper aerodigestive tract. Overview and outlook.

J Biophotonics. 2016 Mar 24;

Authors: Volgger V, Betz CS

Abstract
The gold standard in the treatment of (pre)malignancies of the upper aerodigestive tract (UADT) is either surgery or (chemo)radiotherapy. Nevertheless, there are special indications where an alternative treatment, such as photodynamic therapy (PDT), might be as effective for and better tolerated by the patients concerned. This article aims to present a contemporary and comprehensive review on the role of photodynamic therapy in the treatment of (pre)malignancies of the UADT. PubMed was searched for "photodynamic therapy larynx/oral cavity/oropharynx/head and neck" in 01/2016. PDT can be efficient in the treatment of recurrent, residual or multiple carcinomas of the UADT without other treatment options. It has also been used with success in the treatment of early oral or laryngeal carcinomas, widespread precancerous lesions or "difficult-to-treat" skin cancer, even though these treatments are off-label. For now, unsolved scientific and economical challenges hinder the methods spread. In special cases, PDT is a highly effective method to treat head and neck (pre)malignancies. Nevertheless, further clinical studies are needed to better define its true value in head and neck oncology.

PMID: 27010591 [PubMed - as supplied by publisher]

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Cervical Spine Spondylodiscitis After Esophageal Dilation in Patients With a History of Laryngectomy or Pharyngectomy and Pharyngeal Irradiation.

Cervical Spine Spondylodiscitis After Esophageal Dilation in Patients With a History of Laryngectomy or Pharyngectomy and Pharyngeal Irradiation.

JAMA Otolaryngol Head Neck Surg. 2016 Mar 24;

Authors: D'Souza JN, Luginbuhl AJ, Goldman RA, Heller JE, Curry JM, Cognetti DM

Abstract
Importance: Dysphagia is a frequently reported sequela of treatment for head and neck cancer and is often managed with esophageal dilation in patients with dysphagia secondary to hypopharyngeal or esophageal stenosis. Reported complications of esophagoscopy with dilation include bleeding, esophageal perforation, and mediastinitis. These, though rare, can lead to substantial morbidity or mortality. In patients who have undergone irradiation, tissue fibrosis and devascularization may contribute to a higher incidence of these complications.
Objectives: To describe the occurrence of cervical spine spondylodiscitis (CSS) following esophageal dilation in patients with a history of laryngectomy or pharyngectomy and irradiation with or without chemotherapy.
Design, Setting, and Participants: Medical records from a 5-year period (January 1, 2009, through December 31, 2014) in an academic tertiary care center were searched for patients with a history of laryngopharyngeal irradiation and a diagnosis of CSS following esophageal dilation. Four eligible patients were identified.
Main Outcomes and Measures: Recognition and treatment of CSS in the study population.
Results: A total of 1221 patients underwent esophageal dilation for any reason. Of these, 247 patients carried a diagnosis of head and neck cancer at the following sites: piriform sinus, larynx, hypopharynx, epiglottis, oropharynx, base of the tongue, and tonsil. Of these, 4 patients with a diagnosis of CSS following esophageal dilation were included in this assessment. Prompt diagnosis and multidisciplinary management of CSS with intravenous antibiotics as well as spinal surgical debridement and stabilization led to recovery of full ability to take food by mouth in 3 of the 4 included patients. One patient remained dependent on the feeding tube.
Conclusion and Relevance: In patients with a history of laryngopharyngeal irradiation and esophageal dilation, complaints of neck pain or upper extremity weakness should trigger immediate evaluation for CSS; if present, prompt therapy is essential for prevention of substantial morbidity and mortality.

PMID: 27010455 [PubMed - as supplied by publisher]

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Histoanatomical characteristics to increase the success in transoral surgery for hypopharyngeal cancer.

Histoanatomical characteristics to increase the success in transoral surgery for hypopharyngeal cancer.

