Same Time Next Year!

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Treatment decisions and employment of breast cancer patients: Results of a population-based survey

BACKGROUND

Many patients with breast cancer work for pay at the time of their diagnosis, and the treatment plan may threaten their livelihood. Understanding work experiences in a contemporary population-based sample is necessary to inform initiatives to reduce the burden of cancer care.

METHODS

Women who were 20 to 79 years old and had been diagnosed with stage 0 to II breast cancer, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries in 2014-2015, were surveyed. Of the 3672 eligible women, 2502 responded (68%); 1006 who reported working before their diagnosis were analyzed. Multivariate models evaluated correlates of missing work for >1 month and stopping work altogether versus missing work for ≤1 month.

RESULTS

In this diverse sample, most patients (62%) underwent lumpectomy; 16% underwent unilateral mastectomy (8% with reconstruction); and 23% underwent bilateral mastectomy (19% with reconstruction). One-third (33%) received chemotherapy. Most (84%) worked full-time before their diagnosis; however, only 50% had paid sick leave, 39% had disability benefits, and 38% had flexible work schedules. Surgical treatment was strongly correlated with missing >1 month of work (odds ratio [OR] for bilateral mastectomy with reconstruction vs lumpectomy, 7.8) and with stopping work altogether (OR for bilateral mastectomy with reconstruction vs lumpectomy, 3.1). Chemotherapy receipt (OR for missing >1 month, 1.3; OR for stopping work altogether, 3.9) and race (OR for missing >1 month for blacks vs whites, 2.0; OR for stopping work altogether for blacks vs whites, 1.7) also correlated. Those with paid sick leave were less likely to stop working (OR, 0.5), as were those with flexible schedules (OR, 0.3).

CONCLUSIONS

Working patients who received more aggressive treatments were more likely to experience substantial employment disruptions. Cancer 2017. © 2017 American Cancer Society.

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Issue Information - Ed Board

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Corrigendum

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Drug-eluting bead transarterial chemoembolization in the treatment for unresectable soft tissue sarcoma refractory to systemic chemotherapy: a preliminary evaluation of efficacy and safety

Abstract

Purpose

To preliminarily evaluate the clinical efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) for unresectable soft tissue sarcoma refractory to systemic chemotherapy.

Methods

Ten patients with refractory sarcoma who underwent DEB-TACE therapy between January 2015 and January 2017 were identified. Clinical information and radiological data were retrospectively collected to analyze tumor response, overall survival (OS), progression-free survival and adverse events (AEs). Tumor response to DEB-TACE was assessed with modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines applied to computed tomography or magnetic resonance imaging.

Results

All DEB-TACE procedures were successfully performed for ten patients with 15 tumor lesions. The median follow-up duration was 19 months and the median survival time was 21 months (range 11–30 months). The 1- and 2-year OS rate was 90 and 30%, respectively. According to the guidance of mRECIST, complete response, partial response, stable disease and progressive disease were noted in zero (0%), three (30%), four (40%) and three (30%) patients, respectively. The disease control rate and objective response rate was 70 and 30%, respectively. There were no serious AEs in patients after DEB-TACE.

Conclusions

Our data showed that DEB-TACE was effective and safe for patients with soft tissue sarcoma. Therefore, DEB-TACE can be considered as an alternative treatment option for unresectable soft tissue sarcoma refractory to conventionally systemic chemotherapy.

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Investigating the role of chemical and physical processes on organic aerosol modelling with CAMx in the Po Valley during a winter episode

Publication date: Available online 7 October 2017
Source:Atmospheric Environment
Author(s): A. Meroni, G. Pirovano, S. Gilardoni, G. Lonati, C. Colombi, V. Gianelle, M. Paglione, V. Poluzzi, G.M. Riva, A. Toppetti
Traditional aerosol mechanisms underestimate the observed organic aerosol concentration, especially due to the lack of information on secondary organic aerosol (SOA) formation and processing. In this study we evaluate the chemical and transport model CAMx during a one-month in winter (February 2013) over a 5 km resolution domain, covering the whole Po valley (Northern Italy). This works aims at investigating the effects of chemical and physical atmospheric processing on modeling results and, in particular, to evaluate the CAMx sensitivity to organic aerosol (OA) modeling schemes: we will compare the recent 1.5D-VBS algorithm (CAMx-VBS) with the traditional Odum 2-product model (CAMx-SOAP). Additionally, the thorough diagnostic analysis of the reproduction of meteorology, precursors and aerosol components was intended to point put strength and weaknesses of the modeling system and address its improvement.Firstly, we evaluate model performance for criteria PM concentration. PM10 concentration was underestimated both by CAMx-SOAP and even more by CAMx-VBS, with the latter showing a bias ranging between -4.7 and -7.1 μg m⁻³. PM2.5 model performance was to some extent better than PM10, showing a mean bias ranging between -0.5 μg m⁻³ at rural sites and -5.5 μg m⁻³ at urban and suburban sites. CAMx performance for OA was clearly worse than for the other PM compounds (negative bias ranging between -40% and -75%). The comparisons of model results with OA sources (identified by PMF analysis) shows that the VBS scheme underestimates freshly emitted organic aerosol while SOAP overestimates. The VBS scheme correctly reproduces biomass burning (BBOA) contributions to primary OA concentrations (POA). In contrast VBS slightly underestimates the contribution from fossil-fuel combustion (HOA), indicating that POA emissions related to road transport are either underestimated or associated to higher volatility classes. The VBS scheme under-predictes the SOA too, but to a lesser extent than CAMx-SOAP. SOA underestimation can be related to corresponding underestimation of either aging processes or precursor emissions. This indicates that improvements in the emission inventories for semi- and intermediate-volatility organic compounds are needed for further progress in this area. Finally, the comparison between modeled and observed SOA sources points out the urgency to include processing of OA in particle water phase into SOA formation mechanisms, to reconcile model results and observations.



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Quantitative assessment of source contributions to PM2.5 on the west coast of Peninsular Malaysia to determine the burden of Indonesian peatland fire

Publication date: Available online 7 October 2017
Source:Atmospheric Environment
Author(s): Yusuke Fujii, Susumu Tohno, Norhaniza Amil, Mohd Talib Latif
Almost every dry season, peatland fires occur in Sumatra and Kalimantan Inlands. Dense smoke haze from Indonesian peatland fires (IPFs) causes impacts on health, visibility, transport and regional climate in Southeast Asian countries such as Indonesia, Malaysia, and Singapore. Quantitative knowledge of IPF source contribution to ambient aerosols in Southeast Asia (SEA) is so useful to make appropriate suggestions to policy makers to mitigate IPF-induced haze pollution. However, its quantitative contribution to ambient aerosols in SEA remains unclarified. In this study, the source contributions to PM2.5 were determined by the Positive Matrix Factorization (PMF) model with annual comprehensive observation data at Petaling Jaya on the west coast of Peninsular Malaysia, which is downwind of the IPF areas in Sumatra Island, during the dry (southwest monsoon: June–September) season. The average PM2.5 mass concentration during the whole sampling periods (Aug 2011–Jul 2012) based on the PMF and chemical mass closure models was determined as 20–21 μg m⁻³. Throughout the sampling periods, IPF contributed (on average) 6.1–7.0 μg m⁻³ to the PM2.5, or ∼30% of the retrieved PM2.5 concentration. In particular, the PM2.5 was dominantly sourced from IPF during the southwest monsoon season (51–55% of the total PM2.5 concentration on average). Thus, reducing the IPF burden in the PM2.5 levels would drastically improve the air quality (especially during the southwest monsoon season) around the west coast of Peninsular Malaysia.



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20Q: Current Perspectives on Hyperacusis

A Q & A discussion that reviews current knowledge of hyperacusis. Topics include definition, symptoms, prevalence, and suspected pathophysiology, as well as clinical assessment, treatment, and resources, based on the latest research in this area.

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Neuro-Psychiatric Comorbidity among Psoriatic Adolescents

Abstract

Background

Psoriasis is a known risk factor for neuro-psychiatric diseases among adults. Less is known regarding adolescents.

Objective

Investigating the association between psoriasis and neuro-psychiatric comorbidity and social skills among adolescents.

Methods

A population based cross-sectional study between January 1^st, 1999 and January 1^st, 2014 was conducted. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate to severe psoriasis, respectively. All psoriasis patients were diagnosed by a dermatologist. Neuro-psychiatric diseases were diagnosed by a neurologist and a psychiatrist, accordingly. Social skills were evaluated by a psychosocial assessment. Psoriasis patients were compared to 884653 healthy control patients by a multivariate analysis adjusted for age, sex, country of origin, socio-economic status, cognitive skills and body mass index. A subgroup evaluation was done for comorbidity which could only be evaluated for part of the recruitment years, by a univariate analysis.

