Improvement of the insertion axis for cochlear implantation with a robot-based system.

Improvement of the insertion axis for cochlear implantation with a robot-based system.

Eur Arch Otorhinolaryngol. 2016 Oct 4;:

Authors: Torres R, Kazmitcheff G, De Seta D, Ferrary E, Sterkers O, Nguyen Y

Abstract
It has previously reported that alignment of the insertion axis along the basal turn of the cochlea was depending on surgeon' experience. In this experimental study, we assessed technological assistances, such as navigation or a robot-based system, to improve the insertion axis during cochlear implantation. A preoperative cone beam CT and a mastoidectomy with a posterior tympanotomy were performed on four temporal bones. The optimal insertion axis was defined as the closest axis to the scala tympani centerline avoiding the facial nerve. A neuronavigation system, a robot assistance prototype, and software allowing a semi-automated alignment of the robot were used to align an insertion tool with an optimal insertion axis. Four procedures were performed and repeated three times in each temporal bone: manual, manual navigation-assisted, robot-based navigation-assisted, and robot-based semi-automated. The angle between the optimal and the insertion tool axis was measured in the four procedures. The error was 8.3° ± 2.82° for the manual procedure (n = 24), 8.6° ± 2.83° for the manual navigation-assisted procedure (n = 24), 5.4° ± 3.91° for the robot-based navigation-assisted procedure (n = 24), and 3.4° ± 1.56° for the robot-based semi-automated procedure (n = 12). A higher accuracy was observed with the semi-automated robot-based technique than manual and manual navigation-assisted (p < 0.01). Combination of a navigation system and a manual insertion does not improve the alignment accuracy due to the lack of friendly user interface. On the contrary, a semi-automated robot-based system reduces both the error and the variability of the alignment with a defined optimal axis.

PMID: 27704279 [PubMed - as supplied by publisher]

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Impact of gender and sleep position on relationships between anthropometric parameters and obstructive sleep apnea syndrome.

Impact of gender and sleep position on relationships between anthropometric parameters and obstructive sleep apnea syndrome.

Sleep Breath. 2016 Oct 5;:

Authors: Jeong JI, Gu S, Cho J, Hong SD, Kim SJ, Dhong HJ, Chung SK, Kim HY

Abstract
OBJECTIVE: Considering the mechanisms by which obesity affects obstructive sleep apnea syndrome (OSAS) and the differences of fat distribution depending on gender, associations between anthropometric parameters, and OSAS may differ depending on gender or sleep position. We analyzed the impact of gender and sleep position on the relationship between fat distribution and development of OSAS.
METHODS: One thousand thirty-two consecutive subjects were analyzed. Recorded anthropometric measurements and overnight polysomnographic data of the subjects were reviewed retrospectively. The presence of OSAS was defined by the respiratory disturbance index (RDI) ≥5 with documented symptoms of excessive daytime sleepiness.
RESULTS: Eight hundred fifty-eight males and 174 females were included. Male subjects had significantly higher body mass index (BMI), larger waist circumference (WC), and lower percent of overall body fat (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The severity of OSAS was significantly higher in male subjects (RDI 26.9 ± 22.4 in males vs. 10.2 ± 13.8 in females, P < 0.0001). In male subjects, BMI, WC, and overall body fat were significantly associated with severity of OSAS and had larger impacts on supine RDI than lateral RDI. Overall body fat was not associated with severity of OSAS in female subjects, and there were no significant differences of the associations between all anthropometric parameters and RDIs depending on sleep position.
CONCLUSIONS: Evaluation of the correlation of anthropometric data with severity of OSAS should consider sleep position as well as gender.

PMID: 27704328 [PubMed - as supplied by publisher]

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Improvement of the insertion axis for cochlear implantation with a robot-based system.

Improvement of the insertion axis for cochlear implantation with a robot-based system.

Eur Arch Otorhinolaryngol. 2016 Oct 4;:

Authors: Torres R, Kazmitcheff G, De Seta D, Ferrary E, Sterkers O, Nguyen Y

Abstract
It has previously reported that alignment of the insertion axis along the basal turn of the cochlea was depending on surgeon' experience. In this experimental study, we assessed technological assistances, such as navigation or a robot-based system, to improve the insertion axis during cochlear implantation. A preoperative cone beam CT and a mastoidectomy with a posterior tympanotomy were performed on four temporal bones. The optimal insertion axis was defined as the closest axis to the scala tympani centerline avoiding the facial nerve. A neuronavigation system, a robot assistance prototype, and software allowing a semi-automated alignment of the robot were used to align an insertion tool with an optimal insertion axis. Four procedures were performed and repeated three times in each temporal bone: manual, manual navigation-assisted, robot-based navigation-assisted, and robot-based semi-automated. The angle between the optimal and the insertion tool axis was measured in the four procedures. The error was 8.3° ± 2.82° for the manual procedure (n = 24), 8.6° ± 2.83° for the manual navigation-assisted procedure (n = 24), 5.4° ± 3.91° for the robot-based navigation-assisted procedure (n = 24), and 3.4° ± 1.56° for the robot-based semi-automated procedure (n = 12). A higher accuracy was observed with the semi-automated robot-based technique than manual and manual navigation-assisted (p < 0.01). Combination of a navigation system and a manual insertion does not improve the alignment accuracy due to the lack of friendly user interface. On the contrary, a semi-automated robot-based system reduces both the error and the variability of the alignment with a defined optimal axis.

PMID: 27704279 [PubMed - as supplied by publisher]

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A systematic review of resonant voice therapy.

A systematic review of resonant voice therapy.