Laryngoscope. 2016 Mar 24;

Authors: Chitose SI, Sato K, Fukahori M, Sueyoshi S, Kurita T, Ono T, Shin B, Mihashi R, Umeno H

Abstract
OBJECTIVES/HYPOTHESIS: Transoral laser microsurgery (TLM) for hypopharyngeal cancer results in a lower incidence of complications than conventional open surgery. However, additional knowledge regarding the histoanatomical characteristics of the hypopharynx is necessary to prevent severe complications during TLM. The purpose of this study is to investigate the histoanatomical characteristics of the hypopharynx for TLM.
STUDY DESIGN: Histoanatomical study.
METHODS: Whole organ serial sections of three hypopharynges and larynges from autopsy cases were subjected to hematoxylin & eosin and Elastica van Gieson staining. Surgical histoanatomy of the hypopharynx was observed with each section, and the histoanatomical characteristics directly related to TLM performance were examined microscopically.
RESULTS: The histological structures of muscle layers showed obvious differences between each hypopharyngeal subsite. The posterolateral wall had two kinds of pharyngeal elevator muscles. These fasciae were connected to the perichondrium of the thyroid cartilage. The anterolateral wall between the superior horn and the lamina of the thyroid cartilage had no muscle layer. The superior laryngeal artery and the internal branch of the superior laryngeal nerve run into the larynx and hypopharynx at that site. The inner perichondrium of the thyroid cartilage was present beneath the mucosa. The dihedral angle of the anterior piriform fossa had a deep propria mucosa and paraglottic space. The postcricoid wall consisted of a multilayered structure, including cricoid cartilage covered with laryngeal muscles and mucosa.
CONCLUSION: A precise understanding of the histoanatomical characteristics of the hypopharynx increases the success of TLM, decreases complication rates, and improves laryngeal preservation.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.

PMID: 27010355 [PubMed - as supplied by publisher]

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Comparative pathomorphological, bacteriological and serological examination of broiler breeders and pheasants, experimentally infected with Ornithobacterium rhinotracheale.

Comparative pathomorphological, bacteriological and serological examination of broiler breeders and pheasants, experimentally infected with Ornithobacterium rhinotracheale.

Avian Pathol. 2016 Mar 24;:1-21

Authors: Gavrilović P, Gavrilović A, Vidanović D, Parunović J, Jovanović M

Abstract
The aim of the investigations was to determine the influence of Ornithobacterium rhinotracheale (ORT) on the development of pathomorphological lesions in the respiratory organs and on the health status of experimentally infected broiler breeders and pheasants from the rearing stage. There was no evidence of clinical symptoms in infected broiler breeder hens nor in the group of infected pheasants except for one bird in the latter group which exhibited slower movement and gasping. The frequency and intensity of pathomorphological lesions was higher in pheasants. The gross pathology findings were characterized mainly by redness of the mucosa of the upper respiratory tract and accumulation of mucous content in the nasal cavities, infraorbital sinuses, larynx, and trachea. Histopathology confirmed the presence of inflammation of the upper respiratory tract. Lesions in the lungs included hyperaemia, granulomatous and fibrinous pneumonia. ORT was reisolated only from the group of infected pheasants. Reisolation was successful from the respiratory organs (trachea, larynx, infraorbital sinuses, and lungs) of eight out of 10 infected birds. The serological response in both species was characterized by rapid production of specific antibodies that reached a maximum level in the blood in the first week after experimental infection. The antibody titers decreased gradually and were maintained at a stable level until the twelfth week after inoculation. Fourteen weeks post-inoculation specific antibodies could not be detected by ELISA.

PMID: 27010108 [PubMed - as supplied by publisher]

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Commentary: Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle.

Related Articles

Commentary: Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle.

Neurosurgery. 2015 Nov;77(5):E838-41

Authors: Kartush JM

PMID: 26261883 [PubMed - indexed for MEDLINE]

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A potentially fatal complication that may occur during dental treatment: "foreign body aspiration".

Related Articles

A potentially fatal complication that may occur during dental treatment: "foreign body aspiration".

Pan Afr Med J. 2015;20:36

Authors: Eroglu O, Algan-Kaya H, Coskun F

Abstract
Numerous systemic emergency situations, such as hypotension or allergic reactions, may be encountered during dental treatment. In addition, rare but life-threatening complications such as foreign body aspiration in the air passages may also be seen. Aspirated foreign bodies include teeth, implants, mechanical supports or materials used during procedures. We report two separate cases of aspiration risk developing during the course of dental treatment.