Results

Overall chronic headaches (8.1% vs. 3.4%), intermediate frequency migraine (4.8% vs. 1.6%), low frequency migraine and non-migraine headaches (3.4% vs. 1.8%) were associated only with moderate to severe psoriasis compared to healthy controls [Adjusted odds ratios (adj. ORs) 1.9, 2.3, 1.5; 95% confidence intervals (CIs) 1.6-2.4, 1.8-3.0 and 1.1-2.1, respectively]. Anxiety disorders (2.1% vs. 0.7%) and impaired social adjustment skills (7.5% vs. 4.2%) were also associated only with moderate to severe psoriasis compared to healthy controls (ORs 2.9, 1.9; 95% CIs 1.6-5.5 and 1.3-2.6; Of 466 vs. 265023, respectively).

Conclusion

Psoriasis among adolescents is associated with neuro-psychiatric co-morbidities and impaired adjustment skills, depending on disease severity.

This article is protected by copyright. All rights reserved.

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Comparison of Airway Measurements for Tracheobronchial Stenosis Between Stereoscopic Bronchoscope and MD-CT

Background: Stereoscopic bronchoscopy is a new diagnostic tool to measure the diameter and cross-sectional area of the airway. The stereoscopic bronchoscope, which operates the same as a standard bronchoscope, utilizes 2 lenses to measure the airway using the principles of triangulation. Furthermore, the stereoscopic bronchoscope has the capability to measure the size of the airway during intervention in real-time, including variable stenosis. Materials and Methods: To prospectively compare preoperative stereoscopic and multidetector computed tomography (MD-CT) images to select the appropriate stent size for airway stenosis. Stereoscopic and MD-CT images were then measured to confirm the correct placement of the stent. Results: Airway stenting was performed on 21 consecutive patients of whom, 15 were diagnosed with malignant and 6 with benign diseases. In total, 165 measurements were taken (134 healthy; 31 affected). For the diameter, Bland-Altman plots were used to measure data from 165 matched stereoscopic and MD-CT measurement sites (bias, 0.40±2.86 mm SD; percentage error, 33%), 134 healthy sites (bias, 0.554±2.83 mm SD; percentage error, 34%), and 31 affected sites (bias, 1.20±2.67 mm SD; percentage error, 52%). For the cross-sectional area, matched stereoscopic and MD-CT measurements were analyzed for 65 sites (bias, −10.53±92.85 mm2 SD; percentage error, 89%), 49 healthy sites (bias, −9.88±39.00 mm2 SD; percentage error, 32%), and 16 affected sites (bias, −13.12±48.81 mm2 SD; percentage error, 92%). Conclusion: Stereoscopic bronchoscopy was able to accurately measure the size of the airway during intervention, to assist in selecting the appropriate size of the stent.

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Ponatinib in chronic myeloid leukemia (CML): Consensus on patient treatment and management from a European expert panel

Publication date: Available online 8 October 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Martin C. Müller, Francisco Cervantes, Henrik Hjorth-Hansen, Jeroen J.W.M. Janssen, Dragana Milojkovic, Delphine Rea, Gianantonio Rosti
Five tyrosine kinase inhibitors (TKIs) are currently approved in the European Union for treatment of chronic myeloid leukemia (CML) and all have considerable overlap in their indications. While disease-specific factors such as CML phase, mutational status, and line of treatment are key to TKI selection, other important features must be considered, such as patient-specific comorbidities and TKI safety profiles. Ponatinib, the TKI most recently approved, has demonstrated efficacy in patients with refractory CML, but is associated with an increased risk of arterial hypertension, sometimes severe, and serious arterial occlusive and venous thromboembolic events. A panel of European experts convened to discuss their clinical experience in managing patients with CML. Based on the panel discussions, scenarios in which a CML patient may be an appropriate candidate for ponatinib therapy are described, including presence of the T315I mutation, resistance to other TKIs without the T315I mutation, and intolerance to other TKIs.



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MicroRNAs in glioblastoma pathogenesis and therapy: A comprehensive review

Publication date: Available online 7 October 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Bhavesh K. Ahir, Howard Ozer, Herbert H. Engelhard, Sajani S. Lakka
Glioblastoma (GBM), also known as grade IV astrocytoma, is the most aggressive primary intracranial tumor of the adult brain. MicroRNAs (miRNAs), a class of small non-coding RNA species, have critical functions across various biological processes. A great deal of progress has been made recently in dissecting miRNA pathways associated with the pathogenesis of GBM. miRNA expression signatures called gene signatures also characterize and contribute to the phenotypic diversity of GBM subclasses through their ability to regulate developmental growth and differentiation. miRNA molecules have been identified as diagnostic and prognostic biomarkers for patient stratification and may also serve as therapeutic targets and agents. This review summarizes: (i) the current understanding of the roles of miRNAs in the pathogenesis of GBM, (ii) the potential use of miRNAs in GBM diagnosis and glioma grading, (iii) further prospects of developing miRNAs as novel biomarkers and therapeutic targets for GBM, and (iv) important practical considerations when considering miRNA therapy for GBM patients.



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Thyroid hormone levels in late preterm, early term and term infants: a study with healthy neonates revealing reference values and factors affecting thyroid hormones

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Severe complications after initial management of hyperglycemic hyperosmolar syndrome and diabetic ketoacidosis with a standard diabetic ketoacidosis protocol

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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The relationship between non-alcoholic fatty liver disease and small intestinal bacterial overgrowth among overweight and obese children and adolescents

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Persistent de Quervain tenosynovitis induced by somatotropin treatment

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Oral health status of children with type 1 diabetes: a comparative study

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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Makorin ring finger 3 gene analysis in Koreans with familial precocious puberty

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


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iSepsis – Death by Fluids, Part 1.5 – Moronic Protocols

A Blog by Dr Wong (professor of Surgery) highlighting the stupidity of the mindless adoption of Surviving Sepsis Campaign Guidelines

EMCrit by Paul Marik.

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Response to the letter to the editor regarding “The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach”

Publication date: Available online 7 October 2017
Source:American Journal of Otolaryngology
Author(s): Yuvatiya Plodpai, Nanatphong Paje




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Pediatric Pulmonary Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma: A Case Report and Review of the Literature

Non-Hodgkin's lymphoma (NHL) is a common malignancy of childhood; however, a lung primary presentation is an uncommon finding, as is finding an association with the Epstein-Barr virus (EBV). We report the case of a 23-month-old female who developed EBV-associated diffuse large B-cell lymphoma (DLBCL) that was initially thought to be pneumonia. Extensive tissue necrosis, focal angioinvasion, and angiodestruction were observed. She was refractory to various therapy regimens, subsequently developed DLBCL in the central nervous system, and eventually expired. Although EBV+ DLBCL was initially considered to occur predominantly in elderly patients over 50 years of age, it is now increasingly recognized to occur in younger patients with primarily nodal involvement who have overall better prognoses. To our knowledge, this case is the first reported EBV+ DLBCL occurring in a patient below two years of age with lung involvement as the initial clinical presentation.

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Hydroxyurea therapy in UK children with sickle cell anaemia: A single-centre experience

Abstract

Introduction

Despite the demonstrated efficacy of hydroxyurea therapy, children with sickle cell anaemia in the UK are preferentially managed with supportive care or transfusion. Hydroxyurea is reserved for children with severe disease phenotype. This is in contrast to North America and other countries where hydroxyurea is widely used for children of all clinical phenotypes. The conservative UK practice may in part be due to concerns about toxicity, in particular marrow suppression with high doses, and growth in children.

Methods and results

We monitored 37 paediatric patients with sickle cell anaemia who were treated with hydroxyurea at a single UK treatment centre. Therapy was well tolerated and mild transient cytopenias were the only toxicity observed. Comparative analysis of patients receiving ≥26 mg/kg/day versus <26 mg/kg/day demonstrates increasing dose has a significant positive effect on foetal haemoglobin (Hb; 29.2% vs. 20.4%, P = 0.0151), mean cell volume (94.4 vs. 86.5, P = 0.0183) and reticulocyte count (99.66 × 10⁹/l vs. 164.3 × 10⁹/l, P = 0.0059). Marrow suppression was not a clinical problem with high-dose treatment, Hb 92.25 g/l versus 91.81 g/l (ns), neutrophil count 3.3 × 10⁹/l versus 4.8 × 10⁹/l (ns) and platelet count 232.4 × 10⁹/l versus 302.2 × 10⁹/l (ns). Normal growth rates were maintained in all children. Good adherence to therapy was a significant factor in reducing hospitalisations.

Conclusion

This study demonstrates the effectiveness and safety in practice of high-dose hydroxyurea as a disease-modifying therapy, which we advocate for all children with sickle cell anaemia.

