Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient.

Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient.

Ann Surg Treat Res. 2016 Sep;91(3):145-8

Authors: Kim BK, Lee J, Sun WY

Abstract
About 20%-30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.

PMID: 27617256 [PubMed]

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Orbitocranial Fibrous Dysplasia: Outcome of Radical Resection and Immediate Reconstruction With Titanium Mesh and Pericranial Flap.

Orbitocranial Fibrous Dysplasia: Outcome of Radical Resection and Immediate Reconstruction With Titanium Mesh and Pericranial Flap.

J Craniofac Surg. 2016 Sep 9;

Authors: Fadle KN, Hassanein AG, Kasim AK

Abstract
INTRODUCTION: Fibrous dysplasia (FD) is a non-neoplastic developmental fibro-osseous disease. It represents 2.5% of all bone tumors and 5% to 7% of the benign bone tumors. Orbitocranial region is involved in about 20% of the patients. The main presentations are craniofacial deformity and headache. Loss of vision is the most devastating result of this disease. There is no medical treatment to cure or prevent FD. Radiation therapy is contraindicated. Surgery for the orbitocranial FD is often challenging because of the proximity of neurovascular and ocular structures. Conservative surgical shaving and recontouring is always associated with suboptimal results. Radical excision is potentially curative with no extra morbidity. Orbital hypertelorism, dystopia, or proptosis can be corrected only by radical excision and reconstruction.
AIM: The aim of the study was to evaluate the outcome of radical excision of the orbitocranial FD and immediate reconstruction using titanium mesh and pericranial flap.
PATIENTS AND METHODS: This prospective study had been conducted on 22 patients with orbitocranial FD with age range from 17 to 52 years (mean 29.5). Radical excision of the lesions was done for all patients through transcranial approach. Immediate reconstruction was achieved using titanium mesh and pericranial flap.
RESULTS: Intraoperative dural tears and cerebrospinal fluid leak were reported in 2 patients and repaired with galeal graft. Supraorbital anesthesia occurred in 6 patients. Of these, 2 patients were transient, while the remaining 4 patients were permanent. Wound infection was noticed in 1 patient who improved by medical treatment. Temporary postoperative diplopia occurred in 1 patient and temporary postoperative impaired vision in 1 other patient. In all patients, acceptable or good aesthetic results were observed. No recurrence was detected in our series during the follow-up period that ranged from 24 to 58 months (mean 37.5 months).
CONCLUSION: Radical excision of orbitocranial FD is potentially curative with no extra morbidity. It can achieve good aesthetic and functional results with no recurrence.

PMID: 27617807 [PubMed - as supplied by publisher]

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Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping.

Related Articles

Recurrent, symptomatic, late-onset, contralateral subdural effusion following decompressive craniectomy treated by cranial strapping.

Br J Neurosurg. 2015;29(5):730-2

Authors: Krishnan P, Roy Chowdhury S

Abstract
Subdural effusions following decompressive craniotomy for trauma are usually benign, ipsilateral to the craniotomy and resolve spontaneously. Far less common and more dangerous are contralateral subdural effusions causing external cerebral herniation. We report a case of recurrent contralateral effusion and highlight the management dilemmas. Arachnoid tear is probably the cause of these collections. Contralateral subdural effusions should be suspected in patients who have delayed neurological deterioration after an initial improvement particularly in the setting of increased "flap bulge" though they may also be found in patients who remain moribund after initial surgery. There are no clear-cut guidelines on their management due to their rarity. A variety of options like subduro-peritoneal shunt and drainage with simultaneous cranioplasty may be tried. In situations where resources or patient compliance is an issue, tapping the effusion followed by cranial strapping may be tried as was done in our case.

PMID: 26037938 [PubMed - indexed for MEDLINE]

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A Randomized, Controlled Trial of Behavioral Voice Therapy for Dysphonia Related to Prematurity of Birth.

A Randomized, Controlled Trial of Behavioral Voice Therapy for Dysphonia Related to Prematurity of Birth.

