The effect of adenoid hypertrophy and adenoidectomy in patients on cardiovascular risk reduction.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):251-2
Authors: Şereflican M, Yurttaş V, Erdem F
PMID: 27405084 [PubMed - in process]
Co-occurrence of subacute granulomatous thyroiditis and papillary microcarcinoma.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):248-50
Authors: Şenel F, Karaman H, Ertan T
Abstract
Subacute thyroiditis, which is most commonly observed after a viral infection and may heal spontaneously, is an inflammatory thyroid disease. The co-occurrence of subacute thyroiditis and papillary carcinoma is quite rare. A 58-year-old male patient who applied to our hospital with the complaints of sore throat and neck swelling was performed total thyroidectomy following physical examination, ultrasound, and laboratory analysis. In histopathological examination, many granuloma structures were observed in both lobes, and a papillary microcarcinoma focus of 2 mm in diameter was seen in the left lobe. The co-occurrence of subacute thyroiditis and papillary carcinoma was deemed worthy of presentation as it is rarely observed.
PMID: 27405083 [PubMed - in process]
[Nasal type natural killer/T cell lymphoma: case series and literature review].
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):241-7
Authors: Düzlü M, Ant A, Tutar H, Karamert R, Şahin M, Sayar E, Cesur N
Abstract
Nasal type natural killer/T-cell lymphoma is a rare type of extranodal non-Hodgkin lymphoma which originates from nasal cavity and paranasal sinuses. Exact diagnosis of nasal natural killer/T-cell lymphoma, which is a rapidly progressive clinical condition, may be established by immunohistochemical analysis on biopsy material after clinical suspicion. In this article, we report four cases of nasal natural killer/T-cell lymphoma who were followed-up in our clinic and discuss the diagnosis and treatment of the disease in light of the literature data.
PMID: 27405082 [PubMed - in process]
Isolated middle ear meningioma.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):238-40
Authors: Batıoğlu-Karaaltın A, Turgut FN, Yılmaz M, Batur Ş, Öztürk Ö
Abstract
Meningiomas are slowly progressive, benign tumors that originate from meningothelial cells. Extracranial meningiomas, especially isolated middle ear meningiomas, are very rare. In this article, we report a rare secretory type primary middle ear meningioma which was histopathologically confirmed in a 46-year-old female patient who presented with otological and neurootological symptoms.
PMID: 27405081 [PubMed - in process]
[A case of brucellosis presenting with suppurative parotitis involvement].
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):234-7
Authors: Kanmaz L, Karakeçili F, Çıkman A, Özçiçek F, Karavaş E
Abstract
Brucellosis is a common zoonotic infection caused by Brucella bacteria. Brucella infections are usually presented with various clinical manifestations, and often accompanied by multiple organ involvements. In this article, we present a case of brucellosis with suppurative parotitis involvement accompanied by parotid abscess and fistula in a 60-year-old male patient. According to the literature review we conducted regarding complications of brucellosis, our case is the first case reported in the literature. Significant improvement in patient's suppurative parotitis and clinical findings was observed at the fifth week of combination antibiotic therapy. Patient's complaints resolved completely after eight weeks of treatment.
PMID: 27405080 [PubMed - in process]
Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):228-33
Authors: Özbal Koç AE, Türkoğlu SB, Erol O, Erbek S
Abstract
OBJECTIVES: This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP).
PATIENTS AND METHODS: This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP.
RESULTS: Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups.
CONCLUSION: Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.
PMID: 27405079 [PubMed - in process]
Relationship between serum magnesium level and subjective tinnitus.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):225-7
Authors: Uluyol S, Kılıçaslan S, Yağız Ö
Abstract
OBJECTIVES: This study aims to assess the relationship between serum magnesium level and bilateral subjective tinnitus.
PATIENTS AND METHODS: The study included a total of 76 patients (36 males, 40 females; mean age 48.5±6.5 years; range 43 to 65 years) suffering from severe bilateral subjective tinnitus (accepted as severe and catastrophic according to tinnitus severity index) as the study group and 86 healthy participants (42 males, 44 females; mean age 43.8±7.3 years; range 40 to 61 years) as the control group. Serum magnesium levels of both groups were measured and compared statistically.
RESULTS: The serum magnesium concentration was significantly lower in the study group compared to the control group (1.8±0.2 vs. 2.3±0.4 mg/dL, p=0.03).
CONCLUSION: The significant association between serum magnesium level and tinnitus shows the importance of magnesium in the pathophysiology of subjective tinnitus.
PMID: 27405078 [PubMed - in process]
Role of nasal problems on positional and nonpositional obstructive sleep apnea.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):219-24
Authors: Cevizci R, Kemaloğlu YK, Yılmaz M, Düzlü M, Karamert R
Abstract
OBJECTIVES: This study aims to examine the relationship between nasal pathologies and positional (PP) obstructive sleep apnea (OSA) or nonpositional (NPP) OSA.
PATIENTS AND METHODS: A total of 44 male OSA patients (mean age 48.0±6.8 years; range 31 to 60 years) suffering from nasal obstruction were retrospectively evaluated for nasal obstruction scores, overall apnea hypopnea index (AHI) and AHI in supine and nonsupine positions, daytime sleepiness scores, and body mass index (BMI). Patients were divided into two equal groups as PP group and NPP group. Output parameters were snoring severity index, clinical nasal obstruction score, septal deviation score, conchal hypertrophy score, and allergic rhinitis (AR) score. These parameters were correlated with the type of OSA.
RESULTS: Apnea hypopnea index was significantly lower in PP group than in NPP group (p<0.03). Spearman correlation analysis revealed significant negative correlation between AR score and PP (r=-0.40, p<0.0001). Pearson correlation test revealed significant correlation between AHI and BMI (r=0.32, p<0.05).
CONCLUSION: We suggest that AR is not only an important risk factor for OSA, but also patients with AR tend to be NPP OSA patients because of the serious nasal obstruction which already causes an increase in nasal resistance or pharyngeal collapsibility.
PMID: 27405077 [PubMed - in process]
Paratracheal lymph node dissection, in which patients should it be performed?
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):213-8
Authors: Çomoğlu Ş, Çomoğlu E, Enver N, Yılmaz E, Çelik M, Polat B, Ulusan M, Aslan İ, Değer K
Abstract
OBJECTIVES: This study aims to evaluate the effect of paratracheal lymph node (PTLN) metastasis on survival in patients with advanced laryngeal and hypopharyngeal cancer.
PATIENTS AND METHODS: Medical records of advanced laryngeal and hypopharyngeal cancers who underwent surgery between May 1995 and June 2008 were assessed and 78 of the patients (63 males, 15 females; mean age 55±11.3 years; range 25 to 76 years) who has PTLN metastasis were included in this study. The mean follow-up period was 23 months. Fifty-three patients had primary laryngeal cancer, and the remaining 25 patients had primary hypopharyngeal cancer.
RESULTS: Paratracheal lymph node metastasis was detected in eight (15%) of 53 patients with laryngeal carcinoma, six (42%) of 14 patients with postcricoid carcinoma, and one (14%) of seven patients with posterior pharyngeal wall carcinoma. Paratracheal lymph node metastasis was not detected in patients with pyriform sinus carcinoma (n=4). Paratracheal lymph node metastasis was detected in a total of 15 patients, of whom 11 had extranodal spread (ENS). Multivariate analysis showed that the presence of ENS was the most effective prognostic factor on the overall survival (p<0.0005).
CONCLUSION: The presence of PTLN metastasis with ENS is an important prognostic indicator on overall survival. We recommend PTLN dissection particularly in patients with advanced laryngeal or hypopharyngeal cancer for histopathological analysis and prognostication because ENS can only be precisely detected by pathological evaluation.
PMID: 27405076 [PubMed - in process]
The importance of voice analysis in evaluating the effectiveness of reflux treatment.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):207-12
Authors: Batıoğlu-Karaaltın A, Develioğlu ÖN, Tarhan Ö, Külekçi M
Abstract
OBJECTIVES: This study aims to investigate the effects of reflux treatment in voice disorders in laryngopharyngeal reflux (LPR) patients using acoustic analyses and the relationship between scoring systems.
PATIENTS AND METHODS: A total of 84 LPR patients (18 males, 66 females; mean age 43.1±11.3 years; range 18 to 73 years) were evaluated using reflux symptom index (RSI), reflux findings score (RFS), videolaryngostroboscopic examination, and acoustic analysis with Dr. Speech 4 before LPR treatment and at the first and third months after treatment.