Int J Speech Lang Pathol. 2016 Oct 5;:1-13

Authors: Yiu EM, Lo MC, Barrett EA

Abstract
PURPOSE: The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using resonant voice therapy in treating dysphonia.
METHOD: Refereed journal papers from 1974 to 2014 were retrieved and reviewed by two independent reviewers using the keywords "Humming, Resonance, Resonant Voice, Semi-occluded or closed tube phonation" using available database systems. Quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULT: Thirteen papers met the search criteria. Nine papers were selected by the two reviewers. Two of the papers were randomised-controlled studies and the other seven were observational studies. At least four types of resonant voice therapies were described. They included the Lessac-Madsen Resonant Voice Therapy, Y-Buzz, Resonance Therapy and Humming. The overall level of quality of evidence was graded as "moderate".
CONCLUSION: There were limited studies that investigated the effectiveness of resonant voice therapy. Most studies were small-scale uncontrolled observational studies with the inclusion of only small samples or specific populations. There is clearly a need for more large-scale randomised controlled studies with a wider range of populations to provide further evidence on the effectiveness of resonant voice training for different populations.

PMID: 27705008 [PubMed - as supplied by publisher]

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Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience.

Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience.

Head Neck. 2016 Oct 5;:

Authors: Kadletz L, Grasl S, Grasl MC, Perisanidis C, Erovic BM

Abstract
BACKGROUND: The purpose of this study was to evaluate the clinical outcome in patients with benign parotid gland tumors after extracapsular dissection or superficial parotidectomy (SP).
METHODS: Eight hundred ninety-four patients with primary pleomorphic adenoma or Warthin's tumor were included from this study. Type and length of surgery, tumor size, resection margins, and complication rates were assessed.
RESULTS: Three hundred ninety-five (44.2%) extracapsular dissections and 499 SPs (55.8%) were performed. The rate of positive margins was significantly higher in the extracapsular dissection compared to the SP group (29.4% vs 10.2%; p < .0001). Recurrent disease (extracapsular dissection = 7.2% vs SP = 2.2%; p = .0003) and permanent facial palsy were significantly more frequent after extracapsular dissection than SP (2.2% vs 0.6%; p = .0396). Significant prolonged surgery time was observed after SP (146 vs 94 minutes; p < .0001).
CONCLUSION: Because extracapsular dissection led to a significantly higher percentage of permanent facial palsy, recurrent disease, and positive resection margins compared to SP, we recommend SP for treating benign parotid gland tumors. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704717 [PubMed - as supplied by publisher]

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Weight loss after head and neck cancer: A dynamic relationship with depressive symptoms.

Weight loss after head and neck cancer: A dynamic relationship with depressive symptoms.

Head Neck. 2016 Oct 5;:

Authors: Van Liew JR, Brock RL, Christensen AJ, Karnell LH, Pagedar NA, Funk GF

Abstract
BACKGROUND: Weight loss and depressive symptoms are critical head and neck cancer outcomes, yet their relation over the illness course is unclear.
METHODS: Associations between self-reported depressive symptoms and objective weight loss across the year after head and neck cancer diagnosis were examined using growth curve modeling techniques (n = 564).
RESULTS: A reciprocal covariation pattern emerged-changes in depressive symptoms over time were associated with same-month changes in weight loss (t [1148] = 2.05; p = .041), and changes in weight loss were associated with same-month changes in depressive symptoms (t [556] = 2.43; p = .015). To the extent that depressive symptoms increased, patients lost incrementally more weight than was lost due to the passage of time and vice versa. Results also suggested that pain and eating-related quality of life might explain the reciprocal association between depressive symptoms and weight loss.
CONCLUSION: In head and neck cancer, a transactional interplay between depressive symptoms and weight loss unfolds over time. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704695 [PubMed - as supplied by publisher]

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Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction.

Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction.

Head Neck. 2016 Oct 5;:

Authors: Frisch T

Abstract
BACKGROUND: The facial artery myomucosal (FAMM) island flap is a cheek flap, pedicled on the facial artery and suitable for small to medium-sized reconstructions of the oral cavity and neighboring areas. A novel transposition of the flap to the hypopharynx after laryngectomy is presented in this report.
METHODS: A 58-year-old man, previously irradiated, was laryngopharyngectomized because of a new supraglottic carcinoma. An unexpected need for a flap was solved by tunneling a FAMM island flap lateral to the mandible. The reach and size of the flap were sufficient to close the defect.
RESULTS: Vitality of the flap was ascertained by fiber endoscopy. No donor-site morbidity was seen. Postoperatively, the patient had a minor stomal fistula with spontaneous healing.
CONCLUSION: The pedicled FAMM island flap may be considered for smaller reconstructions of the upper hypopharynx. Accessibility, low donor-site morbidity, and recipient tissue similarity count among the advantages. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704666 [PubMed - as supplied by publisher]

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Efficacy of ultrasound-guided fine-needle aspiration performed by surgeons newly trained in thyroid ultrasound.

Efficacy of ultrasound-guided fine-needle aspiration performed by surgeons newly trained in thyroid ultrasound.

Head Neck. 2016 Oct 5;:

Authors: Graciano AJ, Fischer CA, Chone CT, Bublitz GS, Sonagli M, Filho CA

Abstract
BACKGROUND: There are a growing number of thyroid ultrasound courses to train endocrinologists, pathologists, and surgeons to perform ultrasound-guided fine-needle aspiration (FNA). However, there are limited data to support the efficacy of ultrasound-guided FNA performed by nonradiologists.
METHODS: We compared the efficacy of ultrasound-guided FNA performed by surgeons newly trained in thyroid ultrasound with that of the same technique performed by 1 experienced radiologist. The ratio of nondiagnostic examinations was used to compare the 2 groups.
RESULTS: A total of 197 ultrasound-guided FNAs were performed on 172 women (95.53%) and 8 men (4.47%) over a 12-month period. The efficacy of ultrasound-guided FNA did not differ between groups. A nondiagnostic report was found in 23% and 25.7% of the examinations performed by the radiologist and surgeons, respectively.
CONCLUSION: The efficacy of ultrasound-guided FNAs performed by our 2 surgeons was similar to that of our radiologist. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704660 [PubMed - as supplied by publisher]

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High-dose intravenous steroid regimen for radiation-induced hypoglossal nerve palsy.

High-dose intravenous steroid regimen for radiation-induced hypoglossal nerve palsy.