J Voice. 2016 Sep 8;

Authors: Reynolds V, Meldrum S, Simmer K, Vijayasekaran S, French N

Abstract
OBJECTIVES: Dysphonia is a potential complication of prematurity. Preterm children may sustain iatrogenic laryngeal damage from medical intervention in the neonatal period, and further, adopt compensatory, maladaptive voicing behaviors. This pilot study aimed to evaluate the effects of a voice therapy protocol on voice quality in school-aged, very preterm (VP) children.
METHODS: Twenty-seven VP children with dysphonia were randomized to an immediate intervention group (n = 7) or a delayed-intervention, waiting list control group (n = 14). Following analysis of these data, a secondary analysis was conducted on the pooled intervention data (n = 21). Six participants did not complete the trial.
RESULTS: Change to voice quality was measured via pre- and posttreatment assessments using the Consensus Auditory Perceptual Evaluation of Voice. The intervention group did not demonstrate statistically significant improvements in voice quality, whereas this was observed in the control group (P = 0.026). However, when intervention data were pooled including both the immediate and delayed groups following intervention, dysphonia severity was significantly lower (P = 0.026) in the treatment group.
CONCLUSIONS: Dysphonia in most VP children in this cohort was persistent. These pilot data indicate that some participants experienced acceptable voice outcomes on spontaneous recovery, whereas others demonstrated a response to behavioral intervention. Further research is needed to identify the facilitators of and barriers to intervention success, and to predict those who may experience spontaneous recovery.

PMID: 27618578 [PubMed - as supplied by publisher]

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Mucosal and cutaneous human papillomaviruses in head and neck squamous cell papillomas.

Mucosal and cutaneous human papillomaviruses in head and neck squamous cell papillomas.

Head Neck. 2016 Sep 12;

Authors: Donà MG, Pichi B, Rollo F, Gheit T, Laquintana V, Covello R, Pescarmona E, Spriano G, Pellini R, Giuliani M, Tommasino M, Benevolo M

Abstract
BACKGROUND: Conflicting data exist regarding the contribution of human papillomavirus (HPV) to the development of head and neck squamous cell papillomas.
METHODS: Formalin-fixed paraffin-embedded papillomas were tested for 28 mucosal and 79 cutaneous HPVs using polymerase chain reaction (PCR)-based methods.
RESULTS: Eighty-three papillomas (43 oropharyngeal, 31 oral, 6 laryngeal, and 3 nasopharyngeal) were analyzed. Twenty-four samples (28.9%) harbored mucosal HPVs: 3 oropharyngeal (6.9%), 15 oral (48.3%), 4 laryngeal (66.7%), and 2 nasopharyngeal papillomas (66.7%). Eighty-one cases were also tested for cutaneous HPVs, detected in 16 lesions (19.7%): 11 (13.5%) harbored only cutaneous types, and 5 (6.2%) were positive for both cutaneous and mucosal HPVs. Among these 81 cases, prevalence of mucosal and/or cutaneous HPV infection was 43.2%.
CONCLUSION: HPV DNA detection in a fraction of head and neck papillomas supports the role of HPV in their development. However, other markers need to be considered to confirm the association of HPV infection with these lesions. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27618734 [PubMed - as supplied by publisher]

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Surgical preparation of nasal defects to enhance the implant-retained facial prostheses: A case report.

Surgical preparation of nasal defects to enhance the implant-retained facial prostheses: A case report.

Head Neck. 2016 Sep 12;

Authors: Hofstede TM, Jacob RF, Montgomery P, Wesley P

Abstract
BACKGROUND: Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin.
METHODS: We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants.
RESULTS: Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing.
CONCLUSION: The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27618726 [PubMed - as supplied by publisher]

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Rheumatoid nodule presenting as a buccal submucosal nodule: A rare presentation of a common disease.

Rheumatoid nodule presenting as a buccal submucosal nodule: A rare presentation of a common disease.

Head Neck. 2016 Sep 12;

Authors: Tay GC, Sauer DA, Andersen PE

Abstract
BACKGROUND: Rheumatoid nodules are a common manifestation of rheumatoid arthritis but buccal rheumatoid nodules are extremely rare. The purpose of this study was to report a rare case of a rheumatoid buccal nodule and a review of the literature.
METHODS AND RESULTS: This case is about a 79-year-old woman with rheumatoid arthritis who was taking methotrexate and hydroxychloroquine, presenting with an enlarging left buccal submucosal mass. An incisional biopsy showed features consistent with that of a rheumatoid nodule. The mass was managed expectantly and the patient was taken off methotrexate with a marked reduction in the size of the nodule.
CONCLUSION: Submucosal rheumatoid nodules of the oral cavity are an extremely rare manifestation of rheumatoid arthritis but should be considered in the differential diagnosis in patients with a history of rheumatoid arthritis presenting with submucosal masses. © 2016 Wiley Periodicals, Head Neck 2016.

PMID: 27618678 [PubMed - as supplied by publisher]

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A critical assessment of the fibula flap donor site.

A critical assessment of the fibula flap donor site.

