Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence.

Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence.

Head Neck. 2016 Apr 7;

Authors: Cho YY, Jang HW, Jang JY, Kim TH, Choe JH, Kim JH, Kim JS, Kim SW, Chung JH

Abstract
BACKGROUND: Persistent hypercalcitoninemia is reported in 40% to 60% of patients with medullary thyroid cancer (MTC) after initial therapy, but their clinical outcomes have not been clearly studied. We evaluated the outcomes of MTC with hypercalcitoninemia and assessed the cutoffs of postoperative serum calcitonin for predicting structural recurrence.
METHODS: A dynamic risk assessment system was used to categorize clinical outcomes in this retrospective study. Receiver operating characteristic (ROC) curve analysis was used to calculate the calcitonin cutoffs for predicting structural recurrence.
RESULTS: Among 120 patients operated on, 30 (25%) had persistent hypercalcitoninemia. Of that group, 18 (60%) had biochemical persistent disease and 11 (37%) developed structural identified disease, including 1 death (3%). Postoperative calcitonin <29 pg/mL predicted structural disease with 100% sensitivity, 90.5% specificity, and 100% negative predictive value.
CONCLUSION: One third of the patients with MTC with hypercalcitoninemia experienced structural recurrence, and postoperative basal serum calcitonin might be a simple tumor marker to predict structural recurrence. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062421 [PubMed - as supplied by publisher]

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Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases.

Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases.

Head Neck. 2016 Apr 9;

Authors: Macias AA, Eappen S, Malikin I, Goldfarb J, Kujawa S, Konowitz PM, Kamani D, Randolph GW

Abstract
BACKGROUND: Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.
METHODS: The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.
RESULTS: No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.
CONCLUSION: An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062311 [PubMed - as supplied by publisher]

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Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma.

Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma.

Head Neck. 2016 Apr 7;

Authors: Gweon HM, Koo HR, Son EJ, Kim JA, Youk JH, Hong SW, Lim BJ

Abstract
BACKGROUND: The purpose of this study was to investigate the role of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) as a prognostic marker in conventional papillary thyroid carcinoma (PTC).
METHODS: A total of 397 patients who underwent ultrasound-guided fine-needle aspiration biopsy (FNAB) and surgery for conventional PTCs were enrolled. The association between the Bethesda category and histopathologic result was evaluated.
RESULTS: Among the Bethesda categories, a significant difference was found in the presence of extrathyroidal extension (Bethesda category III, 3.2% [7 of 220]; category V, 19.1% [42 of 220]; and category VI, 77.7% [171 of 220]; p < .001) and lymph node metastasis (Bethesda category III, 3.8% [6 of 156]; category V, 16.7% [26 of 156]; and category VI, 79.5% [124 of 156]; p < .001). Multivariate analysis showed that the Bethesda category was independently predictive of extrathyroidal extension (p = .013) and lymph node metastasis (p = .035).
CONCLUSION: Conventional PTC with a higher Bethesda category at the time of cytology diagnosis would be poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062195 [PubMed - as supplied by publisher]

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Prognostic value of FDG-PET volumetric parameters in patients with p16-positive oropharyngeal squamous cell carcinoma who received curative resection followed by postoperative radiotherapy or chemoradiotherapy.

Prognostic value of FDG-PET volumetric parameters in patients with p16-positive oropharyngeal squamous cell carcinoma who received curative resection followed by postoperative radiotherapy or chemoradiotherapy.

Head Neck. 2016 Apr 9;

Authors: Kim KH, Lee J, Chang JS, Lee CG, Yun M, Choi EC, Kim SH, Keum KC

Abstract
BACKGROUND: The purpose of this study was to determine whether pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) volumetric parameters add more prognostic information to p16-positive oropharyngeal squamous cell carcinoma (SCC).
METHODS: We retrospectively analyzed 86 patients with p16-positive oropharyngeal SCC who underwent surgery and postoperative radiotherapy (RT) or chemoradiotherapy (CRT). Maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured.
RESULTS: Higher total MTV (tMTV), nodal MTV (nMTV), and tumor TLG (tTLG) were significantly associated with lower disease-free survival (DFS) (all p < .05) and higher distant metastasis rates (all p < .05). Multivariate analysis of DFS revealed that tMTV (p = .032), nMTV (p = .004), and tTLG (p = .018) were independently significant prognosticators.
CONCLUSION: Patients with p16-positive disease with high metabolic tumor burden were associated with higher distant metastasis rates, translating into worse survival. These patients may not be optimal candidates for treatment deintensification. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27062085 [PubMed - as supplied by publisher]

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Historical compliance rates for providing postoperative radiotherapy in oral cavity squamous cell carcinoma.

Historical compliance rates for providing postoperative radiotherapy in oral cavity squamous cell carcinoma.

Head Neck. 2016 Apr 9;

Authors: Hinther A, Nakoneshny SC, Dort JC, Chandarana SP, Matthews TW

Abstract
BACKGROUND: In 2014, Alberta Health Services released guidelines for treating oral squamous cell carcinoma (OSCC).
METHODS: A retrospective analysis was performed to assess the historical selection of patients with OSCC for postoperative radiotherapy (PORT) in a prospectively collected cohort of patients being treated with primary surgery. The primary outcome was compliance with the 2014 Alberta Health Services (AHS) guideline recommendations for PORT. The secondary outcome was the selection of PORT according to published pathological indications of high, intermediate, and low risk of recurrence. Reasons for discordance were analyzed.
RESULT: Noncompliance with the new AHS guidelines and published indications for PORT was observed in 17% and 30% of cases, respectively. The reasons for discordance with published indications included: clinician decision (n = 41) and unmodifiable factors (n = 17).
CONCLUSION: The impact of noncompliance on patient outcomes is being studied. The effect of the publication of the guidelines on selection for PORT going forward will be monitored. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061951 [PubMed - as supplied by publisher]

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Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck.

Brachytherapy after salvage surgery in cases with large isolated cervical recurrence of squamous cell carcinoma in the previously irradiated neck.

Head Neck. 2016 Apr 9;

Authors: Miroir J, Biau J, Saroul N, Moreira JF, Russier M, Lapeyre M

Abstract
BACKGROUND: Perioperative brachytherapy after salvage surgery is a therapeutic option in patients with cervical relapse of a primary, controlled, previously irradiated head and neck squamous cell carcinoma. The purpose of this study was to analyze the outcome of this treatment.
METHODS: Between 2008 and 2013, 8 patients underwent cervical brachytherapy after neck dissection. The mean node size was 5.5 cm. Recurrence occurred in an irradiated field (median dose, 50 Gy). Brachytherapy was performed with (192) iridium and dosimetry in accord with the rules of the Paris system. The dose was 60 to 62.7 Gy on the reference isodose.
RESULTS: The mean follow-up was 17 months. The median overall survival (OS) was 12 months. The OS was 19% at 2 years and 0% at 5 years. A grade 5 postoperative adverse event occurred in 1 patient. At 6 months, all patients had a grade 3 neck soft tissue fibrosis. One patient had a lethal hemorrhage at 56 months.
CONCLUSION: Brachytherapy is toxic in this population with poor OS. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061855 [PubMed - as supplied by publisher]

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Antitumor effect of CXCR4 antagonist AMD3100 on the tumorigenic cell line of BHP10-3 papillary thyroid cancer cells.

Antitumor effect of CXCR4 antagonist AMD3100 on the tumorigenic cell line of BHP10-3 papillary thyroid cancer cells.

