Using Social Media at National Meetings in Hematology—Optimal Use, Tips, Strategies, and Limitations

Abstract

Social media has become an important tool for physicians and scientists to rapidly share information with colleagues around the world. Use of social media outlets—in particular, Twitter—has risen rapidly in recent years, and it is now customary for national hematology meetings to have thousands of participants who share photographs and textual summaries of data presentations, as well as personal insights and commentary, with virtual audiences. These messages, or "tweets," can be specifically followed using a hashtag ontology which arose organically over the past several years in the context of medical meetings. This system facilitates communication between meeting attendees and those colleagues near and far with similar interests, thus globalizing the conversation between hematology providers, investigators, patient advocates, professional organizations, regulatory agencies, testing companies, and the pharmaceutical industry about cutting-edge developments in the field.

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Validating a Method to Assess Lipreading, Audiovisual Gain, and Integration During Speech Reception With Cochlear-Implanted and Normal-Hearing Subjects Using a Talking Head.

Objectives: Watching a talker's mouth is beneficial for speech reception (SR) in many communication settings, especially in noise and when hearing is impaired. Measures for audiovisual (AV) SR can be valuable in the framework of diagnosing or treating hearing disorders. This study addresses the lack of standardized methods in many languages for assessing lipreading, AV gain, and integration. A new method is validated that supplements a German speech audiometric test with visualizations of the synthetic articulation of an avatar that was used, for it is feasible to lip-sync auditory speech in a highly standardized way. Three hypotheses were formed according to the literature on AV SR that used live or filmed talkers. It was tested whether respective effects could be reproduced with synthetic articulation: (1) cochlear implant (CI) users have a higher visual-only SR than normal-hearing (NH) individuals, and younger individuals obtain higher lipreading scores than older persons. (2) Both CI and NH gain from presenting AV over unimodal (auditory or visual) sentences in noise. (3) Both CI and NH listeners efficiently integrate complementary auditory and visual speech features. Design: In a controlled, cross-sectional study with 14 experienced CI users (mean age 47.4) and 14 NH individuals (mean age 46.3, similar broad age distribution), lipreading, AV gain, and integration of a German matrix sentence test were assessed. Visual speech stimuli were synthesized by the articulation of the Talking Head system "MASSY" (Modular Audiovisual Speech Synthesizer), which displayed standardized articulation with respect to the visibility of German phones. Results: In line with the hypotheses and previous literature, CI users had a higher mean visual-only SR than NH individuals (CI, 38%; NH, 12%; p

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Prevalence of and Risk Factors for Tinnitus and Tinnitus-Related Handicap in a College-Aged Population.

Objective: Tinnitus is a common otological condition that affects almost 10% of US adults. Research suggests that college students are vulnerable to tinnitus and hearing loss as they are exposed to traumatic levels of noise on a regular basis. Tinnitus and its influence in daily living continue to be underappreciated in the college-aged population. Therefore, the objective for the present study was to analyze prevalence and associated risk factors of tinnitus and tinnitus-related handicap in a sample of college-aged students. Design: A survey was administered to 678 students aged 18-30 years in a cross-section of randomly selected university classes. The survey was adopted from the National Health and Nutrition Examination Survey (2010). It inquired about demographic details, medical and audiological history, routine noise exposure, smoking, sound level tolerance, tinnitus, and tinnitus-related handicap in daily living. Tinnitus-related handicap was assessed by the Tinnitus Handicap Inventory (THI). Participants were divided into four groups: chronic tinnitus (bothersome tinnitus for >1 year), acute tinnitus (bothersome tinnitus for =18). A multinomial regression analysis revealed that individuals with high noise exposure, high sound level tolerance score, recurring ear infections, and self-reported hearing loss had high odds of chronic tinnitus. Females showed higher prevalence of acute tinnitus than males. Individuals with European American ethnicity and smoking history showed high odds of reporting subacute tinnitus. Almost 10% of the subjects reported that they were music students. The prevalence of chronic, acute, and subacute tinnitus was 11.3%, 22.5%, and 32.4%, respectively, for musicians, which was significantly higher than that for nonmusicians. Music exposure, firearm noise exposure, and occupational noise exposure were significantly correlated with tinnitus. Temporal characteristics of tinnitus, self-reported tinnitus loudness, and sound level tolerance were identified as major predictors for the overall THI score. Conclusions: Despite the reluctance to complain about tinnitus, a substantial portion of college-aged individuals reported tinnitus experience and its adverse influence in daily living. It was concluded that environmental and health-related factors can trigger tinnitus perception, while self-reported psychoacoustic descriptors of tinnitus may explain perceived tinnitus-related handicap in daily living by college-aged individuals. Future research is required to explore effects of tinnitus on educational achievements, social interaction, and vocational aspects of college students. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap.