Head Neck. 2016 Sep 12;

Authors: Xu ZF, Bai S, Zhang ZQ, Duan WY, Wang ZQ, Sun CF

Abstract
BACKGROUND: The free fibula flap has become popular for mandibular reconstruction. The purpose of this study was to propose comprehensive functional assessments of the donor site.
METHODS: Thirty free fibula flaps for mandible reconstruction were prospectively enrolled in the study. Objective assessments included isokinetic testing of the ankle joint, electromyographic examination of the superficial peroneal nerve (SPN), and preoperative and postoperative foot scans. The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor site.
RESULTS: The isokinetic values of the donor side showed a significant decrease 1 year postoperatively. The results of the electromyographic test of the SPN were categorized as 3 types. The plantar center pressure shifted to the heel on the donor side 6 months postoperatively. The aesthetic outcome was satisfactory.
CONCLUSION: The functional parameters of the donor site indeed declined in our assessments. Further refinements in the surgical technique are needed to improve the donor site status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27617706 [PubMed - as supplied by publisher]

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Current status and diagnostic values of the Bethesda system for reporting thyroid cytopathology in a papillary thyroid carcinoma-prevalent area.

Current status and diagnostic values of the Bethesda system for reporting thyroid cytopathology in a papillary thyroid carcinoma-prevalent area.

Head Neck. 2016 Sep 12;

Authors: Lee YB, Cho YY, Jang JY, Kim TH, Jang HW, Chung JH, Oh YL, Kim SW

Abstract
BACKGROUND: Most studies validating the Bethesda system for reporting thyroid cytopathology (TBSRTC) have been conducted in Western countries. We explored the current status of TBSRTC in an area where most thyroid malignancies are papillary carcinomas.
METHODS: Fine-needle aspirations (FNAs) of thyroid nodules performed in 2013 were retrospectively analyzed and the results were compared to final pathology on resection.
RESULTS: Of 1947 FNAs, 1925 (98.9%) were reported using TBSRTC. Among 381 resected lesions, 27.3% of nondiagnostic, 19.6% of benign, 56.0% of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 33.3% of follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), 97.7% of suspicious for malignancy, and 100.0% of malignant lesions were malignant on pathology. The sensitivity and specificity of FNA using TBSRTC were 96.7% and 84.1%, respectively.
CONCLUSION: TBSRTC works well in an area in which papillary thyroid cancer is prevalent; however, it may underestimate malignancy rates in AUS/FLUS, benign, and nondiagnostic categories. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27617626 [PubMed - as supplied by publisher]

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Pretreatment lymphocyte-to-monocyte ratio as an independent prognostic factor for head and neck cancer.

Pretreatment lymphocyte-to-monocyte ratio as an independent prognostic factor for head and neck cancer.

Head Neck. 2016 Sep 12;

Authors: Kano S, Homma A, Hatakeyama H, Mizumachi T, Sakashita T, Kakizaki T, Fukuda S

Abstract
BACKGROUND: The purpose of this study was to analyze the relationship between pretreatment inflammatory markers and the prognosis of patients with oropharyngeal, hypopharyngeal, and laryngeal cancers.
METHODS: The data for 285 patients treated with curative intent by concurrent chemoradiotherapy (CRT) were obtained and their pretreatment inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated.
RESULTS: Significant relationships were observed between a high NLR and oropharyngeal or hypopharyngeal cancer, T3 to T4, N2b to N3, and clinical stage III to IV, whereas significant relationships were observed between a high LMR and laryngeal cancer, T1 to T2, and clinical stage I to II. With regard to survival outcomes, a high NLR, a high PLR, and a low LMR were all significantly associated with decreases in overall survival (OS) and disease-free survival (DFS). Furthermore, multivariate analysis showed that LMR was an independent prognostic factor.
CONCLUSION: Pretreatment LMR was found to be an independent prognostic factor for patients with head and neck cancers treated by concurrent CRT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27617428 [PubMed - as supplied by publisher]

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Laryngocele Causing Airway Obstruction: A Unique Case Report.

Laryngocele Causing Airway Obstruction: A Unique Case Report.

West Indian Med J. 2016 Feb 22;

Authors: Topal K, Kilic K, Sakat MS, Altas E, Ucuncu H

Abstract
Laryngocele is an abnormal cystic dilatation of the saccule or appendix of the laryngeal ventricle filled with air and connected to the lumen of the larynx. They rarely cause clinical complaints. But still being rare clinical occasions, they may cause airway obstruction which required emergency interventions. In this report we presented an extremely rare case of laryngocele which causes airway obstruction. A 35-year old male was admitted due to hoarseness, progressive respiratory distress and swelling at the right side of the neck for three years. The laryngoceles are rarely symptomatic but because of their potential to cause sudden airway obstruction, they deserve a serious attention.