Head Neck. 2016 Apr 7;

Authors: Jung YH, Lee DY, Cha W, Kim BH, Sung MW, Kim KH, Ahn SH

Abstract
BACKGROUND: A tumorigenic cell line (BHP10-3M) derived from nontumorigenic papillary thyroid carcinoma (PTC) cells (BHP10-3) having rearranged during transfection (RET)/PTC1 gene rearrangement might have a higher expression of CXCR4, either quantitatively or functionally. The authors also postulated that CXCR4-mediated invasion or tumorigenesis could be blocked by CXCR4 antagonists, including AMD3100.
METHODS: The expression of CXCR4 in BHP10-3 and BHP10-3M cells was assessed using immunoblot analysis, flow cytometry, and quantitative reverse-transcriptase polymerase chain reaction (RT-PCR). The effect of AMD3100 on BHP10-3 and BHP10-3M cell lines was evaluated using cell proliferation assay, invasion assay, and tumor growth experiment in nude mice.
RESULTS: Immunoblotting, flow cytometry, and quantitative RT-PCR proved that BHP10-3M cells expressed a higher level of CXCR4 than BHP10-3 cells. Although blocking CXCR4 with AMD3100 did not suppress cell proliferation in both cell lines from 1 ng/mL to 100 ng/mL concentration, AMD3100 suppressed invasion of BHP10-3M cells in vitro in a dose-dependent manner. At higher concentrations from 10(3) ng/mL to 10(5) ng/mL, the proliferation of BHP10-3M cells was inhibited more strongly by AMD3100 than that of BHP10-3 cells. Intraperitoneal injection of AMD3100 inhibited tumor formation by BHP10-3M cells in the thyroid of nude mice.
CONCLUSION: A tumorigenic cell line (BHP10-3M) of PTC showed higher expression of CXCR4 quantitatively and functionally than a nontumorigenic cell line (BHP10-3). The CXCR4 antagonist (AMD3100) showed a significant antitumor effect on the tumorigenic cell line of PTC BHP10-3 cells both in vitro and in vivo. CXCR4 antagonist can be expected to have an adjuvant role in the management of PTC. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061747 [PubMed - as supplied by publisher]

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Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma.

Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma.

Head Neck. 2016 Apr 7;

Authors: Ko HH, Cheng SL, Lee JJ, Chen HM, Wang CW, Cheng SJ, Kok SH

Abstract
BACKGROUND: Although second primary tumors are common in patients with oral squamous cell carcinoma (OSCC), their predisposing factors and treatment guideline remain uncertain.
METHODS: Three hundred ninety-four patients with OSCC who received radical surgery from January 2002 to December 2009 were retrospectively reviewed.
RESULTS: Forty-five patients developed oral second primary tumors. Areca quid chewing, tongue tumors, and nodal metastasis were risk factors for second primary tumors. Multivariate analyses revealed that no second primary tumor (hazard ratio [HR] = 5.046; 95% confidence interval [CI] = 3.704-12.246; p = .003), contralateral neck dissection for ipsilateral second primary tumors (HR = 6.254; 95% CI = 3.027-13.365; p = .007), and postoperative radiotherapy (RT; HR = 3.987; 95% CI = 1.099-10.381; p = .040) were independent favorable prognostic factors.
CONCLUSION: Areca quid chewing, tongue tumors, and nodal metastasis predisposed patients with OSCC to second primary tumor development. Elective dissection of the contralateral neck in patients with second primary tumors ipsilateral to index tumors and postoperative RT for eligible patients should always be considered in the management of oral second primary tumors. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27061604 [PubMed - as supplied by publisher]

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Benign Paroxysmal Positional Vertigo: Our Experience.

Benign Paroxysmal Positional Vertigo: Our Experience.

Indian J Otolaryngol Head Neck Surg. 2016 Mar;68(1):39-41

Authors: Patangay KK, Ansari R

Abstract
Benign paroxysmal positional vertigo (BPPV) is probably common cause of vertigo. A total of 205 cases reported to ENT OPD for vertigo. Of these 43 patients were found to suffer from BPPV and in our experience BPPV is common condition. BPPV was more common in age group of 4th and 7th decades. The youngest patient reported was 41 years and the oldest patient was 78 years with a mean of 56.5. In this group there were 16 females and 27 males. This is a retrospective case study of 205 cases presenting with vertigo. The modality of treatment was Epley's manoeuvre in cases diagnosed with BPPV. The age of patients ranged from 41 to 78 years with mean of 56.5. The over all success rate was 96 %. All cases were instructed to report recurrence and were followed for 1 year.

PMID: 27066408 [PubMed - as supplied by publisher]

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Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology.

Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology.

Case Rep Neurol. 2016 Jan-Apr;8(1):59-65

Authors: Berntsson SG, Katsarogiannis E, Lourenço F, Moraes-Fontes MF

Abstract
Progressive multifocal leukoencephalopathy (PML) caused by reactivation of the JC virus (JCV), a human polyomavirus, occurs in autoimmune disorders, most frequently in systemic lupus erythematosus (SLE). We describe a HIV-negative 34-year-old female with SLE who had been treated with immunosuppressant therapy (IST; steroids and azathioprine) since 2004. In 2011, she developed decreased sensation and weakness of the right hand, followed by vertigo and gait instability. The diagnosis of PML was made on the basis of brain MRI findings (posterior fossa lesions) and JCV isolation from the cerebrospinal fluid (700 copies/ml). IST was immediately discontinued. Cidofovir, mirtazapine, mefloquine and cycles of cytarabine were sequentially added, but there was progressive deterioration with a fatal outcome 1 year after disease onset. This report discusses current therapeutic choices for PML and the importance of early infection screening when SLE patients present with neurological symptoms. In the light of recent reports of PML in SLE patients treated with rituximab or belimumab, we highlight that other IST may just as well be implicated. We conclude that severe lymphopenia was most likely responsible for JCV reactivation in this patient and discuss how effective management of lymphopenia in SLE and PML therapy remains an unmet need.

PMID: 27065427 [PubMed - as supplied by publisher]

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Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss.

Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss.

Chin Med J (Engl). 2016 20th Apr;129(8):946-952

Authors: Li FJ, Wang DY, Wang HY, Wang L, Yang FB, Lan L, Guan J, Yin ZF, Rosenhall U, Yu L, Hellstrom S, Xue XJ, Duan ML, Wang QJ

Abstract
BACKGROUND: The prevalence of sudden sensorineural hearing loss in children (CSSNHL) is consistently increasing. However, the pathology and prognosis of CSSNHL are still poorly understood. This retrospective study evaluated clinical characteristics and possible associated factors of CSSNHL.
METHODS: One hundred and thirty-six CSSNHL patients treated in Department of Otolaryngology-Head and Neck Surgery and Institute of Otolaryngology at Chinese PLA General Hospital between July 2008 and August 2015 were included in this study. These patients were analyzed for clinical characteristics, audiological characteristics, laboratory examinations, and prognostic factors.
RESULTS: Among the 136 patients (151 ears), 121 patients (121 ears, 80.1%) were diagnosed with unilaterally CSSNHL, and 15 patients (30 ears, 19.9%) with bilateral CSSNHL. The complete recovery rate of CSSNHL was 9.3%, and the overall recovery rate was 37.7%. We found that initial degree of hearing loss, onset of treatment, tinnitus, the ascending type audiogram, gender, side of hearing loss, the recorded auditory brainstem response (ABR), and distortion product otoacoustic emissions (DPOAEs) had prognostic significance. Age, ear fullness, and vertigo had no significant correlation with recovery. Furthermore, the relevant blood tests showed 30.8% of the children had abnormal white blood cell (WBC) counts, 22.1% had elevated homocysteine levels, 65.8% had high alkaline phosphatase (ALP), 33.8% had high IgE antibody levels, and 86.1% had positive cytomegalovirus (CMV) IgG antibodies.
CONCLUSIONS: CSSNHL commonly occurs unilaterally and results in severe hearing loss. Initial severe hearing loss and bilateral hearing loss are negative prognostic factors for hearing recovery, while positive prognostic factors include tinnitus, gender, the ascending type audiogram, early treatment, identifiable ABR waves, and DPOAEs. Age, vertigo, and ear fullness are not correlated with the recovery. Some serologic indicators, including the level of WBC, platelet, homocysteine, ALP, positive CMV IgG antibody, fibrinogen, and some immunologic indicators, are closely related to CSSNHL.