PMID: 26029325 [PubMed - indexed for MEDLINE]

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Delivery of a mucin domain enriched in cysteine residues strengthens the intestinal mucous barrier.

Related Articles

Delivery of a mucin domain enriched in cysteine residues strengthens the intestinal mucous barrier.

Sci Rep. 2015;5:9577

Authors: Gouyer V, Dubuquoy L, Robbe-Masselot C, Neut C, Singer E, Plet S, Geboes K, Desreumaux P, Gottrand F, Desseyn JL

Abstract
A weakening of the gut mucous barrier permits an increase in the access of intestinal luminal contents to the epithelial cells, which will trigger the inflammatory response. In inflammatory bowel diseases, there is an inappropriate and ongoing activation of the immune system, possibly because the intestinal mucus is less protective against the endogenous microflora. General strategies aimed at improving the protection of the intestinal epithelium are still missing. We generated a transgenic mouse that secreted a molecule consisting of 12 consecutive copies of a mucin domain into its intestinal mucus, which is believed to modify the mucus layer by establishing reversible interactions. We showed that the mucus gel was more robust and that mucin O-glycosylation was altered. Notably, the gut epithelium of transgenic mice housed a greater abundance of beneficial Lactobacillus spp. These modifications were associated with a reduced susceptibility of transgenic mice to chemically induced colitis. Furthermore, transgenic mice cleared faster Citrobacter rodentium bacteria which were orally given and mice were more protected against bacterial translocation induced by gavage with adherent-invasive Escherichia coli. Our data show that delivering the mucin CYS domain into the gut lumen strengthens the intestinal mucus blanket which is impaired in inflammatory bowel diseases.

PMID: 25974250 [PubMed - indexed for MEDLINE]

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New developments in goblet cell mucus secretion and function.

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New developments in goblet cell mucus secretion and function.

Mucosal Immunol. 2015 Jul;8(4):712-9

Authors: Birchenough GM, Johansson ME, Gustafsson JK, Bergström JH, Hansson GC

Abstract
Goblet cells and their main secretory product, mucus, have long been poorly appreciated; however, recent discoveries have changed this and placed these cells at the center stage of our understanding of mucosal biology and the immunology of the intestinal tract. The mucus system differs substantially between the small and large intestine, although it is built around MUC2 mucin polymers in both cases. Furthermore, that goblet cells and the regulation of their secretion also differ between these two parts of the intestine is of fundamental importance for a better understanding of mucosal immunology. There are several types of goblet cell that can be delineated based on their location and function. The surface colonic goblet cells secrete continuously to maintain the inner mucus layer, whereas goblet cells of the colonic and small intestinal crypts secrete upon stimulation, for example, after endocytosis or in response to acetyl choline. However, despite much progress in recent years, our understanding of goblet cell function and regulation is still in its infancy.

PMID: 25872481 [PubMed - indexed for MEDLINE]

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Chronic neck pain and episodic vertigo and tinnitus.

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Chronic neck pain and episodic vertigo and tinnitus.

Pain Med. 2015 Jan;16(1):200-2

Authors: Peng B, Pang X, Yang H

PMID: 25339097 [PubMed - indexed for MEDLINE]

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Removal of a maxillary third molar accidentally displaced into the maxillary sinus: presurgical and surgical management.

Removal of a maxillary third molar accidentally displaced into the maxillary sinus: presurgical and surgical management.

Minerva Stomatol. 2016 Apr;65(2):122-5

Authors: Berton F, Stacchi C, Lombardi T, DI Lenarda R

PMID: 27009415 [PubMed - in process]

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Crestal sinus lift by using a mini-invasive procedure: a case series.

Crestal sinus lift by using a mini-invasive procedure: a case series.