Head Neck. 2016 Oct 5;:

Authors: McDowell LJ, Jacobson MC, Levin W

Abstract
BACKGROUND: Hypoglossal nerve palsies are infrequent complications of head and neck radiotherapy. Treatments focus on maintaining function and prevention of abnormal airway-related swallowing events.
METHODS: A patient with longstanding cranial neuropathies, including bilateral hypoglossal involvement, secondary to chemoradiotherapy for nasopharyngeal carcinoma, experienced repeated episodes of life-threatening complications. Initially, 2 courses of 2 weekly 24-hour intravenous methylprednisolone (IVMP) infusions were administered 2 years apart. We report the results of a third course comprising 5 weekly cycles.
RESULTS: Patient-reported outcomes revealed significant improvement in swallowing function, speech, and psychosocial status. Airway invasion during swallowing and pharyngeal retention were assessed videofluoroscopically and evaluated using the Penetration-Aspiration Scale (PAS) and a residue rating scale, respectively. PAS ratings after infusions 2 and 5, improved dramatically from baseline and were maintained at 1-year follow-up.
CONCLUSION: High doses of IVMP may improve radiation-induced neuropathies. Further testing in similar patients is needed to prove reproducibility. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704653 [PubMed - as supplied by publisher]

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Supratracheal partial laryngectomy with tracheohyoidoepiglottopexy (open partial horizontal laryngectomy type IIIa + cricoarytenoid unit): Surgical technique illustrated in the anatomy laboratory.

Supratracheal partial laryngectomy with tracheohyoidoepiglottopexy (open partial horizontal laryngectomy type IIIa + cricoarytenoid unit): Surgical technique illustrated in the anatomy laboratory.

Head Neck. 2016 Oct 5;:

Authors: Succo G, Crosetti E, Bertolin A, Lucioni M, Rizzotto G

Abstract
The first supratracheal partial laryngectomy (STPL) with tracheohyoidoepiglottopexy was performed in 1972. This procedure entailed preservation of the suprahyoid epiglottis as well as a pexy of the hyoid bone and residual epiglottis to the first tracheal ring; however, this technique was abandoned by the same author in the early 1980s because of poor functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704651 [PubMed - as supplied by publisher]

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Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance.

Core-needle biopsy versus repeat fine-needle aspiration for thyroid nodules initially read as atypia/follicular lesion of undetermined significance.

Head Neck. 2016 Oct 5;:

Authors: Choi YJ, Baek JH, Suh CH, Shim WH, Jeong B, Kim JK, Song DE, Kim TY, Chung KW, Lee JH

Abstract
BACKGROUND: The purpose of this study was to evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeat fine-needle aspiration (FNA) for thyroid nodules that are initially read as atypia/follicular lesion of undetermined significance (AUS/FLUS) on FNA.
METHODS: Among 2631 initial AUS/FLUS FNA results, 505 consecutive nodules (295 repeat FNAs and 210 CNBs) were retrospectively analyzed. The primary outcome was inconclusive (ie, nondiagnostic or AUS/FLUS). The secondary outcomes included inconclusive results of the subcategory, risk factors for inconclusive results, and diagnostic performance.
RESULTS: CNB demonstrated significantly fewer inconclusive results than repeat FNA for the overall nodules (40.9% vs 63%; p < .001). Repeat FNA and group FLUS were significant risk factors for inconclusive results (odds ratio = 1.92; p =.001 and odds ratio = 2.08; p <.001, respectively). All diagnostic performances using CNB were higher than repeat FNAs.
CONCLUSION: CNB is more useful than repeat FNAs for reducing inconclusive results and improving the diagnostic performance of thyroid nodules with initial AUS/FLUS FNA results. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704650 [PubMed - as supplied by publisher]

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Predicting lymph node metastasis in patients with papillary thyroid carcinoma by vascular index on power Doppler ultrasound.

Predicting lymph node metastasis in patients with papillary thyroid carcinoma by vascular index on power Doppler ultrasound.

Head Neck. 2016 Oct 5;:

Authors: Lee JH, Shin HJ, Yoon JH, Kim EK, Moon HJ, Lee HS, Kwon HJ, Kwak JY

Abstract
BACKGROUND: For patients with papillary thyroid carcinoma (PTC), lymph node metastasis is associated with an increased recurrence rate. The purpose of this study was to investigate whether the vascular endothelial growth factor (VEGF), microvessel density (MVD), and vascular index (VI) can predict lymph node metastasis in patients with PTC.
METHODS: From January 2011 to October 2011, 202 patients with PTCs underwent preoperative staging ultrasound evaluation. To evaluate vascularity, we measured the VI, VEGF expression, and MVD.
RESULTS: The VI was significantly correlated with MVD (p = .009). On multivariate analysis, young age showed a significant correlation with lymph node metastasis (p < .001; p < .001; p < .001). However, the other clinicopathologic features, VEGF, MVD, and VI failed to show any significant correlations with lymph node metastasis.
CONCLUSION: Although the VI showed significant correlation with MVD, it was not significantly correlated to lymph node metastasis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27704649 [PubMed - as supplied by publisher]

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Intonation patterns in older children with cerebral palsy before and after speech intervention.

Intonation patterns in older children with cerebral palsy before and after speech intervention.

Int J Speech Lang Pathol. 2016 Oct 5;:1-11

Authors: Kuschmann A, Miller N, Lowit A, Pennington L

Abstract
PURPOSE: This paper examined the production of intonation patterns in children with developmental dysarthria associated with cerebral palsy (CP) prior to and after speech intervention focussing on respiration and phonation. The study further sought to establish whether intonation performance might be related to changes in speech intelligibility.
METHOD: Intonation patterns were examined using connected speech samples of 15 older children with moderate to severe developmental dysarthria due to CP (9 females; age range: 11-18). Recordings were made prior to and after speech intervention based on a systems approach. Analyses are focussed on the use of intonation patterns, pitch accentuation and phrasing.
RESULT: Group analyses showed a significant increase in the use of rising intonation patterns after intervention. There were also some indications that this increase might have been related to gains in speech intelligibility for some of the children. No changes were observed regarding pitch accentuation and phrasing following intervention.
CONCLUSION: The findings highlight that changes can occur in the use of intonation patterns in children with dysarthria and CP following speech systems intervention. It is hypothesised that the emergence of the rising pattern in some of the children's intonational inventories possibly reflected improved breath support and control of laryngeal muscles.