RESULTS: Maximum phonation time, fundamental frequency (F0), jitter, and shimmer scores did not show any statistically significant alteration at the posttreatment period according to pretreatment scores (p>0.05). However, the alteration in Harmonics-to-Noise ratio and Signals-to-Noise ratio scores were statistically significant (p=0.017 and p=0.003, respectively). Reflux symptom index results showed significant positive correlation with F0 at the pretreatment, and at posttreatment first and third month evaluations (Spearman's rank correlation coefficient [rho]=0.246, p=0.024; rho=0.300, p=0.006; rho=0.305, p=0.005, respectively).
CONCLUSION: The relationship between the parameters of acoustic analysis and RSI and RFS values seems to be controversial for diagnosis and follow-up of LPR patients, requiring further investigations.
PMID: 27405075 [PubMed - in process]
Endoscopic transcanal stapes surgery: our technique and outcomes.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):201-6
Authors: Dursun E, Özgür A, Terzi S, Oğurlu M, Coşkun ZÖ, Demirci M
Abstract
OBJECTIVES: This study aims to evaluate the outcomes of endoscopic stapes surgery in terms of hearing gain and complications.
PATIENTS AND METHODS: The medical records of 31 patients (13 males, 18 females; mean age 41.5±8.6 years; range 23 to 60 years) who underwent endoscopic stapes surgery in our clinic between April 2013 and June 2015 were retrospectively analyzed. The mean preoperative and postoperative pure tone bone conduction, air-bone gap, postoperative air-bone gap gain, duration of surgery and complications were evaluated.
RESULTS: The right ear was operated on 15 patients and the left ear on 16 patients. The mean postoperative air-bone gap was statistically significantly improved, compared to preoperative values (p<0.001). The mean air-bone gap gain was 25.5±7.0 dB.
CONCLUSION: Our study results suggest that endoscopy is a safe method which can be used in stapes surgery.
PMID: 27405074 [PubMed - in process]
Prevalence of pneumatized uncinate process and accompanying neighboring variations.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):195-200
Authors: Yenigün A, Gün C, Uysal İİ, Keleş MK, Nayman A, Karabulut AK
Abstract
OBJECTIVES: This study aims to investigate the prevalence of uncinate process (UP) pneumatization and also to investigate the association of UP pneumatization with concurrent morphological variations in neighboring structures and the presence of maxillary sinusitis.
PATIENTS AND METHODS: This was a retrospective study where coronal computed tomography scans of 1,500 UPs in 750 patients (483 males, 267 females; mean age 36.3±14.7 years; range 7 to 84 years) were examined to determine the prevalence of UP pneumatization and to assess any concurrent neighboring anatomical structures and the presence of maxillary sinusitis between January 2013 and June 2013.
RESULTS: Uncinate process pneumatization was identified in a total of 6.26% of our patients with 1.60% being bilateral, 2.53% on the right only, and 2.13% on the left side only. Other than concurrent occurrences of right maxillary sinus septa (p=0.046), growth of the right ethmoidal bulla (p=0.044) and presence of maxillary sinusitis (right side: p=0.046, left side: p=0.035) were seen.
CONCLUSION: We detected a 6.2% prevalence of UP pneumatization in our study group. An abnormally sized and over-pneumatized UP can cause narrowing of the infundibulum and impaired sinus drainage. Such functional blockage can lead to recurrent maxillary sinusitis, stuffiness, and decreased olfaction.
PMID: 27405073 [PubMed - in process]
[Immune function alteration in children after tonsillectomy and(or) adenoidectomy].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):418-23
Authors: Hu L, Yang J
Abstract
Tonsillectomy and(or) adenoidectomy are effective procedures for children with chronic tonsillitis, diseases associated with the tonsil and other adenotonsillar diseases, and obstructive sleep apnea-hypopnea syndrome. Since the tonsil and adenoid gland play a dual role in fluid and cell immunity, whether adenotonsillectomy results in the abnormal immune function in children after the surgery has always been the focus of attention. This review focuses on the alterations and impacts on immunity in children after tonsillectomy and/or adenoidectomy. Recent studies confirmed that in short term the immune index may be slightly reduced after the tonsil and adenoid resection in children, however, the decline has no clinical significance because the remaining mucosa-associated lymphoid tissue can compensate for removal of the tonsils and adenoids. Over time, the immune index tends to be normal. The children's postoperative short-term decline in the immune index will gradually recover to the preoperative level or there is no significant difference compared with that in normal children. Therefore, long-term immune function did not decline after tonsil and adenoid resection in children.
PMID: 27382697 [PubMed - indexed for MEDLINE]
The effect of adenoid hypertrophy and adenoidectomy in patients on cardiovascular risk reduction.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):251-2
Authors: Şereflican M, Yurttaş V, Erdem F
PMID: 27405084 [PubMed - as supplied by publisher]
Co-occurrence of subacute granulomatous thyroiditis and papillary microcarcinoma.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):248-50
Authors: Şenel F, Karaman H, Ertan T
Abstract
Subacute thyroiditis, which is most commonly observed after a viral infection and may heal spontaneously, is an inflammatory thyroid disease. The co-occurrence of subacute thyroiditis and papillary carcinoma is quite rare. A 58-year-old male patient who applied to our hospital with the complaints of sore throat and neck swelling was performed total thyroidectomy following physical examination, ultrasound, and laboratory analysis. In histopathological examination, many granuloma structures were observed in both lobes, and a papillary microcarcinoma focus of 2 mm in diameter was seen in the left lobe. The co-occurrence of subacute thyroiditis and papillary carcinoma was deemed worthy of presentation as it is rarely observed.
PMID: 27405083 [PubMed - as supplied by publisher]
[Nasal type natural killer/T cell lymphoma: case series and literature review].
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):241-7
Authors: Düzlü M, Ant A, Tutar H, Karamert R, Şahin M, Sayar E, Cesur N
Abstract
Nasal type natural killer/T-cell lymphoma is a rare type of extranodal non-Hodgkin lymphoma which originates from nasal cavity and paranasal sinuses. Exact diagnosis of nasal natural killer/T-cell lymphoma, which is a rapidly progressive clinical condition, may be established by immunohistochemical analysis on biopsy material after clinical suspicion. In this article, we report four cases of nasal natural killer/T-cell lymphoma who were followed-up in our clinic and discuss the diagnosis and treatment of the disease in light of the literature data.
PMID: 27405082 [PubMed - as supplied by publisher]
Isolated middle ear meningioma.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):238-40
Authors: Batıoğlu-Karaaltın A, Turgut FN, Yılmaz M, Batur Ş, Öztürk Ö
Abstract
Meningiomas are slowly progressive, benign tumors that originate from meningothelial cells. Extracranial meningiomas, especially isolated middle ear meningiomas, are very rare. In this article, we report a rare secretory type primary middle ear meningioma which was histopathologically confirmed in a 46-year-old female patient who presented with otological and neurootological symptoms.
PMID: 27405081 [PubMed - as supplied by publisher]
[A case of brucellosis presenting with suppurative parotitis involvement].
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):234-7
Authors: Kanmaz L, Karakeçili F, Çıkman A, Özçiçek F, Karavaş E
Abstract
Brucellosis is a common zoonotic infection caused by Brucella bacteria. Brucella infections are usually presented with various clinical manifestations, and often accompanied by multiple organ involvements. In this article, we present a case of brucellosis with suppurative parotitis involvement accompanied by parotid abscess and fistula in a 60-year-old male patient. According to the literature review we conducted regarding complications of brucellosis, our case is the first case reported in the literature. Significant improvement in patient's suppurative parotitis and clinical findings was observed at the fifth week of combination antibiotic therapy. Patient's complaints resolved completely after eight weeks of treatment.
PMID: 27405080 [PubMed - as supplied by publisher]
Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):228-33
Authors: Özbal Koç AE, Türkoğlu SB, Erol O, Erbek S
Abstract
OBJECTIVES: This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP).
PATIENTS AND METHODS: This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP.
RESULTS: Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups.
CONCLUSION: Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.
PMID: 27405079 [PubMed - as supplied by publisher]
Relationship between serum magnesium level and subjective tinnitus.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):225-7
Authors: Uluyol S, Kılıçaslan S, Yağız Ö
Abstract
OBJECTIVES: This study aims to assess the relationship between serum magnesium level and bilateral subjective tinnitus.
PATIENTS AND METHODS: The study included a total of 76 patients (36 males, 40 females; mean age 48.5±6.5 years; range 43 to 65 years) suffering from severe bilateral subjective tinnitus (accepted as severe and catastrophic according to tinnitus severity index) as the study group and 86 healthy participants (42 males, 44 females; mean age 43.8±7.3 years; range 40 to 61 years) as the control group. Serum magnesium levels of both groups were measured and compared statistically.