PMID: 27617587 [PubMed - as supplied by publisher]

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Siah-1 is associated with expression of hypoxia-inducible factor-1α in oral squamous cell carcinoma.

Siah-1 is associated with expression of hypoxia-inducible factor-1α in oral squamous cell carcinoma.

Auris Nasus Larynx. 2016 Sep 8;

Authors: Aga M, Kondo S, Wakisaka N, Moriyama-Kita M, Endo K, Nakanishi Y, Murono S, Sugimoto H, Ueno T, Yoshizaki T

Abstract
OBJECTIVE: Hypoxia-inducible factor-1 (HIF-1) is a heterodimeric basic helix-loop-helix transcription factor composed of the HIF-1α and HIF-1β subunits. HIF-1 is a central regulator of responses to hypoxia; it enhances metastasis-related factors such as matrix metalloproteinases and vascular endothelial growth factor (VEGF). We have reported critical roles for HIF-1α in tumor microenvironments, and oncogenic properties of HIF-1α have been suggested in malignancies. Seven in absentia homologue (Siah) appeared to upregulate HIF-1 production, which prompted us to investigate the Siah association with HIF-1α expression in oral squamous cell carcinoma (OSCC).
METHODS: Samples from fifty-five patients with OSCC were evaluated by immunohistochemistry for the protein expressions of Siah-1 and -2, HIF-1α, and VEGF. The expression levels of each protein and clinicopathological data were statistically analyzed.
RESULTS: Siah-1 and, Siah-2, HIF-1α, and VEGF were immunolocalized on the cell membranes and cytoplasm of the tumor cells. The expression of Siah-1 showed a linear dependence on the expression of HIF-1α (r=0.627, p<0.001). In 17 cases of the large tumor size category (T3 and 4), the mean Siah-1 expression score was significantly higher than in 41 cases of the small tumor size category (T1 and 2; p=0.001). In addition, in 16 cases of the lymph node metastasis-positive category (N1-3), the mean Siah-1 expression score was significantly higher than that in 42 cases of the lymph node metastasis-negative category (N0, p=0.001).
CONCLUSION: These results suggested that the expressions of Siah-1 and HIF-1α were clearly correlated in OSCC. Moreover, Siah-1 appears to be correlated with clinicopathological data, particularly tumor size.

PMID: 27616748 [PubMed - as supplied by publisher]

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Free-flap reconstruction for the management of life-threatening hereditary hemorrhagic telangiectasia.

Free-flap reconstruction for the management of life-threatening hereditary hemorrhagic telangiectasia.

Auris Nasus Larynx. 2016 Sep 8;

Authors: Choi JW, Joo YH, Jeong WS, Jang YJ

Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multi-systemic disease that exhibits increasing penetrance with age. Some patients present with severe life-threatening epistaxis which is intractable to all common treatment modalities. A 63-year-old female patient with hereditary hemorrhagic telangiectasia (HHT) presented with recurrent life-threatening epistaxis that required repeated transfusions despite multiple embolizations and septodermoplasty. Previous septodermoplasty failed due to septal perforation. Resurfacing of the nasal lining with a free flap was planned. Total removal of the nasal mucosa and remaining septum was conducted to make the nasal cavity into one common cavity. Nasal passages were resurfaced with a radial forearm free flap. Following surgery, the patient experienced no further significant epistaxis. Fasciocutaneous free-flap resurfacing might represent a curative solution for cases of HHT intractable to conservative treatment and septodermoplasty, especially for patients with large septal perforation.

PMID: 27616747 [PubMed - as supplied by publisher]

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Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society.

Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society.

Auris Nasus Larynx. 2016 Sep 8;

Authors: Tono T, Sakagami M, Kojima H, Yamamoto Y, Matsuda K, Komori M, Hato N, Morita Y, Hashimoto S

Abstract
In order to provide a basis for meaningful exchange of information among those treating cholesteatoma, the Committee on Nomenclature of the Japan Otological Society (JOS) was appointed in 2004 to create a cholesteatoma staging system as simple as possible to use in clinical practice in Japan. Following the announcement of preliminary criteria for the staging of pars flaccida (attic) cholesteatoma in 2008, we proposed the 2010 JOS staging system for two major types of retraction pocket cholesteatoma, pars flaccida and pars tensa cholesteatoma. Since then, the JOS staging system has been widely used in clinical studies of cholesteatoma in Japan, allowing standardization in reporting of surgical outcomes based on the respective stages of cholesteatoma. We have recently expanded the range of cholesteatoma by adding cholesteatoma secondary to a tensa perforation and congenital cholesteatoma as the 2015 JOS staging system for middle ear cholesteatoma. Although further revisions may be required for universal acceptance of these criteria, we hope our staging system will open the way for international consensus on staging and classification of middle ear cholesteatoma in the near future.