PMID: 27064040 [PubMed - as supplied by publisher]

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A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine.

A retrospective analysis of triptan and dhe use for basilar and hemiplegic migraine.

Headache. 2016 Apr 8;

Authors: Mathew PG, Krel R, Buddhdev B, Ansari H, Joshi SG, Spinner WD, Klein BC

Abstract
BACKGROUND: Patients with basilar migraine (BM) and hemiplegic migraine (HM) have been excluded from triptan and DHE clinical trials due to a potential risk of ischemic vascular events, and the FDA mandates that package labeling state that they are contraindicated in BM and HM. The objective of this study was to demonstrate that triptans and DHE can be used for the abortive treatment of BM and HM without significant adverse ischemic vascular events.
METHODS: A retrospective chart review of patients with BM features or HM who received acute abortive treatment with either triptans or DHE was conducted at 4 headache centers to assess the frequency of ischemic vascular events after administration. The diagnoses of BM or HM were made by headache specialists based on The International Classification of Headache Disorders, 2nd edition (ICHD-II). Searchable terms included BM, vertigo, dysarthria, diplopia, hemiplegia/hemiparesis, facial droop, weakness, confusion, altered consciousness, confusion, ataxia, and aphasia, as well as all triptans or DHE.
RESULTS: The study included 67 patients with BM features and 13 patients with HM. Among those receiving triptans, 40 were in the BM group and 5 were in the HM group. Among those receiving DHE, 27 were included in the BM group and 8 were in the HM group. No side effects of stroke or myocardial infarction were reported. In the triptan group, 5 patients reported adverse effects that included GI upset, rash, neck dystonia, nightmares, and flushing. In the DHE group, 5 patients had adverse events that included chest tightness, dystonic reaction, transient asymptomatic anterior T wave inversion, and agitation.
CONCLUSION: In this retrospective study, triptans and DHE were used with no reported, subsequent acute/subacute ischemic vascular events for the abortive treatment of migraines with basilar and hemiplegic-type features. Although the small sample sizes generated theoretical statistical event rates of 4.5% for BM and 23% for HM, there has been no clear evidence that BM and HM carry an actual elevated risk for vascular events compared with migraine with aura.

PMID: 27062528 [PubMed - as supplied by publisher]

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[Acute vertigo of neurological origin].

Related Articles

[Acute vertigo of neurological origin].

Ugeskr Laeger. 2013 Nov 4;175(45):2709-11

Authors: Bruun M, Højgaard JL, Kondziella D

Abstract
Acute vertigo of neurological origin may be caused by haemorrhages and tumours in the posterior fossa and, most frequently, by ischaemic infarction in the vertebrobasilar circulation. Urgent diagnosis is necessary to avoid further ischaemic episodes, herniation due to cerebellar oedema and/or fatal brainstem infarction. The history should focus on accompanying neurological symptoms. However, vertigo with cerebellar lesions may be monosymptomatic and then bedside evaluation of oculomotor function is the key to correct diagnosis. This paper discusses the pathophysiology, symptomatology and clinical evaluation of acute vertigo of neurological origin.

PMID: 24629233 [PubMed - indexed for MEDLINE]

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Evaluation of Analytical Modeling Functions for the Phonation Onset Process.

Evaluation of Analytical Modeling Functions for the Phonation Onset Process.

Comput Math Methods Med. 2016;2016:8469139

Authors: Petermann S, Kniesburges S, Ziethe A, Schützenberger A, Döllinger M

Abstract
The human voice originates from oscillations of the vocal folds in the larynx. The duration of the voice onset (VO), called the voice onset time (VOT), is currently under investigation as a clinical indicator for correct laryngeal functionality. Different analytical approaches for computing the VOT based on endoscopic imaging were compared to determine the most reliable method to quantify automatically the transient vocal fold oscillations during VO. Transnasal endoscopic imaging in combination with a high-speed camera (8000 fps) was applied to visualize the phonation onset process. Two different definitions of VO interval were investigated. Six analytical functions were tested that approximate the envelope of the filtered or unfiltered glottal area waveform (GAW) during phonation onset. A total of 126 recordings from nine healthy males and 210 recordings from 15 healthy females were evaluated. Three criteria were analyzed to determine the most appropriate computation approach: (1) reliability of the fit function for a correct approximation of VO; (2) consistency represented by the standard deviation of VOT; and (3) accuracy of the approximation of VO. The results suggest the computation of VOT by a fourth-order polynomial approximation in the interval between 32.2 and 67.8% of the saturation amplitude of the filtered GAW.

PMID: 27066108 [PubMed - as supplied by publisher]

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In vitro characterization of design and compressive properties of 3D-biofabricated/decellularized hybrid grafts for tracheal tissue engineering.

In vitro characterization of design and compressive properties of 3D-biofabricated/decellularized hybrid grafts for tracheal tissue engineering.

J Mech Behav Biomed Mater. 2016 Mar 31;59:572-585

Authors: Johnson C, Sheshadri P, Ketchum JM, Narayanan LK, Weinberger PM, Shirwaiker RA

Abstract
Infection or damage to the trachea, a thin walled and cartilage reinforced conduit that connects the pharynx and larynx to the lungs, leads to serious respiratory medical conditions which can often prove fatal. Current clinical strategies for complex tracheal reconstruction are of limited availability and efficacy, but tissue engineering and regenerative medicine approaches may provide viable alternatives. In this study, we have developed a new "hybrid graft" approach that utilizes decellularized tracheal tissue along with a resorbable polymer scaffold, and holds promise for potential clinical applications. First, we evaluated the effect of our decellularization process on the compression properties of porcine tracheal segments, and noted approximately 63% decrease in resistance to compression following decellularization. Next we developed four C-shape scaffold designs by varying the base geometry and thickness, and fabricated polycaprolactone scaffolds using a combination of 3D-Bioplotting and thermally-assisted forming. All scaffolds designs were evaluated in vitro under three different environmental testing conditions to determine the design that offered the best resistance to compression. These were further studied to determine the effect of gamma radiation sterilization and cyclic compression loading. Finally, hybrid grafts were developed by securing these optimal design scaffolds to decellularized tracheal segments and evaluated in vitro under physiological testing conditions. Results show that the resistance to compression offered by the hybrid grafts created using gamma radiation sterilized scaffolds was comparable to that of fresh tracheal segments. Given that current clinical attempts at tracheal transplantation using decellularized tissue have been fraught with luminal collapse and complications, our data support the possibility that future embodiments using a hybrid graft approach may reduce the need for intraluminal stenting in tracheal transplant recipients.

PMID: 27062124 [PubMed - as supplied by publisher]

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A rare case of a spontaneous neck hematoma in a patient with type 1 neurofibromatosis.

A rare case of a spontaneous neck hematoma in a patient with type 1 neurofibromatosis.

