Vestibular Evoked Myogenic Potentials in a Female Population with Migraine.

Vestibular Evoked Myogenic Potentials in a Female Population with Migraine.

Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):207-10

Authors: Yetiser S, Gok MH, Kutukcu Y, Ince D

Abstract
The objective is to analyze the vestibular system by vestibular evoked myogenic potential (VEMP) in 30 female patients with migraine and balance problem in a controlled study. Thirty female patients with migraine and vestibular problems were enrolled in the study (2009-2012). Fifteen age-matched healthy subjects were selected as the controls. Air conduction cervical VEMP was used. Tone-burst sound stimuli of 95 dB nHL with rarefaction polarity, 5 Hz stimulus repetition rate, 1 ms rise/fall time and 2 ms plateau time were delivered at 500 Hz. 200 sweeps were averaged. Myogenic responses were amplified and band-pass filtered (800-10 Hz). The latency and the amplitude of p1 and n1 waves and interpeak amplitude and latency differences were measured. Results were given as mean and SDs. Interaural p1 and n1 amplitude greater than 30 % asymmetry was accepted as abnormal. VEMP results were compared with controls. The One-way ANOVA test was used. Statistical significance was set at P < 0.05. VEMP responses were elicited in all controls and the patients. Comparative analysis of p1 amplitude between the patients and the controls was statistically significant (P = 0.010). P1n1 interaural amplitude difference was greater than 30 % in 4 patients (13.4 %). No statistically significant difference was found when comparing latency of all wave forms between the patients and healthy controls (P > 0.05). VEMP is an useful tool to test the vestibular system in patients with migraine and balance problem at the very early period. Clinicians should always consider migraine in patients with vertigo.

PMID: 27340638 [PubMed]

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Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA).

Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA).

Rev Port Pneumol (2006). 2016 Jun 20;

Authors: Quintas-Neves M, Preto J, Drummond M

Abstract
A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea-hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB). In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1-2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.

PMID: 27339391 [PubMed - as supplied by publisher]

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Survival and quality of life in oropharyngeal cancer patients treated with primary chemoradiation after salivary gland transfer.

Survival and quality of life in oropharyngeal cancer patients treated with primary chemoradiation after salivary gland transfer.

J Laryngol Otol. 2016 Jun 24;:1-8

Authors: Morand GB, Madana J, Da Silva SD, Roskies M, Sultanem K, Black MJ, Mlynarek AM, Hier MP

Abstract
OBJECTIVES: Salivary gland transfer surgery can reduce xerostomia in oropharyngeal squamous cell carcinoma patients undergoing primary chemoradiation. A potential drawback of salivary gland transfer is the treatment delay associated with the surgery, and its complications. This study aimed to determine whether the treatment delay affects patient survival and to evaluate patient quality of life after salivary gland transfer.
METHODS: A retrospective analysis of 138 patients (salivary gland transfer group, n = 58; non-salivary gland transfer group, n = 80) was performed. Patient survival was compared between these groups using multivariate analysis. Salivary gland transfer patients were further evaluated for surgical complications and for quality of life using the head and neck module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.
RESULTS: Salivary gland transfer and non-salivary gland transfer patients had comparable baseline clinical characteristics. Salivary gland transfer patients experienced a median treatment delay of 16.5 days before chemoradiation (p = 0.035). Multivariate analysis showed that this did not, however, correspond to a survival disadvantage (p = 0.24 and p = 0.97 for disease-free and disease-specific survival, respectively). A very low complication rate was reported for the salivary gland transfer group (1.7 per cent). Questionnaire scores for the item 'xerostomia' were very low in salivary gland transfer patients.
CONCLUSION: The treatment delay associated with salivary gland transfer surgery does not negatively affect patient survival. Oropharyngeal squamous cell patients have an excellent quality of life after salivary gland transfer.

PMID: 27339712 [PubMed - as supplied by publisher]

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Spontaneous intracranial hypotension caused by cervical CSF fistulae mimicking subarachnoid haemorrhage - a case report.

Spontaneous intracranial hypotension caused by cervical CSF fistulae mimicking subarachnoid haemorrhage - a case report.

Br J Neurosurg. 2016 Jun 24;:1-3

Authors: Eristavi A, Sabin I

Abstract
We describe an unusual and rarely documented site of SIH supported by clear radiological evidence: a case of spontaneous cerebrospinal fluid (CSF) fistulae involving the C7 and C8 nerve root sheaths, presenting with sudden onset headache and requiring surgical intervention to seal the leaks. Investigations confirmed the leaks and the typical MRI findings of meningeal enhancement, which were resolved after surgery.

PMID: 27341482 [PubMed - as supplied by publisher]

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Spontaneous intracranial hypotension syndrome: contribution of radioisotope cisternography.

Spontaneous intracranial hypotension syndrome: contribution of radioisotope cisternography.

Rev Esp Med Nucl Imagen Mol. 2016 Jun 20;

Authors: Suárez JP, Domínguez ML, Gómez MA, Muñoz JL

Abstract
Spontaneous intracranial hypotension is a clinical syndrome caused by a loss of cerebrospinal fluid volume, usually secondary to leaking through structural defects of the spinal dura mater. Radioisotope cisternography (RC) can confirm the diagnosis of spontaneous intracranial hypotension, especially in doubtful or atypical case presentations. A retrospective study was conducted on 8 patients who underwent RC because spontaneous intracranial hypotension was suspected, and they presented with atypical clinical manifestations and/or inconclusive findings in other imaging techniques. RC detected paradural extravasation of cerebrospinal fluid in 7 patients. Moreover, there was indirect evidence of cerebrospinal fluid leaks in all 8 patients (early appearance of radioactivity in the bladder, soft tissue uptake of radioisotope and/or reduction in the amount of radiotracer in the brain at 24hours). RC had a significant impact on the diagnosis of 6 patients, and on the therapeutic management of 4 patients.