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Comment on: Value of flow cytometric analysis of peripheral blood samples in children diagnosed with acute lymphoblastic leukemia

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Dramatic response to nivolumab in xeroderma pigmentosum skin tumor

Abstract

We report the case of a 6-year-old female with xeroderma pigmentosum (XP) who developed a nonoperable scalp tumor, treated with anti-programmed cell death protein 1 (anti-PD-1) therapy (nivolumab). She presented with a sarcomatoid carcinoma of the scalp with bone lysis as well as vascular and meningeal contact. Nivolumab was initiated because it has emerged as a promising immunotherapy. We observed a dramatic tumor response with excellent tolerance. However, while on nivolumab therapy she developed two large skin melanomas and several squamous cell carcinomas, which have been resected. These results demonstrate that cancer immunotherapy in patients with XP can be impressive but complex and warrants further investigation.

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Cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia and lymphoma: A cross-sectional cohort study using culturally competent, performance-based assessment

Abstract

Background

This study sought to characterize cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL).

Procedure

In this cross-sectional cohort study, Latino survivors of ALL (n = 57) and LL (n = 5) aged 6–16 years were pooled and evaluated using validated measures of cognitive, academic, and behavioral function and English language proficiency. Performance was compared with norms using single-sample t-tests.

Results

In this cohort (n = 62, 50% male), mean ages at diagnosis and testing were 4.5 and 10.8 years, respectively; mean time off treatment was 44.7 months. All participants spoke English and over half (57%) identified Spanish as the primary language in the home. Forty-two families (68%) placed in the two lowest Hollingshead socioeconomic status categories. Participants were below average for working memory (P < 0.001). Overall, participants were in the average range, but significantly lower than published norms on domain-specific measures of verbal comprehension (P < 0.001); perceptual reasoning (P = 0.033); processing speed (P = 0.003); visual memory (P < 0.001); visuomotor attention, scanning, and sequencing (P = 0.005); and reading comprehension (P = 0.001). Parents reported concerns with working memory (P < 0.001) and metacognition (P = 0.014).

Conclusions

Similar to other childhood ALL/LL survivors, overall cognitive function in this Latino sample was relatively preserved but selected deficits were observed. Routine cognitive screening is indicated in this population.

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Triple therapy of vincristine, bleomycin and etoposide for children with Kaposi sarcoma: Results of a study in Malawian children

Abstract

Background

Kaposi sarcoma (KS) is the most common paediatric cancer in human immunodeficiency virus (HIV) endemic countries of sub-Saharan Africa, but there is little research on management and outcomes.

Methods

Children with KS at Queen Elizabeth Central Hospital, Blantyre, Malawi treated between August 2012 and March 2015 with six courses of vincristine, bleomycin and etoposide combination chemotherapy, including antiretroviral therapy (ART) if HIV infected, were studied and outcomes compared with previously reported results.

Findings

Fifty-six children were included; 38 (68%) were male; and 48 (86%) were HIV positive, of whom 36 (77%) were on ART at diagnosis. Median age at diagnosis was 8 years (interquartile range [IQR] 3–12) and median follow-up was 16.9 months (IQR 3.4–36.4). Quality of life improved in 45 (80%) children; the median Lansky Score increased from 80% pre-treatment to 100% post-treatment. Eighteen (32%) children had complete response to treatment. At 12 months, overall survival was 71% (95% confidence interval [CI] 56–82) and event-free survival (event = death, loss to follow-up or relapse) was 50% (95% CI 36–63). At 1 year, the risk of loss to follow-up was 13.4%. In a previous, same-site, randomized controlled study of vincristine monotherapy, vincristine and bleomycin, or oral etoposide, oral etoposide monotherapy had the best outcome with survival at 12 month of 66% (95% CI 46–80) and event-free survival of 52% (95% CI 33–68); however, loss to follow-up was not reported.

Conclusion

Overall survival, event-free survival and quality of life appear to have improved with this three-agent combination chemotherapy; however larger, randomized studies are needed to determine optimal management.

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Comparison of two cytoreductive regimens for αβ-T-cell-depleted haploidentical HSCT in pediatric malignancies: Improved engraftment and outcome with TBI-based regimen

Abstract

Background

Graft manipulation using selective depletion of αβ-T cells provides a source of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) enriched in effector cells. We report our experience implementing this haplo-HSCT for high-risk malignancies in pediatric patients focusing on the conditioning regimen.

Procedure

We performed a retrospective study of patients who underwent T-cell receptor αβ-depleted haplo-HSCT for high-risk pediatric malignancies.

Results

Eighteen patients underwent haplo-HSCT using this method. The initial reduced-toxicity chemotherapy-based conditioning regimen was given to eight patients, and resulted in a high rate of graft rejections (six of eight patients). Thus, total body irradiation (TBI) based regimen was introduced in the following 10 patients and resulted in engraftment in all patients. Neutrophil and platelet engraftment were rapid (median time to engraft, 10 days and 12 days, respectively). Significant treatment-related complications for both cohorts were all due to graft failure in patients receiving chemotherapy-based conditioning, with a treatment-related mortality rate of 17%. None of the patients developed hepatic sinusoidal-obstruction syndrome, and no grade III–IV acute graft versus host disease (GVHD) was observed. The majority of patients were free of immunosuppression in the first 100 days post-HSCT, and only two patients developed chronic GVHD. The cumulative incidence of relapse was 39%. Compared to patients conditioned with chemotherapy, patients conditioned with TBI had superior actuarial overall survival (66% vs. 37%, P = 0.05) and event-free survival (61% vs. 33%, P = 0.04).

Conclusions

A TBI-based conditioning for haplo-HSCT using αβ-T-cell depletion for malignant diseases ensured engraftment and resulted in acceptable outcomes.

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Inconsistency in classifying vascular anomalies: What's in a name?

Abstract

Background

Vascular anomalies are a heterogeneous group of disorders seen in children and adults. A standard nomenclature for classification has been offered by the International Society for the Study of Vascular Anomalies. Its application is important for communication among the multiple specialties involved in the care of patients and for planning treatment, as well as for research and billing. We hypothesized that terminology still is not uniformly applied, and that this could have an impact on treatment.

Methods

We retrospectively reviewed the medical records of patients with nonbrain lesions from our institutional vascular anomalies database seen during 2010–2016 for whom at least one clinic visit, radiologic imaging report, and pathology report were available to compare diagnoses among and within disciplines, and treatment recommendations. Diagnoses and referral patterns by community healthcare providers were also reviewed.

Results

Of 400 patients seen during the targeted time interval, 35 had clinical, imaging, and pathology reports. Agreement in terminology from initial clinic notes with imaging and pathology reports was noted in only three cases (9%). "Hemangioma" was often misused; "lymphangioma" and "cystic hygroma" persist as diagnostic labels. Community healthcare providers referred vascular malformations with a diagnosis of "mass" or "hemangioma" in 17 of 18 cases where that information was available. Incomplete or mislabeling of vascular anomalies sometimes delayed referrals to appropriate clinics, though it did not have a major impact on treatment.

Conclusions

An understanding of vascular anomalies as tumors or malformations is not uniform. Ongoing education will be needed to promote consensus terminology and facilitate referrals.

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Immature platelet fraction in immune thrombocytopenia: Useful in diagnosis but does it predict bleeding?

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Small percentage of anaphylactic reactions treated with epinephrine during food challenges in Dutch children

Publication date: Available online 7 October 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Johanna P.M. van der Valk, Irene Berends, Roy Gerth van Wijk, Nicolette. J.T. Arends, Maurits S. van Maaren, Hans de Groot, Harry J. Wichers, Joyce A.M. Emons, Anthony E.J. Dubois, Nicolette W. de Jong
BackgroundSevere allergic reactions, including anaphylaxis, occur during oral food challenges (OFCs) and the first-line treatment of anaphylaxis is epinephrine.ObjectiveTo evaluate the percentage of anaphylactic reactions treated with epinephrine during OFCs and to identify associated factors for the administration of epinephrine.MethodsChildren who underwent an OFC with peanut, hazelnut, cow's milk, hen's egg, or cashew nut from 2005 through 2015 in the Netherlands were evaluated. Children with reactions meeting the criteria for anaphylaxis according to the European Academy of Allergy and Clinical Immunology guidelines for food allergy and anaphylaxis were included. Children with an anaphylactic reaction treated with vs without epinephrine were compared. Possible factors associated with the administration of epinephrine, such as age, sex, symptoms consistent with asthma, history of an allergic reaction to the tested allergen, and symptom types during the anaphylactic reaction, were evaluated using logistic regression analysis.ResultsEighty-three children in clinical and research settings (43% boys; median age, 7 years; range, 1–17) who met the criteria for anaphylaxis were included in this study. Thirty-two of 83 children (39%) with anaphylaxis were treated with epinephrine. Respiratory symptoms during the OFC were treated significantly more often with epinephrine than gastrointestinal symptoms (P = .01).ConclusionOnly 39% of children with anaphylaxis, according to the guideline criteria, were treated with epinephrine during the OFC and most of these children had respiratory symptoms. There is need for an easy-to-use international guideline for the treatment of allergic symptoms during OFCs.