Objective: To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence. Methods: This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment. Results: Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported. Conclusion: The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps. (C) 2017 by Mutaz B. Habal, MD.

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Dermal Regenerative Template as a Cost-Effective Alternative for Complex Scalp Reconstruction.

Background: Use of dermal regeneration template (DRT) is well documented in the literature for complex wounds ranging from the scalp, trunk, and lower extremity. Methods: A retrospective cohort study was performed of the use of dermal regeneration template and skin grafting. A literature review was performed of all studies where DRT was used for scalp reconstruction. Results: Patients in the DRT cohort had an average age of 70, with wounds averaging 108 cm2 in size. These patients also had a relatively low rate of complications (0.4), a short hospital stay (average 2 days), and a relatively short operating room time (114 minutes). Conclusion: This study demonstrates dermal regeneration template to be an effective and reliable option for soft tissue reconstruction with minimal morbidity and complications in patients with extensive medical comorbidities. Emerging applications include radiation exposure and hypercoaguable states. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Hypercorrection of Trigonocephaly: Evaluation of Surgical Outcomes.

Background: A lasting correction of trigonocephaly is difficult to achieve, as a durable correction requires significant expansion to overcome galeal restriction and soft tissue recoil of the scalp. High rates of relapse have been reported throughout the literature. The specific aim of this study was to determine if the senior author's method of "hypercorrection" decreases relapse and the need for subsequent revisional surgery. Methods: Patients who underwent operative correction of metopic craniosynostosis between 1988 and 2011 were reviewed. All patients underwent the "hypercorrection" technique performed by the senior author. Hypercorrection consisted of a fronto-orbital advancement of 2.5 to 3.5 cm and a concomitant hyperexpansion of bitemporal projection. Split cranial bone grafting ensured adequate coverage of the significantly expanded cranial vault. Only patients who had at least 5 years of follow-up were included for review of outcomes. Relapse was defined as recurrence of bitemporal constriction or lateral orbital retrusion, requiring surgical correction. Results: Fifty-eight patients met criteria. Mean age at the time of surgery was 11 months. Mean follow-up was 9.0 years. During this time, 2 patients exhibited relapse requiring camouflage procedures. Cranial bone defects were found in 4 patients (7%), 3 of whom underwent cranial bone grafting, while 1 underwent methylmethacrylate placement at an outside institution. One patient underwent fat grafting for areas of soft tissue irregularity. No patients exhibited persistent sequelae of hypercorrection significant enough to require repeat fronto-orbital advancement. Conclusion: Surgical hypercorrection of trigonocephaly seems to minimize relapse and the need for revision in long-term follow-up and is therefore an important technique to consider. (C) 2017 by Mutaz B. Habal, MD.

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Isolated Intraorbital Frontosphenoidal Synostosis.

Unilateral anterior plagiocephaly is most commonly the result of deformational plagiocephaly or unilateral coronal synostosis, a premature fusion of the frontoparietal suture. However, other sutures within the coronal ring have been implicated in producing anterior cranial asymmetries. These fusions can occur in isolation or in concert with adjacent sutures. The frontosphenoidal suture is one such suture within the coronal ring that has been involved both concomitantly with and independently of frontoparietal suture fusion. Although isolated frontosphenoidal synostosis has been presented previously in the literature, these reports include patients with fusion of the extraorbital portion of the frontosphenoidal suture. This clinical report presents the first clearly documented patient of isolated frontosphenoidal synostosis that occurs entirely within the intraorbital region. The patient presented to Plastic Surgery Clinic at 3 months of age with left frontal flattening, supraorbital rim retrusion, and temporal bulging that was noted soon after birth. Computed tomography analysis revealed an isolated fusion of the greater and lesser wings of the sphenoid bone to the frontal bone on the left side. The patient had no family history of cranial anomalies and genetic testing was negative for mutations. The infant was treated with a cranial orthotic for 3 months, underwent open fronto-orbital advancement and cranial vault remodeling at 6 months, and continued wearing a cranial orthotic for another 4.5 months. Following surgical and orthotic treatment, the patient achieved a satisfactory result. (C) 2017 by Mutaz B. Habal, MD.

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Positive Effect of Incubated Adipose-Derived Mesenchymal Stem Cells on Microfat Graft Survival.