PMID: 27337940 [PubMed - as supplied by publisher]

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Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study.

Chin J Integr Med. 2016 Jul;22(7):525-31

Authors: Mao LY, Li LL, Mao ZN, Han YP, Zhang XL, Yao JX, Li M

Abstract
OBJECTIVE: To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.
METHODS: A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.
RESULTS: A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.
CONCLUSIONS: Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.

PMID: 27339160 [PubMed - in process]

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Use of the submental vessels for free gracilis muscle transfer for smile reanimation.

Use of the submental vessels for free gracilis muscle transfer for smile reanimation.

Head Neck. 2016 Jun 24;

Authors: Goyal N, Jowett N, Dwojak S, Cunane MB, Zander D, Hadlock TA, Emerick KS

Abstract
BACKGROUND: Free muscle transfer is an important in dynamic facial reanimation; however, suitable donor vessels in this population can be inadequate. In this case series, the submental vessels were used as donors to free gracilis muscle in vessel-depleted patients.
METHODS: Five patients underwent free gracilis muscle transfer for smile reanimation, 2 with a prior failed free gracilis transfer, 2 with vascular anomalies, and 1 with previous distal ligation of the facial vessels. The submental artery was used as a donor in all cases, and the submental vein was used in 3 cases.
RESULTS: There were no complications or flap failure. Postoperative arterial and venous blood flow was confirmed in all patients using Doppler color flow imaging above and below the anastomoses.
CONCLUSION: The submental vessels are suitable for microvascular anastomosis for free flaps having short pedicles, such as the free gracilis muscle flap, in the vessel-depleted hemiface. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27341470 [PubMed - as supplied by publisher]

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Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere's Disease Patients.

Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere's Disease Patients.

J Int Adv Otol. 2016 Apr;12(1):92-97

Authors: Atrache Al Attrache N, Krstulovic C, Pérez Guillen V, Morera Pérez C, Pérez Garrigues H

Abstract
OBJECTIVE: To assess the effectiveness and response over time of intratympanic dexamethasone on the symptoms of Meniere's disease.
MATERIALS AND METHODS: We performed a matched cohort study of 24 patients with Meniere's disease who were unresponsive to initial treatment and underwent 3 sessions of weekly intratympanic dexamethasone injections using a concentration of 16 mg/mL and 24 matched controls with the same characteristics with regard to vertigo spells.
RESULTS: Compared with control subjects, intratympanic dexamethasone injections resulted in a decrease in the frequency of vertigo spells in the first 6-month period. In the dexamethasone-treated group, a ≥60% decrease in vertigo spells was achieved by 70.8% of patients in the first 6 months. Total remission was achieved by 20.8% of patients in the first 8 months, but after this, the effect tapered. A slight improvement in Tinnitus loudness and no changes in hearing levels were found. The stage of Meniere's disease, years from disease onset, and mean number of vertigo spells per month did not have any effects on the percentage of decrease in vertigo spells.
CONCLUSION: Intratympanic dexamethasone temporarily reduces the frequency of vertigo spells during the initial months but does not remove the probability of having further spells in the future. This therapy provides a valuable tool to accomplish a rapid decrease in vertigo spells in subjects with Meniere's disease, and it is considered an alternative to chemical or surgical labyrinthectomy.

PMID: 27340991 [PubMed - as supplied by publisher]

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Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial.

Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial.

Disabil Rehabil. 2016 Jun 24;:1-9

Authors: Ribeiro KM, Freitas RV, Ferreira LM, Deshpande N, Guerra RO

Abstract
PURPOSE: To evaluate short-term effects of balance Vestibular Rehabilitation Therapy (VRT) on balance, dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo (BPPV).
METHOD: In this randomized, single-blind and controlled trial, older adults with chronic BPPV were randomized into two groups, the experimental group (n = 7, age: 69 (65-78) years) and the control group (n = 7, age: 73 (65-76) years). Patients in the experimental group underwent balance VRT (50 min per session, two times a week) and Canalith Repositioning Maneuver (CRM) as required, for 13 weeks. The control group was treated using only CRM as required. Standing and dynamic balance, dizziness symptoms and quality of life were measured at the baseline, and at one, five, nine and thirteen weeks.
RESULTS: There were no between-group differences in dizziness, quality of life and standing balance over the 13 weeks. Significant differences were observed in dynamic balance measures between groups (p <  0.05 for most tests) through assessments. In intragroup analysis, both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group.
CONCLUSIONS: The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM. Implications for Rehabilitation The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals' clinical decision making to design interventions for seniors suffering from BPPV; Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT; Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness Handicap Index suggests that addition of balance VRT does not influence dizziness symptomatology, per se, and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life.

PMID: 27340939 [PubMed - as supplied by publisher]

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Audiologic Patterns of Otic Capsule Preserving Temporal Bone Fracture: Effects of the Affected Subsites.

Audiologic Patterns of Otic Capsule Preserving Temporal Bone Fracture: Effects of the Affected Subsites.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Kim SY, Kim YJ, Kim YH, Park MH

Abstract
Objectives: This study was aimed to assess the relationship between the type of temporal bone area involved and conductive hearing loss.
Methods: We enrolled 97 patients who visited the otolaryngology clinics of Seoul National University Hospital or Boramae Medical Center, Seoul Metropolitan Government-Seoul National University with temporal bone fracture between January 2004 and January 2014. Audiometric parameters, including initial and improved air-bone (AB) conduction gap values, were reviewed in accordance with the temporal bone computed tomography (external auditory canal [EAC], middle ear [ME], mastoid [M], and ossicle [O]).
Results: Patients with ossicular chain involvement exhibited a larger AB gap compared to those with no ossicular chain involvement at 250, 1,000, 2,000, and 4,000 Hz. Among the groups without ossicular chain involvement, the initial AB gap was largest in patients with EAC+ME+M involvement, followed by the ME+M and M-only involvement groups. The greatest improvement in the AB gap was observed in the EAC+ME+M group followed by the ME+M and M-only groups, irrespective of ossicular chain involvement. Improvements in AB gap values were smallest at 2,000 Hz.
Conclusion: Conductive hearing loss pattern differed according to the temporal bone area involved. Therefore, areas such as the hematoma and hemotympanum, as well as the fracture line of the temporal bone area, must be evaluated to predict audiologic patterns with otic capsule preserving temporal bone fracture.