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Immediate reactions to iodinated contrast media

Publication date: Available online 7 October 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Cristina Morales-Cabeza, Dasha Roa-Medellín, Inés Torrado, Manuel De Barrio, Carmen Fernández-Álvarez, Juan Francisco Montes-Aceñero, Inmaculada De La Riva, Alicia Prieto-García
BackgroundImmediate hypersensitivity reactions (IHRs) to iodinated contrast media (ICMs) remain a common clinical concern. Positive skin test and basophil activation test results suggest a specific IgE-mediated mechanism in some cases. Skin test and controlled challenge test (CCT) are useful to manage these patients.ObjectiveTo study clinical and allergologic features of IHRs to ICMs in a Spanish tertiary hospital during a 7-year period.MethodsDemographic and clinical data concerning the reaction were recorded. Patients treated at the Allergy Department of Hospital General Universitario Gregorio Marañón, Madrid, Spain, underwent skin tests. In those with positive results, CCTs with an alternative skin-test-negative ICM was performed. Global reaction rate was calculated and compared for each ICM.ResultsA total of 342 reactions occurred in 329 patients. Cutaneous symptoms were the most common (87.7%). A total of 196 patients underwent an allergy workup, 15 (7.6%) of whom had positive skin test results. Reactions were more severe in patients with positive vs negative skin test results (grade 1, 46.7% vs 73.6%; grade 2, 33.3% vs 20.9%; grade 3, 20% vs 5.46%; P < .05). Three patients had cross-reactivity to 3 ICMs, all including ioversol and iomeprol. Six patients allergic to iopamidol tolerated ioversol and 1 tolerated iomeprol. Four patients allergic to ioversol and 1 allergic to iomeprol tolerated iopamidol. The global reaction rate was 0.2%, differing for each ICM (iopamidol, 0.14%; ioversol, 0.2%; and iomeprol, 0.4%; P < .001). Positive skin test results were found in a low percentage of patients in whom skin test–based CCT identified an alternative non–cross-reactive ICM. Low-grade cross-reactivity was found, especially between iopamidol and ioversol. Reactions were more severe in patients with positive skin test results. The reaction rate was greater for iomeprol compared with iopamidol (reaction rate, 2.8%) and ioversol (reaction rate, 2%).ConclusionsThis study identified a possible underlying specific IgE-mediated mechanism by positive skin test result in a low percentage of patients with IHRs to ICMs. In these patients, the CCT based on skin test results was useful for identifying an alternative non–cross-reactive ICM. More studies are needed to investigate the underlying mechanism in patients with IHRs and negative skin test results.



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Successful perinatal management of hereditary angioedema with normal C1 esterase inhibitor and factor XII mutation using C1 esterase inhibitor therapy

Publication date: Available online 7 October 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kathleen R. Gibbons, Tina Abraham, Monica Sandhu, Brian P. Peppers, Julia F. Girzhel, Robert W. Hostoffer




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Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women

Publication date: January 2018
Source:Gait & Posture, Volume 59
Author(s): Marie-Louise Bird, Natalie El Haber, Frances Batchelor, Keith Hill, John D. Wark
ContextVitamin D status and parathyroid hormone (PTH) levels influence the risk of accidental falls in older people, but the mechanisms underlying this effect remain unclear.ObjectiveInvestigate the relationship between circulating PTH and 25 hydroxyvitamin D (25-OHD) levels and clinical tests of gait stability and balance as physical fall risk factors. We hypothesized that high levels of PTH and low 25-OHD levels would be significantly associated with gait stability and decreased balance performance.DesignObservational cohort study.SettingAustralian community.Participants119 healthy, ambulatory female twin adults aged 47–80 years residing in Victoria, Australia.Outcome measuresSerum PTH and 25-OHD levels with clinical tests of gait stability [double support duration (DSD)] and dynamic balance (Step Test). Associations were investigated by regression analysis and by comparing groups divided by tertiles of PTH (<3.5, 3.5–4.9, >4.9pmol/L) and 25-OHD (<53, 53–75, >75 nmol/L) using analysis of variance.ResultsSerum PTH was associated positively with DSD, with an increase of 10.6–15.7% when the mid and highest PTH tertiles were compared to the lowest tertile (p <0.025) when 25-OHD was included in the regression analysis. 25-OHD was significantly associated with DSD (greater by 10.6–11.1% when lowest and mid-tertiles compared with the highest 25-OHD tertile) (p <0.025) and dynamic balance (better performance by 12.6% in the highest compared with the lowest 25OHD tertile) (p <0.025).ConclusionThese findings reveal an important new relationship between parathyroid hormone and gait stability parameters and add to understanding of the role of 25-OHD in motor control of gait and dynamic balance in community-dwelling women across a wide age span.



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3D gait analysis with and without an orthopedic walking boot

Publication date: January 2018
Source:Gait & Posture, Volume 59
Author(s): H. Gulgin, K. Hall, A. Luzadre, E. Kayfish
IntroductionOrthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot.MethodsForty healthy participants (m=20, f=20, age 20.7±1.8 yrs., ht. 171.6±9.5cm, wt. 73.2±11.0kg, BMI 24.8±3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis.ResultsWhen wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb.ConclusionThe walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol.



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Everyday multitasking habits: University students seamlessly text and walk on a split-belt treadmill

Publication date: Available online 7 October 2017
Source:Gait & Posture
Author(s): Dorelle Clare Hinton, Yeu-Yao Cheng, Caroline Paquette
With increasing numbers of adults owning a cell phone, walking while texting has become common in daily life. Previous research has shown that walking is not entirely automated and when challenged with a secondary task, normal walking patterns are disrupted. This study investigated the effects of texting on the walking patterns of healthy young adults while walking on a split-belt treadmill. Following full adaptation to the split-belt treadmill, thirteen healthy adults (23±3years) walked on a tied-belt and split-belt treadmill, both with and without a simultaneous texting task. Inertial-based movement monitors recorded spatiotemporal components of gait and stability. Measures of spatial and temporal gait symmetry were calculated to compare gait patterns between treadmill (tied-belt and split-belt) and between texting (absent or present) conditions. Typing speed and accuracy were recorded to monitor texting performance. Similar to previous research, the split-belt treadmill caused an alteration to both spatial and temporal aspects of gait, but not to time spent in dual support or stability. However, all participants successfully maintained balance while walking and were able to perform the texting task with no significant change to accuracy or speed on either treadmill. From this paradigm it is evident that when university students are challenged to text while walking on either a tied-belt or split-belt treadmill, without any other distraction, their gait is minimally affected and they are able to maintain texting performance.



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Difference in kick motion of adolescent soccer players in presence and absence of low back pain

Publication date: Available online 7 October 2017
Source:Gait & Posture
Author(s): Michio Tojima, Suguru Torii
Many adolescent soccer players experience low back pain (LBP). However, there are no reports studying the kick motion of adolescent soccer players experiencing LBP. This study aimed to clarify the kick motion of adolescent soccer players in the presence and absence of LBP. We recruited 42 adolescent soccer players and divided them into two groups according to the presence of LBP (LBP group, n=22) and absence of LBP (NBP group, n=20). We measured real-time kick motion using a three-dimensional motion analysis system. We placed 65 spherical markers on each anatomical landmark and calculated the angle of the lumbar spine, center of mass (COM) of the whole body, and displacement of the support foot. We used an unpaired t-test to compare the data between the groups. Compared with the NBP group, the LBP group showed a lateral shift in COM, which increased the duration of kick motion. The presence of LBP affected the posterior positioning of the support foot and restricted the player's lumbar spine from bending laterally. A lateral shift in COM and larger rotation of the lumbar spine could stress the lumbar spine during kick motion. Therefore, coaches and athletic trainers should pay attention to soccer players' lumbar spine rotation and the COM shift during kick motion. This would be important for preventing LBP in adolescent soccer players.



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The effects of actors vocal exercises for relaxation on fluency: A preliminary study.

The effects of actors vocal exercises for relaxation on fluency: A preliminary study.

J Fluency Disord. 2017 Sep 18;:

Authors: Monteagudo E, Sawyer J, Sivek-Eskra A

Abstract
PURPOSE: To determine the efficacy of treatment based on Kristin Linklater's technique for vocal preparation for performance for use with people who stutter.
METHOD: A protocol for a treatment for stuttering involving breathing exercises, relaxation techniques, and focus on awareness was designed by the first author from Linklater's published exercises in her book Freeing the Natural Voice (2006). Four adults who stutter participated in a 12-week, single-case reversal design study. Treatment efficacy was determined by baseline and post-treatment measures on the OASES, self-report naturalness, tension and severity scale, and percentage of stuttering-like disfluency (SLD). Qualitative measures included a daily tension and practice log, a program completion questionnaire, and accounts from the clinicians administering the treatment protocol.
RESULTS: Three of four participants scored lower on the OASES post-treatment, suggesting that the impact of stuttering on their daily lives had decreased. All four experienced a reduction in the number of SLD counted throughout treatment sessions compared to baseline data.
CONCLUSION: A treatment for stuttering based on Linklater's work including regulation of breathing, relaxation, and awareness of breath may be effective in improving fluency and decreasing the impact of stuttering and warrants further study.