Autologous fat grafting is commonly used for soft tissue augmentation, but its unpredictably high resorption rate remains a major limitation. Although adipose-derived mesenchymal stem cells (ASCs) are an attractive candidate for enhancing graft retention, their poor posttransplantation viability limits their application. The authors aimed to evaluate the effect of incubated ASCs on microfat graft survival in an immunocompromised mouse model. Lipoaspirates for microfat injection were collected from the wasted lower abdominal adipose tissues of 5 patients who had undergone breast reconstructive surgery with an abdominal flap. Adipose-derived mesenchymal stem cells were also isolated and proliferated from these fat tissues. Sixty athymic mice were randomly allocated to a control group (microfat grafting alone; n = 30) or ASCs group (microfat grafting plus simultaneous human ASCs injection; n = 30). The volume and weight of survived fat were measured at 8 and 16 weeks, and histopathological and immunologic staining was performed at 16 weeks. The survived fat volume of the ASCs group was significantly greater than that of the control group at 8 and 16 weeks, whereas the weight of survived fat tissues did not significantly differ. Histologic evaluation of the harvested fat indicated significantly higher levels of adipocytes, and fewer cysts and fibrosis in the tissues in the ASCs group than in the control group. The ASCs group also exhibited a significantly higher number of capillary vessels than the control group on CD31 and alpha-smooth muscle actin staining. In conclusion, transplanted fat survival is markedly higher when simultaneous microfat graft and ASCs injection were performed, as compared with that in the classical microfat graft alone method in mice; this improvement was primarily attributed to the increased ability to produce blood vessels. (C) 2017 by Mutaz B. Habal, MD.

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More Than Meets the Eye: The Effect of Intercanthal Distance on Perception of Beauty and Personality.

In judging normalcy, surgeons rely on established facial anthropometric measures and proportions. However, there exists a range of "normal," and a degree of disproportion may be considered more attractive. The authors set out to determine how changes in only intercanthal distance affect the layperson's perception of beauty and personality traits of a face. The authors used Amazon.com's Mechanical Turk (MTurk), a crowdsourcing tool, to determine how changes in intercanthal distance affect overall perception of beauty and personality. MTurk respondents provided demographic information and were asked to survey 16 female subjects, each digitally edited to be hypoteloric or hyperteloric. Data were collected from 490 MTurk crowd raters. Paired t test analysis found that respondents perceived subjects to be more submissive, friendly, and attractive with increased intercanthal distance (P 46 years of age were less likely to perceive a change in any of the 7 traits upon intercanthal widening, compared with respondents between 18 and 25 years of age (P

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An Algorithm for Managing Intraosseous Vascular Anomalies of the Craniofacial Skeleton.

Background: Intraosseous vascular anomalies (IOVA) are rare in the craniofacial skeleton and present a diagnostic and therapeutic challenge. This study aims to describe the clinical management based on a large case series. Methods: A retrospective chart review was performed and 9 IOVA were identified over a 15-year period. Data on demographics, diagnostic features, clinical management, and outcomes were reviewed. Results: Five frontal bone IOVA and 4 orbital IOVA were identified. The postoperative follow-up ranged from 4 months to 4 years. All 9 lesions were diagnosed with computed tomography (CT) imaging. Magnetic resonance imaging (MRI) was used to delineate soft tissue involvement in 2 patients presenting with oculo-orbital dystopia and ophthalmoplegia. En bloc excision was performed in all patients. Preoperative interventional embolization was critical in the successful resection of an orbital IOVA following 2 previously failed attempts that were aborted secondary to hemorrhage. Intraoperative 3-dimensional stereotactic navigation was used for the accurate en bloc excision of a frontal IOVA to prevent injury to the frontal sinus. Reconstruction of esthetic and functional deformities was successfully accomplished. Conclusion: The diagnosis of IOVA relies primarily on clinical assessment and CT imaging. Further interpretation of the involvement of periorbital, facial, and intracranial soft tissue is best defined by MRI. Multidisciplinary care with interventional radiology and neurosurgery must be considered for ensuring the safe and adequate en bloc excision of craniofacial IOVA. (C) 2017 by Mutaz B. Habal, MD.

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Alterations in Nasal Sensibility Following Calcium Hydroxyapatite Dorsal Augmentation.

Background: There are a many types of filler products that surgeons used for soft tissue augmentation. Soft Tissue Fillers, also known as injectable grafts, is a medical device implants. One of the materials used in soft tissue fillers is calcium hydroxylapatite (CaHA) that is commonly used for treating nasal deformities and nasal reshaping too. Calcium hydroxylapatite is a kind of mineral that can be found in human teeth and bones. It is considered long-lasting but nonpermanent filler and is biocompatible with human tissue. Aim: The aim of this study is to measure the alterations in sensibility and patient satisfaction following CaHA filler injection. Patient/Methods: In a prospective study, 30 patients who underwent CaHA filler injections from January to December 2016 at a Private Tertiary Care Hospital in Riyadh, Saudi Arabia were included. Results: Means and standard deviations were measured for pressure threshold values at each test area preprocedure 2 weeks after procedure (Table 1). Alterations between pre and postprocedure values were verified using the match-paired Student t test preprocedures. None of the patients had any subjective sensory symptoms. Majority of patients were extremely satisfied with the results. Conclusion: With correct anatomic knowledge and precise technique in doing the CaHA gel injection procedure, nasal sensibility will not be altered. In addition, injection of CaHA gel can be valuable tool for plastic surgeons to consider for nasal reshaping. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Management of Migraine Headache.