PMID: 27337953 [PubMed - as supplied by publisher]

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The Effect of Sleep Disordered Breathing on Olfactory Functions: Analysis by Apnea-Hypopnea Index.

The Effect of Sleep Disordered Breathing on Olfactory Functions: Analysis by Apnea-Hypopnea Index.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Shin DH, Ahn SH, Yang Y, Choi S, Cho JH, Hong SC, Kim JK

Abstract
Objectives: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters.
Methods: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin's stick test I, II (KVSS I, II) were performed.
Results: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell.
Conclusion: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.

PMID: 27337952 [PubMed - as supplied by publisher]

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Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Kang DH, Lee MJ, Lee KY, Lee SH, Jang JH

Abstract
Objectives: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children.
Methods: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared.
Results: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046).
Conclusion: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.

PMID: 27337951 [PubMed - as supplied by publisher]

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Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers.

Testing a New Anticoagulation Method for Free Flap Reconstruction of Head and Neck Cancers.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Karimi E, Ardestani SH, Jafari M, Hagh AB

Abstract
Objectives: Free flaps are widely used to reconstruct head and neck defects. Despite the improvement in the surgical techniques and the surgeons' experiences, flap failures still occur due to thrombotic occlusion after small vessels anastomosis. To reduce the possibility of flap loss as a result of thrombotic occlusion, various anticoagulants have been used. In this study we decided to evaluate a new protocol for anticoagulation therapy and its effect on flap survival and complications.
Methods: In this interventional study, 30 patients with head and neck cancer underwent surgical defects were reconstructed by microvascular free flap between 2013 and 2014. In the postoperative period patients have taken aspirin (100 mg/day) for 5 days and enoxaparin (40 mg/day subcutaneously) for 3 days. The flap survival was followed for three weeks.
Results: Given that there was no complete necrosis or loss of flap, the free flap success rate was as much as 100%. The need for re-exploration occurred in 3 patients (10%). Only in one patient the need for re-exploration was due to problem in venous blood flow.
Conclusion: The aspirin-enoxaparin short-term protocol may be a good choice after free flap transfer in reconstruction of head and neck surgical defects.

PMID: 27337950 [PubMed - as supplied by publisher]

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The Expression and Relationship of CD68-Tumor-Associated Macrophages and Microvascular Density With the Prognosis of Patients With Laryngeal Squamous Cell Carcinoma.

The Expression and Relationship of CD68-Tumor-Associated Macrophages and Microvascular Density With the Prognosis of Patients With Laryngeal Squamous Cell Carcinoma.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Sun S, Pan X, Zhao L, Zhou J, Wang H, Sun Y

Abstract
Objectives: We sought to identify the expression of CD68-tumor-associated macrophages (TAMs) and CD34-microvascular density (MVD) in laryngeal squamous cell carcinoma (LSCC), to study the relationship with clinical pathological parameters and to determine whether their expression is predictive of disease.
Methods: Pathologically confirmed 45 LSCC tissue and 20 peritumoral non-tumor tissue were examined. Immunohistochemical studies were used to detect the expression of CD68-TAMs and CD34-MVD.
Results: The positive expression rate of CD68 in LSCC tissue was 82% (37/45), which was higher than the 10% (2/20) expression rate of the peritumoral tissue (P<0.05). The CD34-MVD positive expression rate in the LSCC tissue was 26.5±6.4, which obviously higher than 12.2±4.0 expression rate of the peritumoral tissue (P<0.05). The positive expression rates of both CD68 and CD34-MVD were higher in the lymph node metastasis (LNM) positive group than in the LNM negative group. The expression of CD68 had positive correlation with CD34-MVD. The 5-year disease-free survival rate in the group with the low CD68 expression was significantly higher than that in the group with high CD68 expression (76% vs. 42%, respectively).
Conclusion: The high expression of CD68-TAMs in LSCC and its positive correlation with CD34-MVD illustrates that both play an important role in promoting the metastasis and angiogenesis of this cancer. Their expression was also positively correlated with the prognoses of these patients, suggesting that they could be used as important prognostic markers for LSCC.

PMID: 27337949 [PubMed - as supplied by publisher]

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Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience.

Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Denaro N, Merlano MC, Russi EG

Abstract
As the patients population ages, cancer screening increases, and cancer treatments improve, millions more head and neck carcinoma (HNC) patients will be classified as cancer survivors in the future. Change in epidemiology with human papillomavirus related HNC leads to a number of young treated patients. After treatment for HNC intensive surveillance, including ear, nose and throat (ENT) endoscopy, imaging, and serology, confers a survival benefit that became less evident in unresectable recurrence. We performed a comprehensive revision of literature and analyzed the experience of our centre. We revised publications on this topic and added data derived from the interdisciplinary work of experts within medical oncology, ENT, and radiation oncology scientific societies. We retrospectively collected local and distant recurrence of chemoradiation treated patients at Santa Croce and Carle University Hospital. A HNC follow-up program is not already codified and worldwide accepted. There is a need of scheduled follow-up. We suggest adopting a standardized follow-up guideline, although a multidisciplinary approach is frequently requested to tailor surveillance program and treatment on each patient.

PMID: 27337948 [PubMed - as supplied by publisher]

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The Anatomical Relationship Between Recurrent Laryngeal Nerve and First Tracheal Ring in Males and Females.

The Anatomical Relationship Between Recurrent Laryngeal Nerve and First Tracheal Ring in Males and Females.