Minerva Stomatol. 2016 Apr;65(2):107-21

Authors: Borgonovo AE, Vitaliano T, Medagliani P, Bianchi A, Re D

Abstract
BACKGROUND: The aim of this study was to present a case series treated with an atraumatic procedure for maxillary sinus lift by crestal approach. This technique avoids the use of classical osteotomes, thus decreasing complications due to percussive and vibratory forces.
METHODS: Three cases of partial edentulism in the distal maxillae with inadequate bone volume are treated by using SinCrest® procedure (Meta, Reggio Emilia, Italy). With the guide of surgical templates, the sinus lift was performed, and implants were placed during the same procedure. After 6 months an X-ray was taken to check the success of the operation.
RESULTS: SinCrest® allows the operator to advance progressively, maintaining the correct axis for implant placement. The plane tip of drills prevents accidental perforations of Schneiderian mucose, and the stops, available in different lengths, avoid the overtreatment. The manual screwing of SinCrest® osteotome ensures precision during the cortical approach, while the built-in probe allows to check residual strength of sinusal floor, making sure that the Schneiderian mucose is reached and lifted. This technique does not depend on the operator's skills and decreases the onset of adverse effects due to the hammering with classical osteotomes. SinCrest® requires a small flap and osteotomy, which means less healing time and more comfort for the patient, both during and after the surgery.
CONCLUSIONS: SinCrest® is a valid alternative to other mini-invasive procedures for sinus lift in cases with a residual height bone of at least 5 mm, allowing an atraumatic, safe and controlled operation.

PMID: 27009414 [PubMed - in process]

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Headache and temporo mandibular disorders: epidemiological assessment.

Headache and temporo mandibular disorders: epidemiological assessment.

Minerva Stomatol. 2016 Apr;65(2):85-96

Authors: D'Urso A, Serritella E, Tolevski Meshkova D, Falisi G, DI Paolo C

Abstract
BACKGROUND: Temporo mandibular disorders (TMDs) and headache are closely related pathologies. The aim of this study was to determine the prevalence, incidence, and the intensity of headache in 3304 dysfunctional patients (G1) at the Service of Clinical Gnathology of the Head-Neck Assistance Department of Umberto I Polyclinic at Sapienza University of Rome.
METHODS: G1 is composed by two subgroups of patient S1 (N.=2375) and S2 (N.=929) analyzed in different periods, respectively 1996-2006 and 2011-2013. The findings were compared with those of a control group of subjects from the general Italian population recently reported elsewhere. The prevalence of headache in the dysfunctional population was analyzed by calculating the proportion of that population who tested positive to cephalic pain for the entire study period. The incidence of headache has been calculated by determining the proportion cases of headache in TMD population, during the period analyzed among those considered at risk at the beginning of the examination period. The intensity of cephalic pain was evaluated using the Verbal Numeric Scale. Confidence Intervals (CI) at the 95% confidence level were calculated to get a precise estimate of research data.
RESULTS: Comparison of G1 and control sample did not reveal many important differences, respectively with a headache prevalence of 49.5% (95%CI 47.8%-51.2%) and 42.8%(95%CI 46.8-38.8%). However, comparison of S1, which constituted a sample similar in numbers to the control sample and was observed during a similar time period, revealed a clearly greater prevalence of headache in the dysfunctional population 67.3% (95%CI 64.3-70.3%) than in the general representative population of Italian people 42.8% (95%CI 46.8-38.8%). The incidence of headache in the dysfunctional population was 39.49% (95%CI 37.79-41.19%). Headache incidence in the first subgroup (S1) was 32.7%(95%CI 34.6-30.8%), while in S2 was 59.24%(95%CI 56.24-62.24%), demonstrating an increase of incidence in the second subgroup analyzed. In G1 the average intensity of headache was severe (VNS>50). Headache is more intense in dysfunctional patients of the second subgroups (S2) than the first subgroup (S1) VNS 24.91 (95%CI 23.11-26.71) vs. 70.00 (95%CI 67.0-73.0).
CONCLUSIONS: These findings confirm the existence of a relationship between headache and TMDs, showing that a dysfunctional patient has a greater predisposition to headache than a non-dysfunctional subject.

PMID: 27009413 [PubMed - in process]

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Comparison of the palatal expansion obtained via the use of the rapid maxillary expander compared with surgically assisted rapid maxillary expansion.

Comparison of the palatal expansion obtained via the use of the rapid maxillary expander compared with surgically assisted rapid maxillary expansion.