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 +/- 6.3 episodes per month to 1.9 +/- 2.4 episodes per month (P

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Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement.

Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method. Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method. The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4 mm, ranging from 12 to 20 mm. Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Yes. This is a Missed Opportunity. Let's Turn Traumatic Injury into a Life-saving Event" by Haider AH in Ann Surg 265: 854-855, 2017.

No abstract available

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Postoperative Changes in Isolated Medial Orbital Wall Fractures Based on Computed Tomography.

The treatment has been improved on the accurate reduction of blow-out fracture for many decades. But still, it has been limited to reduce completely when surgeons are approaching by conventional technique. The authors analyzed the postoperative results using computed tomography (CT) scans after conventional open reduction of isolated medial wall fracture. Thirty-seven patients with isolated medial wall fracture were reviewed. All patients underwent preoperative, immediate, and postoperative CT scans. Two surgeons have performed the surgery by conventional open reduction with transcaruncular approach and absorbable mesh insertion. The authors evaluated changing orbital volume and distance, comparing the immediate and 6 months postoperative outcomes with preoperative outcome. The differences between immediate postoperative and 6 months postoperatively data were statistically evaluated. The authors used the distant value to minimize bias of CT view selection. Significant differences from the 2 kinds of data were observed (P

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Comments on the eighth edition of the TNM classification for lung cancer. Radical changes and limitations: Does size matter?

Abstract

Aim-Background

Cancer is a major public health problem worldwide and the second leading cause of death in the United States of America (USA), following heart disease. Male lung cancer death rates are decreasing in the western world and increasing in China and several other countries in Asia and Africa. Female lung cancer death rates are increasing worldwide, with the exception of the USA, Canada and Australia. Differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use. Staging of cancer at the time of diagnosis is the most important predictor of survival, and treatment options should be based on the stage. The aim of this overview is to discuss the changes in the 8th Edition of the TNM (Tumor, Nodes, Metastasis) Classification of lung cancer and its impact on predicting patient prognosis. Potential limitations of the classification system and future directions are discussed.

Methods

A systematic literature search was performed to identify relevant reports. Studies and articles were identified using several online searches of the U.S. National Library of Medicine via www.pubmed.com. The article is based on the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee report. An international lung cancer database was developed from 35 sources in 16 countries around the globe, with staging and outcome data on 94,708 cases of lung cancer.

Result

This new edition of lung cancer TNM staging placed additional emphasis on tumor size, and size cut-off points have been added, which will now be a descriptor in all TNM categories. For the first time a new term was introduced, defined as minimally invasive adenocarcinoma. The additional cut-off point changes will definitely alter treatment recommendations in the future. The node classification remained unchanged in the new edition. Regarding metastasis, M1a refers to cases with intrathoracic metastases, M1b cases with a single metastasis outside the thoracic cavity. The situation involving multiple metastatic deposits, usually in more than one organ, is now classified as M1c.

Conclusions

The new staging of lung cancer is based on analysis of survival in large databases, based on tumor size and disease proliferation, and is therefore expected to assess the prognosis of the individual patient more accurately. Based on the current edition of the TNM staging system many patients will be given a different staging category,. It is evident that improved survival may reflect the expected improvements in diagnosis and treatment, the net effect being a stage-for-stage survival increase at all stages. This 8th edition of the TNM classification for lung cancer has placed additional emphasis on tumor size.

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Size matters: Better staging of lung cancer, better outcomes!

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Compression of the neurovascular bundle above and below the clavicle

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In memoriam

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The TNM staging system: A stable value in the battle against cancer. A brief historical overview

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Ruptured liver abscess presenting as pneumoperitoneum

Abstract

The presence of free air within the peritoneal cavity, referred to as pneumoperitoneum, in 85% to 90% of cases is due to perforated bowel. The rare case is reported of pneumoperitoneum resulting from a ruptured liver abscess in a young male with no comorbidity.