RESULTS: The serum magnesium concentration was significantly lower in the study group compared to the control group (1.8±0.2 vs. 2.3±0.4 mg/dL, p=0.03).
CONCLUSION: The significant association between serum magnesium level and tinnitus shows the importance of magnesium in the pathophysiology of subjective tinnitus.
PMID: 27405078 [PubMed - as supplied by publisher]
Severe Asthma: A Heterogeneous Disease.
Immunol Allergy Clin North Am. 2016 Aug;36(3):xv-xvi
Authors: Katial RK
PMID: 27401631 [PubMed - in process]
Severe Asthma: Chipping Away at the Unmet Need.
Immunol Allergy Clin North Am. 2016 Aug;36(3):xiii
Authors: Tilles SA
PMID: 27401630 [PubMed - in process]
Emerging Biologics in Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):609-23
Authors: Pavord ID, Hilvering B, Shrimanker R
Abstract
Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by persistently elevated sputum and/or blood eosinophils and by a significant response to treatments that suppress eosinophilia. Eosinophil activity in the airway may be more important than their numbers and this needs to be investigated. Transcriplomic or Metabolomic signatures may also be useful to identify this endotype.
PMID: 27401629 [PubMed - in process]
Traditional Therapies for Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):581-608
Authors: Wang E, Hoyte FC
Abstract
Severe asthma is a complex and heterogeneous disease. The European Respiratory Society and American Thoracic Society guidelines define severe asthma for patients 6 years or older as "asthma which requires treatment with high-dose inhaled corticosteroids…plus a second controller or systemic corticosteroids to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy." This article reviews available traditional therapies, data behind their uses in severe asthma, and varying recommendations. As various asthma endotypes and phenotypes are better understood and characterized, targeted therapies should help improve disease outcomes, efficacy, and cost-effectiveness.
PMID: 27401628 [PubMed - in process]
Neutrophilic and Pauci-immune Phenotypes in Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):569-79
Authors: Panettieri RA
Abstract
Although 2 T-helper type 2 inflammation evokes airway hyperresponsiveness and narrowing, neutrophilic or pauci-immune asthma accounts for significant asthma morbidity. Viruses, toxicants, environmental tobacco smoke exposure, and bacterial infections induce asthma exacerbations mediated by neutrophilic inflammation or by structural cell (pauci-immune) mechanisms. Therapeutic challenges exist in the management of neutrophilic and pauci-immune phenotypes because both syndromes manifest steroid insensitivity. The recognition that neutrophil subsets exist and their functions are unique poses exciting opportunities to develop precise therapies. The conventional thought to target neutrophil activation or migration globally may explain why current drug development in neutrophilic asthma remains challenging.
PMID: 27401627 [PubMed - in process]
Eosinophilic Endotype of Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):559-68
Authors: Aleman F, Lim HF, Nair P
Abstract
Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by elevated sputum and/or blood eosinophils on at least 2 occasions and by a significant response to treatments that suppress eosinophilia. Histopathologic demonstration of eosinophils in the airways provides the most direct diagnosis of eosinophilic asthma; but it is invasive, thus, impractical in clinical practice.
PMID: 27401626 [PubMed - in process]
Biomarkers in Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):547-57
Authors: Wan XC, Woodruff PG
Abstract
Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma.
PMID: 27401625 [PubMed - in process]
Imaging of Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):529-45
Authors: Richards JC, Lynch D, Koelsch T, Dyer D
Abstract
Asthma is one of the most common diseases of the lung. Asthma manifests with common, although often subjective and nonspecific, imaging features at radiography and high-resolution computed tomography. The primary role of imaging is not to make a diagnosis of asthma but to identify complications, such as allergic bronchopulmonary aspergillosis, or mimics of asthma, such as hypersensitivity pneumonitis. This article reviews the imaging features of asthma as well as common complications and mimics.
PMID: 27401624 [PubMed - in process]
Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: Nothing New Under the Sun.
Immunol Allergy Clin North Am. 2016 Aug;36(3):515-28
Authors: Putcha N, Wise RA
Abstract
The debate about whether asthma and chronic obstructive pulmonary disease (COPD) are distinct clinical syndromes is not new; there is heightened interest in understanding the group of individuals with obstructive lung disease who seem to have elements of both conditions because recent studies have demonstrated increased risk for respiratory events and exacerbations. We describe the clinical characteristics of this subtype of disease and suggest 4 working definitions of individuals who would fall into the asthma-COPD overlap category. Understanding the mechanisms underlying these subtypes will hopefully lead into a better understanding of therapeutic strategies that can target specific pathobiologic pathways.
PMID: 27401623 [PubMed - in process]
Chronic Rhinosinusitis and Aspirin-Exacerbated Respiratory Disease.
Immunol Allergy Clin North Am. 2016 Aug;36(3):503-14
Authors: Dunn NM, Katial RK
Abstract
Patients with severe asthma and concomitant chronic rhinosinusitis often have severe, refractory upper and lower airway inflammation. This inflammation has been proposed to be similar throughout the upper and lower airways leading to the unified airways concept. This article reviews chronic rhinosinusitis with and without nasal polyps, and the subgroup with aspirin-exacerbated respiratory disease, while focusing on the relationship with asthma. Additionally, diagnosis and treatment with current and newer therapies are discussed.
PMID: 27401622 [PubMed - in process]
Chronic Infection and Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):483-502
Authors: Carr TF, Kraft M
Abstract
Chronic bacterial infection is implicated in both the development and severity of asthma. The atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae have been identified in the airways of asthmatics and correlated with clinical features such as adult onset, exacerbation risks, steroid sensitivity, and symptom control. Asthmatic patients with evidence of bacterial infection may benefit from antibiotic treatment directed towards these atypical organisms. Examination of the airway microbiome may identify microbial communities that confer risk for or protection from severe asthma.
PMID: 27401621 [PubMed - in process]
Role of Small Airways in Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):473-82
Authors: Finkas LK, Martin R
Abstract
Asthma is an inflammatory condition of both the small and large airways. Recently the small airways have gained attention as studies have shown significant inflammation in the small airways in all severities of asthma. This inflammation has correlated with peripheral airway resistance and as a result, noninvasive methods to reliably measure small airways have been pursued. In addition, recent changes in asthma inhalers have led to alterations in drug formulations and the development of extrafine particle inhalers that improve delivery to the distal airways.
PMID: 27401620 [PubMed - in process]
Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):461-71
Authors: Rogers L
Abstract
Gastroesophageal reflux and obstructive sleep apnea syndrome are conditions that practitioners have been encouraged to evaluate and treat as part of a comprehensive approach to achieving asthma control. In this review, the author looks at the evidence linking these two conditions as factors that may impact difficult-to-control asthma and looks critically at the evidence suggesting that evaluation and treatment of these conditions when present impacts asthma control.
PMID: 27401619 [PubMed - in process]
Psychosocial Factors in Severe Pediatric Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):449-60
Authors: Booster GD, Oland AA, Bender BG
Abstract
Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.
PMID: 27401618 [PubMed - in process]
Linkage and Genetic Association in Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):439-47
Authors: Jones BL, Rosenwasser LJ
Abstract
A significant body of work in the genetics of asthma currently exists. However, current knowledge has not been clarifying in understanding the pathophysiology of asthma and therapeutic treatment of the disease. Severe asthma in adults and children is a significant burden in relation to disproportionate disease morbidity, mortality, and health utilization. This disease phenotype is not well understood; current effective treatment regimens are limited. Genetic studies may lead to improved understanding of the pathophysiology of severe asthma and identification of relevant subsets, which allow more targeted and effective therapies and the realization of Precision Medicine in asthma.
PMID: 27401617 [PubMed - in process]
Epidemiology and Pulmonary Physiology of Severe Asthma.
Immunol Allergy Clin North Am. 2016 Aug;36(3):425-38
Authors: O'Toole J, Mikulic L, Kaminsky DA
Abstract
The epidemiology and physiology of severe asthma are inherently linked because of varying phenotypes and expressions of asthma throughout the population. To understand how to better treat severe asthma, we must use both population data and physiologic principles to individualize therapies among groups with similar expressions of this disease.