Minerva Stomatol. 2016 Apr;65(2):72-84

Authors: Giannini L, Maspero C, Galbiati G, Feresini M, Farronato G

Abstract
BACKGROUND: The aim of this retrospective study was to evaluate and compare cephalometrically the skeletal and dental effects of maxillary expansion by the rapid maxillary expander compared to a surgical assisted rapid maxillary expansion.
METHODS: The records which included 102 patients (50 female, 52 male) with maxillary bilateral cross bite caused by narrowness of the apical base are collected and divided into two treatment groups: the first group (63 patients, 36 male and 27 female) included patients who had been treated with an orthopedic rapid maxillary expander. The second group (39 patients, 16 male, 23 female) included patients who had been treated by a surgical assisted rapid maxillary expansion. For each patient two frontal cephalograms, one taken before treatment (T0) and a second one after the retention phase (T1), were analyzed. Descriptive statistics included the means and standard deviations (SD). The mean differences in cephalometric measurements at T0 and T1 were examined. Statistical analysis was undertaken using a T test for paired samples. Statistical significance was considered at P<0.05 level.
RESULTS: Both the therapeutic approaches have shown a statistically significant widening of the maxilla and a symmetrization of the two halves of the bone, at both skeletal and dental levels.
CONCLUSIONS: Rapid maxillary expander and surgically assisted rapid maxillary expansion SARME can be used for the resolution of malocclusions characterized by a transverse maxillary hypoplasia. The choice between RME and SARME is linked to the age of the patient, and the biological stage of the maxillary suture.

PMID: 27009412 [PubMed - in process]

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The influence of concentration of HEMA on degree of conversion and cytotoxicity of a dental bonding resin.

The influence of concentration of HEMA on degree of conversion and cytotoxicity of a dental bonding resin.

Minerva Stomatol. 2016 Apr;65(2):65-71

Authors: DE Carvalho RV, Chisini LA, Ferrua CP, Guiraldo RD, Gonini A, Moura SK, Tarquínio SB, Demarco FF

Abstract
BACKGROUND: This study evaluated the influence of 2-hydroxyethyl methacrylate (HEMA) on the degree of conversion (DC) and cytotoxicity of a dental bonding resin (DBR).
METHODS: A monomer mixture based on 61.9 wt% of bisphenol A glycidyl methacrylate (Bis-GMA), 36.9 wt% of triethylene glycol dimethacrylate (TEGDMA), and photoactivated using a binary system based on camphoroquinone (0.4 wt%) and ethyl 4-dimethylamine benzoate (0.8 wt%) was used as DBR. Different groups were obtained with addition of HEMA in crescent concentrations. DC was accessed by Real time Fourier Transform infrared spectroscopy. The cytotoxicity was evaluated with MTT assay. The DC and cytotoxicity were analyzed by one-way ANOVA followed by Tukey's Test (P<0.05).
RESULTS: A decrease in the DC was observed in the group with higher amount of HEMA. All tested-extracts were cytotoxic and there was an increased cytotoxic effect with higher HEMA addition.
CONCLUSIONS: Higher amount of HEMA in the DBR resulted in adverse effects, with more cell toxicity and lower degree of conversion.

PMID: 27009411 [PubMed - in process]

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Average optimal DPOAE primary tone levels in normal-hearing adults.

Average optimal DPOAE primary tone levels in normal-hearing adults.