A ruptured pyogenic left lobe liver abscess in a 23-year-old male was accompanied by chest X-ray features suggestive of free gas under the diaphragm with peritonitis. Exploratory laparotomy was performed, with localization and drainage of the liver abscess and thorough peritoneal lavage. Culture of the pus from the liver abscess grew Klebsiella sensitive to Piperacillin and Tazobactam, and antibiotic treatment was administere

Conclusion: Although pneumoperitoneum resulting from a ruptured liver abscess is rare, it must be kept in mind as a possible source, especially when the hollow organs are normal.

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Subcutaneous dirofilariasis of the groin in a male due to Dirofilaria repens

Abstract

Dirofilariasis is a rare human parasitic disease. Dirofilaria repens most commonly causes subcutaneous and ocular infections. The case is presented of a 24-year-old Greek male with a painless swelling in the right groin of one month's duration. Exploratory incision of the lesion revealed a whitish living worm of approximately 7 cm in length. The worm was removed and identified by its morphology as D. repens. This is the first case of dirofilariasis of the groin to be reported in Southwestern Greece.

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Endocrine surgery: Diagnostic tools with doubtful findings, and rare tumors of the adrenal gland

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Splenic abscess in an immunocompetent adult

Abstract

Abscess of the spleen is, a rare clinical entity with about 600 cases documented to date, and an incidence of 0.2 to 0.7% in autopsy-based studies [1,2]. Because of its nonspecific clinical picture, splenic abscess constitutes a diagnostic challenge, but it should be suspected in febrile patients with left upper quadrant tenderness and leucocytosis. The diagnosis is based mainly on imaging studies, microbiological and/or histopathological evidence, or by response to antibiotic or antifungal treatment.

A case of splenic abscess is reported here, which occurred in an immunocompetent male and was treated in a tertiary care institution in eastern India.

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Pectoralis minor syndrome: Report of two cases and review

Abstract

Pectoralis minor syndrome (PMS) is an infrequent entity that mimics thoracic outlet syndrome. PMS is characterized by axillary vein stenosis/obstruction below the clavicle, due to compression by the pectoralis minor muscle. The typical clinical symptoms are pain, weakness, numbness, paresthesia, cyanosis and swelling of the upper extremity, aggravated by exercise. Two cases are presented here of right-sided PMS of symptomatic stenosis of the axillary vein. The importance is emphasized of diagnosis by dynamic venography imaging and treatment by surgery.

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Early postoperative anastomotic leakage due to necrotizing candidiasis after abdomino-thoracic resection for T1 esophageal cancer

Abstract

We present a case of early postoperative anastomotic leakage after abdomino-thoracic esophageal resection for cancer in a female, due to a necrotizing, transmural infection with Candida species (spp). The infection was treated successfully with redo surgery and systemic antimycotic therapy with caspofungin. The patient was disease-free at 49 month follow-up, but her long-term quality of life, as assessed by the EORTC questionnaire (QLQ C-30) was reduced. Aggressive surgical and medical therapy led to successful treatment of this rare complication.

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Laparoscopic cholecystectomy in patients with ventriculoperitoneal shunts: A case series

Abstract

Introduction

Patients with ventriculoperitoneal shunts (VPS) are at risk of associated complications during laparoscopic surgery. Although these cases are rare, the surgeon should be aware of the pathophysiology of such complications in order to recognize and avoid them.

Case presentation

Three patients with a VPS who underwent laparoscopic cholecystectomy are presented. Two of the patients suffered from symptomatic gallstone disease, and the third, the oldest, from acute calculus cholecystitis. All patients had a VPS because of hydrocephalus. There were no intraoperative complications in this series.

Discussion

This small case series presents a rare condition that can be the cause of complications during laparoscopic surgery. Septic complications, including VPS infection and cerebrospinal fluid (CSF) infection, pneumocephalus, CSF pseudocyst, and adhesions due to the presence of the VPS, are all possible occurrences. These are discussed, with a short literature review.

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Bilateral adrenal myelolipoma: A case report

Abstract

Myelolipoma is a relatively rare benign tumor composed of mature adipose tissue with variable amounts of hematopoietic element of both the myeloid and the erythroid series. It is usually asymptomatic, and bilateral tumors are unusual. The case is reported of a 62-yr-old male who presented with an ill-defined firm, non-tender, bimanually palpable mass in the right lumbar region, encroaching into right hypochondrium. It showed slight movement with respiration and was intraperitoneal. Contrast enhanced computed tomography (CECT) scan of the abdomen showed bilateral, heterogenous, hypoattenuating lesions with an enhancing rim of soft tissue in the adrenal fossae. At surgery the right sided tumor was treated by adrenalectomy and the left by enucleation of the tumor.