PMID: 27401616 [PubMed - in process]
Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jul 8;
Authors: Cheng YL, Gould A, Kurago Z, Fantasia J, Muller S
Abstract
Despite being one of the most common oral mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology or pathogenesis, and with uncertain premalignant potential. More research is urgently needed; however, the research material must be based on an accurate diagnosis. Accurate identification of OLP is often challenging, mandating inclusion of clinico-pathological correlation in the diagnostic process. This article summarizes current knowledge regarding OLP, discusses the challenges of making an accurate diagnosis, and proposes a new set of diagnostic criteria upon which to base future research studies. A checklist is also recommended for clinicians to provide specific information to pathologists when submitting biopsy material. The diagnostic process of OLP requires continued clinical follow-up after initial biopsy, because OLP mimics can manifest, necessitating an additional biopsy for direct immunofluorescence study and/or histopathological evaluation in order to reach a final diagnosis.
PMID: 27401683 [PubMed - as supplied by publisher]
Mammary Analog Secretory Carcinoma (MASC) Involving the Thyroid Gland: A Report of the First 3 Cases.
Head Neck Pathol. 2016 Jul 11;
Authors: Dettloff J, Seethala RR, Stevens TM, Brandwein-Gensler M, Centeno BA, Otto K, Bridge JA, Bishop JA, Leon ME
Abstract
Salivary gland-type tumors have been rarely described in the thyroid gland. Mammary Analog Secretory Carcinoma (MASC) is a recently defined type of salivary gland carcinoma characterized by a t(12;15)(p13;q25) resulting in an ETV6-NTRK3 fusion gene. We report 3 cases of MASC involving the thyroid gland without clinical evidence of a salivary gland or breast primary; the clinico-pathologic characteristics are reviewed. Assessment for rearrangement of the ETV6 (12p13) locus was conducted by fluorescence in situ hybridization (FISH) on representative FFPE sections using an ETV6 break apart probe (Abbott Molecular, Des Plaines, IL, USA). The patients were two females (52 and 55 years-old) and 1 male (74 years-old). The tumors were poorly circumscribed solid white tan nodules involving the thyroid. Histologically, they were invasive and showed solid, microcystic, cribriform, and tubular growth patterns composed of variably bland polygonal eosinophilic cells with vesicular nuclear chromatin and conspicuous nucleoli. All three cases showed metastasis to lymph nodes; one case showed lateral neck involvement. The tumor cells were positive for S100 and mammaglobin. GATA-3 and PAX-8 were positive in 2 cases, one of which only focally so. All three cases were negative for TTF-1 and thyroglobulin. Rearrangement of the ETV6 locus was confirmed in all cases and a diagnosis of MASC rendered for each case. A site of origin distinct from the thyroid gland was not identified, with a median follow up of 24 months. MASC may rarely involve the thyroid gland. The origin of these lesions is unknown; while an origin from ectopic salivary gland-type cells is entertained, a metastatic origin from an occult primary cannot be definitively excluded at this time. Given the histologic (follicular-like microcystic pattern with colloid-like secretions and papillary pattern), immunophenotypic (PAX-8), and even molecular overlap, MASC can be mistaken for papillary thyroid carcinoma and should be considered in the differential diagnosis of a thyroid mass.
PMID: 27400918 [PubMed - as supplied by publisher]
[A study on vowel duration and word length of adductor spasmodic dysphonia].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):378-80
Authors: Chen Z, Ge P
Abstract
OBJECTIVE: To understand the vowel duration and statement reading of the adductor spasmodic dysphonia (ADSD) patients compared with their normal controls, and provide ideas for clinical diagnosis and treatment.
METHOD: Twenty-nine ADSD patients were included in the research, with 31 normal controls. All subjects filled in form voice handicap index (VHI) by themselves. Maximum phonetic time (MPT) and maximum loudness phonetic time(MLPT) were tested on /a/ sound for all patients. Also, all the patients were required to read aloud a standard mandarin assay named <parents heart>, duration were measured with Praat5. 0 software after sounds were collected. A one-way t-test was performed to compare spasmodic group with control group on VHI, MPT, MLPT and duration for reading standard sentences. Pearson/Spearman correlation was tested. Result: The VHI of the 29 ADSD patients is 89±12, and their normal controls 15±16, indicating that the VHI in ADSD group is significantly higher than in the control group(P<0. 01). The MPT of the ADSD group is(16. 9±9. 8 s), and the control group is (25. 3±10.0)s, indicating that MPT in the ADSD group is significantly shorter than the control group(P<0. 01). The MLPT of the ADSD group is (15.7±7. 6)s, and the control group is (26. 5±11. 4)s, indicating that MLPT in the ADSD group is significantly shorter than the control group (P<0. 01). The duration of standard sentence reading of the ADSD group is (55.0±14. 2)s, and the control group is (37. 8±4. 8)s, indicating that the duration of standard sentence reading in the ADSD group is significantly longer than the control group (P<0. 01). Correlation analysis showed that MPT and MLPT are related within the ADSD group(r=0. 697,P< 0.01), other indexes being tested have no significant correlations.
CONCLUSION: The voice disorder condition of the ADSD patients is significantly worse than normal people. Their pronunciations on continuous vowels are not lasting compared with normal people. In the meantime, their ability to read sentences is worse than normal people, needing longer time to complete the reading task. There is a significant correlation between MLPT and MPT, which can be used as an alternative to MPT.
PMID: 27382680 [PubMed - indexed for MEDLINE]
A Nationwide study of multiple endocrine neoplasia type 2A in Norway. Predictive avd prognostic factors for the clinical course of medullary thyroid carcinoma.
Thyroid. 2016 Jul 11;
Authors: Opsahl EM, Schlichting E, Helset K, Svartberg J, Brauckhoff K, Mæhle L, Engebretsen LF, Sigstad E, Grøholt K, Akslen LA, Jørgensen LH, Varhaug JE, Bjøro T
Abstract
BACKGROUND: Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome caused by activating germline mutations in the RET (REarranged during Transfection) proto-oncogene. MEN 2A has a strong (>95%) and age dependent (5-25 years) clinical penetrance of medullary thyroid carcinoma (MTC). Several major studies have analyzed the predictive and prognostic factors for MEN 2A to find indicators that predict the optimal timing of prophylactic thyroidectomy. The aim of this study was to describe all known RET positive MEN 2A patients diagnosed in Norway and evaluate the clinical course of MTC, as well as its predictive and prognostic factors.
METHODS: This nationwide retrospective cohort study included data for 65 (14 index and 51 screening patients) out of a total of 67 MEN 2A patients with the RET gene mutation who were diagnosed in Norway since 1974. Data were collected by reviewing patient files. The variables analyzed were genotype, phenotype, preoperative basal calcitonin, age at thyroid surgery, central lymph node dissection and nodal status at primary surgery, number of surgical procedures, and biochemical cure. Of the 65 patients, 60 had undergone thyroid surgery. The median follow-up period was 9.9 years. The patients were divided into pre-RET-and RET-era, which included patients who had thyroid surgery before January 1, 1994 and after, respectively.
RESULTS: In index and screening patients, MTC was found, respectively, in 100% vs. 45% of cases, central lymph node dissection at primary surgery was done for 64% vs. 52% of patients, and the median total number of surgical procedures was 2 (range 1-6) vs. 1 (range 1-4). At primary surgery, all patients (13) with lymph node metastases had preoperative basal calcitonin levels ≥ 68 pg/ml, and all patients (17) without central lymph node dissection and preoperative basal calcitonin < 40 pg/mL were biochemically cured. Multivariate analysis showed that preoperative basal calcitonin was a significant predictive factor for MTC superior to age at thyroid surgery when analyzing the entire period (p=0.009) and the RET-era separately (p=0.021). Prognostic factors for biochemical cure were preoperative basal calcitonin, central lymph node dissection and nodal status at primary surgery (p=0.037/p=0.002/p=0.005) when analyzing the entire….
PMID: 27400880 [PubMed - as supplied by publisher]
Got rice? An unusual case of iodine-deficiency hypothyroidism.
Thyroid. 2016 Jul 11;
Authors: Nguyen CT, Braverman LE, Singer PA
Abstract
N/A - Letter to the Editor.
PMID: 27400805 [PubMed - as supplied by publisher]
Unemployment risk and decreased income 2 and 4 years after thyroid cancer diagnosis: a population based study.
Thyroid. 2016 Jul 11;
Authors: Ratzon NZ, Uziely B, de Boer AG, Rottenberg Y
Abstract
BACKGROUND: Thyroid cancer (TC) is a disease of relatively young patients with a high cure rate. Decreased psychological and physical well-being lowers their work abilities. The aim of this study was to compare the risk for unemployment and decreasing income change among TC survivals to a matched non-cancer group at 2 and 4 years after diagnosis and to predict unemployment and income changes at 2 years and 4 years after diagnosis.