PMID: 27616746 [PubMed - as supplied by publisher]

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Effects of Autologous Serum Eye Drops on Conjunctival Expression of MUC5AC in Patients With Ocular Surface Disorders.

Related Articles

Effects of Autologous Serum Eye Drops on Conjunctival Expression of MUC5AC in Patients With Ocular Surface Disorders.

Cornea. 2016 Mar;35(3):336-41

Authors: López-García JS, García-Lozano I, Rivas L, Giménez C, Acera A, Suárez-Cortés T

Abstract
PURPOSE: To assess the effects of autologous serum eye drops on conjunctival expression of the mucin gene MUC5AC by means of quantitative reverse transcription polymerase chain reaction (RT-qPCR).
METHODS: A prospective and comparative interventional case series study of 38 eyes of 19 patients with different ocular surface disorders was performed before and 6 weeks after the treatment with autologous serum eye drops. All patients underwent a complete ophthalmic assessment, including evaluation of the tear film, ocular surface exploration, conjunctival impression cytology (IC), and MUC5AC detection by reverse transcription polymerase chain reaction.
RESULTS: A total of 34 eyes were studied by IC and MUC5AC quantitative reverse transcription polymerase chain reaction before and after treatment with autologous serum. This treatment improved breakup time, conjunctival squamous metaplasia, goblet cell density, and subjective perception in 76.2%, 70.6%, 55.9% and 73.5% of eyes, respectively. Treatment with autologous serum enhanced conjunctival expression of MUC5AC (P = 0.001), although these differences were not statistically significant if data are analyzed patient by patient (P = 0.09). In 13 of 34 eyes (38.2%), we found increased expression of MUC5AC; in 12 eyes (35.3%), no significant changes were found; and in 9 eyes (26.5%), a decreased expression was found. The MUC5AC gene upregulation was related to the conjunctival involvement before treatment and with the improvement in the degree of squamous metaplasia and the increase in the number of goblet cells in IC after treatment (P = 0.001).
CONCLUSIONS: Treatment with autologous serum enhances the conjunctival expression of MUC5AC by increasing the density of goblet cells, mainly in patients with severe conjunctival involvement.

PMID: 26785302 [PubMed - indexed for MEDLINE]

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Parathyroid Imaging with Simultaneous Acquisition of 99mTc-Sestamibi and 123I: The Relative Merits of Pinhole Collimation and SPECT/CT.

Related Articles

Parathyroid Imaging with Simultaneous Acquisition of 99mTc-Sestamibi and 123I: The Relative Merits of Pinhole Collimation and SPECT/CT.

J Nucl Med Technol. 2015 Dec;43(4):275-81

Authors: Bhatt PR, Klingensmith WC, Bagrosky BM, Walter JC, McFann KK, McIntyre RC, Raeburn CD, Koo PJ

Abstract
UNLABELLED: The objective of this study was to determine the relative utility of 3 state-of-the-art parathyroid imaging protocols: single-time-point simultaneous acquisition of (99m)Tc-sestamibi and (123)I images with pinhole collimation in the anterior and bilateral anterior oblique projections, single-time-point simultaneous acquisition of (99m)Tc-sestamibi and (123)I images with SPECT/CT, and the combination of the first and second protocols.
METHODS: Fifty-nine patients with surgical proof of parathyroid adenomas were evaluated retrospectively. All 3 protocols included perfectly coregistered subtraction images created by subtracting the (123)I images from the (99m)Tc-sestamibi images, plus an anterior parallel-hole collimator image of the neck and upper chest. The pinhole protocol was performed first, followed by the SPECT/CT protocol. Three image sets were derived from each study in each patient according to the above protocols. Two experienced observers recorded the size, location, and degree of certainty of any identified lesion.
RESULTS: The 59 patients had 61 adenomas. For the 2 observers combined, the localization success rate was 88% for the pinhole protocol, 69% for the SPECT/CT protocol, and 81% for the combined protocol. The pinhole protocol detected more adenomas than the SPECT/CT protocol and missed fewer adenomas than either the SPECT/CT protocol or the combined pinhole and SPECT/CT protocol (P < 0.01). The 2 protocols that included SPECT/CT provided superior anatomic information relative to the location and size of the parathyroid adenomas.
CONCLUSION: The pinhole protocol localized significantly more adenomas than the SPECT/CT protocol. However, the protocols that included SPECT/CT provided more anatomic information than pinhole imaging alone.