Clin Exp Otorhinolaryngol. 2016 Jun 25;

Authors: Akil F, Yollu U, Ayral M, Turgut F, Yener M

Abstract
Objectives: Despite the modern advances in thyroid surgery, recurrent laryngeal nerve (rln) paralysis is still a critical problem. In order to decrease the rate of this complication, rln anatomy has been studied intensively. In our study, we aimed to recognize the relationship of rln and landmarks of the first tracheal ring.
Methods: Eighty-six female and 18 male patients who were undergone total thyroidectomy were included in this study. Trachea vertical height (tvh), right recurrent laryngeal nerve height (rrh), left recurrent laryngeal nerve height (lrh), right recurrent laryngeal nerve to trachea anterior face median raphe distance (rrd), left recurrent laryngeal nerve to trachea anterior face median raphe distance (lrd), right recurrent laryngeal nerve respect to trachea ratio (rrtr), and left recurrent laryngeal nerve respect to trachea ratio (lrtr) parameters of all patients were measured and compared in males and females using independent t-test and measurements on both right and left sides were compared statistically without sex discrimination.
Results: There were no significant differences between groups in tvh, rrh, rrd, lrd, rrtr, and lrtr parameters. Lrh parameter was significantly higher in males than in females (P<0.04). Comparison of right and left sides revealed that lrh was significantly higher than rrh (P<0.001), lrd was significantly higher than rrd (P<0.001), and rrtr was significantly higher than lrtr (P<0.001).
Conclusion: In this study, we have shown that in all cases the rln was located around the lower half of trachea vertical length and at this level left rln was located significantly deeper than the right side.

PMID: 27337947 [PubMed - as supplied by publisher]

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Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension.

Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension.

J Neurosurg. 2016 Jun 24;:1-11

Authors: Frič R, Eide PK

Abstract
OBJECTIVE Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF). To explore this hypothesis, the authors specifically investigated whether ICP is comparable in CMI and IIH and whether intracranial volumes (ICVs) are different in patients with CMI and IIH, which could explain the tonsillar ectopy in CMI. The authors also examined whether the symptom profile is comparable in these 2 patient groups. METHODS The authors identified all CMI and IIH patients who had undergone overnight diagnostic ICP monitoring during the period from 2002 to 2014 and reviewed their clinical records and radiological examinations. Ventricular CSF volume (VV), PCF volume (PCFV), and total ICV were calculated from initial MRI studies by using volumetric software. The static and pulsatile ICP scores during overnight monitoring were analyzed. Furthermore, the authors included a reference (REF) group consisting of patients who had undergone ICP monitoring due to suspected idiopathic normal-pressure hydrocephalus or chronic daily headache and showed normal pressure values. RESULTS Sixty-six patients with CMI and 41 with IIH were identified, with comparable demographics noted in both groups. The occurrence of some symptoms (headache, nausea, and/or vomiting) was comparable between the cohorts. Dizziness and gait ataxia were significantly more common in patients with CMI, whereas visual symptoms, diplopia, and tinnitus were significantly more frequent in patients with IIH. The cranial volume measurements (VV, PCFV, and ICV) of the CMI and IIH patients were similar. Notably, 7.3% of the IIH patients had tonsillar descent qualifying for diagnosis of CMI (that is, > 5 mm). The extent of tonsillar ectopy was significantly different between the CMI and IIH cohorts (p < 0.001) but also between these 2 cohorts and the REF group. Pulsatile ICP was elevated in both cohorts without any significant between-group differences; however, static ICP was significantly higher (p < 0.001) in the IIH group. CONCLUSIONS This study showed comparable and elevated pulsatile ICP, indicative of impaired intracranial compliance, in both CMI and IIH cohorts, while static ICP was higher in the IIH cohort. The data did not support the hypothesis that reduced PCFV combined with increased ICP causes tonsillar ectopy in CMI. Even though impaired intracranial compliance seems to be a common pathophysiological mechanism behind both conditions, the mechanisms explaining the different clinical and radiological presentations of CMI and IIH remain undefined.

PMID: 27341045 [PubMed - as supplied by publisher]

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The Agreement between Protocols for the Investigation of Asymmetrical Audiovestibular Symptoms.

The Agreement between Protocols for the Investigation of Asymmetrical Audiovestibular Symptoms.

J Int Adv Otol. 2016 Apr;12(1):98-100

Authors: Nash R, Majithia A, Singh A

Abstract
OBJECTIVE: There are a number of published criteria for the investigation of asymmetrical audiovestibular symptoms. Our aim was to determine the agreement between these protocols when determining whether to investigate a group of patients treated at our institution.
MATERIALS AND METHODS: Retrospective audit of the indications for arranging 854 consecutive magnetic resonance imaging scans of the internal auditory meatus. These indications were compared to the Oxford, Northern, Charing Cross, and Nashville guidelines on the investigation of asymmetrical audiovestibular symptoms.
RESULTS: The level of agreement was low, with kappa values ranging between 0.15 and 0.58 between the four selected protocols.
DISCUSSION: While these criteria seem very similar in nature, due to the number of patients with mild asymmetry and subtle distinctions such as the inclusion or exclusion of tinnitus, there are low levels of agreement between protocols. This study highlights another area of difficulty when determining which patients to investigate.

PMID: 27340992 [PubMed - as supplied by publisher]

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Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere's Disease Patients.

Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere's Disease Patients.