METHODS: A nested case control study was designed, with cohort inception and baseline measurement of people participating in the Israeli Central Bureau of Statistics 1995 National Census, and follow up until 2011. Cancer incidence and employment status were ascertained through the Israel Cancer Registry and Tax Authority, respectively. A matched group was sampled from the population in the census. Binary logistic regression analyses were used to assess odds ratios for study's outcomes, while controlling for age, gender, ethnicity, education years, socioeconomic position and status of employment at 2 years prior to diagnosis.
RESULTS: A total of 417 cases of TC and 1277 non-cancer matched group were included in the study after excluding persons who died during the study period. The mean age at the time of cancer diagnosis was 43.5 years in the group of TC and 43.8 years in the match group (p=0.6). A positive association between TC and risk of unemployment 2 years after diagnosis (OR=1.46, 95% CI: 1.09-1.95), decreased income 2 years after diagnosis (OR=1.61, 95% CI: 1.23-2.01) and at 4 years after diagnosis (OR=1.63, 95% CI: 1.25-2.13) were found after adjusting for potential confounders. In contrast, the association between TC and unemployment 4 years after diagnosis was found to weaken and actually lose significance (OR=1.30, 95% CI: 0.98-1.72).
CONCLUSIONS: TC survivorship is associated with subsequent unemployment at 2 years and decreased income at 2 and 4 years, while income decreasing may be a marker for shifting to part time work rather than full return for work. On a more practical note, the clinical ramifications of our findings suggest that intervention in order to enhance return to full work is required at this population.
PMID: 27400754 [PubMed - as supplied by publisher]
The use of intrathecal fluorescein in cerebrospinal fluid leak repair: management from an anesthesiologist's point-of-view.
Acta Anaesthesiol Scand. 2016 Jul 11;
Authors: Antunes P, Perdigão M
PMID: 27401542 [PubMed - as supplied by publisher]
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[MEDIUM-TERM EFFECTIVENESS OF Waveflex SYSTEM IN TREATMENT OF MULTIPLE LUMBAR DEGENERATIVE DISEASES].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Sep;29(9):1104-8
Authors: Xue Y, Wang D, Dai W, Ma C, Xia J
Abstract
OBJECTIVE: To evaluate the medium-term effectiveness of Waveflex system in the treatment of multiple lumbar degenerative diseases.
METHODS: Between May 2010 and July 2012, 26 patients with multiple lumbar degenerative diseases underwent posterior decompression, transforaminal lumbar interbody fusion (TLIF), and internal fixation with Waveflex system. There were 15 males and 11 females, aged 23-65 years (mean, 34.2 years). The disease duration was 9 months to 8 years (median, 3 years and 3 months). The lesion located at L3-S1. The visual analogue scale (VAS), Oswestry disability index (ODI), and the short-form 36 health survey scale (SF-36) were used to evaluate the status of clinical recovery, meanwhile the Stauffer-Coventry evaluation standard was used to access the satisfaction at last follow-up; the disc space height (DSH), intervertebral angle (IVA), and range of motion (ROM) were measured on X-ray film or three-dimensional CT, and the adjacent segment degeneration was classified by Pfirrmann score based on MRI findings.
RESULTS: All patients obtained primary incision healing without nerve injury, cerebrospinal fluid leakage, or internal fixation failure. All patients were followed up 31-50 months (mean, 40.6 months). The VAS, ODI, and SF-36 scores were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P<0.05), but no significant difference was found between at 6 months and last follow-up (P>0.05). According to the Stauffer-Coventry evaluation standard, the results were excellent in 21 cases, good in 2 cases, moderate in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5% at last follow-up. X-ray films showed that there was no complication of screws pulling-out or fixed rod rupture and displacement. At 7 days, 6 months, and last follow-up, the DSH of adjacent segment was significantly increased (P<0.05), and the ROM of adjacent segment was significantly decreased (P<0.05) when compared with preoperative ones; there was no significant difference in IVA between at pre- and post-operation (P>0.05). According to Brantigan grade for fusion, 19 cases were rated as grade E, 6 cases as grade D, and 1 case as grade C, and the fusion rate was 96%. There was no significant difference in Pfirrmann score between at pre-operation and last follow-up (Z=0.000, P=1.000).
CONCLUSION: The Waveflex system combined with TLIF is effective and safe to treat multiple lumbar degenerative diseases during medium-term follow-up.
PMID: 26750008 [PubMed - indexed for MEDLINE]
Biofilm on the tracheoesophageal voice prosthesis: considerations for oral decontamination.
Eur Arch Otorhinolaryngol. 2016 Jul 11;
Authors: Somogyi-Ganss E, Chambers MS, Lewin JS, Tarrand JJ, Hutcheson KA
Abstract
The tracheoesophageal puncture (TEP) restores verbal communication after total laryngectomy using a one-way valved voice prosthesis (VP). Microbial colonization can shorten VP device life. Our aims were to investigate patterns of prosthetic and oral colonization, and record changes in VP device life after targeted decontamination. We conducted a retrospective review of TEP clinic patients who underwent microbial analysis of the VP between 01/2003 and 07/2013. Two subgroups were analyzed: (1) patients with microbial analysis of the VP and the mouth were analyzed to identify patterns of common contamination, and (2) patients who were prescribed targeted oral decontamination on the basis of the microbial analysis of the VP were analyzed to evaluate effects on device life. Among 42 patients, 3 patients had only fungal, 5 only bacterial, and 33 had polyspecies fungal and bacterial colonization. In the TEP-oral microflora subgroup (n = 15), 7 had common microorganisms in the mouth and on the VP. Among the decontamination subgroup (n = 23), 6 patients received broad spectrum rinse, 16 antifungal agents and 13 antibiotics, or a combination thereof. After targeted decontamination, the median device life of prostheses improved from 7.89 to 10.82 weeks (p = 0.260). The majority of patients with a suboptimal VP device life in this pilot had polyspecies bacterial and fungal colonization. VPs rarely had fungal contamination alone (3 %), and non-albicans fungal species were more common than expected. For these reasons, we are exploring the use of targeted decontamination regimens that were associated with 1.4-fold improvement in VP duration.
PMID: 27400694 [PubMed - as supplied by publisher]
[Clinical efficacy and quality of life evaluation of BPPV by different reduction methods].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):392-5
Authors: Qi H, Wang B, Yu W, Zheng Z, Yang J
Abstract
OBJECTIVE: Comparative analysis of the clinical curative effect of manipulative reduction and TRV- CRP treatment of BPPV, comfort degree during reset and quality of life improvement.
METHOD: One hundred and thirty-two patients with BPPV were randomly divided into two groups ,one group underwent the traditional manip- ulative reduction, the other group with TRV-CRP. DRI and VAS was evaluated in the pre and after treatment and evaluation of the efficacy was conducted. The results of two groups were compared.
RESULT: The effective rate of manipulative reduction after a week treatment was 89. 23% and TRV-CRP.was 98. 51%, which was higher in TRV-CRP group than that of the manipulation reduction group(P<0. 05). The comfort degree of the manipulation reduction group was 4. 54±2. 48,higher than the TRV-CRP group which was 5. 48±1. 44 (P<0. 05). The score of DHI showed no significant difference before treatment between manipulation reduction group and TRV-CRP group(P>0. 05), the score of the two groups were decreased after a week of reduction, but the improvement of TRV-CRP group was higher than that of manipulation reduction group(P<0. 05).
CONCLUSION: The success rate of TRV-CRP was higher than that of manipulative reduction,but manipulative reduction comfort degree was higher than TRV-CRP, the two methods can both improve the quality of life of patients with BPPV. TRV-CRP has many advantages over manipulative reduction, but manipulative reduction is simple with low cost, and the effect is still a great advantage. In clinical work, we should reasonable combine the two methods,so as to improve the cure rate of RPPV.
PMID: 27382685 [PubMed - indexed for MEDLINE]
 |
Related Articles |
[New Developments in Pharmacotherapy of Vertigo and Balance Disorders].
Fortschr Neurol Psychiatr. 2015 Sep;83(9):489
Authors: Dieterich M
PMID: 26421855 [PubMed - indexed for MEDLINE]
The prognostic value of pretreatment platelet count in patients with head and neck squamous cell carcinoma.