PMID: 27705032 [PubMed - as supplied by publisher]

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Therapeutic effects of intensive voice treatment (LSVT LOUD) for children with spastic cerebral palsy and dysarthria: A phase I treatment validation study.

Therapeutic effects of intensive voice treatment (LSVT LOUD) for children with spastic cerebral palsy and dysarthria: A phase I treatment validation study.

Int J Speech Lang Pathol. 2016 Oct 5;:1-15

Authors: Boliek CA, Fox CM

Abstract
PURPOSE: The aim of the present study was to validate and extend the evaluation of treatment outcomes following LSVT LOUD® in children with dysarthria secondary to cerebral palsy (CP).
METHOD: Seven children (5 females, 6-10 years) with spastic quadriplegia and dysarthria received LSVT LOUD. Outcomes included: (a) quantitative and qualitative indices of communication and social functioning representing therapeutic effects and (b) features of the acoustic signal representing physiological effects on the speech mechanism. A matched group of typically developing children served as controls. Testing occurred just prior to (PRE), immediately following (POST), and at 12 weeks post-treatment (FUP).
RESULT: Expert listeners preferred voice quality and articulatory precision of children with CP at FUP as compared to PRE. Acoustic data indicated improvements on select measures of vocal functioning at POST with some maintenance at FUP. Single word intelligibility improved immediately POST, but was not maintained at FUP. Parents rated positive changes in characteristics of voice and speech and qualitative changes in communication at both POST and FUP.
CONCLUSION: The present study validated some of the previous LSVT LOUD outcomes in children with dysarthria and CP and extended our understanding of therapeutic effects through qualitative data obtained from extensive parent interviews.

PMID: 27705010 [PubMed - as supplied by publisher]

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A systematic review of resonant voice therapy.

A systematic review of resonant voice therapy.

Int J Speech Lang Pathol. 2016 Oct 5;:1-13

Authors: Yiu EM, Lo MC, Barrett EA

Abstract
PURPOSE: The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using resonant voice therapy in treating dysphonia.
METHOD: Refereed journal papers from 1974 to 2014 were retrieved and reviewed by two independent reviewers using the keywords "Humming, Resonance, Resonant Voice, Semi-occluded or closed tube phonation" using available database systems. Quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULT: Thirteen papers met the search criteria. Nine papers were selected by the two reviewers. Two of the papers were randomised-controlled studies and the other seven were observational studies. At least four types of resonant voice therapies were described. They included the Lessac-Madsen Resonant Voice Therapy, Y-Buzz, Resonance Therapy and Humming. The overall level of quality of evidence was graded as "moderate".
CONCLUSION: There were limited studies that investigated the effectiveness of resonant voice therapy. Most studies were small-scale uncontrolled observational studies with the inclusion of only small samples or specific populations. There is clearly a need for more large-scale randomised controlled studies with a wider range of populations to provide further evidence on the effectiveness of resonant voice training for different populations.

PMID: 27705008 [PubMed - as supplied by publisher]

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Speech and nonspeech: What are we talking about?

Speech and nonspeech: What are we talking about?

Int J Speech Lang Pathol. 2016 Oct 5;:1-15

Authors: Maas E

Abstract
Understanding of the behavioural, cognitive and neural underpinnings of speech production is of interest theoretically, and is important for understanding disorders of speech production and how to assess and treat such disorders in the clinic. This paper addresses two claims about the neuromotor control of speech production: (1) speech is subserved by a distinct, specialised motor control system and (2) speech is holistic and cannot be decomposed into smaller primitives. Both claims have gained traction in recent literature, and are central to a task-dependent model of speech motor control. The purpose of this paper is to stimulate thinking about speech production, its disorders and the clinical implications of these claims. The paper poses several conceptual and empirical challenges for these claims - including the critical importance of defining speech. The emerging conclusion is that a task-dependent model is called into question as its two central claims are founded on ill-defined and inconsistently applied concepts. The paper concludes with discussion of methodological and clinical implications, including the potential utility of diadochokinetic (DDK) tasks in assessment of motor speech disorders and the contraindication of nonspeech oral motor exercises to improve speech function.

PMID: 27701907 [PubMed - as supplied by publisher]

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Responses made by late talkers and typically developing toddlers during speech assessments.

Responses made by late talkers and typically developing toddlers during speech assessments.

Int J Speech Lang Pathol. 2016 Oct 5;:1-14

Authors: Hodges R, Baker E, Munro N, Mcgregor KK

Abstract
PURPOSE: Assessing toddlers' speech is challenging. We explored responses made by late talkers and their typically developing peers in structured speech sampling contexts and determined if late talker subgroups could be identified.
METHOD: Twenty-six late talkers and 26 age-matched typically developing toddlers participated in an expressive phonology assessment and an elicited non-word imitation test. We quantified the breadth of toddler responses used in a subset of monosyllabic stimuli from the toddler phonology assessment and in the non-word imitation test. Correlational and cluster analyses were conducted.
RESULT: There were six response types: no response, protoword response, different verbal response, correct phoneme, common and uncommon phonological errors. Toddlers' use of most of the response types correlated across the two sampling contexts. Use of the response types also correlated with several direct and parent-report assessments. There were significant group differences in the use of several response types in both sampling contexts. Five late talker subgroups were identified that presented with differing profiles of responses.
CONCLUSION: Toddlers respond in a variety of ways during structured speech sampling contexts. Responses made by late talkers offer insights about the nature of late talking and their heterogeneity. Implications for research and clinical management of late talkers are discussed.