Auris Nasus Larynx. 2016 Apr 6;

Authors: Dova S, Ktenidis K, Karkos P, Blioskas S, Psillas G, Iliadis A, Markou K

Abstract
Neurofibromatosis type 1 (NF-1) is a genetic disorder that affects one in 3000 individuals. Although NF-1 notably involves nerves and connective tissue, vascular involvement in large series is estimated to range from 0.4% to 6.4%. Jugular vein involvement in these patients is rare. Spontaneous neck hematomas and hemorrhages are also unusual. We present a case of a NF-1 patient with a spontaneous neck hematoma with possible leakage from the left internal jugular vein, presenting as a lateral neck mass. The fragility of the vein wall and the surrounding tissue led patient to a severe intraoperative bleeding. Pathological examination revealed degenerated neurofibroma which was in contact with or infiltrated the vein wall. ENT and other clinicians should be aware of this potentially fatal entity considering that it may present as a lateral neck mass.

PMID: 27061148 [PubMed - as supplied by publisher]

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Comparison of 1% cyclosporine eye drops in olive oil and in linseed oil to treat experimentally-induced keratoconjunctivitis sicca in rabbits.

Related Articles

Comparison of 1% cyclosporine eye drops in olive oil and in linseed oil to treat experimentally-induced keratoconjunctivitis sicca in rabbits.

Arq Bras Oftalmol. 2015 Sep-Oct;78(5):295-9

Authors: Parrilha LR, Nai GA, Giuffrida R, Barbero RC, Padovani LD, Pereira RH, Silva DA, Silva MC, Diniz MS, Andrade SF

Abstract
PURPOSE: To evaluate the effectiveness of topical 1% cyclosporine eye drops diluted in either of the two vehicles-olive and linseed oil-and that of the oils themselves in treating experimentally-induced keratoconjunctivitis sicca (KCS) in rabbits.
METHODS: KCS was induced in 25 New Zealand rabbits using 1% atropine sulfate eye drops for 7 days before treatment and throughout the treatment period (12 weeks). The rabbits were divided into five groups: one control (C) group without KCS induction and four treatment groups in which KCS was induced and treated topically with olive oil (O), linseed oil (L), cyclosporine in olive oil (CO), and cyclosporine in linseed oil (CL). The animals were evaluated using Schirmer tear test 1 (STT), the fluorescein test (FT), tear-film break-up time (TBUT), the rose bengal test (RBT), and histopathological analysis.
RESULTS: Values of STT and TBUT significantly decreased 1 week post-induction (p<0.05) and were similar to initial values after the 4th week of treatment, in all groups. After KCS induction, there was significantly less corneal damage in group L than in group CL, as assessed FT and RBT. Histopathology demonstrated that Groups L and CL presented less edema and corneal congestion. There was no significant difference in the goblet cell density (cells/mm2) between the groups (p=0.147).
CONCLUSION: Cyclosporine diluted in olive oil or linseed oil was effective in the treatment of KCS, although it had better efficacy when diluted in linseed oil. Linseed oil presented better effectiveness, whether associated or not, than olive oil. These results may contribute to the creation of novel topical ophthalmic formulations for KCS treatment in future.

PMID: 26466228 [PubMed - indexed for MEDLINE]

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Potential of biofluid components to modify silver nanoparticle toxicity.

Related Articles

Potential of biofluid components to modify silver nanoparticle toxicity.

J Appl Toxicol. 2015 Jun;35(6):665-80

Authors: Murphy A, Sheehy K, Casey A, Chambers G

Abstract
Establishing realistic exposure scenarios is critical for cytotoxic investigation of silver nanoparticles (AgNP) in the gastrointestinal tract. This study investigated the potential interaction with and effect of biofluid components, namely cholic acid, deoxycholic acid and ursodeoxycholic acid, on AgNP toxicity. Two cell lines corresponding to organs related to the biofluid components were employed. These were HepG-2 a hepatocellular carcinoma derived from liver tissue and Hep2 an epithelial cell line. Physiochemical and cytotoxic screening was performed and the ability of biofluid components to modify AgNP cytotoxicity was explored. No alteration to the physiochemical characteristics of AgNP by biofluid components was demonstrated. However, biofluid component addition resulted in alteration of AgNP toxicity. Greater reactive oxygen species induction was noted in the presence of cholic acid and deoxycholic acid. Ursodeoxycholic acid demonstrated no modification of toxicity in HepG-2 cells; however, significant modification was noted in Hep2 cells. It is concluded that biofluid components can modify AgNP toxicity but this is dependent on the biofluid component itself and the location where it acts.

PMID: 25752502 [PubMed - indexed for MEDLINE]

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Spontaneous CSF Rhinorrhea Our Experience.

Spontaneous CSF Rhinorrhea Our Experience.

Indian J Otolaryngol Head Neck Surg. 2016 Mar;68(1):126-129

Authors: Sarkar A, Sharma N

Abstract
Cerebrospinal fluid (CSF) leak occurs due to an abnormal communication between the subarachnoid space and sinonasal tract. We reported a retrospective case series of five patients of spontaneous CSF rhinorrhea. These patients were undergone successful repair with a single transnasal endoscopic procedure. This is seen in anterior part of the cribriform plate of middle aged obese females. HRCT paranasal sinus (1 mm cuts) was an effective modality of investigation in our study with ancillary investigations been CT cisternography. Endoscopic repair of CSF rhinorrhea carries a high success rate with very low morbidity rate.

PMID: 27066429 [PubMed - as supplied by publisher]

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Imaging of Cerebrospinal Fluid Leak.

Imaging of Cerebrospinal Fluid Leak.

Semin Ultrasound CT MR. 2016 Apr;37(2):143-9

Authors: Bathla G, Moritani T

Abstract
A cerebrospinal fluid leak from the cranial cavity requires presence of a fistulous communication between the subarachnoid and extracranial space through the skull base. Imaging plays a crucial role in identifying and characterizing the skull base defect and evaluating coexisting pathologies that may alter surgical approach. The authors discuss the epidemiology, imaging, and management of cerebrospinal fluid leak, with particular reference to the imaging modalities and findings.

PMID: 27063664 [PubMed - in process]

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Pure Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Adenomas in the Elderly: Surgical Outcomes and Complications in 158 Patients.

Related Articles

Pure Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Adenomas in the Elderly: Surgical Outcomes and Complications in 158 Patients.

World Neurosurg. 2015 Dec;84(6):1572-8

Authors: Zhan R, Ma Z, Wang D, Li X

Abstract
OBJECTIVE: To evaluate the safety and efficacy of the endoscopic endonasal transsphenoidal approach (EETA) for nonfunctioning pituitary adenoma (NFPA) in the elderly population.
METHODS: We performed a retrospective review of operative cases over a 7-year period, in which 158 elderly patients (age 65 years and older) who underwent a pure EETA to remove a pituitary adenoma were identified and compared with a series of 155 younger patients (age 40-55 years) who underwent the same procedure during the same period. The medical charts of the patients were reviewed to collect demographic information, such as age, sex, clinical symptoms, tumor size, the extent of tumor resection, clinical outcome, and complications.
RESULTS: In the elderly group, total resection was achieved in 120 patients (75.9%), and 124 patients (78.5%) achieved significant postsurgical visual remission. In the younger group, total resection was achieved in 119 patients (76.8%), with 126 patients (81.2%) achieving significant postsurgical visual remission. Regarding surgical complications in the elderly group, transient diabetes insipidus occurred postoperatively in 28 (17.8%) patients, and permanent diabetes insipidus occurred in 7 (4.4%) patients. Six (6.4%) patients experienced postoperative cerebrospinal fluid leakage, and new developments of anterior hypopituitarism occurred in 15 (9.5%) cases. In the younger group, 21 (13.6%) patients developed transient diabetes insipidus postoperatively, and 5 (3.2%) patients experienced permanent diabetes insipidus. Six (3.9%) patients reported postoperative cerebrospinal fluid leaks, and 13 (8.4%) patients developed a new anterior hypopituitarism. There were no cases of either carotid artery injury or death in either group. During the follow-up (mean, 32 months), 11 (6.9%) patients experienced tumor recurrence in the elderly group compared with 24 (15.5%) patients in the younger group. Of the 15 elderly patients who developed new hypopituitarism, 13 (86.7%) recovered without hormone replacement; accordingly, the rate of hypopituitarism remission was 84.6% in the younger patients.
CONCLUSIONS: NFPAs in the elderly can be resected via a pure endoscopic technique with low morbidity and mortality.