Auris Nasus Larynx. 2016 Jul 8;
Authors: Pardo L, Valero C, López M, García J, Camacho M, Quer M, León X
Abstract
OBJECTIVE: Thrombocytosis is commonly observed in patients with solid tumors. This study aimed to evaluate the prognostic role of circulating pretreatment platelet count in a large series of patients with head and neck squamous cell carcinoma (HNSCC).
METHODS: We retrospectively studied 824 patients with HNSCC treated at a single institution from 2000 to 2012. Disease-specific survival and local, regional, and distant recurrence-free survival were analyzed according to the distribution of the platelet count.
RESULTS: By defining the platelet count 250.05×10(9)/L as a cut-off point with the best predictive capacity, we classified the patients into two groups: those with a high platelet count (n=378, 45.9%), and those with a low platelet count (n=446, 54.1%). On univariate analysis, there were significant differences in disease-specific survival depending on pretreatment platelet count (P=0.001). The 5-year specific survival rates were 74.1% (CI 95%: 69.8-78.4%) and 61.6% (CI 95%: 56.4-66.8%) for patients with a low and high platelet count, respectively. According to the results of a multivariate analysis, patients with a high count of platelets had a tendency to a lower disease-specific survival, but the hazard ratio did not reach statistically significant differences (HR 1.24, CI 95%: 0.97-1.61, P=0.085).
CONCLUSION: Platelet count was significantly associated with survival in univariate analysis. However, in a multivariate analysis it lost its prognostic capacity, limiting its utility as a prognostic marker in patients with HNSCC. Considering separately each primary tumor location, patients with hypopharyngeal cancer and a high platelet count had a significant decrease of disease-specific survival.
PMID: 27401121 [PubMed - as supplied by publisher]
Awake emergency endotracheal intubation using sheath-assisted technique for patients having malignant tracheal stenosis under fluoroscopy guidance: a retrospective study.
Acta Radiol. 2016 Jul 8;
Authors: Jiao D, Han X, Wu G, Ren J, Li Z, Wang L
Abstract
BACKGROUND: For patients having a severe larynx or tracheal stenosis, emergency endotracheal intubation (EEI) may be needed due to respiratory failure.
PURPOSE: To evaluate the feasibility and effectiveness of awake EEI using a fluoroscopy-guided sheath-assisted technique for adult patients having a malignant tracheal stenosis.
MATERIAL AND METHODS: From October 2009 to May 2015, 219 patients having a malignant tracheal stenosis causing dyspnea or asphyxia required EEI. Of these, 32 patients who experienced intubation difficulties or failure were included in this study. Data on the technical success, procedure time, complications, and clinical outcome were collected. The pulse oxygen saturation (SpO2) and Hugh-Jones classification were used to evaluate the respiratory function before and after EEI.
RESULTS: Awake fluoroscopy-guided EEI was technically successful in 15 ± 4 min and acute dyspnea was resolved in all patients. The SpO2 and Hugh-Jones classification increased after EEI (P < 0.05). Subsequent treatments included tracheal stents (n = 15), surgical resection (n = 10), and palliative tracheotomy (n = 7), which were performed within 72 h after EEI.
CONCLUSION: Awake EEI using a sheath-assisted technique for adult patients having a malignant tracheal stenosis is a safe and effective procedure.
PMID: 27400991 [PubMed - as supplied by publisher]
[Cause and treatment of unilateral vocal cord paralysis].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):423-6
Authors: Xu D, Li K
Abstract
Unilateral vocal cord paralysis(UVCP) is defined as affected side vocal cord emerges immobility or motion weakening and abnormal tension due to unilateral intrinsic laryngeal muscles suffering from disorder about motor nerve. The patients usually present with hoarse voice, disability of high pitch, cough, aspiration, or a combination of these symptoms. There are increasing therapeutics researches and case analyses regarding UVCP in recent years. Thus this review summarized the progression about its causes and treatment methods.
PMID: 27382698 [PubMed - indexed for MEDLINE]
[CO2 laser assisted posterior cordotomy for bilateral vocal cord paralysis].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Mar;30(5):373-4, 377
Authors: Zhu M, Li J, Guo H
Abstract
OBJECTIVE: To investigate the feasibility and efficacy of CO2 laser assisted posterior cordotomy for patients with bilateral paralysis of the vocal cord.
METHOD: Twenty-one patients with bilateral paralysis of the vocal cord underwent CO2 laser assisted posterior cordotomy in our hospital from Jul. 2009 to Jun. 2015. The causes of the bilateral paralysis of the vocal cord were thyroidectomy in 15 cases, cervical trauma in 2 cases, resection of pituitary tumor in 1 case, inflammation in 1 case and without cause in 2 cases. Ten patients underwent tracheotomy before the operation; 9 patients underwent tracheotomy after the operation; 2 cases without tracheotomy.
RESULT: The tracheotomy tube was plugged next day after posterior cordotomy. Lots of patients were breathing well without any effort. A few patients were breathing hard, so the tracheotomy tube was plugged discontinuously. Seventeen patients were decannulated 1 year after operation. Two patients were failed to decannulated. The patients were followed up for 3 months 6 years after operation, and all of them were breathing well.
CONCLUSION: Our limited experience showed that CO2 laser assisted posterior cordotomyis an effective and reliable surgical procedure for patients with bilateral paralysis of the vocal cord.
PMID: 27382678 [PubMed - indexed for MEDLINE]
[The clinical features and drug therapy of unilateral idiopathic vocal fold paralysis].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Feb;30(3):235-7
Authors: Yang F, Wang B, Huang H, Huang H, Yu W
Abstract
OBJECTIVE: To investigate the clinical features and medication of unilateral idiopathic vocal fold paralysis.
METHOD: Thirty-nine of medical treated patients with unilateral idiopathic vocal fold paralysis were retrospectively studied, and relevant literatures were reviewed.
RESULT: After 4 to 19 days of medical therapy, 9 patients were cured, the vocal fold movement of 18 sufferers were improved, and 12 pantients were not healed.
CONCLUSION: Unilateral idiopathic vocal fold paralysis is common, and the treatment efficacy of medicine is almost the same with others. Unilateral idiopathic vocal fold paralysis is a disease with spontaneous recovery, which should be followed up.
PMID: 27373097 [PubMed - indexed for MEDLINE]
[Application of fibroptic-bronchoscope for intubation in high-risk epiglottic cyst surgery].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Feb;30(4):326-7
Authors: Sun Jian, Zang Chuanshan, Qiu Jie
PMID: 27373045 [PubMed - indexed for MEDLINE]
[Acoustic analysis in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Feb;30(4):268-71
Authors: Ma Y, Xu X, Hou G, Zhou L, Zhuang P
Abstract
OBJECTIVE: To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases.
METHOD: The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F₀) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test.
RESULT: (1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR.
CONCLUSION: The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.
PMID: 27373031 [PubMed - indexed for MEDLINE]
[Application of narrow band imaging in early diagnosis of pharyngolaryngeal tumors].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Feb;30(4):264-7
Authors: Chen Z, Xiong S, Chen F, Ma D, Li W, Lin G, Wang J
Abstract
OBJECTIVE: To investigate the application value of narrow band imaging (NBI) in early diagnosis of pharyngolaryngeal tumors.
METHOD: A total of 106 patients received NBI endoscopy in the endoscopic diagnosis. Lesions found under the white-light endoscopy mode and NBI endoscopy mode were compared in the morphology of capillaries on lesiorn surface and the clarity of lesion rim. Biopsy was performed in suspected areas with those two endoscopies for the lesions found under white-light endoscopy and NBI endoscopy, the morphology of capillaries on the surface of lesion and the clarity of lesion boundary were compared between both. Biopsy was performed for suspected areas under two modes, and specimens were preserved in 10% formaldehyde for pathological examination. The characteristic, position and endoscopic diagnosis under two modes were recorded. All the patients underwent corresponding laryngeal tumor resection according to the histopathological result of biopsy, and the histopathological result of resected tissues was taken as the gold standard for diagnosis. The biopsy detection rate and biopsy correct detection rate of malignant lesions in two groups were calculated and statistical compared.
RESULT: The diagnostic accuracy under white-light mode was 75.47%, while that under NBI mode was 96.23%, and the difference between them was statistically significant (χ² = 18.375, P < 0.01). The biopsy correct detection rate under white-light mode was 82.08%, while that under NBI mode was 95.28%, and the difference between them was statistically significant (χ² = 12.071, P < 0.01). The correct detection rate of malignant tumor under white-light mode was 48.15%, while that under NBI mode was 92.59%, and the difference between them was statistically significant (χ² = 10.083, P < 0.01).