Conclusion: Bilateral myelolipoma of adrenal gland is a very rare entity and warrants careful evaluation, by abdominal CECT scan and fat suppressing magnetic resonance imaging (MRI).

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Safety and quality: Two basic components of contemporary surgical care

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Port site Richter’s hernia. Case report and review

Abstract

The incidence of port site hernia (PSH) after a range of laparoscopic procedures has been variously reported as between 0.14% and 22%. In addition to pain, PSH may be associated with severe complications, including bowel obstruction, strangulation, and perforation. The case is reported of Richter's hernia in a 45-year-old male at a 5 mm port site 6 years after laparoscopic cholecystectomy (LC).He presented with a lump in the right lumbar region associated with sudden onset pain and non-passage of stool for two days. With a diagnosis of PSH, he underwent exploratory laparotomy with a right lumbar skin incision, which revealed herniation of the omentum and part of the antimesenteric wall of a small bowel loop through the port site defect of about 1 x 1 cm.

The gangrenous omentum was excised and the rest of the omentum and viable bowel loops were reposited.

PubMed database search 1991 to 2016 showed an incidence of PSH ranging from 0.38% to 5.4% with an overall incidence of 1.7% in a review from 1995 to 2008. The umbilicus was the most common port to be associated with incisional hernia. It is rarely associated with strangulation or bowel obstruction. Not closing the fascial defect is thought to be implicated, although closing the fascia is not preventive.

PSH at secondary port sites is very rare. Richter's hernia with strangulation at a 5 mm port-site is the rarest presentation.

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Comparision of preoperative and postoperative histopathology findings in patients undergoing thyroidectomy

Abstract

Aim

To compare the histopathological findings on fine needle aspiration (FNA) biopsy of thyroid nodules and thyroidectomy surgical specimens, in order to determine the efficacy, specificity and sensitivity of FNA in the diagnosis of thyroid malignancy.

Methods

The data on a series of 86 patients who underwent thyroidectomy for thyroid nodules were evaluated retrospectively. The demographic characteristics and imaging findings were reviewed, and the histopathological findings on the preoperative FNA biopsy and the surgical thyroid specimen were compared.

Results

The FNA findings on the thyroid nodules were: 32.1% benign, 12.2% malignant, 2.7% suspicion of malignancy, 6% atypia of undetermined significance, 15.7% follicular lesion and/or suspicion of follicular neoplasm, and in 31.3% the aspirate was inadequate. The postoperative histopathological specimens were evaluated as 31 malignant (36%) and 55 benign (64%). Statistically significant correlation was demonstrated between the FNA and the postoperative histopathological findings (p<0.05). In this series, the overall sensitivity of FNA biopsy was 10%, the specificity 70.9%, the positive predictive value 16% and the negative predictive value 58%.

Conclusions

This study identified a high negative predictive value of FNA biopsy, and an increased rate of "nondiagnostic" and "microcarcinoma" outcomes, but the sensitivity of FNA in the preoperative diagnosis of thyroid malignancy was low.

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Case–control study of mandibular canal branching and tooth-related inflammatory lesions

Abstract

Objectives

Morphological variations of mandibular canals increase the risk of neurovascular damage and bleeding during surgical procedures by decreasing the predictability of the inferior alveolar neurovascular bundle location. To improve the predictability with such variations, the present study aimed to verify the possibility of a relationship between mandibular canal branches (MCBs) and tooth-related inflammatory lesions, using trough cone-beam computed tomography (CBCT) examinations.

Methods

The sample comprised 150 age and sex-matched examinations (50 cases and 100 controls) from two databases. The CBCT examinations were grouped by the presence of MCBs starting in the mandibular body regions as the outcome variable. Tooth-related inflammatory lesions and measurements of gray levels in the posterior region of the alveolar ridge were assessed in both groups. A multiple logistic regression analysis was applied to verify the relationships between MCBs and independent variables (p < 0.05).

Results

Occurrence of tooth-related inflammatory lesions increased the risk of MCBs in the mandibular body regions (p < 0.001; OR 11.640; 95% CI 4.327–31.311). High-contrast images had a weaker association with MCBs (p = 0.002; OR 1.002; 95% CI 1.002–1.003). The most frequent tooth-related inflammatory lesions in both groups were endodontic (34 lesions; 45.94% of the total lesions). Most of the tooth-related inflammatory lesions related to MCBs were endodontic (20 cases) and combined endodontic and periodontal inflammation (20 cases).

Conclusions

An association was observed between MCBs in the mandibular body regions and tooth-related inflammatory lesions. Inflammatory lesions of endodontic origin are most often associated with MCBs.