PMID: 26584615 [PubMed - indexed for MEDLINE]

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Distribution of the internal branch of the human accessory nerve.

Related Articles

Distribution of the internal branch of the human accessory nerve.

Anat Sci Int. 2015 Jun;90(3):180-6

Authors: Liu HF, Won HS, Chung IH, Kim IB, Han SH

Abstract
It was recently reported that the internal branch of the accessory nerve not only comprises the cranial root but also various combinations of the cranial root, spinal root, and the vagal component of the vagus nerve. The aim of this study was to demonstrate the anatomical distribution of each component of the internal branch of the human accessory nerve. Ten half-heads and necks of adult cadavers were used. The internal branch of the accessory nerve had three courses: the pharyngeal branch, the descending branch to the thorax, and the recurrent laryngeal nerve. The pharyngeal branch of the internal branch originated mainly from the vagus nerve, rather than from the cranial root of the accessory nerve. All of the components of the internal branch descended to the thorax along the vagus nerve. The recurrent laryngeal nerve comprised the internal branch and the vagus nerve in all specimens, and it was separated into bundles originating from the internal branch and vagus nerve. Both bundles gave off branches to the trachea and esophagus. The laryngeal distribution of the internal branch and vagus nerve was confirmed in the posterior cricoarytenoid, lateral cricoarytenoid, and thyroarytenoid muscles. These three laryngeal muscles were innervated by the cranial root and/or vagus nerve, but the distribution pattern was different in each specimen. Although the vagus nerve and cranial root are morphologically distinct nerves in the cranial cavity, they can be regarded functionally as the same nerve based on their distribution in the laryngeal muscles.

PMID: 24939450 [PubMed - indexed for MEDLINE]

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Toward a Differential Diagnosis of Hidden Hearing Loss in Humans.

Toward a Differential Diagnosis of Hidden Hearing Loss in Humans.

PLoS One. 2016;11(9):e0162726

Authors: Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF

Abstract
Recent work suggests that hair cells are not the most vulnerable elements in the inner ear; rather, it is the synapses between hair cells and cochlear nerve terminals that degenerate first in the aging or noise-exposed ear. This primary neural degeneration does not affect hearing thresholds, but likely contributes to problems understanding speech in difficult listening environments, and may be important in the generation of tinnitus and/or hyperacusis. To look for signs of cochlear synaptopathy in humans, we recruited college students and divided them into low-risk and high-risk groups based on self-report of noise exposure and use of hearing protection. Cochlear function was assessed by otoacoustic emissions and click-evoked electrocochleography; hearing was assessed by behavioral audiometry and word recognition with or without noise or time compression and reverberation. Both groups had normal thresholds at standard audiometric frequencies, however, the high-risk group showed significant threshold elevation at high frequencies (10-16 kHz), consistent with early stages of noise damage. Electrocochleography showed a significant difference in the ratio between the waveform peaks generated by hair cells (Summating Potential; SP) vs. cochlear neurons (Action Potential; AP), i.e. the SP/AP ratio, consistent with selective neural loss. The high-risk group also showed significantly poorer performance on word recognition in noise or with time compression and reverberation, and reported heightened reactions to sound consistent with hyperacusis. These results suggest that the SP/AP ratio may be useful in the diagnosis of "hidden hearing loss" and that, as suggested by animal models, the noise-induced loss of cochlear nerve synapses leads to deficits in hearing abilities in difficult listening situations, despite the presence of normal thresholds at standard audiometric frequencies.

PMID: 27618300 [PubMed - as supplied by publisher]

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[Transcranial direct current stimulation: new clinical roadmaps for psychiatric research].

[Transcranial direct current stimulation: new clinical roadmaps for psychiatric research].