CONCLUSION: Using NBI endoscopy to observe the morphological changes of capillaries on the pharyngolaryneal mucosa surface can increase the detection rate of early pharyngolaryngeal tumors, so it is worth to be widely applied.
PMID: 27373030 [PubMed - indexed for MEDLINE]
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Infantile Hemangioma with a Focus on Airway Hemangioma.
ORL Head Neck Nurs. 2016;34(2):18-23
Authors: Mackey WS
PMID: 27305734 [PubMed - indexed for MEDLINE]
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[Effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis].
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Jan;51(1):57-62
Authors: Li M, Zheng H, Chen S, Chen D, Wang W
Abstract
OBJECTIVE: To study the effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis (UVFP).
METHODS: The charts of 467 consecutive patients with UVFP were reviewed retrospectively. Preoperative and postoperative data, including videostroboscopy, perceptual evaluation of voice (GRBAS scale), acoustic analysis, maximum phonation time (MPT) and laryngeal reinnervation were collected. Multivariable logistic regression analysis was used to identify possible influential factors including the age of patient, gender, degree of nerve injury and duration of nerve injury. Then stratification analysis was performed on the variable-duration of nerve injury, to study how the duration of nerve injury could affect the surgical outcome of laryngeal reinnervation.
RESULTS: Multivariable logistic regression analysis showed that the age of patient, degree of nerve injury and duration of nerve injury were significant variables. Stratification analysis on duration of nerve injury demonstrated that in each subgroup postoperative data were significantly improved. When compared among the three subgroups, postoperative data in group with a duration of 6-12 months and group with a duration 12-24 months were significantly better than group with a duration more than 24 months. However, there were no significant differences between group with a duration of 6-12 months and 12-24 months.
CONCLUSION: Surgical outcome of laryngeal reinnervation is better in patients those with a duration of nerve injury less than 2 years than in those with a duration of nerve injury more than 2 years.
PMID: 26791770 [PubMed - indexed for MEDLINE]
Invasive sinonasal adenocarcinoma with an absent olfactory bulb: a case report.
J Surg Case Rep. 2016;2016(7)
Authors: Newman TH, Tipper GA, Hussain Z
Abstract
Sinonasal adenocarcinomas are rare, locally invasive tumours. In this case the symptomatic profile was unusual and the diagnosis was missed at the primary care stage. Interestingly this would be the first documented case with an absent ipsilateral olfactory bulb. A 55-year old male presented with symptoms of behavioural change and mild headaches. He was later found to have a large Sinonasal adenocarcinoma which penetrated the skull base. This was treated by a combined craniotomy and endonasal approach. Sinonasal adenocarcinomas are unusual tumours and further research is required in order to clarify management strategies and prognosis. This interesting case was more unusual again given its presentation, extent and absence of the olfactory bulb. Importantly for primary care physicians the initial diagnosis was considered psychiatric rather than organic; despite there being specific features of the presentation which were suggestive of an intra-cranial lesion.
PMID: 27402540 [PubMed]
Whole-transcriptome analysis of chordoma of the skull base.
Virchows Arch. 2016 Jul 11;
Authors: Bell D, Raza SM, Bell AH, Fuller GN, DeMonte F
Abstract
Fourteen skull base chordoma specimens and three normal specimens were microdissected from paraffin-embedded tissue. Pools of RNA from highly enriched preparations of these cell types were subjected to expression profiling using whole-transcriptome shotgun sequencing. Using strict criteria, 294 differentially expressed transcripts were found, with 28 % upregulated and 72 % downregulated. The transcripts were annotated using NCBI Entrez Gene and computationally analyzed with the Ingenuity Pathway Analysis program. From these significantly changed expressions, the analysis identified 222 cancer-related transcripts. These 294 differentially expressed genes and non-coding RNA transcripts provide here a set to specifically define skull base chordomas and to identify novel and potentially important targets for diagnosis, prognosis, and therapy of this cancer. Significance Genomic profiling to subtype skull base chordoma reveals potential candidates for specific biomarkers, with validation by IHC for selected candidates. The highly expressed developmental genes T, LMX1A, ZIC4, LHX4, and HOXA1 may be potential drivers of this disease.
PMID: 27401718 [PubMed - as supplied by publisher]
[Pediatric orthopedic cervical spine problems].
Duodecim. 2016;132(11):1025-32
Authors: Helenius I
Abstract
Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more than a week should be recognized, because it can be treated by skull traction. Cervical spine fractures in children under school age are very rare, the most common being a fracture of the base of the dens of the second cervical vertebra. Cervical spine instability is almost always associated with an underlying disease.
PMID: 27400588 [PubMed - in process]
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Maxillary changes with bone-borne surgically assisted rapid palatal expansion: A prospective study.
Am J Orthod Dentofacial Orthop. 2016 Mar;149(3):374-83
Authors: Asscherickx K, Govaerts E, Aerts J, Vande Vannet B
Abstract
INTRODUCTION: The aim of this prospective study was to analyze the postexpansion positional changes of the maxillary halves and their initial stability after transpalatal distraction with a bone-borne distractor and standard corticotomies of the anterior, lateral, and median bony supports of the maxilla without pterygomaxillary disjunction.
METHODS: The sample consisted of 21 patients (15 female, 6 male; mean age, 26 years 5 months). Measurements on the maxillary study casts and the posteroanterior cephalograms were obtained before surgery, at the end of palatal expansion, and 10 weeks later. No orthodontic treatment was initiated during the examination period.
RESULTS: After palatal expansion, significantly wider measurements were noted in the canine (35.5%), premolar (26.3%), and molar (17.8%) regions. Angulation changes in the premolar (-7°) and molar (-8°) segments were observed. No significant changes were seen between the end of palatal expansion and 10 weeks later. Arch perimeter increased by 9.16% between presurgery and 10 weeks after the end of expansion.
CONCLUSIONS: The results indicated that more expansion was achieved anteriorly, and that there was buccal tipping of the split maxillary halves. Bone-borne surgically assisted rapid palatal expansion can provide significant expansion of the maxilla with an increase in arch perimeter, and it shows initial stability.
PMID: 26926025 [PubMed - indexed for MEDLINE]
Burn Injuries and Their Impact on Cognitive-Communication Skills in the Inpatient Rehabilitation Setting.
J Burn Care Res. 2016 Jul 8;
Authors: Hendricks CT, Camara K, Violick Boole K, Napoli MF, Goldstein R, Ryan CM, Schneider JC
Abstract
The prevalence and extent of cognitive-communication disorders and factors that have impact on outcomes are examined in the burn population within an inpatient rehabilitation facility. A retrospective data analysis was conducted on adults diagnosed with burn injury (n = 144). Descriptive statistics were used to identify the prevalence of cognitive-communication deficits on admission and discharge. The main outcomes were cognitive-communication ratings on discharge from inpatient rehabilitation as measured by the memory and problem-solving domains of the Functional Independence Measure (FIM) and composite score of the Functional Communication Measure (FCM). Medical, demographic and rehabilitation predictors of the main outcomes were assessed using regression analyses. On admission to inpatient rehabilitation, 79% of the total population presented with cognitive-communication impairments, and of them, 27% presented with persistent deficits on discharge. Admission FIM memory score, marital status, and age were significant predictors of discharge FIM memory score. Admission FIM problem-solving score, age, marital status, and prehospital living-with were significant predictors of discharge FIM problem-solving score. Admission FCM score and age were significant predictors of discharge FCM cognitive score. Persons with burn injuries are at risk for cognitive-communication impairments, which may persist after inpatient rehabilitation. FIM data obtained on admission can be used as a screening tool to identify these at-risk patients. Future work is needed to assess the efficacy of speech-language pathologist intervention for cognitive-communication deficits within the burn injury population.
PMID: 27404164 [PubMed - as supplied by publisher]
Magnetic resonance volumetric measurement of endolymphatic space in patients without vertiginous or cochlear symptoms.
Acta Otolaryngol. 2016 Jul 12;:1-7
Authors: Inui H, Sakamoto T, Ito T, Kitahara T
Abstract
CONCLUSION: Magnetic resonance volumetric measurement of inner ear endolymphatic space (ELS) was performed in patients without vertiginous or cochlear symptoms. The existence of the ELS in patients with chronic rhinosinusitis (CRS) was shown. The ELS in the cochlea and vestibule was classified into four categories. These findings could be useful as a standard reference for further research.
OBJECTIVES: To identify normal values of the ELS in the cochlea and vestibule.
