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

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

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

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

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

PMID: 25974330 [PubMed - indexed for MEDLINE]

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

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

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

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

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

PMID: 27017714 [PubMed - in process]

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

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

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

Authors: Andreu-Gallien J, Tourniaire B

PMID: 26112502 [PubMed - indexed for MEDLINE]

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

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

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

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

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

PMID: 24717672 [PubMed - indexed for MEDLINE]

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

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

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

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

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

PMID: 26339960 [PubMed - indexed for MEDLINE]

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

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

Int J Lang Commun Disord. 2016 Mar 27;

Authors: Stansfield J, Armstrong L

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

PMID: 27018211 [PubMed - as supplied by publisher]

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DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

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

Authors: Kovacić M, Kovacić I, Dželalija B

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

PMID: 27017733 [PubMed - in process]

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

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

PLoS One. 2016;11(3):e0151327

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

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

PMID: 27019106 [PubMed - as supplied by publisher]

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

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

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

Authors: Li XH, Sun Z, He LL

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

PMID: 25966138 [PubMed - indexed for MEDLINE]

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

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

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

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

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

PMID: 25416844 [PubMed - indexed for MEDLINE]

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

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

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

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

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

PMID: 27018694 [PubMed - as supplied by publisher]

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

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

Head Neck. 2016 Mar 28;

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

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

PMID: 27018982 [PubMed - as supplied by publisher]

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