J Int Adv Otol. 2016 Apr;12(1):92-97

Authors: Atrache Al Attrache N, Krstulovic C, Pérez Guillen V, Morera Pérez C, Pérez Garrigues H

Abstract
OBJECTIVE: To assess the effectiveness and response over time of intratympanic dexamethasone on the symptoms of Meniere's disease.
MATERIALS AND METHODS: We performed a matched cohort study of 24 patients with Meniere's disease who were unresponsive to initial treatment and underwent 3 sessions of weekly intratympanic dexamethasone injections using a concentration of 16 mg/mL and 24 matched controls with the same characteristics with regard to vertigo spells.
RESULTS: Compared with control subjects, intratympanic dexamethasone injections resulted in a decrease in the frequency of vertigo spells in the first 6-month period. In the dexamethasone-treated group, a ≥60% decrease in vertigo spells was achieved by 70.8% of patients in the first 6 months. Total remission was achieved by 20.8% of patients in the first 8 months, but after this, the effect tapered. A slight improvement in Tinnitus loudness and no changes in hearing levels were found. The stage of Meniere's disease, years from disease onset, and mean number of vertigo spells per month did not have any effects on the percentage of decrease in vertigo spells.
CONCLUSION: Intratympanic dexamethasone temporarily reduces the frequency of vertigo spells during the initial months but does not remove the probability of having further spells in the future. This therapy provides a valuable tool to accomplish a rapid decrease in vertigo spells in subjects with Meniere's disease, and it is considered an alternative to chemical or surgical labyrinthectomy.

PMID: 27340991 [PubMed - as supplied by publisher]

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Angiotensin-Converting Enzyme (ACE) I/D and Alpha-Adducin (ADD1) G460W Gene Polymorphisms in Turkish Patients with Severe Chronic Tinnitus.

Angiotensin-Converting Enzyme (ACE) I/D and Alpha-Adducin (ADD1) G460W Gene Polymorphisms in Turkish Patients with Severe Chronic Tinnitus.

J Int Adv Otol. 2016 Apr;12(1):77-81

Authors: Yuce S, Sancakdar E, Bağcı G, Koc S, Kurtulgan HK, Bağcı B, Doğan M, Uysal İO

Abstract
OBJECTIVE: Tinnitus is described as a disturbing sound sensation in the absence of external stimulation. We aimed to investigate whether there is any relationship between severe chronic tinnitus and angiotensin-converting enzyme (ACE) I/D and α-adducin (ADD1) G460W gene polymorphisms.
MATERIALS AND METHODS: The patient group and control group consisted of 89 and 104 individuals, respectively. The evaluation of tinnitus was performed using the Strukturiertes Tinnitus-Interview (STI). The Tinnitus Handicap Inventory (THI) was used to evaluate the tinnitus severity. Polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques were used for genotyping.
RESULTS: With regard to the ACE I/D polymorphism, there was no significant difference in genotype and allele frequencies between the patient group and control group. However, a statistically significant difference was found in genotype (p<0.01) and allele frequencies (p=0.021) of the ADD1 G460W gene polymorphism. Combined genotype analysis showed that the ACE II /ADD1 GW genotype was statistically significantly higher in the patient group than in the control group (X2: 7.15, p=0.007). The odds ratio value of the GW genotype was 2.5 (95% CI=1.4-4.7) (p<0.01).
CONCLUSION: Our results demonstrate an association between ADD1 G460W gene polymorphism and susceptibility to severe chronic tinnitus. It was found that the GW genotype increased the disease risk by 2.5-fold compared with other genotypes. This indicates that ADD1 G460W polymorphism could be an important factor in the pathophysiology of tinnitus.

PMID: 27340988 [PubMed - as supplied by publisher]

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Tinnitus Retraining Therapy in Unilateral Tinnitus Patients with Single Side Deafness.

Tinnitus Retraining Therapy in Unilateral Tinnitus Patients with Single Side Deafness.

J Int Adv Otol. 2016 Apr;12(1):72-76

Authors: Kim SH, Byun JY, Yeo SG, Park MS

Abstract
OBJECTIVE: The purpose of this study was to evaluate the audiologic and clinical characteristics of the tinnitus in single-sided deafness (SSD) patients and to determine whether tinnitus retraining therapy (TRT) is beneficial to those patients who suffer from tinnitus with SSD.
MATERIALS AND METHODS: Thirty-six tinnitus patients with unilateral sensorineural profound hearing loss were included in the SSD group, and 46 tinnitus patients with normal hearing were included in the normal hearing group (NH group). Tinnitus evaluation consisted of the Tinnitus Handicap Inventory (THI), and visual analog scales (VAS) were obtained at the initial interview and 6 months after TRT. The therapeutic response was analyzed and compared between the two groups.
RESULTS: The subjective intensity of tinnitus and objective loudness were greater in the SSD group. According to the THI scores prior to TRT, the SSD group showed significantly higher values, except in the emotional subscale. The THI score was significantly improved after TRT in both groups. The total THI score and all the subscale scores were significantly reduced. The VAS average scores were reduced from 6.5 to 5.1 in the SSD group, without statistical significance, whereas in the NH group, the VAS average scores significantly decreased from 5.8 to 4.5 after TRT.
CONCLUSION: TRT was effective in SSD patients with subjective tinnitus.

PMID: 27340987 [PubMed - as supplied by publisher]

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Gliosarcoma in Cerebellopontine Angle with Rapid Tumor Growth and Intratumoral Hemorrhage: Case Report.

Gliosarcoma in Cerebellopontine Angle with Rapid Tumor Growth and Intratumoral Hemorrhage: Case Report.

World Neurosurg. 2016 Jun 20;

Authors: Duan H, Kitazawa K, Yako T, Ichinose S, Kobayashi S, Sudo M

Abstract
BACKGROUND: Gliosarcoma is a relatively rare and bimorphous brain tumor, predominantly located in the brain lobe. Here we report a rare case of gliosarcoma presenting radiologically in the cerebellopontine angle (CPA) region.
CASE DESCRIPTION: The patient was a 71-year-old woman suffered from progressive tinnitus. A series of image examinations showed a rapidly growing CPA tumor which enlarged from nonexistence to 4cm in diameter with extension to the internal auditory canal in a short period of 6 months. The patient was operated on in emergency because of intratumoral hemorrhage and rapidly deteriorating neurological symptoms. Under the diagnosis of gliosarcoma confirmed by pathological examination, chemotherapy and radiotherapy were conducted following partial resection. The patient recovered uneventfully and the residual tumor disappeared nearly completely on the image taken 6 months later.
CONCLUSIONS: Though rare, gliosarcoma should be considered in the differential diagnosis of CPA tumors, especially if it is associated with rapid tumor growth and/or intratumoral hemorrhage.