PMID: 28985970 [PubMed - as supplied by publisher]

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Diagnosis and treatment options for sequelae following radiation treatment of brain tumors

Publication date: Available online 7 October 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Swapnil Mehta, Aatman Shah, Henry Jung
Radiation serves an important role in the treatment of metastatic and primary brain tumors. Radiation carries a risk of post radiation treatment effects, such as pseudoprogression and radiation necrosis. The ability to differentiate between radiation necrosis, pseudoprogression, and tumor recurrence remains a diagnostic conundrum with varying treatment options. In this review, we will discuss the pathophysiology, diagnostic imaging modalities, and treatments of these post-radiation treatment effects. We focus on the latest developments in magnetic resonance imaging (MRI) modalities including imaging biomarkers and the newest therapeutics such as VEGF inhibitors, Hyperbaric Oxygen Therapy, sensitized cytotoxic T cells, and Laser Interstitial Thermal Therapy (LITT).



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Vocal Evaluation of Children with Congenital Hypothyroidism.

Vocal Evaluation of Children with Congenital Hypothyroidism.

J Voice. 2017 Oct 03;:

Authors: Dassie-Leite AP, Behlau M, Nesi-França S, Lima MN, de Lacerda L

Abstract
OBJECTIVE: To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles.
MATHERIAL AND METHODS: Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination).
RESULTS: In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data.
CONCLUSION: Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

PMID: 28986152 [PubMed - as supplied by publisher]

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Traumatic occipito-cervical dissociation in adults: a Middle Eastern cohort study.

Traumatic occipito-cervical dissociation in adults: a Middle Eastern cohort study.

Eur J Orthop Surg Traumatol. 2017 Oct 06;:

Authors: Menon KV, Al Habsi I, Al Ghafri K

Abstract
The objective of this study is to describe a series of cranio-cervical dissociation victims and evaluate their outcomes as well as discuss the clinical dilemmas we faced in the context of current literature evidence. This is a retrospective cohort study of traumatic occipito-cervical dissociation in five patients (three males and two females) encountered between 2010 and 2016 at a tertiary care facility in the Middle East region. All patients underwent occipito-cervical fusion using screws and rods system with mean postoperative follow-up period of 2.5 years. All patients survived, and four were independently mobile and one wheel chair bound. Most had some degree of neurological sequelae, often due to associated injuries and all complained of limited neck range of motion. Contemporary literature review shows that CT scan with MRI is often the best diagnostic modality. Surgery is usually indicated though rare cases treated conservatively have been reported. The commonest predictor of mortality is missed injury, associated head injury and wide separation between the skull base and C1 on imaging studies.

PMID: 28986644 [PubMed - as supplied by publisher]

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Internal Carotid Artery and Its Relationship with Structures in Sellar Region: Anatomy Study and Its Clinical Applications.

Internal Carotid Artery and Its Relationship with Structures in Sellar Region: Anatomy Study and Its Clinical Applications.

World Neurosurg. 2017 Oct 03;:

Authors: Zhang Y, Yang W

Abstract
BACKGROUND: Complications of the ICA in surgeries are rare but severe. This study aims to locate the ICA with 5 stationary bony structures in the sellar region: the anterior clinoid process (ACP), the tuberculum sellae, the bottom of the hypophyseal fossa, the posterior edge of the hypophyseal fossa and the post clinoid process and do measurements to determine their anatomic relationship with the ICA.
METHODS: After multiple planar reconstructions on computer tomographic angiography images of 120 ICA in 60 individuals, we defined the 5 bony structures as 5 origins in horizontal, sagittal and vertical planes with the 3D coordinate system and got the cross-sections of bilateral ICA on the coronal plane passing through each origin. We measured the distances between the cross-sections and the origins and angles between the horizontal plane and the line passing through the origin and the cross sections on each coronal plane. We also measured the distances between bilateral ICA on the 5 coronal planes. Besides, we measured the coordinate of the anterior edge of bilateral ICA taking the anterior clinoid process as the origin.
RESULTS: With the three-dimensional coordinate system, we located the ICA to the bony structures in skull base. Distance between bilateral ICA on coronal planes is 18.8±2.9mm, 23.6±3.7mm, 19.9±3.4mm, 24.7±4.3mm, 23.5±3.5mm, from anterior to posterior respectively.
CONCLUSION: The 3D coordinate system used in this study is of value in preoperational assessment and data we obtained indicate the safety ranges avoiding damage to the ICA in surgeries.

PMID: 28986226 [PubMed - as supplied by publisher]

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Establishment of Next-Generation Neurosurgery Research and Training Laboratory with Integrated Human Performance Monitoring.

Establishment of Next-Generation Neurosurgery Research and Training Laboratory with Integrated Human Performance Monitoring.

World Neurosurg. 2017 Oct;106:991-1000

Authors: Bernardo A

Abstract
Quality of neurosurgical care and patient outcomes are inextricably linked to surgical and technical proficiency and a thorough working knowledge of microsurgical anatomy. Neurosurgical laboratory-based cadaveric training is essential for the development and refinement of technical skills before their use on a living patient. Recent biotechnological advances including 3-dimensional (3D) microscopy and endoscopy, 3D printing, virtual reality, surgical simulation, surgical robotics, and advanced neuroimaging have proved to reduce the learning curve, improve conceptual understanding of complex anatomy, and enhance visuospatial skills in neurosurgical training. Until recently, few means have allowed surgeons to obtain integrated surgical and technological training in an operating room setting. We report on a new model, currently in use at our institution, for technologically integrated surgical training and innovation using a next-generation microneurosurgery skull base laboratory designed to recreate the setting of a working operating room. Each workstation is equipped with a 3D surgical microscope, 3D endoscope, surgical drills, operating table with a Mayfield head holder, and a complete set of microsurgical tools. The laboratory also houses a neuronavigation system, a surgical robotic, a surgical planning system, 3D visualization, virtual reality, and computerized simulation for training of surgical procedures and visuospatial skills. In addition, the laboratory is equipped with neurophysiological monitoring equipment in order to conduct research into human factors in surgery and the respective roles of workload and fatigue on surgeons' performance.

PMID: 28985669 [PubMed - in process]

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The Orbit as Seen Through Different Surgical Windows: Extensive Anatomosurgical Study.

The Orbit as Seen Through Different Surgical Windows: Extensive Anatomosurgical Study.

World Neurosurg. 2017 Oct;106:1030-1046

Authors: Bernardo A, Evins AI, Mattogno PP, Quiroga M, Zacharia BE

Abstract
A thorough understanding of the orbit, structures within it, and complex spatial relationships among these structures bears relevance in a variety of neurosurgical cases. We describe the 3-dimensional surgical anatomy of the orbit and fragile and complex network of neurovascular architectures, flanked by a series of muscular and glandular structures, found within the orbital dura.

PMID: 28985657 [PubMed - in process]

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The Changing Face of Technologically Integrated Neurosurgery: Today's High-Tech Operating Room.

The Changing Face of Technologically Integrated Neurosurgery: Today's High-Tech Operating Room.

World Neurosurg. 2017 Oct;106:1001-1014

Authors: Bernardo A

Abstract
Over the last decade, surgical technology in planning, mapping, optics, robotics, devices, and minimally invasive techniques has changed the face of modern neurosurgery. We explore the current advances in clinical technology across all neurosurgical subspecialties, examine how clinical practice is being shaped by this technology, and suggest what the operating room of tomorrow may look like.

PMID: 28985655 [PubMed - in process]

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Supraglottoplasty for laryngomalacia: The experience from Concepcion, Chile

Publication date: Available online 7 October 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Sahba Sedaghat, Felipe Fredes, Mario Tapia
ObjectiveTo review the clinical manifestations and outcomes of supraglottoplasty in patients with moderate to severe laryngomalacia at Guillermo Grant Benavente Hospital between January 2015 and January 2017.MethodsRetrospective study of patients with laryngomalacia who underwent CO2 laser supraglottoplasty at a tertiary referral center. A review of medical records of these patients was performed. Epidemiological data along with symptoms, comorbidities, morphological type of laryngomalacia, synchronous airway lesions, surgery outcomes and satisfaction of parents after the procedure were recorded. Surgical success was defined as the resolution of the criteria of severity of laryngomalacia.ResultsTwenty-four patients were operated, 1 was excluded due to prior tracheostomy. Twenty-three patients were included, the median age at the time of surgery was 5.5 months. All the patients had stridor, 87% presented feeding difficulties, 34.8 % had cyanosis and 21.7% had failure to thrive. Six cases had congenital anomalies and four cases had nongenetic comorbidities. Fifteen patients (65.2%) had synchronous airway lesions. 17.4% had type I laryngomalacia and 82.6% were type 2. The postoperative average hospital stay was 1.3 days. The average follow-up was 14 months and no complications were reported. The overall success rate of surgery was 95%.ConclusionsPatients with laryngomalacia and any symptom of severity should undergo a full airway evaluation, to rule out synchronous airway lesions, and supraglottoplasty if needed, as it has been shown to be a safe and effective technique for the management of these patients.