PMID: 26341428 [PubMed - indexed for MEDLINE]

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Foramen magnum meningioma: The midline suboccipital subtonsillar approach.

Foramen magnum meningioma: The midline suboccipital subtonsillar approach.

Clin Neurol Neurosurg. 2016 Apr 2;145:28-34

Authors: Dobrowolski S, Ebner F, Lepski G, Tatagiba M

Abstract
OBJECTIVES: Foramen magnum meningiomas (FMMs) represent a technical challenge even for experienced neurosurgeons, because they grow in close contact with osteoarticular, nervous, and vascular structures that cannot be sacrificed or retracted during surgery. Our goal is to present our experience with 24 cases of surgically resected foramen magnum meningiomas used the midline suboccipital subtonsillar approach and discussed the present risks associated with the treatment of this condition.
PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent surgery treatment for foramen magnum meningiomas operated on between August 2005 and July 2013. A total of 24 cases were included. Data regarding age, sex, symptoms and sign types, locations, surgical aspects, postoperative new deficits, and follow-up are presented.
RESULTS: There were 18 female and 6 male patients (mean age: 52 years). The symptom among most patients (14 patients) was cervico-occipital pain, dysphagia and gait unsteadiness in five, and paresthesia of the upper limbs in four. Total removal of the tumor was achieved in 20 patients, subtotal in two, and partial resection in four patients. Two patients had permanent deficits. Follow-up was 45.6 months (range, 6 months to 8 years), there was no recurrence among tumors totally removed but 1 patient of regrowth among the cases with subtotal removal.
CONCLUSIONS: Our experience confirmed that the midline suboccipital subtonsillar approach was accurate in safely removing anterior, anterolateral, and posterior FMMs. There was no significant postoperative complication in the remainder of the patientes, and their conditions improved after surgery.

PMID: 27064859 [PubMed - as supplied by publisher]

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Imaging of Cerebrospinal Fluid Leak.

Imaging of Cerebrospinal Fluid Leak.

Semin Ultrasound CT MR. 2016 Apr;37(2):143-9

Authors: Bathla G, Moritani T

Abstract
A cerebrospinal fluid leak from the cranial cavity requires presence of a fistulous communication between the subarachnoid and extracranial space through the skull base. Imaging plays a crucial role in identifying and characterizing the skull base defect and evaluating coexisting pathologies that may alter surgical approach. The authors discuss the epidemiology, imaging, and management of cerebrospinal fluid leak, with particular reference to the imaging modalities and findings.

PMID: 27063664 [PubMed - in process]

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Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations.

Dural Venous System in the Cavernous Sinus: A Literature Review and Embryological, Functional, and Endovascular Clinical Considerations.

Neurol Med Chir (Tokyo). 2016 Apr 11;

Authors: Mitsuhashi Y, Hayasaki K, Kawakami T, Nagata T, Kaneshiro Y, Umaba R, Ohata K

Abstract
The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery "medial venous axis" carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves "lateral venous axis" are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves "intermediate venous axis" contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.

PMID: 27063146 [PubMed - as supplied by publisher]

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Training for skull base surgery by using a colored temporal bone model created by three-dimensional printing technology.

Training for skull base surgery by using a colored temporal bone model created by three-dimensional printing technology.

World Neurosurg. 2016 Apr 5;

Authors: Wanibuchi M, Noshiro S, Sugino T, Akiyama Y, Mikami T, Iihoshi S, Miyata K, Komatsu K, Mikuni N

PMID: 27062915 [PubMed - as supplied by publisher]

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Predictors of functional outcome following treatment of posterior fossa arteriovenous malformations.

Related Articles

Predictors of functional outcome following treatment of posterior fossa arteriovenous malformations.

J Clin Neurosci. 2015 Feb;22(2):357-62

Authors: Yang W, Wang JY, Caplan JM, Braileanu M, Shang H, Upadhyay U, Zenonos GA, Rigamonti D, Colby GP, Coon AL, Tamargo RJ, Huang J

Abstract
Posterior fossa arteriovenous malformations (AVM) present particular therapeutic challenges. Studies aimed at clarifying risk of hemorrhage focus on obliteration rates, but few have addressed functional outcomes in these patients. In this study, we aim to explore the predictors of good functional outcome for posterior fossa AVM after treatment. A retrospective review of patients diagnosed with posterior fossa AVM at our institution from 1990 to 2013 was performed, and 61 patients met the inclusion criteria. Functional outcomes were assessed using the modified Rankin Scale (mRS), and mRS ⩽ 1 was defined as good outcome. Within our cohort, 39 patients presented with hemorrhage (64.0%). Spetzler-Martin grades were I (n = 9, 14.8%), II (n = 20, 32.8%), III (n = 22, 36.1%), IV (n = 8, 13.1%), and V (n = 2, 3.3%). Patients were treated with surgery (n = 8), radiosurgery (n = 34), embolization (n = 2) or multimodal therapies (n = 8). Nine patients did not undergo treatment. Average follow-up was 41.9 months. Obliteration of AVM was confirmed in 44.3% of patients (n = 27). Forty-three patients (70.5%) achieved good functional outcomes (mRS ⩽ 1). The absence of pre-treatment symptoms (p < 0.01) and AVM obliteration (p = 0.04) were predictive of good functional outcomes. In contrast, non-hemorrhagic presentation was not a significant predictor (p = 0.60). Asymptomatic presentation and AVM obliteration are associated with good functional outcomes in patients with posterior fossa AVM. Non-hemorrhagic presentation does not necessarily predict good functional outcome. Therefore treatment should not be considered only for those who present with hemorrhage. Posterior fossa AVM should be considered for definitive treatment in order to prevent future hemorrhages and subsequent poor functional outcomes.

PMID: 25439748 [PubMed - indexed for MEDLINE]

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Tremor in dystonia.

Tremor in dystonia.

Parkinsonism Relat Disord. 2016 Apr 1;

Authors: Pandey S, Sarma N

Abstract
Tremor has been recognized as an important clinical feature in dystonia. Tremor in dystonia may occur in the body part affected by dystonia known as dystonic tremor or unaffected body regions known as tremor associated with dystonia. The most common type of tremor seen in dystonia patients is postural and kinetic which may be mistaken for familial essential tremor. Similarly familial essential tremor patients may have associated dystonia leading to diagnostic uncertainties. The pathogenesis of tremor in dystonia remains speculative, but its neurophysiological features are similar to dystonia which helps in differentiating it from essential tremor patients. Treatment of tremor in dystonia depends upon the site of involvement. Dystonic hand tremor is treated with oral pharmacological therapy and dystonic head, jaw and voice tremor is treated with injection botulinum toxin. Neurosurgical interventions such as deep brain stimulation and lesion surgery should be an option in patients not responding to the pharmacological treatment.

PMID: 27062584 [PubMed - as supplied by publisher]

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[The Influence of Hearing Loss Represented by Standard Audiogram Types to Unaided APHAB Scores].

[The Influence of Hearing Loss Represented by Standard Audiogram Types to Unaided APHAB Scores].