PMID: 27701903 [PubMed - as supplied by publisher]

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Speech-language pathology research in the Philippines in retrospect: Perspectives from a developing country.

Speech-language pathology research in the Philippines in retrospect: Perspectives from a developing country.

Int J Speech Lang Pathol. 2016 Oct 5;:1-9

Authors: Bondoc IP, Mabag V, Dacanay CA, Macapagal ND

Abstract
PURPOSE: There is a need for speech-language pathology (SLP) research in the Philippines, in order to fill in knowledge gaps relevant to the local context. Information about the local SLP research status remains inadequate. This study describes local SLP research done over the almost past four decades.
METHOD: Using a descriptive retrospective design, a search was made for all empirical research articles completed by Filipino SLPs from 1978 to 2015.
RESULT: A total of 250 research articles were identified and described along several parameters. A predominant number were authored by the SLPs in the academe (97.20%). There was a focus on language (27.60%) and the nature of communication/swallowing disorders (20.80%). More than half utilised quantitative exploratory research designs (69.20%). Several used survey forms to generate data (38.41%). Nearly all were unpublished (93.60%) and were unfunded (94.80%).
CONCLUSION: The current study revealed a dearth of research studies, limited diversity of research articles, limited research dissemination and funding concerns. It is suggested that the results of the current study can serve as a reference point to restructure research systems in the Philippines and in other developing countries, and offer data that can be used to develop a research agenda for the profession.

PMID: 27701895 [PubMed - as supplied by publisher]

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Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing.

Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing.

Acta Otolaryngol. 2016 Oct 5;:1-7

Authors: Qi B, Liu Z, Gu X, Liu B

Abstract
CONCLUSION: Mandarin-speaking adults can use the Fine Structure Processing (FSP) coding strategy as well as the Continuous Interleaved Sampling (CIS+) coding strategy. No loss in performance was observed after switch-over. Tone identification improves over time with the FSP coding strategy, which is of benefit to tonal-language users. After some time, fine structure was preferred.
OBJECTIVE: This study aimed to determine speech perception, tone perception, and the subjective preferences of Mandarin-speaking adults who received the FSP coding strategy, at upgrade from the CIS + coding strategy.
METHODS: Thirteen Mandarin-speaking subjects were tested at switch-over from CIS + to the FSP coding strategy ∼1-month after switch-over, 2-months after switch-over, and 3-months after switch-over with the Mandarin Hearing in Noise Test (M-HINT), the Mandarin Tone Identification in Noise Test (M-TINT), and a visual analogue scale assessing Sound and Speech Assessment (SSA).
RESULTS: There were no significant differences in the M-HINT between presentation levels (62 dB SPL vs 65 dB SPL), over time, nor when compared to the CIS + coding strategy. Tone perception improved significantly over time with the FSP coding strategy. Subjects rated the FSP coding strategy with the OPUS 2 as significantly more 'full' and 'rich' than with the CIS + coding strategy after 3-months.

PMID: 27701966 [PubMed - as supplied by publisher]

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Racial and Ethnic Disparities in Nasopharyngeal Cancer Survival in the United States: A SEER Study.

Racial and Ethnic Disparities in Nasopharyngeal Cancer Survival in the United States: A SEER Study.

Otolaryngol Head Neck Surg. 2016 Oct 4;:

Authors: Patel VJ, Chen NW, Resto VA

Abstract
OBJECTIVE: To determine whether patient race and ethnicity affect nasopharyngeal cancer survival.
STUDY DESIGN: Retrospective database analysis.
SETTING: National Cancer Institute's SEER database (Surveillance, Epidemiology, and End Results), 1988-2010.
SUBJECTS AND METHODS: Nasopharyngeal carcinoma cases were extracted according to site codes and histology recode-broad groupings. The cohort of 5427 patients was used to calculate disease-specific survival in regard to race and ethnicity. Extracted data were further analyzed through direct comparisons and multivariable Cox regression models controlling for patient, tumor, and treatment characteristics.
RESULTS: Unadjusted survival curves for all nasopharyngeal carcinomas considered together showed a statistically significant better disease-specific survival for the African American race (P = .02) and Asian ethnicity (P = .01) relative to Caucasian patients. The survival advantage for both these groups was eliminated after controlling for the age and sex of the patients.
CONCLUSION: African American and Asian patients with nasopharyngeal cancer have better disease-specific survival as compared with Caucasian patients, while Hispanic ethnicity has no effect relative to Caucasians. This disparity is accounted for by diagnosis at an older age in Caucasian patients but remains poorly explained in regard to Hispanic patients.

PMID: 27703094 [PubMed - as supplied by publisher]

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Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas.

Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas.

Otolaryngol Head Neck Surg. 2016 Oct 4;:

Authors: Patel NS, Van Abel KM, Link MJ, Driscoll CL, Van Gompel JJ, Neff BA, Lane JI, Carlson ML

Abstract
OBJECTIVE: Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome.
STUDY DESIGN: Case series with chart review.
SETTING: Academic referral center.
SUBJECTS AND METHODS: A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed.
RESULTS: Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P = .01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P = .04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00).
CONCLUSION: Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

PMID: 27703093 [PubMed - as supplied by publisher]

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Survival Outcomes for Combined Modality Therapy for Sinonasal Undifferentiated Carcinoma.

Survival Outcomes for Combined Modality Therapy for Sinonasal Undifferentiated Carcinoma.