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Pain control following tonsillectomy in children: A survey of patients

Publication date: Available online 7 October 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Philip Persino, Lena Saleh, David Walner
ObjectiveThis prospective study aimed to survey pediatric patients and their parents after tonsillectomy to assess their pain management utilization and satisfaction.IntroductionTonsillectomy is the second most common surgical procedure performed in pediatric patients. Postoperative recovery is often associated with high levels of pain and severe functional limitations. There is currently no consensus on pain control regimens. Additionally, a recent FDA Black Box Warning on narcotic use has caused more uncertainty in appropriate pain control regimens.Methods111 pediatric patients (≤18 years) included in this study underwent tonsillectomy with or without adenoidectomy between October 2013 and August 2015. Postoperatively, each patient/parent was counseled to alternate on an over-the-counter regimen of acetaminophen and ibuprofen and given an additional as-needed acetaminophen with hydrocodone prescription. A survey was administered during the patient's 2-week follow-up that included questions regarding pain levels, worst post-op pain day, pain medications taken during recovery, and patient/parental perceived satisfaction of having the acetaminophen with hydrocodone prescription.Results84 patients/parents (75.7%) felt that OTC medications were not adequate for pain control and used hydrocodone at least once. Between those who took hydrocodone versus those who did not, there was no significant difference in mean age (6.7 ± 2.9 vs. 6.0 ± 2.4 years), percentage of patients with severe pain (36.9% vs. 22.2%) and worst post-op pain day (4.3 ± 1.5 vs. 3.9 ± 1.9 days) (p > 0.05). However, regardless of pain control regimen followed, the majority of patients/parents found it valuable to have the hydrocodone prescription (p = 0.004).ConclusionPost-tonsillectomy patients and their parents find being provided with an acetaminophen-hydrocodone prescription is therapeutically valuable, and many find it necessary in their postoperative pain management. However, further studies are needed to determine patient factors that influence narcotic utilization.



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Direct tracheobronchopexy via left lateral thoracotomy for severe tracheobronchomalacia

Publication date: Available online 7 October 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Evan J. Propst, Faisal Zawawi, Roxanne E. Kirsch, Osami Honjo
An infant with pulmonary atresia/ventricular septal defect/major aortopulmonary collateral arteries underwent unifocalization, ventriculoseptal defect closure and placement of a right ventricle to pulmonary artery conduit via median sternotomy. Aortopexy and pulmonary arteriopexy via redo sternotomy were insufficient to allow weaning of continuous positive airway pressure and he required direct tracheobronchopexy via left lateral thoracotomy to alleviate posterior trachealis intrusion along the length of the trachea and left main bronchus. He also underwent laryngotracheoplasty with placement of a posterior costal cartilage graft for bilateral vocal cord paralysis. The patient was weaned from positive pressure and discharged in stable condition.



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[Speech audiometry and data logging in CI patients : Implications for adequate test levels. German version].

[Speech audiometry and data logging in CI patients : Implications for adequate test levels. German version].

HNO. 2017 Oct 06;:

Authors: Hey M, Hocke T, Ambrosch P

Abstract
BACKGROUND: As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems.
OBJECTIVES: Which test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting?
PATIENTS AND METHODS: In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40-80 dB.
RESULTS: For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range 50-59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB.
CONCLUSIONS: Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65-70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.

PMID: 28986605 [PubMed - as supplied by publisher]

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Transcervical fat injection laryngoplasty for unilateral vocal fold paralysis: an easy way to do the job.

Transcervical fat injection laryngoplasty for unilateral vocal fold paralysis: an easy way to do the job.

Eur Arch Otorhinolaryngol. 2017 Oct 06;:

Authors: Elbadan HEM, Hussein WKA, Elmaghraby RM

Abstract
Unilateral vocal fold paralysis resulting in glottic incompetence can cause impairment of laryngeal functions, including airway protection and phonation. The objective of this study is to present an easy new technique for harvesting and injection of abdominal fat into the vocal fold for patients with unilateral vocal fold paralysis. This is a retrospective study of patients carried out on 16 patients suffering from unilateral vocal fold paralysis resulting from different etiologies. All patients were subjected to the protocol of voice assessment pre- and postoperatively. All patients were subjected to fat injection of the paralyzed vocal fold. There was a statistically significant difference between the pre- and postoperative grade of voice parameters. Vocal fold injection using fat medializes a paralyzed vocal fold by increasing vocal fold volume. Fat injections are safe and easily mastered; and in the absence of the standard settings for fat harvesting and injection, it could be performed with minimal equipment that are readily available in any operating room.

PMID: 28986671 [PubMed - as supplied by publisher]

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Vocal Evaluation of Children with Congenital Hypothyroidism.

Vocal Evaluation of Children with Congenital Hypothyroidism.

J Voice. 2017 Oct 03;:

Authors: Dassie-Leite AP, Behlau M, Nesi-França S, Lima MN, de Lacerda L

Abstract
OBJECTIVE: To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles.
MATHERIAL AND METHODS: Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination).
RESULTS: In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data.
CONCLUSION: Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

PMID: 28986152 [PubMed - as supplied by publisher]

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Anterior cingulate cortex sulcation and its differential effects on conflict monitoring in bilinguals and monolinguals

Publication date: December 2017
Source:Brain and Language, Volume 175
Author(s): Arnaud Cachia, Nicola Del Maschio, Gregoire Borst, Pasquale Anthony Della Rosa, Christophe Pallier, Albert Costa, Olivier Houdé, Jubin Abutalebi
The role of the anterior cingulate cortex (ACC) in modulating the effect of bilingual experience on cognitive control has been reported at both functional and structural neural levels. Individual differences in the ACC sulcal patterns have been recently correlated with cognitive control efficiency in monolinguals. We aimed to investigate whether differences of ACC sulcation mediate the effect of bilingualism on cognitive control efficiency. We contrasted the performance of bilinguals and monolinguals during a cognitive control task (i.e., the Flanker Task) using a stratification based on the participants' ACC sulcal features. We found that performance of the two groups was differentially affected by ACC sulcation. Our findings provide the first evidence that early neurodevelopmental mechanisms may modulate the effect of different environmental backgrounds – here, bilingual vs monolingual experience – on cognitive efficiency.



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An Augmented Reality Magic Mirror as Additive Teaching Device for Gross Anatomy

Publication date: Available online 7 October 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Daniela Kugelmann, Leonard Stratmann, Nils Nühlen, Felix Bork, Saskia Hoffmann, Golbarg Samarbarksh, Anna Pferschy, Anna Maria von der Heide, Andreas Eimannsberger, Pascal Fallavollita, Nassir Navab, Jens Waschke
When preparing young medical students for clinical activity, it is indispensable to acquaint them with anatomical section images which enable them to use the clinical application of imaging methods A new Augmented Reality Magic Mirror (AR MM) system, which provides the advantage of a novel, interactive learning tool in addition to a regular dissection course, was therefore tested and evaluated by 880 first-year medical students as part of the macroscopic anatomy course in 2015/16 at Ludwig-Maximilians-Universität (LMU) in Munich. The system consists of an RGB-D sensor as a real-time tracking device, which enables the system to link a deposited section image to the projection of the user's body, as well as a large display mimicking a real-world physical mirror. Using gesture input, the users have the ability to interactively explore radiological images in different anatomical intersection planes. We designed a tutorial during which students worked with the system in groups of about 12 and evaluated the results. Subsequently, each participant was asked to assess the system's value by filling out a Likert-scale questionnaire. The respondents approved all statements which stressed the potential of the system to serve as an additional learning resource for anatomical education. In this case, emphasis was put on active learning, 3-dimensional understanding, and a better comprehension of the course of structures. We are convinced that such an AR MM system can be beneficially installed into anatomical education in order to prepare medical students more effectively for the clinical standards and for more interactive, student-centered learning.



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Pitfalls and errors in measuring jitter

Publication date: November 2017
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Erik Stålberg, Donald B. Sanders, João Aris Kouyoumdjian
The safety factor of neuromuscular transmission can be assessed by measuring the neuromuscular jitter, which reflects the time variability of processes in the motor end-plate. Jitter is increased in any condition with disturbed end-plate function, such as myasthenic conditions and ongoing reinnervation. Jitter is increasingly being measured with concentric needle (CN) electrodes, which are more prone to artefacts than single fiber EMG recordings.The objective of this review is to identify and demonstrate pitfalls that can be seen with CN jitter measurements, made with both voluntary activation and electrical stimulation.With voluntary activation, errors are caused by poor signal quality; inappropriate time reference points on the signal; an irregular firing rate; and signals with dual latencies, i.e., "flip-flop." With electrical stimulation, additional errors result from insufficient stimulation intensity; from abrupt change in firing rate; and from axon reflexes.Many pitfalls cannot be avoided during recording and can only be detected during post-processing.It is critical to be aware of these artefacts when measuring jitter with CN electrodes.