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Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis

Abstract

Patients undergoing radiation therapy for the head and neck are susceptible to a significant and often abrupt deterioration in their oral health. The oral morbidities of radiation therapy include but are not limited to an increased susceptibility to dental caries and periodontal disease. They also include profound and often permanent functional and sensory changes involving the oral soft tissue. These changes range from oral mucositis experienced during and soon after treatment, mucosal opportunistic infections, neurosensory disorders, and tissue fibrosis. Many of the oral soft tissue changes following radiation therapy are difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. We discuss the presentation, prognosis, and management strategies of the dental structure and oral soft tissue morbidities resulting from the administration of therapeutic radiation in head and neck patient. A case for a collaborative and integrated multidisciplinary approach to the management of these patients is made, with specific recommendation to include knowledgeable and experienced oral health care professionals in the treatment team.

Oral complications of radiation therapy to the head and neck can result in acute and long-term deterioration in oral soft tissues and dentition. The presentation, prognosis, and strategies to manage the dental and nondental morbidities of radiation therapy to the head and neck are discussed in this manuscript.

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Cancer Registry follow-up for 17 million person-years of a nationwide maternity cohort

Abstract

Population-based Finnish Maternity Cohort (FMC) comprises 2M first trimester sera collected from 1M women during 33 years. Informed consent is by the opt-out principle, and linkages with cancer and population registries provide a base for over time and over generation studies. Follow-up for 17M person-years by the end of 2014 can identify 39,700 cases of invasive cancer and 18,900 cases of premalignant breast and cervix lesions, and basal cell carcinoma diagnosed after serum sampling. For women with multiple pregnancies, serial samples taken before cancer diagnosis are available. Offspring of the women have developed more than 4000 cancers. For 100,000 individuals, samples taken during the pregnancies of both their mothers and grandmothers enable familial cancer studies. FMC continues to collect samples, and surveillance of exposures or interventions like vaccination programs is feasible. In summary, the FMC is a unique, accessible biobank for epidemiological, biomarker, and surveillance studies on cancer.

We announce a biobank comprising virtually the entire population of Finnish females, who have been pregnant since 1983. The Finnish Maternity Cohort (FMC) is linkable with population-based health registers including the Finnish Cancer Registry. Serial prediagnostic serum samples and comprehensive data accessible over three generations provide possibilities for unique study settings. Selected examples on the use of the FMC in cancer studies hopefully stimulate international quest for this open access resource.

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A microRNA signature from serum exosomes of patients with glioma as complementary diagnostic biomarker

Abstract

Malignant gliomas, the most frequent primary brain tumors, are characterized by a dismal prognosis. Reliable biomarkers complementary to neuroradiology in the differential diagnosis of gliomas and monitoring for post-surgical progression are unmet needs. Altered expression of several microRNAs in tumour tissues from patients with gliomas compared to normal brain tissue have been described, thus supporting the rationale of using microRNA-based biomarkers. Although different circulating microRNAs were proposed in association with gliomas, they have not been introduced into clinical practice so far. Blood samples were collected from patients with high and low grade gliomas, both before and after surgical resection, and the expression of miR-21, miR-222 and miR-124-3p was measured in exosomes isolated from serum. The expression levels of miR-21, miR-222 and miR-124-3p in serum exosomes of patients with high grade gliomas were significantly higher than those of low grade gliomas and healthy controls and were sharply decreased in samples obtained after surgery. The analysis of miR-21, miR-222 and miR-124-3p in serum exosomes of patients affected by gliomas can provide a minimally invasive and innovative tool to help the differential diagnosis of gliomas at their onset in the brain and predict glioma grading and non glial metastases before surgery.

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Comparative one- and two-photon uncaging of MNI-glutamate and MNI-kainate on hippocampal CA1 neurons

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Stefan Passlick, Graham C.R. Ellis-Davies
BackgroundThe light-induced release of neurotransmitters from caging chromophores provides a powerful means to study the underlying receptors in a physiologically relevant context. Surprisingly, most caged neurotransmitters, including the widely used 4-methoxy-7-nitroindolinyl (MNI)-glutamate, show strong antagonism against GABA-A receptors. Kainate has been shown to exhibit a higher efficacy at glutamate receptors compared to glutamate itself. Thus, uncaging of kainate might allow the application of the caged compound at lower, less antagonistic concentrations.New methodsThis study provides a detailed comparison of MNI-glutamate and MNI–kainate uncaging by different modes of one- and two-photon irradiation on hippocampal CA1 pyramidal neurons in acute brain slices.Results/Comparison with existing methodsUnexpectedly, the data revealed that currents in response to MNI-glutamate uncaging were larger compared to MNI-kainate with local one-photon laser uncaging at the soma and two-photon uncaging at the same spines. Furthermore, the direct comparison demonstrates the influence of type of caged agonist and light delivery conditions used for uncaging on the amplitude and kinetic properties of the current response.ConclusionThese findings highlight the importance of experimental design for uncaging experiments and provide a basis for future studies employing one- and two-photon uncaging to understand glutamate-dependent processes. It further provides the first example of two-photon uncaging of kainate at single spines in acute brain slices.