Otolaryngol Head Neck Surg. 2016 Oct 4;:

Authors: Kuo P, Manes RP, Schwam ZG, Judson BL

Abstract
OBJECTIVE: Sinonasal undifferentiated carcinoma is a rare and aggressive malignancy of the nasal cavity and paranasal sinuses. Multi-institutional studies examining outcomes of combined modality treatment versus other treatment modalities have not been performed. The objective of our study was to present outcomes for multimodality therapy through use of the National Cancer Database.
STUDY DESIGN: Retrospective cohort study.
SETTING: National Cancer Database.
METHODS: A total of 435 cases of SNUC diagnosed between 2004 and 2012 were identified. Kaplan-Meier analyses were performed to find 5-year cumulative survival rates. Multivariate Cox regression evaluated overall survival based on treatment when adjusting for other prognostic factors (age, primary site, sex, race, comorbidity, insurance, and TNM stage). Within the surgery + chemoradiotherapy group, survival analysis was also performed to compare outcomes for induction and adjuvant chemotherapy.
RESULTS: The cumulative 5-year survival rate was 41.5%, and 36.1% of patients received surgery with chemoradiotherapy. In multivariate analysis, surgery + chemoradiotherapy was associated with significantly improved overall survival versus surgery + radiotherapy and radiotherapy but not significantly different from chemoradiotherapy. Within the surgery + chemoradiotherapy group, induction and adjuvant chemotherapy groups did not have associated differences in survival.
CONCLUSION: Combined modality therapy (chemoradiotherapy or surgery + chemoradiotherapy) is associated with improved survival outcomes versus other treatment modalities in patients with sinonasal undifferentiated carcinoma.

PMID: 27703092 [PubMed - as supplied by publisher]

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Selenium supplementation significantly reduces thyroid autoantibody levels in patients with chronic autoimmune thyroiditis: A systematic review and meta-analysis.

Selenium supplementation significantly reduces thyroid autoantibody levels in patients with chronic autoimmune thyroiditis: A systematic review and meta-analysis.

Thyroid. 2016 Oct 5;:

Authors: Wichman J, Winther KH, Bonnema SJ, Hegedus L

Abstract
BACKGROUND: Selenium supplementation may decrease circulating thyroid autoantibodies in patients with chronic autoimmune thyroiditis (AIT), but the previous trials are heterogenous. Here, we expand and critically reappraise the knowledge on this topic.
METHODS: A literature search identified 3366 records. Controlled trials in adults (≥ 18 years) with AIT, comparing selenium with or without levothyroxine (LT4), versus placebo and/or LT4, were eligible. Assessed outcomes were serum thyroid peroxidase (TPO-Ab), thyroglobulin (Tg-Ab) autoantibody levels, and immunomodulatory effects. After screening and full-text assessment, sixteen controlled trials were included in the systematic review. Random effects meta-analyses in weighted mean difference (WMD) were performed for three, six, and twelve months of supplementation in two different populations: one receiving LT4-therapy and one newly diagnosed and untreated. Heterogeneity was estimated using I2 and quality of evidence was assessed per outcome, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.
RESULTS: In LT4-treated populations, the selenium group had significantly lower TPO-Ab levels after three months (seven studies, WMD: -271, 95% CI: -366 to -175, p<0.0001, I2 = 45.4%), which was consistent at six months (three studies) and twelve months (one study). Tg-Ab decreased at twelve months but not at three or six months. In untreated populations, the selenium group showed a decrease of TPO-Ab levels after three months (three studies, WMD: -512, 95% CI: -626 to -398, p <0.0001, I2 = 0.0%), but not after six or twelve months. Tg-Ab decreased at three months, but neither at six nor at twelve months. Quality of evidence was generally assessed as low. Study participants receiving selenium had a significantly higher risk than controls of reporting adverse effects (p = 0.036).
CONCLUSIONS: Selenium supplementation reduced serum TPO-Ab levels after three, six and twelve months in an LT4-treated AIT population and after three months in an untreated AIT population. Whether these effects correlate with clinically relevant measures remains to be demonstrated.

PMID: 27702392 [PubMed - as supplied by publisher]

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Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing.

Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing.

Acta Otolaryngol. 2016 Oct 5;:1-7

Authors: Qi B, Liu Z, Gu X, Liu B

Abstract
CONCLUSION: Mandarin-speaking adults can use the Fine Structure Processing (FSP) coding strategy as well as the Continuous Interleaved Sampling (CIS+) coding strategy. No loss in performance was observed after switch-over. Tone identification improves over time with the FSP coding strategy, which is of benefit to tonal-language users. After some time, fine structure was preferred.
OBJECTIVE: This study aimed to determine speech perception, tone perception, and the subjective preferences of Mandarin-speaking adults who received the FSP coding strategy, at upgrade from the CIS + coding strategy.
METHODS: Thirteen Mandarin-speaking subjects were tested at switch-over from CIS + to the FSP coding strategy ∼1-month after switch-over, 2-months after switch-over, and 3-months after switch-over with the Mandarin Hearing in Noise Test (M-HINT), the Mandarin Tone Identification in Noise Test (M-TINT), and a visual analogue scale assessing Sound and Speech Assessment (SSA).
RESULTS: There were no significant differences in the M-HINT between presentation levels (62 dB SPL vs 65 dB SPL), over time, nor when compared to the CIS + coding strategy. Tone perception improved significantly over time with the FSP coding strategy. Subjects rated the FSP coding strategy with the OPUS 2 as significantly more 'full' and 'rich' than with the CIS + coding strategy after 3-months.

PMID: 27701966 [PubMed - as supplied by publisher]

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Development of Tinnitus at a Low Dose of Sertraline: Clinical Course and Proposed Mechanisms.

Development of Tinnitus at a Low Dose of Sertraline: Clinical Course and Proposed Mechanisms.

Case Rep Psychiatry. 2016;2016:1790692

Authors: Miller CW

Abstract
Introduction. Serotonin is involved in filtering of auditory stimuli. Cochlear input is processed through complex interactions between serotonergic, glutamatergic, and GABAergic neurotransmitter systems. Options for treatment of tinnitus include selective serotonin reuptake inhibitors (SSRIs); however in rare instances this symptom may occur as a side effect of this class of medications. Case Presentation. A 50-year-old woman developed bilateral tinnitus after several weeks of being treated with sertraline 50 mg. She had been on a long-standing daily dose of aspirin 325 mg which had been discontinued shortly before starting sertraline. Medical work-up was negative for her symptom. Shortly after discontinuation of the medication, her tinnitus subsided completely. Discussion. Tinnitus is a rare side effect of sertraline and may be related to particular distribution of serotonin receptor subtypes within the auditory system, and serotonergic agents may reinforce or desensitize the activity of different receptors. Also, there may be a priming effect of salicylate agents on the auditory system, predisposing particular patients to be more sensitive to how auditory stimuli are processed.