PMID: 27338213 [PubMed - as supplied by publisher]

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Above the Sphenoid in to Dermoid-Expanded Endoscopic Two Nostrils Four Hand Technique: A Case Report.

Above the Sphenoid in to Dermoid-Expanded Endoscopic Two Nostrils Four Hand Technique: A Case Report.

Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):254-6

Authors: Sundhar Krishnan G, Balasubramaniam D, Vikram VJ

Abstract
This rare case report presents the 2 nostrils 4 hands expanded endoscopic excision of the suprasellar dermoid through planum sphenoidale approach. This minimally invasive technique through the natural passage offers panaromic view of vital structures, complete excision of the lesion with reconstruction of the skull base defect at the same procedure.

PMID: 27340646 [PubMed]

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Importance of CT Scan of Paranasal Sinuses in the Evaluation of the Anatomical Findings in Patients Suffering from Sinonasal Polyposis.

Importance of CT Scan of Paranasal Sinuses in the Evaluation of the Anatomical Findings in Patients Suffering from Sinonasal Polyposis.

Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):167-72

Authors: Varshney H, Varshney J, Biswas S, Ghosh SK

Abstract
Sinonasal polyps are benign lesions arising from nose and/or sinuses mucosa. Paranasal sinuses computed tomogram (CT) scan are important for functional endoscopic sinus surgery (FESS) as their information assist the surgeon in pre-operative planning. This study aimed to show importance of CT scan in evaluation of anatomical variations to prove a correlation with disease process and extent of disease in sinonasal polyposis patients. A study was done from Sept, 2010 to Sept, 2011 with 33 patients presenting with nasal polyps. All recruited patients, after thorough history, general examination and thorough ENT examination, were examined by nasal endoscopy and sinus CT scans. All scans were carried out using a 3 mm thickness in axial and coronal planes with sagittal reconstruction. An analysis was then carried out to see anatomical variations and disease extent in CT scans. Maxillary sinus was the most commonly and most severely affected sinus, while the sphenoid sinus was the least involved sinus. Ostiomeatal complex (OMC) was found to be blocked in 84.85 % cases. There were few anatomic variations (57.58 %) found as hypertrophied uncinate process (30.30 %), septal deviation (21.21 %), skull base type-2, Concha bullosa, Haller's cell, Paradoxical middle turbinate, Onodi cell, pneumatized crista galli and dehiscent skull base. Hyperdense and heterogeneous opacification in paranasal sinuses was seen in 12.12 % patients. Importance of CT scans is to know anatomical variations as etiology, fungal etiology, to know extent of polyposis and anatomical variations to prevent complications during FESS and Navigation sinus surgery.

PMID: 27340631 [PubMed]

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Central Skull Base Osteomyelitis: Diagnostic Dilemmas and Management Issues.

Central Skull Base Osteomyelitis: Diagnostic Dilemmas and Management Issues.

Indian J Otolaryngol Head Neck Surg. 2016 Jun;68(2):149-56

Authors: Muranjan SN, Khadilkar SV, Wagle SC, Jaggi ST

Abstract
The aim of this study is to describe the clinical presentation of central skull base osteomyelitis and to discuss the classical imaging findings and various diagnostic and therapeutic challenges faced in the management of this condition. This is a retrospective analysis of inpatient case records, carried out in a multidisciplinary tertiary care hospital. The study subjects included five elderly diabetic patients presenting to the ENT surgeon or neurologist with headache followed by multiple cranial nerve paralysis with no temporal bone involvement in four patients and a past history of otitis externa in one patient. These patients were diagnosed to have an infective pathology of the central skull base detected by imaging and confirmed by biopsy in three. All were treated successfully with antibiotics administered for an average period of 6 weeks. Three patients followed up over 4 years and showed no relapses. One succumbed to other medical co morbidities after 8 months and one diagnosed a month prior is still under follow up. A symptom complex of headache and cranial neuropathies usually raises the suspicion of malignancy. Central skull base osteomyelitis, a relatively uncommon pathology, must also be considered as a possible differential diagnosis despite absence of a definite septic focus. Imaging studies showing bony destruction and adjacent soft tissue involvement should raise the suspicion of this clinical entity. Malignancy needs to be ruled out by biopsy. Early diagnosis and prompt initiation of antibiotics administered for an adequate duration is of paramount importance in successfully treating these patients. A multidisciplinary approach is needed for a successful outcome.

PMID: 27340628 [PubMed]

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Clinical evaluation of ZTE attenuation correction for brain FDG-PET/MR imaging-comparison with atlas attenuation correction.

Clinical evaluation of ZTE attenuation correction for brain FDG-PET/MR imaging-comparison with atlas attenuation correction.

J Nucl Med. 2016 Jun 23;

Authors: Sekine T, Ter Voert EE, Warnock G, Buck A, Huellner MW, Veit-Haibach P, Delso G