METHODS: Twenty-four patients with CRS were enrolled. Inner ear fluid space images and positive perilymph/positive endolymph images were acquired using a 3.0-tesla unit. Three-dimensional (3-D) images were constructed semi-automatically using both anatomical and tissue information by fusing the 3-D images of the inner ear fluid space and the ELS.
RESULTS: Among all patients, the mean ELS/the total fluid space (TFS) ratio in the cochlea was 8.8% and that in the vestibule was 16.2%. The ELS in the cochlea and vestibule was classified into four categories. Age-related differences were found in the TFS, ELS, and ELS/TFS ratio in the inner ear and the ELS and ELS/TFS ratio in the vestibule.
PMID: 27403573 [PubMed - as supplied by publisher]
Relationship between serum magnesium level and subjective tinnitus.
Kulak Burun Bogaz Ihtis Derg. 2016 Jul-Aug;26(4):225-7
Authors: Uluyol S, Kılıçaslan S, Yağız Ö
Abstract
OBJECTIVES: This study aims to assess the relationship between serum magnesium level and bilateral subjective tinnitus.
PATIENTS AND METHODS: The study included a total of 76 patients (36 males, 40 females; mean age 48.5±6.5 years; range 43 to 65 years) suffering from severe bilateral subjective tinnitus (accepted as severe and catastrophic according to tinnitus severity index) as the study group and 86 healthy participants (42 males, 44 females; mean age 43.8±7.3 years; range 40 to 61 years) as the control group. Serum magnesium levels of both groups were measured and compared statistically.
RESULTS: The serum magnesium concentration was significantly lower in the study group compared to the control group (1.8±0.2 vs. 2.3±0.4 mg/dL, p=0.03).
CONCLUSION: The significant association between serum magnesium level and tinnitus shows the importance of magnesium in the pathophysiology of subjective tinnitus.
PMID: 27405078 [PubMed - as supplied by publisher]
[Evaluation of repetitive transcranial magnetic stimulation effectiveness in treatment of psychiatric and neurologic diseases].
Pol Merkur Lekarski. 2016 Jun 29;40(240):388-392
Authors: Pastuszak Ż, Stępień A, Piusińska-Macoch R, Brodacki B, Tomczykiewicz K
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness especially in drug resist depression. It is used in functional brain mapping before neurosurgery operations and diagnostic of corticospinal tract transmission. Many studies are performed to evaluate rTMS using in treatment of obsessive - compulsive disorder, schizophrenia, autism, strokes, tinnitus, Alzheimer and Parkinson diseases, cranial traumas. Moreover rTMS was used in treatment of multiple sclerosis, migraine, dystonia. Electromagnetical field generated by rTMS penetrate skin of the scalp and infiltrate brain tissues to a depth of 2 cm, cause neurons depolarization and generating motor, cognitive and affective effects. Depending on the stimulation frequency rTMS can stimuli or inhibit brain cortex. rTMS mechanism of action remains elusive. Probably it is connected with enhancement of neurotransmitters, modulation of signals transductions pathways in Central Nervous System, gene transcription and release of neuroprotective substances. Studies with use of animals revealed that rTMS stimulation can generate brain changes similar to those seen after electric shock therapy without provoking seizures. The aim of presenting study was to analyze actual researches evaluating rTMS use in treatment of psychiatric and neurological diseases.
PMID: 27403908 [PubMed - as supplied by publisher]
Electrical Stimulation of the Ear, Head, Cranial Nerve, or Cortex for the Treatment of Tinnitus: A Scoping Review.
Neural Plast. 2016;2016:5130503
Authors: Hoare DJ, Adjamian P, Sereda M
Abstract
Tinnitus is defined as the perception of sound in the absence of an external source. It is often associated with hearing loss and is thought to result from abnormal neural activity at some point or points in the auditory pathway, which is incorrectly interpreted by the brain as an actual sound. Neurostimulation therapies therefore, which interfere on some level with that abnormal activity, are a logical approach to treatment. For tinnitus, where the pathological neuronal activity might be associated with auditory and other areas of the brain, interventions using electromagnetic, electrical, or acoustic stimuli separately, or paired electrical and acoustic stimuli, have been proposed as treatments. Neurostimulation therapies should modulate neural activity to deliver a permanent reduction in tinnitus percept by driving the neuroplastic changes necessary to interrupt abnormal levels of oscillatory cortical activity and restore typical levels of activity. This change in activity should alter or interrupt the tinnitus percept (reduction or extinction) making it less bothersome. Here we review developments in therapies involving electrical stimulation of the ear, head, cranial nerve, or cortex in the treatment of tinnitus which demonstrably, or are hypothesised to, interrupt pathological neuronal activity in the cortex associated with tinnitus.
PMID: 27403346 [PubMed - in process]
Lingual Artery-Retromandibular Vein Fistula Four Years after an Uncomplicated Carotid Endarterectomy: Case Report and Review of Possible Etiologies and Treatment Options.
J Vasc Interv Neurol. 2016 Jun;9(1):12-9
Authors: Manjila S, Kumar K, Kulhari A, Singh G, Jung RS, Tarr RW, Bambakidis NC
Abstract
The external carotid artery's lingual branch to retromandibular venous fistula following a carotid endarterectomy has not been reported earlier in literature. We report a unique case of an 87-year-old man who had a right-sided carotid endarterectomy in 2009 and presented four years later with complaints of fullness and discomfort in the area of right parotid gland with associated pulsatile tinnitus. A computed tomography (CT) scan of the neck revealed a deep portion of the right parotid gland having abnormal aneurysmal dilatation of a vascular structure, which appeared to be an arteriovenous fistula between branches of right external carotid artery and the retromandibular vein. Conventional catheter angiogram showed a complex arteriovenous fistula seen with the right retromandibular vein receiving multiple small arterial feeders from the right external carotid artery via its lingual artery branch. Slight reflux was noted into the right pterygoid plexus, right maxillary, and right submental veins as well. Surgical treatment was deferred due to high risk of inadvertent facial nerve injury from extensive parotid dissection involved in the procedure. Transarterial embolization of five discrete arterial branches from the right external carotid artery supplying the fistula was performed using particles with resultant remarkable slowing of the venous drainage into the retromandibular vein. After the procedure, his tinnitus and ear fullness resolved completely. The presence of arteriovenous fistula after carotid endarterectomy is a rare yet serious complication and therefore should be diagnosed early and treated promptly. The article highlights the relevant literature on arteriovenous fistula formation in the setting of arterial patch, intraoperative shunting, and surgical-site infections.
PMID: 27403218 [PubMed]
Orbital Pseudotumor as a Rare Extrahepatic Manifestation of Hepatitis C Infection.
Case Rep Gastroenterol. 2016 Jan-Apr;10(1):108-14
Authors: Misselwitz B, Epprecht J, Mertens J, Biedermann L, Scharl M, Haralambieva E, Lutterotti A, Weber KP, Müllhaupt B, Chaloupka K
Abstract
Hepatitis C is frequently accompanied by immune-related extrahepatic manifestations affecting the skin, kidneys, central and peripheral nervous system and exocrine glands. We present the case of a 40-year-old man with left-sided ptosis, exophthalmos and headache. MRI demonstrated left-sided orbital pseudotumor with lacrimal and retro-orbital contrast enhancement extending to the cavernous sinus and the vestibulocochlear nerve. Immunological tests of serum and cerebrospinal fluid identified hepatitis C virus (HCV) as a potential causative agent but did not indicate any additional infectious, malignant or immunological disorder. Hepatological evaluation revealed no signs of advanced liver disease. After initial spontaneous improvement, the patient subsequently developed vestibulocochlear failure with gait disorder, tinnitus and transient left-parietal sensory loss. Lacrimal biopsy demonstrated lymphocytic infiltrate, prompting steroid treatment. After initial improvement, steroids could not be tapered below 40 mg daily for several months due to recurrent symptoms. Twelve months after the initial presentation, the patient's chronic HCV infection was successfully treated with sofosbuvir, simeprevir and ribavirin and he remains now free of symptoms without steroids. In patients with chronic hepatitis C, lymphocytic infiltrate of the salivary and lacrimal glands is a frequent phenomenon. However, the extent of the lymphocytic infiltrate beyond the lacrimal gland to the tip of the orbit, cavernous sinus and vestibulocochlear nerve as in our patient is highly unusual. For all symptomatic extrahepatic manifestations of hepatitis C infection, treatment of HCV as the underlying immune stimulus is recommended, and it helped to control the symptoms in our patient. In addition, long-term follow-up for recurrent lymphocyte infiltrate and development of lymphoma is warranted.
PMID: 27403111 [PubMed]