Laryngorhinootologie. 2016 Apr 11;

Authors: Löhler J, Akcicek B, Kappe T, Wollenberg B, Schlattmann P, Schönweiler R

Abstract
Background: Questionnaires as the APHAB (Abbreviated Profile of Hearing Aid Benefit) are besides pure-tone and speech-audiometry the third method of diagnostics in audiology. Up to now there has been no research on the influence of individual hearing loss, represented by standard audiograms, on the scores of the unaided APHAB (APHABu) done with a big number of subjects. This study will investigate whether there does exist such a relationship or not. Methods: A total of 2 745 records provided by a database were analysed. First, the subjects' audiograms (air conduction) were allocated to 7 standardised audiogram types. By using a multivariant mixed linear model a potential connection was examined between these standard audiograms and particular APHABu scores for its four subscales: EC - ease of communication, BN - background noise, RV - reverberation, AV - aversiveness of sounds. Results: There was no evidence for a dependency between any type of hearing loss dependence and unaided APHAB-scores. The values on the EC-scale vary between 49.8 and 58.0, on the BN-scale between 45.3 and 46.6, on the RV-scale between 44.4 and 52.4, and on the AV-scale between 47.6 and 50.1. Discussion: This result confirms earlier studies with other questionnaires. Therefore, the APHABu can be used as an initial instrument for the diagnostics of individual hearing loss independently on whether hearing aids will be fitted subsequently or not.

PMID: 27064271 [PubMed - as supplied by publisher]

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A rare case of a spontaneous neck hematoma in a patient with type 1 neurofibromatosis.

A rare case of a spontaneous neck hematoma in a patient with type 1 neurofibromatosis.

Auris Nasus Larynx. 2016 Apr 6;

Authors: Dova S, Ktenidis K, Karkos P, Blioskas S, Psillas G, Iliadis A, Markou K

Abstract
Neurofibromatosis type 1 (NF-1) is a genetic disorder that affects one in 3000 individuals. Although NF-1 notably involves nerves and connective tissue, vascular involvement in large series is estimated to range from 0.4% to 6.4%. Jugular vein involvement in these patients is rare. Spontaneous neck hematomas and hemorrhages are also unusual. We present a case of a NF-1 patient with a spontaneous neck hematoma with possible leakage from the left internal jugular vein, presenting as a lateral neck mass. The fragility of the vein wall and the surrounding tissue led patient to a severe intraoperative bleeding. Pathological examination revealed degenerated neurofibroma which was in contact with or infiltrated the vein wall. ENT and other clinicians should be aware of this potentially fatal entity considering that it may present as a lateral neck mass.

PMID: 27061148 [PubMed - as supplied by publisher]

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Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss.

Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss.

Chin Med J (Engl). 2016 20th Apr;129(8):946-952

Authors: Li FJ, Wang DY, Wang HY, Wang L, Yang FB, Lan L, Guan J, Yin ZF, Rosenhall U, Yu L, Hellstrom S, Xue XJ, Duan ML, Wang QJ

Abstract
BACKGROUND: The prevalence of sudden sensorineural hearing loss in children (CSSNHL) is consistently increasing. However, the pathology and prognosis of CSSNHL are still poorly understood. This retrospective study evaluated clinical characteristics and possible associated factors of CSSNHL.
METHODS: One hundred and thirty-six CSSNHL patients treated in Department of Otolaryngology-Head and Neck Surgery and Institute of Otolaryngology at Chinese PLA General Hospital between July 2008 and August 2015 were included in this study. These patients were analyzed for clinical characteristics, audiological characteristics, laboratory examinations, and prognostic factors.
RESULTS: Among the 136 patients (151 ears), 121 patients (121 ears, 80.1%) were diagnosed with unilaterally CSSNHL, and 15 patients (30 ears, 19.9%) with bilateral CSSNHL. The complete recovery rate of CSSNHL was 9.3%, and the overall recovery rate was 37.7%. We found that initial degree of hearing loss, onset of treatment, tinnitus, the ascending type audiogram, gender, side of hearing loss, the recorded auditory brainstem response (ABR), and distortion product otoacoustic emissions (DPOAEs) had prognostic significance. Age, ear fullness, and vertigo had no significant correlation with recovery. Furthermore, the relevant blood tests showed 30.8% of the children had abnormal white blood cell (WBC) counts, 22.1% had elevated homocysteine levels, 65.8% had high alkaline phosphatase (ALP), 33.8% had high IgE antibody levels, and 86.1% had positive cytomegalovirus (CMV) IgG antibodies.
CONCLUSIONS: CSSNHL commonly occurs unilaterally and results in severe hearing loss. Initial severe hearing loss and bilateral hearing loss are negative prognostic factors for hearing recovery, while positive prognostic factors include tinnitus, gender, the ascending type audiogram, early treatment, identifiable ABR waves, and DPOAEs. Age, vertigo, and ear fullness are not correlated with the recovery. Some serologic indicators, including the level of WBC, platelet, homocysteine, ALP, positive CMV IgG antibody, fibrinogen, and some immunologic indicators, are closely related to CSSNHL.

PMID: 27064040 [PubMed - as supplied by publisher]

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Comparison of maximal tongue strength and tongue strength used during swallowing in relation to age in healthy adults.

Comparison of maximal tongue strength and tongue strength used during swallowing in relation to age in healthy adults.

J Phys Ther Sci. 2016 Jan;28(2):442-445

Authors: Park JS, Oh DH, Chang M

Abstract
[Purpose] The aim of this study was to measure and compare the maximal tongue strength and tongue strength used during swallowing in young and older adults. [Subjects and Methods] The study recruited 80 healthy young (aged 20 to 39 years) and older adults (aged ≥65 years) in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and tongue strength used during swallowing. For each subject, the peak value of three measurements was recorded and analyzed. [Results] Maximal tongue strength was statistically significantly higher for the young adults group than the older adults group. Conversely, tongue strength used during swallowing was statistically significantly higher for the older adults group than the young adults group. The percentages of tongue strength used during swallowing for the young adults and older adults groups were approximately 38.8% and 53.8%, respectively. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength than young adults, but a higher tongue strength used during swallowing.

PMID: 27064477 [PubMed - as supplied by publisher]

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Sumatriptan iontophoretic transdermal system for acute treatment of episodic migraine.

Sumatriptan iontophoretic transdermal system for acute treatment of episodic migraine.

Expert Rev Neurother. 2016 Apr 11;

Authors: Cohen SP, Chaudhry H

Abstract
Migraine is a common and debilitating condition affecting approximately nearly one in four women in the USA and Europe. Episodic attacks can be associated with a number of symptoms, with nausea and/or vomiting being among the most frequent and distressing. Sumatriptan is widely used for acute treatment of migraine and is available in several formulations. The efficacy of oral sumatriptan is well-established. However, patients who experience migraine-associated nausea and/or vomiting can have difficulty swallowing tablets and may delay taking anti-migraine medication. In addition, absorption of oral sumatriptan can be reduced by migraine-associated gastroparesis. Non-oral formulations of sumatriptan are recommended for patients with nausea and/or vomiting, but their use may be limited by adverse effects and patient acceptance. A new transdermal formulation of sumatriptan has recently become available in the USA for acute treatment of migraine in adults. In this article, we review the properties of the sumatriptan iontophoretic transdermal patch and discuss the evidence to support its use in clinical practice.

PMID: 27063965 [PubMed - as supplied by publisher]

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Exploring the effects of synchronous pharyngeal electrical stimulation with swallowing carbonated water on cortical excitability in the human pharyngeal motor system.

Exploring the effects of synchronous pharyngeal electrical stimulation with swallowing carbonated water on cortical excitability in the human pharyngeal motor system.