Abstract
Accurate attenuation correction (AC) on PET/MR is still challenging. The purpose of this study was to evaluate the clinical feasibility of AC based on fast zero-echo-time (ZTE) MR imaging by comparing it the default atlas-based AC on a clinical PET/MR scanner.
METHODS: We recruited 10 patients with malignant diseases not located on the brain. In all patients, a clinically-indicated whole-body (18)F-FDG-PET/CT was acquired. In addition, a head PET/MR scan (GE SIGNA TOF-PET/MR) was performed voluntarily. For each patient, two AC maps were generated from the MR images. One was Atlas-AC, derived from T1-weighted LAVA-FLEX images (clinical standard). The other was ZTE-AC, derived from proton-density-weighted ZTE images by applying tissue segmentation and assigning continuous attenuation values to the bone. The AC map generated by PET/CT was used as silver standard. Based on each AC map, PET images were reconstructed from identical raw data on the PET/MR scanner. All PET images were normalized to the SPM5 PET template. After that, these images were qualified visually and quantified in 67 volumes-of-interest (VOIs; automated anatomical labeling (AAL), atlas). Relative differences (%diff) and absolute relative differences (|%diff|) between PET images based on each AC were calculated. FDG uptake in all 670 VOIs and generalized merged VOIs were compared using paired t-test.
RESULTS: Qualitative analysis shows that ZTE-AC was robust to patient variability. Nevertheless, misclassification of air and bone in mastoid and nasal areas led the overestimation of PET in the temporal lobe and cerebellum (%diff of ZTE-AC; 2.46±1.19% and 3.31±1.70%, respectively). The |%diff| of all 670 VOIs on ZTE was improved by approximately 25% compared to Atlas-AC (ZTE-AC vs. Atlas-AC; 1.77±1.41% vs. 2.44±1.63%, P < 0.01). In two out of seven generalized VOIs, |%diff| on ZTE-AC were significantly smaller than Atlas-AC (ZTE-AC vs. Atlas-AC; Insula and cingulate, 1.06±0.67% vs. 2.22±1.10%, P < 0.01; central structure, 1.03±0.99% vs. 2.54±1.20%, P < 0.05).
CONCLUSION: The ZTE-AC could provide more accurate AC than clinical Atlas-AC by improving the estimation of head skull attenuation. The misclassification in mastoid and nasal areas must be addressed to prevent the overestimation of PET in regions near the skull base.

PMID: 27339875 [PubMed - as supplied by publisher]

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Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.

Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.

Acta Neurochir (Wien). 2016 Jun 24;

Authors: Freeman JL, Sampath R, Casey MA, Quattlebaum SC, Ramakrishnan VR, Youssef AS

Abstract
BACKGROUND: Fixed retraction of the internal carotid artery (ICA) has previously been described for use during transcranial microscopic surgery. We report the novel use of a self-retaining microvascular retractor for static repositioning and protection of the ICA during expanded endonasal endoscopic approaches to the paramedian skull base.
METHODS: The transmaxillary, transpterygoid approach was performed in five cadaver heads (ten sides). The self-retaining microvascular retractor was used to laterally reposition the pterygopalatine fossa contents during exposure of the pterygoid base/plates and the paraclival ICA to expose the petrous apex. Maximum ICA retraction distance was measured in the x-axis for all ten sides.
RESULTS: The average horizontal distance of ICA retraction measured at the mid-paraclival segment for all ten sides was 4.75 mm. In all cases, the carotid artery was repositioned without injury to the vessel or disruption of the surrounding neurovascular structures.
CONCLUSIONS: Static repositioning of the ICA and other delicate neurovascular structures was effectively performed during endonasal, endoscopic cadaveric surgery of the skull base and has potential merits in live patients.

PMID: 27339269 [PubMed - as supplied by publisher]

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Reversal of Visual Impairment Associated with Vasospasm after Resection of Sphenoclinoidocavernous Meningioma with Intra-arterial Verapamil.

Reversal of Visual Impairment Associated with Vasospasm after Resection of Sphenoclinoidocavernous Meningioma with Intra-arterial Verapamil.

World Neurosurg. 2016 Jun 20;

Authors: Amuluru K, Al-Mufti F, Singh IP, Frohman LP, Gandhi CD, Liu JK

Abstract
BACKGROUND: Visual loss can be encountered in the immediate, early, or even delayed postoperative period after resection of skull base meningiomas involving the optic apparatus. Various mechanisms for visual loss can include mechanical injury, vascular insult, optic nerve and chiasm edema, and vasospasm of the blood supply to the visual apparatus.
DESCRIPTION: In this paper, we describe a patient who developed unilateral visual worsening in the early postoperative period after skull base resection of a sphenoclinoidocavernous meningioma that was compressing the ipsilateral optic nerve. After implementing hyperdynamic therapy and high-dose corticosteroids, catheter angiography demonstrated severe vasospasm of the ipsilateral ophthalmic artery with delayed filling of the choroidal blush. Intra-arterial chemical angioplasty with verapamil was administered which resulted in angiographic improvement and clinical restoration of vision back to preoperative baseline. Vision remained stable in the postoperative course and continued to improve after discharge from the hospital.
CONCLUSIONS: To our knowledge, this is the first report of successful reversal of postoperative unilateral visual loss related to vasospasm after resection of a skull base sphenoclinoidocavernous meningioma. This may be a useful strategy to diagnose and treat possible vasospasm-induced visual loss after resection of skull base meningiomas involving the optic apparatus.

PMID: 27338210 [PubMed - as supplied by publisher]

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Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions: Experience With 212 Cases.

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Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions: Experience With 212 Cases.

Neurosurgery. 2015 Dec;77(6):888-97; discussion 897

Authors: Kooshkabadi A, Choi PA, Koutourousiou M, Snyderman CH, Wang EW, Fernandez-Miranda JC, Gardner PA