PMID: 27703829 [PubMed - in process]

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Acute high-intensity noise induces rapid Arc protein expression but fails to rapidly change GAD expression in amygdala and hippocampus of rats: Effects of treatment with D-cycloserine.

Acute high-intensity noise induces rapid Arc protein expression but fails to rapidly change GAD expression in amygdala and hippocampus of rats: Effects of treatment with D-cycloserine.

Hear Res. 2016 Oct 1;:

Authors: Kapolowicz MR, Thompson LT

Abstract
Tinnitus is a devastating auditory disorder impacting a growing number of people each year. The aims of the current experiment were to assess neuronal mechanisms involved in the initial plasticity after traumatic noise exposure that could contribute to the emergence of tinnitus and to test a potential pharmacological treatment to alter this early neural plasticity. Specifically, this study addressed rapid effects of acute noise trauma on amygdalo-hippocampal circuitry, characterizing biomarkers of both excitation and inhibition in these limbic regions, and compared them to expression of these same markers in primary auditory cortex shortly after acute noise trauma. To assess excitatory plasticity, activity-regulated cytoskeleton-associated (Arc) protein expression was evaluated in male rats 45 min after bilateral exposure to acute high-intensity noise (16 kHz, 115 dB SPL, for 1 h), sufficient to cause acute cochlear trauma, a common cause of tinnitus in humans and previously shown sufficient to induce tinnitus in rat models of this auditory neuropathology. Western blot analyses confirmed that up-regulation of amygdalo-hippocampal Arc expression occurred rapidly post-noise trauma, corroborating several lines of evidence from our own and other laboratories indicating that limbic brain structures, i.e. outside of the classical auditory pathways, exhibit plasticity early in the initiation of tinnitus. Western blot analyses revealed no noise-induced changes in amygdalo-hippocampal expression of glutamate decarboxylase (GAD), the biosynthetic enzyme required for GABAergic inhibition. No changes in either Arc or GAD protein expression were observed in primary auditory cortex in this immediate post-noise exposure period, confirming other reports that auditory cortical plasticity may not occur until later in the development of tinnitus. As a further control, our experiments compared Arc protein expression between groups exposed to the quiet background of a sound-proof chamber to those exposed not only to the traumatic noise described above, but also to an intermediate, non-traumatic noise level (70 dB SPL) for the same duration in each of these three brain regions. We found that non-traumatic noise did not up-regulate Arc protein expression in these brain regions. To see if changes in Arc expression due to acute traumatic noise exposure were stress-related, we compared circulating serum corticosterone in controls and rats exposed to traumatic noise at the time when changes in Arc were observed, and found no significant differences in this stress hormone in our experimental conditions. Finally, the ability of D-cycloserine (DCS; an NMDA-receptor NR1 partial agonist) to reduce or prevent the noise trauma-related plastic changes in the biomarker, Arc, was tested. D-cycloserine prevented traumatic noise-induced up-regulation of Arc protein expression in amygdala but not in hippocampus, suggesting that DCS alone is not fully effective in eliminating regionally-specific early plastic changes after traumatic noise exposure.

PMID: 27702572 [PubMed - as supplied by publisher]

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A typical but seldom recognized foreign body in the esophagus of a laryngectomized patient.

A typical but seldom recognized foreign body in the esophagus of a laryngectomized patient.

Rev Esp Enferm Dig. 2016 Oct;108(10):660-661

Authors: Rodrigues JP, Pinho R, Carvalho J

Abstract
A 57-year-old man with a past medical history of total laryngectomy for squamous cell carcinoma of the larynx was admitted to our institution 5 months after the procedure, for surgical resection of a local recurrence of the tumor. In the postoperative period, endoscopically guided placement of a nasogastric tube was scheduled, after previous failed attempts. Upper gastrointestinal endoscopy revealed an anastomotic dehiscence, 13 cm distal to the incisors, and a foreign body penetrating through the esophageal wall, 20cm distal to the incisors. We were unable to identify the foreign body with certainty but, after consulting with the assistant otorhinolaryngologist, we realized that it was a voice prosthesis.

PMID: 27701887 [PubMed - in process]

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Changing head model extent affects finite element predictions of transcranial direct current stimulation distributions.

Changing head model extent affects finite element predictions of transcranial direct current stimulation distributions.

J Neural Eng. 2016 Oct 05;13(6):066006

Authors: Indahlastari A, Chauhan M, Schwartz B, Sadleir RJ

Abstract
OBJECTIVE: In this study, we determined efficient head model sizes relative to predicted current densities in transcranial direct current stimulation (tDCS).
APPROACH: Efficiency measures were defined based on a finite element (FE) simulations performed using nine human head models derived from a single MRI data set, having extents varying from 60%-100% of the original axial range. Eleven tissue types, including anisotropic white matter, and three electrode montages (T7-T8, F3-right supraorbital, Cz-Oz) were used in the models.
MAIN RESULTS: Reducing head volume extent from 100% to 60%, that is, varying the model's axial range from between the apex and C3 vertebra to one encompassing only apex to the superior cerebellum, was found to decrease the total modeling time by up to half. Differences between current density predictions in each model were quantified by using a relative difference measure (RDM). Our simulation results showed that [Formula: see text] was the least affected (a maximum of 10% error) for head volumes modeled from the apex to the base of the skull (60%-75% volume).
SIGNIFICANCE: This finding suggested that the bone could act as a bioelectricity boundary and thus performing FE simulations of tDCS on the human head with models extending beyond the inferior skull may not be necessary in most cases to obtain reasonable precision in current density results.

PMID: 27705955 [PubMed - as supplied by publisher]

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Short stature Revealing a Pycnodysostosis: A Case Report.