Neurogastroenterol Motil. 2016 Apr 8;

Authors: Magara J, Michou E, Raginis-Zborowska A, Inoue M, Hamdy S

Abstract
BACKGROUND: Previous reports have revealed that excitation of human pharyngeal motor cortex can be induced by pharyngeal electrical stimulation (PES) and swallowing carbonated water (CW). This study investigated whether combining PES with swallowing (of still water, SW or CW) can potentiate this excitation in either cortical and/or brain stem areas assessed with transcranial and transcutaneous magnetic stimulation (TMS).
METHODS: Fourteen healthy volunteers participated and were intubated with an intraluminal catheter to record pharyngeal electromyography and deliver PES. Each participant underwent baseline corticopharyngeal, hand and craniobulbar motor-evoked potential (MEP) measurements. Subjects were then randomized to receive each of four 10-min interventions (PES only, ShamPES+CW, PES+CW, and PES+SW). Corticobulbar, craniobulbar and hand MEPs were then remeasured for up to 60 min and data analyzed using anova and post hoc t-tests.
KEY RESULTS: A two-way rmanova for Interventions × Time-point showed a significant corticopharyngeal interaction (p = 0.010). One-way anova with post hoc t-tests indicated significant cortical changes with PES only at 45 (p = 0.038) and 60 min (p = 0.023) and ShamPES+CW immediately (p = 0.008) but not with PES+CW or PES+SW. By contrast, there were immediate craniobulbar amplitude changes only with PES+CW (p = 0.020) which were not sustained.
CONCLUSIONS & INFERENCES: We conclude that only PES produced long-term changes in corticopharyngeal excitability whereas combination stimuli were less effective. Our data suggest that PES alone rather than in combination, may be better for the patients who have difficulty in performing voluntary swallows.

PMID: 27061591 [PubMed - as supplied by publisher]

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Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism.

Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism.

Eur J Neurosci. 2016 Apr 8;

Authors: Venhovens J, Meulstee J, Bloem BR, Verhagen WI

Abstract
The primary aim of our study was to determine the extent of vestibular dysfunction in patients with Parkinson's disease (PD). Our secondary aim was to determine if vestibular dysfunction in PD is a risk factor for falling. The tertiary aim was to determine both the extent of vestibular dysfunction and if this dysfunction is a risk factor for falling in patients with atypical parkinsonism (AP). 25 healthy subjects, 30 PD patients, and 14 AP patients were matched for age and gender in a case-control study design. All subjects underwent clinical neurological and neurotological assessments, cervical and ocular vestibular evoked myogenic potentials (VEMPs), brainstem auditory evoked potentials (BAEPs), subjective visual vertical measurements, and videonystagmography with caloric and rotatory chair stimulation. 90% of PD patients (27 of 30) and all 14 AP patients had signs of vestibular dysfunction on laboratory examinations. The evoked potential (VEMPs and BAEPs) test results of PD patients showed significant prolongation of the p13, n1, interpeak III-V latencies on the symptomatic brainstem side (0.003 ≤ P ≤ 0.019) compared to healthy subjects. Also, vestibular testing abnormalities were correlated with an increased risk for falling when fallers among PD and AP patients were compared to the non-fallers (P ≤ 0.001). To conclude, vestibular dysfunction on vestibular laboratory testing is highly prevalent in both PD and AP patients compared to healthy subjects, and is associated with an increased risk for falling. This article is protected by copyright. All rights reserved.

PMID: 27062368 [PubMed - as supplied by publisher]

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Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases.

Transorbital endoscopic assisted management of intraorbital lesions: lessons learned from our first 9 cases.

Rhinology. 2016 Apr 9;

Authors: Dallan I, Castelnuovo P, Turri-Zanoni M, Fiacchini G, Locatelli D, Battaglia P, Sellari-Franceschini S

Abstract
BACKGROUND: The management of intraorbital lesions is challenging and it is strongly dependent to their nature, position and biological behaviour. Traditionally, the superior and lateral compartments of the orbit are addressed via lateral orbitotomy or transcranial approaches. Herein we present our preliminary experience in the management of selected supero-lateral intraorbital lesion through an endoscopic-assisted superior-eyelid approach.
METHODOLOGY: All cases of intraorbital lesion treated in two Italian tertiary care referral centres using a superior eyelid endoscopic-assisted transorbital approach were retrospectively reviewed.
RESULTS: Nine patients have been analysed. The aim of surgery was diagnostic in 5 cases and curative in the remaining 4 patients. Significant tissue biopsy was obtained in all the five diagnostic procedures. Complete resection was obtained in 3/4 lesions. No major intra- or postoperative complications have been observed. Mean surgical time was 68 minutes. Mean hospitalization time was 4.4 days. All patients were satisfied about the surgical procedure, as emerged by the post-operative counselling. At present, the mean follow-up time is 18 months, ranging from 11 to 25 months.
CONCLUSIONS: Our preliminary results are promising with successful functional and cosmetic outcomes and reduced morbidity for the patient. This approach should be considered as an option for selected intraorbital lesions.

PMID: 27059408 [PubMed - as supplied by publisher]

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Rhinology. 2016 Apr 9; Authors: Veyseller B, Dogan R, Yenigun A, Aksoy...

Rhinology. 2016 Apr 9;

Authors: Veyseller B, Dogan R, Yenigun A, Aksoy F, Tugrul S, Dogan EE, Ozturan O

Abstract
BACKGROUND: Hyperbaric Oxygen therapy is recommended as an adjuvant therapy for diabetic neuropathy. To investigate olfactory dysfunction and show the effectiveness of hyperbaric oxygen treatment in patients with type 2 diabetic neuropathy.
MATERIAL AND METHODS: Patients diagnosed with Type 2 DM and diabetic neuropathy were included in the group 1. Patients of Group 1 were administered with a hyperbaric oxygen therapy for 30 sessions and patients who returned for a check up following 30 sessions were incorporated into the Group 2. Healthy volunteers with no medical problems were included in the study as a control group (Group 3). Connecticut Chemosensory Clinical Research (CCCRC) test and the subjective visual analog scale (VAS; 0-100) were utilized to evaluate the olfactory function.
RESULTS: There was a statistically significant difference both between the control group and the patient group as well as before and after the HBO therapy in terms of total CCCRC scoring averages and VAS Scoring averages.
CONCLUSION: When compared to normal individuals, type 2 diabetic neuropathy can cause an olfactory dysfunction, and a statistically significant improvement in olfaction can be obtained with HBO therapy. This is the first study demonstrating that the HBO therapy can play a role in treating olfactory dysfunctions suffered by the patients with diabetic olfactory neuropathies.

PMID: 27059271 [PubMed - as supplied by publisher]

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Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study.

Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study.

Rhinology. 2016 Apr 9;

Authors: Langdon C, Herman P, Verillaud B, Carrau RL, Prevedello D, Nicolai P, Schreiber A, Padoan G, Castelnuovo P, Bernal-Sprekelsen M

Abstract
OBJECTIVES: Endoscopic resection has become an established surgical option for most juvenile nasopharyngeal angiofibromas (JNA). However, surgical management of JNA with intracranial extension remains challenging. This retrospective multicenter study reviews a series of patients with advanced stage JNA treated via endonasal/endoscopic approach.
METHODS: The experience of five academic tertiary or quaternary care ORL-HNS Departments were included. Medical records of all patients operated for JNA staged as Radkowski stage IIIA or IIIB were reviewed. Main outcome measures included intraoperative blood loss, length of hospital stay, complication rate, and rate of persistence or recurrence.
RESULTS: A total of 74 male patients with stages IIIA and IIIB were included. The mean age was 16.4 years and preoperative embolization was performed in 71 patients. The mean blood loss in 45 patients for whom the data was available was 1279.7 ml. The more anatomic subsites were involved, the higher the risk was of intraoperative bleeding. The mean follow-up for 54 out of 73 patients was 37.9 months. Patients with residual disease are significantly linked to involvement of combined (anterior-lateral and posterior) anatomic subsites and to a higher number of affected subsites. At last follow-up, all patients were asymptomatic and those with residual tissue displayed no imaging signs of growth.
CONCLUSIONS: This retrospective multicenter study supports the notion that expanded endonasal endoscopic approaches for advance staged JNA are a feasible option associated with good long-term results.