Abstract
BACKGROUND: The endoscopic endonasal approach (EEA) for craniocervical lesions involving the lower clivus and occipital condyles carries an unclear risk of atlanto-occipital (AO) instability requiring arthrodesis.
OBJECTIVE: Elucidate risk factors for AO instability following EEA for clival lesions.
METHODS: We reviewed patients with clival tumors who underwent EEA at our institution between 2002 and 2012. Resection of the lower clivus, foramen magnum, AO joint, and occipital condyles were evaluated on fine-cut postoperative computed tomography.
RESULTS: Two hundred twelve patients (mean age 47.9 years, 57.1% male) underwent transclival EEA for lower clival lesions. In addition to the lower clivus, resection involved the condyle in 14.2% of patients, the foramen magnum in 16.5%, and the AO joint in 1.4%. Quantification of condyle resection revealed complete resection in 3 cases, 75% resection in 8 cases, 50% resection in 6 cases, and 25% resection in 13 cases. Seven of these patients had EEA combined with an open, far-lateral approach. In total, 7 patients required arthrodesis following EEA (3.3%), 4 of them after a combined approach. All patients who underwent arthrodesis had primary bone tumors such as chordoma, chondrosarcoma, or osteosarcoma (P = .022). Degree of condyle resection was a significant factor predisposing to occipitocervical instability (P = .001 and P < .001 for 75% and 100% condyle resection, respectively). Use of a combined approach was significantly associated with arthrodesis (P < .001).
CONCLUSION: EEA resection of the occipital condyles that results in greater than 75% condyle resection or EEA in combination with an open approach significantly increases the risk of AO instability and likely necessitates AO fixation.
ABBREVIATIONS: AO, atlanto-occipitalEEA, endoscopic endonasal approachOC, occipitocervical.

PMID: 26237341 [PubMed - indexed for MEDLINE]

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Lawsonia intracellularis infection of intestinal crypt cells is associated with specific depletion of secreted MUC2 in goblet cells.

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Lawsonia intracellularis infection of intestinal crypt cells is associated with specific depletion of secreted MUC2 in goblet cells.

Vet Immunol Immunopathol. 2015 Nov 15;168(1-2):61-7

Authors: Bengtsson RJ, MacIntyre N, Guthrie J, Wilson AD, Finlayson H, Matika O, Pong-Wong R, Smith SH, Archibald AL, Ait-Ali T

Abstract
The expression patterns of secreted (MUC2 and MUC5AC) and membrane-tethered (MUC1, MUC4, MUC12 and MUC13) mucins were monitored in healthy pigs and pigs challenged orally with Lawsonia intracellularis. These results showed that the regulation of mucin gene expression is distinctive along the GI tract of the healthy pig, and may reflect an association between the function of the mucin subtypes and different physiological demands at various sites. We identified a specific depletion of secreted MUC2 from goblet cells in infected pigs that correlated with the increased level of intracellular bacteria in crypt cells. We concluded that L. intracellularis may influence MUC2 production, thereby altering the mucus barrier and enabling cellular invasion.

PMID: 26377360 [PubMed - indexed for MEDLINE]

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Lentivirus‑delivered nemo‑like kinase small interfering RNA inhibits laryngeal cancer cell proliferation in vitro.

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Lentivirus‑delivered nemo‑like kinase small interfering RNA inhibits laryngeal cancer cell proliferation in vitro.

Mol Med Rep. 2015 Oct;12(4):5619-24

Authors: Tai J, Rao Y, Fang J, Huang Z, Yu Z, Chen X, Zhou W, Xiao X, Long T, Han Y, Liu Q, Li A, Ni X

Abstract
Laryngeal squamous cell carcinoma is the most common form of head and neck squamous cell carcinoma. Multiple approaches have been applied to treat this type of cancer; however, no significant improvement in survival rate has been achieved. In the present study, the role of nemo‑like kinase (NLK) in human laryngeal carcinoma Hep‑2 cells was investigated. NLK has been identified as an important regulator of cell growth, patterning and cell death in a variety of organisms. Lentivirus‑mediated‑shRNA was employed to silence endogenous NLK expression. Downregulation of the expression of NLK following lentivirus infection was confirmed using reverse transcription quantitative polymerase chain reaction and western blot analysis. The effects of NLK downregulation on Hep‑2 cell proliferation and cell cycle progression were analyzed using an MTT assay and flow cytometry, respectively. Downregulation of NLK also inhibited tumorigenesis and regulated the expression of cell cycle protein expression levels. Therefore, it was hypothesized that NLK is necessary for cell survival and tumorigenesis in laryngeal cancer cells. Furthermore, the absence of NLK may lead to cancer cell death. Collectively, the results of the present study demonstrated that the lentivirus‑mediated targeted disruption of NLK may be a promising therapeutic method for the treatment of laryngeal cancer.

PMID: 26252054 [PubMed - indexed for MEDLINE]

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Effect of thyroid function variations within the laboratory reference range on health status, mood and cognition in levothyroxine treated subjects.

Effect of thyroid function variations within the laboratory reference range on health status, mood and cognition in levothyroxine treated subjects.

Thyroid. 2016 Jun 23;

Authors: Samuels M, Kolobova I, Smeraglio A, Niederhausen M, Janowsky J, Schuff KG

Abstract
BACKGROUND: There has been recent debate within the thyroid field regarding whether current upper limits of the TSH reference range should be lowered. This debate can be better informed by investigation of whether variations in thyroid function within the reference range have clinical effects. One important target organ for thyroid hormone is the brain, but little is known about variations in neurocognitive measures within the reference range for thyroid function.
METHODS: This was a cross-sectional study of 132 otherwise healthy hypothyroid subjects receiving chronic replacement therapy with levothyroxine (L-T4) who had TSH levels across the full span of the laboratory reference range (0.34-5.6 mU/L). Subjects underwent detailed tests of health status, mood, and cognitive function, with an emphasis on memory and executive functions.
RESULTS: Subjects with low-normal (≤2.5 mU/L) and high-normal (>2.5 mU/L) TSH levels did not differ on most tests of health status, mood, or cognitive function, and there were no correlations between TSH, free T4, or free T3 levels and most outcomes. There was, however, a suggestion that thyroid function affected performance on the Iowa Gambling Task, which mimics real life decision-making. Subjects with low-normal TSH levels made more advantageous decisions than those with high-normal TSH level.
CONCLUSIONS: Variations in thyroid function within the laboratory reference range do not appear to have clinically relevant effects on health status, mood, or memory in L-T4 treated subjects. However, decision making, which encompasses many executive functions, may be affected. Unless further studies strengthen this finding, these data do not support narrowing the TSH reference range.

PMID: 27338133 [PubMed - as supplied by publisher]

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