Int J Audiol. 2016 Mar 24;:1-8

Authors: Marcrum SC, Kummer P, Kreitmayer C, Steffens T

Abstract
OBJECTIVE: Despite great progress towards optimizing DPOAE primary tone characteristics, factors such as stimulus and intra-subject emission variability have not been addressed. The purpose of this study was to identify optimal primary tone level relationships when these sources of variability were acknowledged, and to identify any influences of test frequency.
DESIGN: Following coupler-based measurements assessing primary tone level stability, two experiments were conducted. In experiment 1, DPOAE test-retest reliability without probe replacement was measured for f2 = 1-6 kHz with L1 = L2 = 65 dB SPL. In experiment 2, optimal L1-L2 relationships were identified for f2 = 1-6 kHz. For 20 ≤ L2 ≤ 75 dB SPL, L1 was varied 15 dB SPL above and below the recommendation of L1 = 0.4 L2 + 39 [dB SPL].
STUDY SAMPLE: Eleven normal-hearing adults participated in experiment 1. Thirty normal-hearing adults participated in experiment 2.
RESULTS: Stimulus variability did not exceed 0.1 dB SPL. DPOAE reliability testing revealed an across-frequency mean standard error of measurement of 0.52 dB SPL. The average optimal L1-L2 relationship was described by L1 = 0.49 L2 + 41 [dB SPL]. A significant effect of frequency was identified for 6 kHz.
CONCLUSION: Including relevant sources of variability improves internal validity of a primary tone level optimization formula.

PMID: 27010374 [PubMed - as supplied by publisher]

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Average optimal DPOAE primary tone levels in normal-hearing adults.

Average optimal DPOAE primary tone levels in normal-hearing adults.

Int J Audiol. 2016 Mar 24;:1-8

Authors: Marcrum SC, Kummer P, Kreitmayer C, Steffens T

Abstract
OBJECTIVE: Despite great progress towards optimizing DPOAE primary tone characteristics, factors such as stimulus and intra-subject emission variability have not been addressed. The purpose of this study was to identify optimal primary tone level relationships when these sources of variability were acknowledged, and to identify any influences of test frequency.
DESIGN: Following coupler-based measurements assessing primary tone level stability, two experiments were conducted. In experiment 1, DPOAE test-retest reliability without probe replacement was measured for f2 = 1-6 kHz with L1 = L2 = 65 dB SPL. In experiment 2, optimal L1-L2 relationships were identified for f2 = 1-6 kHz. For 20 ≤ L2 ≤ 75 dB SPL, L1 was varied 15 dB SPL above and below the recommendation of L1 = 0.4 L2 + 39 [dB SPL].
STUDY SAMPLE: Eleven normal-hearing adults participated in experiment 1. Thirty normal-hearing adults participated in experiment 2.
RESULTS: Stimulus variability did not exceed 0.1 dB SPL. DPOAE reliability testing revealed an across-frequency mean standard error of measurement of 0.52 dB SPL. The average optimal L1-L2 relationship was described by L1 = 0.49 L2 + 41 [dB SPL]. A significant effect of frequency was identified for 6 kHz.
CONCLUSION: Including relevant sources of variability improves internal validity of a primary tone level optimization formula.

PMID: 27010374 [PubMed - as supplied by publisher]

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Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations.

Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations.

Laryngoscope. 2016 Mar 24;

Authors: Boyce BJ, Curry JM, Luginbuhl A, Cognetti DM

Abstract
OBJECTIVES/HYPOTHESIS: The transoral robotic approach to parapharyngeal space (PPS) tumors is a new technique with limited data available on its feasibility, safety, and efficacy. We analyzed our experience with transoral robotic excisions of PPS tumors to evaluate the safety and efficacy of this technique.
STUDY DESIGN: Retrospective chart analysis at tertiary academic medical center. From July 2010 to June 2014, 17 patients who had transoral robotic excision of PPS tumors were included in the study. Our cohort had an average age of 61.6 years and was 52.9% male.
RESULTS: All patients had successful removal of their PPS tumors, and the average size of the tumors was 27.3 cm(3) (range 2-80 cm(3) ). Two cases (11.7%) required a cervical incision to assist with tumor removal. The average total operative time was 140.5 minutes. Two PPS PAs had focal areas of capsule rupture and one was fragmented. The average length of stay was 1.8 days (range 1-7 days), and all patients were discharged on an oral diet. Three patients experienced complications. There was no clinical or radiographic evidence of recurrence.
CONCLUSION: This is the largest single-institution case series of transoral robotic approaches to PPS tumors. We demonstrate that this approach is feasible and safe but also note limitations of the robotic approaches for tumors on the far lateral and superior areas of the PPS, which required transcervical assistance. There were no patients who demonstrated recurrent tumor either radiographically or clinically.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 27010862 [PubMed - as supplied by publisher]

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Morphological study of the posterior osseous structures of subaxial cervical spine in a population from northeastern China.