PMID: 27059153 [PubMed - as supplied by publisher]

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Real-life study showing better control of allergic rhinitis by immunotherapy than regular pharmacotherapy.

Real-life study showing better control of allergic rhinitis by immunotherapy than regular pharmacotherapy.

Rhinology. 2016 Apr 9;

Authors: Droessaert V, Timmermans M, Dekimpe E, Seys S, Ceuppens JJ, Fokkens WJ, Hellings PW

Abstract
BACKGROUND: Treatment for allergic rhinitis (AR) aims at reducing the burden of allergic inflammation, either by suppression of the nasal inflammation with pharmacotherapy or by inducing tolerance via immunotherapy (IT). At present, we lack information on the comparison between the degree of symptom control in AR patients treated with IT and those on pharmacotherapy.
AIMS: An observational study was conducted evaluating the degree of symptom control, the total and individual nasal symptom severity and current medication use at 3 years after starting either pharmacotherapy or subcutaneous immunotherapy (SCIT) for AR.
METHODS: A total number of 800 patients diagnosed with AR between October 2007 and February 2010 at the Ear, Nose and Throat Unit and Allergology Clinical Department of the University Hospitals of KU Leuven, Belgium, were included. Among these patients, 120 had been started on IT at the time of their initial visit, and 680 were prescribed guideline-based pharmacotherapy. In 2013, patients were sent a questionnaire asking for the current severity of nasal symptoms using a visual analogue scale (VAS) score, duration of nasal symptoms and presence or absence of abnormal sleep, impairment of daily activities, sport, leisure, impaired functioning at work/school, troublesome symptoms, and current medication use. A VAS score for total nasal symptoms (TNS) was used to distinguish between controlled and uncontrolled AR.
RESULTS: An overall response rate of 54%. At 3 years after the initiation of the treatment, the IT group showed lower VAS scores for TNS than the pharmacotherapy group, with lower percentages of patients having a VAS score of equal or higher than 5. The IT group consisted of more patients with mild AR than the pharmacotherapy group despite the higher percentage of polysensitization at the onset of treatment in the IT group. 18% of the IT patients met the criteria of persistent AR whereas this was 51% amongst non-IT patients. Interestingly, 70% of IT patients did not use any medical treatment for AR anymore, whereas 61% of pharmacotherapy patients were still on medical treatment.
CONCLUSIONS: This observational study demonstrates that IT is associated with higher control of AR, reduced symptom severity and reduced medication use at 3 years after the onset of treatment. Therefore, this real-life study reinforces the clinical value of immunotherapy in allergic rhinitis.

PMID: 27059095 [PubMed - as supplied by publisher]

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What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Abouzayd M, Smith PF, Moreau S, Hitier M

Abstract
Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.

PMID: 27059840 [PubMed - as supplied by publisher]

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A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials.

A better design is needed for clinical studies of chronic tympanic membrane perforations using biological materials.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Lou ZC

PMID: 27059839 [PubMed - as supplied by publisher]

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Concerning: Subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy (Wu SH et al., Eur Arch Otorhinolaryngol. 2015;272(11):3295-8. doi:10.1007/s00405-014-2991-9. Epub 2014 Mar 12).

Concerning: Subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy (Wu SH et al., Eur Arch Otorhinolaryngol. 2015;272(11):3295-8. doi:10.1007/s00405-014-2991-9. Epub 2014 Mar 12).

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Wittekindt C, Kroll T

PMID: 27059838 [PubMed - as supplied by publisher]

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Reply to the letter to the editor concerning: "Long-term symptom relief after septoplasty" by Sundh and Sunnergren.

Reply to the letter to the editor concerning: "Long-term symptom relief after septoplasty" by Sundh and Sunnergren.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Sundh C, Sunnergren O

PMID: 27059837 [PubMed - as supplied by publisher]

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Radiotherapy alone or combined with chemotherapy as definitive treatment for squamous cell carcinoma of the tonsil.

Radiotherapy alone or combined with chemotherapy as definitive treatment for squamous cell carcinoma of the tonsil.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Kennedy WR, Herman MP, Deraniyagala RL, Amdur RJ, Werning JW, Dziegielewski P, Kirwan J, Morris CG, Mendenhall WM

Abstract
This study is aimed at updating our institution's experience with definitive radiotherapy (RT) for squamous cell carcinoma of the tonsil. We reviewed 531 patients treated between 1983 and 2012 with definitive RT for squamous cell carcinoma of the tonsil. Of these, 179 patients were treated with either induction (n = 19) or concomitant (n = 160) chemotherapy. Planned neck dissection was performed on 217 patients: unilaterally in 199 and bilaterally in 18 patients. Median follow-up was 5.2 years for all patients (range 0.1-31.6 years) and 8.2 years for living patients (range 1.9-31.6 years). The 5-year local control rates by T stage were as follows: T1, 94 %; T2, 87 %; T3 79 %; T4, 70 %; and overall, 83 %. Multivariate analysis revealed that local control was significantly influenced by T stage and neck dissection. The 5-year cause-specific survival rates by overall stage were as follows: I, 94 %; II, 88 %; III, 87 %; IVA, 75 %; IVB, 52 %; and overall, 78 %. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, N stage, overall stage, fractionation, neck dissection, sex, and ethnicity. Of 77 patients treated with ipsilateral fields only, contralateral neck failure occurred in 1 %. The rate of severe complications was 12 %. Definitive RT for patients with tonsillar squamous cell carcinoma provides control rates equivalent to other modalities with a comparatively low incidence of late complications. Patients with anterior tonsillar pillar or tonsillar fossa primaries that are well lateralized with no base of tongue or soft palate extension may be treated with ipsilateral fields.

PMID: 27059836 [PubMed - as supplied by publisher]

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From strategy to delivery: taking the ENT, Hearing and Balance research agenda into the future.

From strategy to delivery: taking the ENT, Hearing and Balance research agenda into the future.

Clin Otolaryngol. 2016 Apr 5;

Authors: Bohm N, Lund V, Blackshaw H, Narula T, Schilder A

PMID: 27059767 [PubMed - as supplied by publisher]

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Corrigendum to "Molecular subtypification of human papillomavirus in male adult individuals with recurrent respiratory papillomatosis" [Auris Nasus Larynx 42 (5) 2015, 385-389].

Corrigendum to "Molecular subtypification of human papillomavirus in male adult individuals with recurrent respiratory papillomatosis" [Auris Nasus Larynx 42 (5) 2015, 385-389].

Auris Nasus Larynx. 2016 Jun;43(3):366

Authors: García-Romero CS, Akaki-Caballero M, Saavedra-Mendoza AG, Guzmán-Romero AK, Canto P, Coral-Vázquez RM

PMID: 27059135 [PubMed - as supplied by publisher]

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What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis.

Eur Arch Otorhinolaryngol. 2016 Apr 8;

Authors: Abouzayd M, Smith PF, Moreau S, Hitier M

Abstract
Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.

PMID: 27059840 [PubMed - as supplied by publisher]

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