Med Sci (Paris). 2016 8-9;32(8-9):752-7

Authors: Heeren A, Coussement C, Colon É

Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that has undergone intensive research over the past decade with promising results. tDCS is based on the application of weak, direct current over the scalp, leading to cortical hypo- or hyperpolarization according to the specified parameters. Recent studies have shown that tDCS is able to induce potent changes in cortical excitability as well as to elicit long-lasting modifications in brain activity. Over the last decade, tDCS physiological mechanisms of action have been intensively investigated. This research has given support for the investigation of tDCS applications in a wide range of clinical populations, including patients with post-stroke motor and language deficits, chronic pain, and tinnitus. Recently, its efficacy to treat psychiatric conditions has been explored increasingly. In this review, we will gather clinical studies involving tDCS to ameliorate psychiatric symptoms and discuss reasonable next steps in this direction.

PMID: 27615184 [PubMed - in process]

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Vitamin D pathway regulatory genes encoding 1α-hydroxylase and 24-hydroxylase are dysregulated in sinonasal tissue during chronic rhinosinusitis.

Vitamin D pathway regulatory genes encoding 1α-hydroxylase and 24-hydroxylase are dysregulated in sinonasal tissue during chronic rhinosinusitis.

Int Forum Allergy Rhinol. 2016 Sep 12;

Authors: Christensen JM, Cheng J, Earls P, Gunton J, Sewell W, Sacks R, Harvey RJ

Abstract
BACKGROUND: Vitamin D deficiency is associated with many inflammatory respiratory disease states. However, serum vitamin D concentrations may not reflect tissue-specific availability. In this study we sought to assess the local expression of genes essential in vitamin D regulation in chronic rhinosinusitis (CRS).
METHODS: A cross-sectional study of adult patients undergoing endoscopic sinus surgery was performed. Patients were defined as having CRS with polyps (CRSwNP) or without polyps (CRSsNP), or normal sinus mucosa. Sinus mucosal biopsies were assessed using quantitative polymerase chain reaction to determine expression of genes encoding the vitamin D receptor (VDR), 25-hydroxylase (CYP2R1), 1α-hydroxylase (CYP27B1), and 24-hydroxylase (CYP24A1). Expression levels correlated with serum 25(OH)D [sum 25(OH)D2  and 25(OH)D3 ], the 22-item Sinonasal Outcome Test (SNOT-22), and Nasal Symptom Score (NSS). Separate analyses were performed for patients grouped by tissue eosinophilia.
RESULTS: Thirty-one patients were assessed (age 49.47 ± 18.14 years, 48.4% female), including 8 CRSsNP, 10 CRSwNP, and 13 controls. CRSsNP and CRSwNP mucosa exhibited decreased CYP27B1 compared with controls (0.0437 [Interquartile range (IQR) 0.0999] vs 0.3260 [IQR 2.9384] vs 0.6557 [IQR 1.1005], p = 0.039), whereas CYP24A1 was upregulated (0.8522 [IQR 1.3170] vs 1.2239 [IQR 4.4197] vs 0.1076 [IQR 0.1791], p = 0.025). CYP24A1 was upregulated in both non-eosinophilic CRS and eosinophilic CRS (1.1337 [IQR 2.3790] vs 0.9555 [IQR 3.2811] vs 0.1076 [IQR 0.1791], p = 0.033). Significant correlations were observed between NSS and CYP2R1 (r = -0.432, p = 0.022), CYP24A1 (r = 0.420, P = 0.026), and VDR (r = 0.425, p = 0.024), although no correlations with serum 25(OH)D were observed.
CONCLUSIONS: The local regulation of vitamin D in sinonasal tissue during CRS may be independent of serum 25(OH)D levels. Vitamin D may be dysregulated at multiple levels, with decreased transcription of the metabolic gene CYP27B1 and increased transcription of the catabolic gene CYP24A1 observed.

PMID: 27618536 [PubMed - as supplied by publisher]

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Resection of olfactory groove meningioma - a review of complications and prognostic factors.

Related Articles

Resection of olfactory groove meningioma - a review of complications and prognostic factors.