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Morphological study of the posterior osseous structures of subaxial cervical spine in a population from northeastern China.

J Orthop Surg Res. 2015;10:53

Authors: Wang Z, Leng J, Liu J, Liu Y

Abstract
BACKGROUND: Laminar screws and lateral mass screws have been increasingly used in the treatment of cervical diseases. The purpose of this study is to determine the morphological characteristics of the posterior anatomical structures of the subaxial cervical vertebrae in a northeastern Chinese population.
METHODS: Sixty-one consecutive patients underwent cervical spine computed tomography (CT). We analyzed a total of 610 axial images and 61 sagittal images. The following parameters were measured: lamina outer width (LOW), lamina inner width (LIW), lamina axis length (LAL), lamina transverse angle (LTA), lateral mass longitudinal diameter (LMLD), lateral mass transverse diameter (LMTD), sagittal spinous process length (SSPL), axial spinous process length (ASPL), spinal canal transverse diameter (SCTD), spinal canal longitudinal diameter (SCLD), osseous spinal canal area (OSCA), and Pavlov ratio (PR). The participants were classified into male and female groups and developmental canal stenosis (DCS; PR ≤0.75) and non-DCS (NDCS; PR >0.75) groups.
RESULTS: Significant differences were observed among the different vertebral levels for almost all evaluated parameters, except for LTA and OSCA. Statistical differences were found between the right and left sides in all parameters, except for LIW and LOW. All linear parameters, except for SCLD and the angular parameter LTA, significantly differed between the sexes. Significant differences were found between the DCS and NDCS groups in terms of all parameters, except for SCTD.
CONCLUSIONS: Various measurements of the posterior structures of subaxial cervical vertebrae differed between the left and right sides, females and males, and the DCS and NDCS groups. Different techniques for lateral mass screw insertion should be used according to different vertebral level. Only C7 laminar may be able to safely accommodate a 2.5-mm translaminar screw. The study data can help doctors to make better surgical decisions and develop more appropriate implants for northeastern Chinese patients.

PMID: 25896074 [PubMed - indexed for MEDLINE]

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Clinical findings of extranodal SNT lymphoid malignancies in a four-decade single-centre series.

Clinical findings of extranodal SNT lymphoid malignancies in a four-decade single-centre series.

Eur Arch Otorhinolaryngol. 2016 Mar 24;

Authors: Vähämurto P, Silventoinen K, Vento SI, Karjalainen-Lindsberg ML, Haapaniemi A, Bäck L, Mannisto S, Leppä S, Mäkitie AA

Abstract
Sinonasally located lymphoid malignancies are rare lesions with first symptoms similar to other obstructive conditions. Additionally, they often coexist with nasal inflammation and mucosal necrosis. Therefore, time from the first symptoms to diagnosis tends to be long. Awareness and early diagnosis of this disease entity could improve treatment outcome. Altogether, 142 patients with sinonasal or nasopharyngeal (i.e. sinonasal tract, SNT) lymphoid malignancies, diagnosed and treated at the Helsinki University Hospital, during a 39-year period from 1975 to 2013, were retrospectively reviewed. There were 90 males (63 %) and 52 females (37 %) with a median age of 64 years (range 26-92). Eighty-four percent of the patients had primary diseases and 16 % had relapses of lymphoid malignancies primarily diagnosed at other locations. The mean duration of symptoms prior to diagnosis was 4.8 months (range 0.5-24). The most common histological entity was diffuse large B-cell lymphoma (43 %), followed by plasmacytoma (18 %). The most common location was nasopharynx (58 %) followed by nasal cavity (44 %) and paranasal sinuses (35 %). Sixty-nine percent of the lesions were at a single anatomic location of the sinonasal tract. Fifty-two percent of the cases were of Ann Arbor Stage I. Lymphoid malignancies form an important and diverse group in the differential diagnosis of SNT tumours. They most often present with general obstructive nasal symptoms due to tumour location. Most of them are primary lesions, highlighting the importance of an accurate diagnosis as early as possible.

PMID: 27010643 [PubMed - as supplied by publisher]

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