Short stature Revealing a Pycnodysostosis: A Case Report.

J Orthop Case Rep. 2016 Apr-Jun;6(2):43-45

Authors: Aynaou H, Skiker I, Latrech H

Abstract
INTRODUCTION: Pycnodysostosis is a rare genetic disease characterized by osteosclerosis and bone fragility. The clinical aspects are varied including short stature, acro-osteolysis of distal phalanges, and dysplasia of the clavicles. Oral and maxillofacial manifestations of this disease are very clear. The head is usually large, a beaked nose, obtuse mandibular angle, and both maxilla and mandible are hypoplastic. Dental abnormalities are common. We report a case with the typical clinical and radiological characteristics of the Pycnodysostosis associated with a conductive hearing loss, an association rarely reported.
CASE PRESENTATION: A 12-year-female was admitted in our institute for short stature with a dysmorphic facies for evaluation. The patient reported a history of multiple fractures of the long bones after a trivial fall. On physical examination, she had the following features: short stature, limited mouth opening, short hands and feet with dysplastic nails; frontal and occipital bossing; and hypoplasia of the maxilla and mandible. Examination of the mouth: grooved palate, caries of the teeth, impacted and malposed teeth, persistent deciduous teeth and missing teeth. Laboratory investigations were normal. The radiographic examination showed a generalized increase in the bone density, slight condensation of the skull base and a very open mandibular angle. X-rays showed tapered phalanges with acro-osteolysis of the distal phalanges. A symptomatic treatment was proposed based on fracture prevention, oral hygiene, frequent dental visits and psychiatric support.
CONCLUSION: The clinical and radiological features are the bases for the diagnosis of this disease. It is important to make the diagnosis as early as possible in order to plan the treatment and to provide a better life quality to the patients.

PMID: 27703936 [PubMed - in process]

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Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas.

Prevalence and Surgical Implications of Dural Enhancement at the Porus Acusticus in Vestibular Schwannomas.

Otolaryngol Head Neck Surg. 2016 Oct 4;:

Authors: Patel NS, Van Abel KM, Link MJ, Driscoll CL, Van Gompel JJ, Neff BA, Lane JI, Carlson ML

Abstract
OBJECTIVE: Demonstrate the association of radiographic dural enhancement with increased tumor adherence at the porus acusticus, which may influence completeness of resection and facial nerve outcome.
STUDY DESIGN: Case series with chart review.
SETTING: Academic referral center.
SUBJECTS AND METHODS: A total of 205 consecutive patients with histopathologically confirmed vestibular schwannoma (VS) were evaluated. Patients with tumors exhibiting dural enhancement on postgadolinium T1-weighted magnetic resonance imaging were identified and compared with matched controls. Completeness of resection, intraoperative details, and facial nerve outcomes were analyzed.
RESULTS: Excluding strictly intracanalicular tumors (n = 32, 16%) and those with NF2 (n = 10, 4.9%), the presence of dural enhancement was radiographically confirmed in 16 (9.8%) cases. Paired analysis did not reveal significant baseline differences between cases and controls. Subtotal resection was performed in 5 (31%) of the 16 patients with tumors exhibiting dural enhancement, in contrast to 1 (3%) of the matched controls (P = .01). Four (25%) demonstrated increased tumor adherence at the porus acusticus intraoperatively, compared with 1 control (3%, P = .04). Long-term facial nerve function was similar between cases and controls (81% vs 84% House-Brackmann I-II function, P = 1.00).
CONCLUSION: Dural enhancement is present in approximately 10% of extracanalicular VS. Dural enhancement at the porus acusticus may represent hypervascularity, dural reaction, or infiltration, and portends increased tumor adherence and greater likelihood of subtotal resection to preserve facial nerve function. To our knowledge, this is the first series that reports the prevalence of this phenomenon in VS and the potential surgical implications. Recognition preoperatively may be valuable toward patient counseling.

PMID: 27703093 [PubMed - as supplied by publisher]

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Rhabdomyosarcoma of Cervix: A Case Report.

Rhabdomyosarcoma of Cervix: A Case Report.

Iran J Cancer Prev. 2016 Jun;9(3):e4383

Authors: Hosseini MS, Ashrafganjoei T, Sourati A, Tabatabeifar M, Mohamadianamiri M

Abstract
INTRODUCTION: Rhabdomyosarcoma has known as a highly malignant soft tissue sarcoma. It has been the most common soft tissue sarcoma in childhood, accounting for about 3 to 4 % of all cases of childhood cancer. Rhabdomyosarcoma was rare in adults, accounting for 3% of all soft-tissue sarcomas. embryonal rhabdomyosarcoma of female genital tract including uterine cervix in an adult was rare.
CASE PRESENTATION: This study has reported a 33-year-old woman presented with abnormal vaginal discharge. Gynecologic examination revealed a cervical mass with grape- like feature protruding into vagina with posterior- superior vaginal wall involvement. Biopsy has performed and pathologic examination was consistent with embryonal botryoid type rhabdomyosarcoma. She has undergone the staging work up measurements including thoracic computed tomography (CT) scan, abdominopelvic magnetic resonance imaging (MRI), bone scan and bone marrow examination. In exception of abdominopelvic MRI, with 2 suspicious pelvic lymph nodes in addition of cervical mass, all others were normal. Radical hysterectomy with lymph node debulking and ovarian preservation has performed. Final results have shown embryonal botryoid type rhabdomyosarcoma of cervix. ovaries, endometrium, parametrium, and follopian tubes were unremarkable. Pelvic lymph nodes pathology and intraabdominal fluid cytology were negative for malignancy. Lymphovascular invasion was identified. She has advised for adjuvant chemotherapy.
CONCLUSIONS: This case has reminded that embryonal rhabdomyosarcoma could occur in uncommon site and older female. Longer follow up of these cases has required due to lack of survival data for embryonal rhabdomyosarcoma of this site and age group.

PMID: 27703644 [PubMed - in process]

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