Br J Neurosurg. 2015;29(5):685-92

Authors: Mukherjee S, Thakur B, Corns R, Connor S, Bhangoo R, Ashkan K, Gullan R

Abstract
INTRODUCTION: High complication rates have been cited following olfactory groove meningioma (OGM) resection but data are lacking on attendant risk factors. We aimed to review the complications following OGM resection and identify prognostic factors.
METHODS: A retrospective review was performed on 34 consecutive patients who underwent primary OGM resection at a single London institution between March 2008 and February 2013. Collected data included patient comorbidities, pre-operative corticosteroid use, tumour characteristics, imaging features, operative details, extent of resection, histology, use of elective post-operative ventilation, complications, recurrence and mortality.
RESULTS: Complication rate was 39%. 58% of complications required intensive care or re-operation. Higher complication rates occurred with OGM > 40 mm diameter versus ≤ 40 mm (53 vs. 28%; p = 0.16); OGM with versus without severe perilesional oedema (59 vs. 19%; p = 0.26), more evident when corrected for tumour size; and patients receiving 1-2 days versus 3-5 days of pre-operative dexamethasone (75 vs. 19%; p = 0.016). Patients who were electively ventilated post-operatively versus those who were not had higher risk tumours but a lower complication rate (17 vs. 44%; p = 0.36) and a higher proportion making a good recovery (83 vs. 55%; p = 0.20). Complete versus incomplete resection had a higher complication rate (50 vs. 23%; p = 0.16) but no recurrence (0 vs. 25%; p = 0.07).
CONCLUSION: Risk of morbidity with OGM resection is high. Higher complication risk is associated with larger tumours and greater perilesional oedema. Pre-operative dexamethasone for 3-5 days versus shorter periods may reduce the risk of complications. We describe a characteristic pattern of perilesional oedema termed 'sabre-tooth' sign, whose presence is associated with a higher complication rate and may represent an important radiological prognostic sign. Elective post-operative ventilation for patients with high-risk tumours may reduce the risk of complications.

PMID: 26174632 [PubMed - indexed for MEDLINE]

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The diffusion-weighted imaging and 11-C-methionine positron emission tomography depiction of an endodermal cyst at the cervico-medullary junction.

Related Articles

The diffusion-weighted imaging and 11-C-methionine positron emission tomography depiction of an endodermal cyst at the cervico-medullary junction.

Br J Neurosurg. 2015;29(5):739-41

Authors: Riva M, Rodriguez Y Baena R, Pessina F, Egesta L, Fernandes B, Galli C, Rossi M, Bello L

Abstract
A case of a 52-year-old male with left-sided neck pain, vertigo and gait instability is reported. A MRI scan revealed an intra-dural mass at the cervico-medullary junction, further characterised by diffusion-weighted imaging and 11-C-methionine positron emission tomography. Pathological diagnosis was endodermal cyst. The clinico-surgical relevance of the imaging findings is discussed.

PMID: 25812023 [PubMed - indexed for MEDLINE]

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Cervical lymph node metastases after thyroidectomy for papillary thyroid carcinoma usually remain stable for years.

Cervical lymph node metastases after thyroidectomy for papillary thyroid carcinoma usually remain stable for years.

Thyroid. 2016 Sep 11;

Authors: Tomoda C, Sugino K, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Ito K

Abstract
BACKGROUND: Lymph node (LN) recurrence detected by ultrasound (US) is a very common problem after initial treatment for papillary thyroid carcinoma (PTC). Most patients with PTC have an excellent disease-specific survival even with LN recurrence. Recently, watchful waiting with serial cervical US evaluations would be considered a reasonable approach to management of LN recurrence in selected patients. On the other hand, some patients with LN recurrence have demonstrated clinically significant disease progression during follow-up. The objective of the present study was to document the changes of cervical LN metastases after initial treatment and identify useful information for deciding how best to manage individual patients with LN recurrence.
METHODS: This retrospective review identified 83 consecutive PTC patients with at least one LN on the postoperative US diagnosed with fine needle aspiration biopsy or the thyroglobulin titer in the wash-out of the needle. The change in LN size was determined using serial US studies over time.
RESULTS: The subjects were 15 men and 68 women, with a median age at initial surgery of 50.6 years (range: 18-80 years). The median LN size at the start of the observation period was 1.3 cm (range, 0.5-2.4 cm) in the largest diameter. After a median follow-up of 7.2 years, the median growth rate of the nodes showing structural progression was 1.4 mm per year (range, 0-12.0 mm/year). Seventeen of 83 patients (20.5%) demonstrated an increase in LN size of at least 3 mm, only 8.4% (7 of 83) had an increase of at least 5 mm, and 39.7% (33 of 83) resolved. Distant metastases were present in 11 of 83 patients. 10-year and 15-year disease-specific survival rates (DSSs) after diagnosis of LN recurrence were 84.7% and 72.6%, respectively. Older age and recurrent LN growth of more than 3 mm/year were recognized as independent predictors for short survival on both univariate and multivariate analyses (p<0.05).
CONCLUSIONS: Most lymph node recurrences may remain stable for a long time and not be immediately life-threatening. However, recurrent LN growth of more than 3 mm per year could be related to mortality.

PMID: 27616725 [PubMed - as supplied by publisher]

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