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Eye movements in genetic parkinsonisms affecting the α-synuclein, PARK9, and manganese network

Publication date: Available online 7 October 2017
Source:Clinical Neurophysiology
Author(s): Elena Pretegiani, Francesca Rosini, Antonio Federico, Lance M. Optican, Alessandra Rufa




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Effects of supramaximal balloon dilatation pressures on adult cricoid and tracheal cartilage: A cadaveric study

Objectives/Hypothesis

Cricoid fracture is a serious concern for balloon dilatation in airway stenosis. Furthermore, there are no studies examining tracheal rupture in balloon dilatation of stenotic segments. The aim of this study was to evaluate the effect of supramaximal pressures of balloons on the cricoid and tracheal rings.

Study Design

Prospective cadaveric study.

Methods

Seven cadaveric laryngotracheal complexes of normal adults with intact cricothyroid membranes were acquired. Noncompliant vascular angioplasty balloons (BARD-VIDA) were used for dilatation. The subglottis and trachea were subjected to supramaximal dilatation pressures graduated to nominal burst pressure (NBP) and, if necessary, rated burst pressure (RBP). Larger-diameter balloons, starting from 18 mm size to 24 mm, were used. Dilatations were maintained for 3 minutes.

Results

The cricoid ring was disrupted by larger-diameter balloons (22 mm and 24 mm) even at lower pressures (less than NBP) in six cases. Tracheal cartilages were very distensible, and external examination after supramaximal dilatation (24 mm close to RBP) revealed no obvious cartilage fractures or trachealis tears. Histopathological examination revealed sloughing of mucosa in the areas corresponding to balloon placement, but no microfractures or disruption of the perichondrium of tracheal ring cartilages.

Conclusions

These results indicate that the cricoid is vulnerable to injury from larger balloons even at lower dilatation pressures. The tracheal cartilages and the membranous wall of the trachea remained resilient to supramaximal dilatation and larger balloons.

Level of Evidence

NA Laryngoscope, 2017

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Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube–fed patients

Objectives/Hypothesis

Aspiration of gastric refluxate is one of the most commonly observed complications among long-term nasogastric tube (NGT) fed patients. The upper esophageal sphincter (UES) pressure barrier is the main defense mechanism against pharyngeal reflux of gastric contents. Our objective was to investigate the efficacy and safety of the UES assist device (UES-AD) in preventing gastric reflux through the UES in long-term NGT-fed patients.

Study Design

Self-Controlled Case series.

Methods

We studied 10 patients (mean age = 90.6 ± 3.4 years, four females) with dysphagia caused by stroke or dementia who were fed for 0.5 to 5 years (median = 3 years) by NGT. External pressures of 20 to 30 mm Hg were applied by using a handmade UES-AD, which was started 2 hours after the beginning of NGT infusion and was alternated between periods of 2 hours on and 2 hours off, for a total of 12 hours. Placement of the impedance sensors within the UES was guided by high-resolution manometry. Trans-UES and intraesophageal reflux events were recorded by using 24-hour combined pH-impedance measurements.

Results

No aspiration pneumonia events were noted in the period 1 month before or during the study in any of the cohort. Baseline UES pressure averaged 17.5 ± 9.4 mm Hg and was increased to 38.9 ± 11.9mm Hg after application of the UES-AD. Overall frequency of trans-UES reflux decreased significantly with the UES-AD compared to without (0.8 ± 0.9 vs. 3.3 ± 2.8, P < .05 for the 12-hour study period). There was no effect of the UES-AD on esophageal reflux events (7.4 ± 4.4 vs. 6.4 ± 3.0, P > .05).

Conclusions

UES-AD significantly decreases the number of trans-UES reflux events and can potentially reduce the aspiration risk associated with NGT feeding.

Level of Evidence

4. Laryngoscope, 2017

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A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor

Objectives/Hypothesis

Botulinum toxin chemodenervation (BTX) is used to treat essential voice tremor (EVT), but results are not uniformly satisfactory. This study sought to assess the comparative utility of injection augmentation (IA) for EVT.

Study Design

Prospective crossover treatment study.

Methods

Patients with EVT underwent BTX. After washout patients underwent IA. Multidimensional assessment carried out prior to and 30 days after each treatment included 1) videostroboscopy graded by the Vocal Tremor Scoring System (VTSS), 2) acoustic and aerodynamic assessment (cepstral peak prominence, cepstral spectral index of dysphonia, cepstral peak prominence fundamental frequency, airflow, peak air pressure and intensity, maximum phonation time, and amplitude/frequency of tremor), 3) audio-perceptual assessment via Consensus Audio-Perceptual Evaluation of Voice (CAPE-V), and 4) patient self-assessment via Voice Handicap Index-10 (VHI-10) and Percent of Normal Function (PNF) scale. Findings were analyzed via paired t tests and Wilcoxon rank sum tests.

Results

Seven patients (five female and two male; mean age 67 years old; range, 46–82 years old) participated. VTSS grading showed divergent outcomes for certain individual sites of tremor, but without significant differences. Airflow increased following BTX and decreased following IA, and VHI-10 scores indicated slight improvement post-BTX (26.29–23.57), and decline post-IA (25.86–29.86), although differences were not significant. Only changes in audio-perceptual ratings of loudness achieved significance, which decreased with BTX and increased with IA. Five patients chose to resume BTX; two elected long-term IA. No findings supported patient preferences.

Conclusions

IA demonstrated no advantage over BTX in the treatment of EVT.

Level of Evidence

2b Laryngoscope, 2017

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Survival of renal cell carcinoma metastatic to nonthyroid head and neck region: A systematic review

Objective

Metastasis of renal cell carcinoma to nonthyroid head and neck region is rare. Survival benefit for complete metastasectomy of more common renal cell foci has been reported in the literature. It is uncertain whether metastasectomy in nonthyroid head and neck region would provide a similar benefit.

Data Sources

We conducted a retrospective review of all renal cell metastases to the head and neck region treated in the past 15 years at an academic hospital, and a systematic review of all relevant reports with survival data in the literature between 1960 and 2016.

Review Methods

An analysis of pooled data was performed to estimate overall survival.

Results

Six cases from our institution and 260 independent cases reported in the literature were included in the survival analyses (n = 266). The median follow-up time was 12 months (range 0–180 months). The overall median survival was 36 months (95% confidence interval [CI] 23.7–48.3). The median survival for those who underwent complete metastasectomy in the head and neck was significantly higher at 60 months (95% CI 41.1–78.9) than those who had incomplete or no metastasectomy (12 months, 95% CI 9.5–14.5). Multivariable Cox proportional hazards model estimated that, after controlling for potential confounders, complete metastasectomy remained associated with reduced risk of death (hazard ratio 0.44, 95% CI 0.29–0.69).

Conclusion

Complete metastasectomy was associated with 4-year longer median overall survival than incomplete metastasectomy or no metastasectomy. Laryngoscope, 2017

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Treatment, survival, and costs of oropharyngeal cancer care in the elderly

Objectives/Hypothesis

To examine associations between treatment, survival, and costs in elderly patients with oropharyngeal squamous cell cancer (OPSCC).

Study Design

Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results–Medicare data.

Methods

We evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using cross-tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis.

Results

The majority of patients were nonsmokers (79%), had advanced-stage disease (59%), and received chemoradiation (38%) or radiation (28%). Surgery with postoperative radiation (hazard ratio [HR]: 0.33 [95% CI: 0.20-0.53]) and chemoradiation (HR: 0.45 [95% CI: 0.29-0.71]) were associated with improved survival, whereas stage IV disease was associated with poorer survival (HR: 1.95 [95% CI: 1.13-3.38]). Additional cancer-directed treatment after primary treatment was more likely following chemoradiation (odds ratio [OR]: 3.44 [95% CI: 1.78-6.63]). Salvage surgery was performed in 25% of patients undergoing subsequent additional cancer-directed treatment, and was associated with high-volume hospitals (OR: 2.81 [95% CI: 1.07-7.74]). Additional radiation (HR: 0.47 [95% CI: 0.31-0.72]) and salvage surgery (HR: 0.61 [95% CI: 0.38-0.99]) were associated with improved overall survival when performed >6 months following initial treatment, whereas salvage neck dissection alone was not significantly associated with survival after controlling for time to salvage (HR: 0.38 [95% CI: 0.05-2.78]). Treatment and 5-year overall costs were highest for chemoradiation, surgery with postoperative radiation, and additional cancer-directed treatment.

Conclusions

Multimodality treatment in elderly OPSCC patients was associated with improved survival and increased costs. Chemoradiation was associated with an increased likelihood of additional cancer-directed treatment. Salvage surgery was centralized at high-volume hospitals, and was associated with improved survival when performed >6 months after last initial treatment date, but was performed in <20% of patients undergoing additional treatment.

Level of Evidence

2c Laryngoscope, 2017

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Malignant fibrous histiocytoma: Database review suggests a favorable prognosis in the head and neck

Objective

The malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of the head and neck. Currently, most of the data on this tumor relies on small retrospective studies. The objective of this study is to use the Surveillance, Epidemiology, and End Results (SEER) database to compare characteristics of this tumor based on location to better understand its prognosis in the head and neck region. This article represents the largest study analyzing prognosis of this tumor in the head and neck to date.

Study Design

Retrospective analysis of SEER database.

Methods

Using the SEER database, 395 patients with MFH of the head and neck were compared with 3,968 patients with MFH of the trunk and extremities. Disease-specific survival was carried out comparing these two cohorts, as well as univariate and multivariate analysis to determine hazard ratios.

Results

Head and neck MFH had a significantly higher disease-specific survival compared with trunk and extremity disease. However, head and neck tumors were more frequently a smaller size (P < .0001) and lower grade (P < .0001). Larger tumors and grade III and IV tumors conferred a worse prognosis (P < .0001).

Conclusion

Head and neck malignant fibrous histiocytoma presents at a smaller size and lower grade, likely due to earlier presentation in this region. Because of this, head and neck malignant fibrous histiocytoma represents a more favorable survival prognosis compared with trunk and extremity disease.

Level of Evidence

4. Laryngoscope, 2017

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What antibiotic should be used in the management of an otherwise healthy adult with a peritonsillar abscess?

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Positive fresh frozen section margins as an adverse independent prognostic factor for local recurrence in oral cancer patients

Objectives

To access 1) the value of further surgical resection (completion surgery) in cases with a positive intraoperative margin analysis, and 2) whether cancers that undergo completion surgery following positive intraoperative margin analysis with subsequent negative margins should be considered true margin-negative (R0) resections in terms of adjuvant treatment planning.

Study Design

Retrospective analysis of patients with primary oral cancer.

Methods

One hundred and fifty-one patients underwent primary surgical resection of oral squamous cell carcinoma with intraoperative margin examination. In all cases for which frozen section margin analysis was positive, an extended resection was performed. Only patients with clear final margins were included in the study.

Results

The intraoperative analysis of surgical margins revealed that cancer-free margins were achieved in 123 cases (81.5%). In 28 specimens (18.5%), the surgical margins were positive. Local recurrence was observed in 28 (18.5%) patients, whereas regional recurrence developed in 30 (19.9%) patients. Factors significantly (P < 0.05) increased the risk of local recurrence: advanced stage of the disease (III/IV), node N-positive status, lymphovascular invasion and positive fresh frozen surgical margins. On multivariate analysis, only positive fresh frozen surgical margins remained significant independent adverse factors.

Conclusion

Our study demonstrates that positive fresh frozen margins, regardless of re-resection to R0 status, could be a powerful adverse factor that determines an aggressive nature of the tumor. This feature should be taken into consideration in adjuvant treatment planning. The greatest impact this could have is in borderline clinical situations for which the indication for adjuvant treatment may be questionable.

Level of Evidence

4. Laryngoscope, 2017

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Evidence against the mucosal traction theory in cholesteatoma

Objectives

To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.

Study Design

Comparative human temporal bone study.

Methods

We selected temporal bones from 14 donors with a diagnosis of cholesteatoma, 15 with chronic otitis media without retraction pockets, 14 with chronic otitis media with retraction pockets, 14 with cystic fibrosis (CF), and 16 controls. We mapped the distribution of the ciliated cells in the mucosal lining of the middle ear and tympanic membrane using three-dimensional reconstruction analysis, and counted the number of ciliated cells in the middle ear mucosa.

Results

Ciliated cells are extremely sparse in the epithelial lining of the lateral surface of the ossicles in the epitympanum and the medial surface of the tympanic membrane. Furthermore, there is a significant decrease in the number of ciliated cells in these areas in temporal bones with cholesteatoma, chronic otitis media, chronic otitis media with retraction pockets, and CF compared to controls. Ciliated cells most commonly are located at the hypotympanum and the Eustachian tube opening but not the tympanic membrane or epitympanum.

Conclusion

The paucity of ciliated epithelial cells on the medial side of the tympanic membrane and the lateral surface of the ossicles in the epitympanum in cases with cholesteatoma and/or chronic otitis media do not support the mucosal migration theory of cholesteatoma formation.

Level of Evidence

NA. Laryngoscope, 2017

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Clinical utility of 18F-fluorodeoxyglucose/positron emission tomography in diagnosis of immunoglobulin G4–related sclerosing sialadenitis

Objectives/Hypothesis

The aim of this study was to evaluate the utility of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for accurately diagnosing immunoglobulin G4-related sclerosing sialadenitis (IgG4-SS).

Study Design

Retrospective cohort study.

Methods

We reviewed the records of 64 patients with IgG4-SS (35 male and 29 female patients) and 10 patients with clinically suspected IgG4-SS. Pathological diagnoses of patients clinically suspected with IgG4-SS included four cases of malignant lymphoma, one case of multicentric Castleman disease, one case of Sjögren's syndrome, and four cases of sialadenitis. All patients underwent submandibular gland (SMG) biopsies and baseline FDG-PET/CT evaluation. Clinical, serological, pathological, and PET/CT findings were analyzed. We also investigated maximum standardized uptake values (SUVmax) in the salivary glands of 15 patients with malignant disease of the salivary glands during the same period.

Results

Increased FDG uptake in the SMG and parotid gland was found in 63 (98%) and 23 (35%) patients with IgG4-SS, respectively. FDG uptake of the bilateral SMG and unilateral SMG was recorded in 57 patients (89%) and six patients (9%), respectively. Mean SUVmax in patients with malignant disease of the salivary glands was significantly higher than that in patients with IgG4-SS (P = .035). We defined a positive test for IgG4-SS diagnosis as high SMG FDG uptake and serum IgG4 level ≥135 mg/dL, resulting in a sensitivity, specificity, and accuracy of 96.9%, 90.0%, and 86.4%, respectively.

Conclusions

FDG-PET/CT findings in combination with serological and clinical findings may have the capacity to diagnose IgG4-SS and lead to less-invasive biopsy procedures.

Level of Evidence

4. Laryngoscope, 2017

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Outcomes and reliability of the flow coupler in postoperative monitoring of head and neck free flaps

Objectives/Hypothesis

To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.

Study Design

Retrospective single-institution study, April 2015 to March 2017.

Methods

Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.

Results

Eleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.

Conclusions

Monitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.

Level of Evidence

4. Laryngoscope, 2017

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Online and call center referral for endocrine surgical pathology within institutions

Objectives/Hypothesis

We hypothesized that self-referred patients to academic centers will be equally distributed between general surgery and otolaryngology departments that perform thyroid surgery. We sought to quantify disparities in the assignment of these self-referred patients who may reach an institution through call centers or online pathways.

Study design

Cross-sectional survey.

Methods

Key words "thyroid surgery" and "thyroid cancer" were used along with the name of the Accreditation Council for Graduate Medical Education–listed otolaryngology program in both Google and Bing search engines. The top three search results for departments were reviewed, and a tally was given to general surgery (GS), otolaryngology–head and neck surgery (OLHNS), or neither. A multidisciplinary center with both GS and OLHNS was recorded as "equitable." Telephone calls were tallied if they were directed to GS or OLHNS.

Results

Out of 400 program tallies, 117 (29.25%) patients were directed to GS and 50 (12.5%) were directed to OLHNS. An additional 181 (45.25%) were directed to neither group ("neither") (P < .05). Fifty-two (13%) of the patients were referred to multidisciplinary groups ("equitable"). A telephone call survey had 62 patients (62%) assigned to a general surgeon, as opposed to 38 (38%) for OLHNS (P < .05). Five institutions offered a multidisciplinary group when searching with Bing, and 11 were found by searching with Google.

Conclusions

There is not an equal distribution of self-referred patients with thyroid surgical pathology. It may be important to increase the online presence of OLHNS surgeons who perform thyroid surgery at academic medical institutions. Multidisciplinary centers focused on thyroid and parathyroid surgical disease represents one model of assigning self-referred patients.

Level of Evidence

NA Laryngoscope, 2017

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Toolbox of assessment tools of technical skills in otolaryngology–head and neck surgery: A systematic review

Objective

To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology–head and neck surgery (OTL-HNS) core procedures and summarized their characteristics.

Methods

We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL-HNS core procedures.

Results

Of the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task-specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting.

Conclusions

Our study reports on published tools for assessing technical skills for OTL-HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work-based direct-observation assessment for core surgical procedures in OTL-HNS. The sparsity of tools specific to OTL-HNS may become a barrier to a fluid transition to competency-based medical education. Laryngoscope, 2017

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Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy

Objectives/Hypothesis

Thyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well-differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes.

Study Design

This is an international cohort study.

Methods

Primary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow-up were analyzed.

Results

Thirty-five patients with well-differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery.

Conclusions

Well-differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies.

Level of Evidence

4 Laryngoscope, 2017

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