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A microRNA signature from serum exosomes of patients with glioma as complementary diagnostic biomarker

Abstract

Malignant gliomas, the most frequent primary brain tumors, are characterized by a dismal prognosis. Reliable biomarkers complementary to neuroradiology in the differential diagnosis of gliomas and monitoring for post-surgical progression are unmet needs. Altered expression of several microRNAs in tumour tissues from patients with gliomas compared to normal brain tissue have been described, thus supporting the rationale of using microRNA-based biomarkers. Although different circulating microRNAs were proposed in association with gliomas, they have not been introduced into clinical practice so far. Blood samples were collected from patients with high and low grade gliomas, both before and after surgical resection, and the expression of miR-21, miR-222 and miR-124-3p was measured in exosomes isolated from serum. The expression levels of miR-21, miR-222 and miR-124-3p in serum exosomes of patients with high grade gliomas were significantly higher than those of low grade gliomas and healthy controls and were sharply decreased in samples obtained after surgery. The analysis of miR-21, miR-222 and miR-124-3p in serum exosomes of patients affected by gliomas can provide a minimally invasive and innovative tool to help the differential diagnosis of gliomas at their onset in the brain and predict glioma grading and non glial metastases before surgery.

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Announcements

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tDCS over the motor cortex improves lexical retrieval of action words in post-stroke aphasia

One-third of stroke survivors worldwide suffer from aphasia. Speech and language therapy (SLT) is considered effective in treating aphasia, but due to time constraints, improvements are often limited. Non-invasive brain stimulation is a promising adjuvant strategy to facilitate SLT. However, stroke might render "classical" language regions ineffective as stimulation sites. Recent work showed the effectiveness of motor-cortex stimulation together with intensive naming therapy to improve outcomes in aphasia (Meinzer et al., 2016). Although, this study highlights the involvement of the motor cortex, the functional aspects by which it influences language are yet unclear. In this study, we focus on the role of motor cortex in language, investigating its functional involvement in access to specific lexico-semantic (object- vs. action related) information in post-stroke aphasia. To this end, we tested effects of anodal tDCS to the left motor cortex on lexical retrieval in 16 patients with post-stroke aphasia in a sham-controlled, double-blind study design. Critical stimuli were action and object words, and pseudowords. Participants performed a lexical-decision task, deciding whether stimuli were words or pseudowords. Anodal tDCS improved accuracy in lexical decision, especially for words with action-related content and for pseudowords with an "action-like" ending (t15 = 2.65, p = 0.036), but not for words with object-related content and pseudowords with "object-like" characteristics. We show as a proof-of-principle that the motor cortex may play a specific role in access to lexical-semantic content. Thus, motor-cortex stimulation may strengthen content-specific word-to-semantic concept associations during language treatment in post-stroke aphasia.

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Central pattern generators in the turtle spinal cord: selection among the forms of motor behaviors

Neuronal networks in the turtle spinal cord have considerable computational complexity even in the absence of connections with supraspinal structures. These networks contain Central Pattern Generators (CPGs) for each of several behaviors, including three forms of scratch, two forms of swim, and flexion reflex. Each behavior is activated by a specific set of cutaneous or electrical stimuli. The process of selection among behaviors within the spinal cord has multisecond memories of specific motor patterns. Some spinal cord interneurons are partially shared among several CPGs while other interneurons are active during only one type of behavior. Partial sharing is a proposed mechanism that contributes to the ability of the spinal cord to generate motor pattern blends with characteristics of multiple behaviors. Variations of motor patterns, termed deletions, assist in characterization of the organization of the pattern-generating components of CPGs. Single-neuron recordings during both normal and deletion motor patterns provide support for a CPG organizational structure with Unit Burst Generators (UBGs) whose members serve a direction of a specific degree of freedom of the hindlimb, e.g., the hip-flexor UBG, the hip-extensor UBG, the knee-flexor UBG, the knee-extensor UBG, etc. The classic half-center hypothesis that includes all the hindlimb flexors in a single flexor half-center and all the hindlimb extensors in a single extensor half-center lacks the organizational complexity to account for the motor patterns produced by turtle spinal CPGs. Thus, the turtle spinal cord is a valuable model system for studies of mechanisms responsible for selection and generation of motor behaviors.

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Object maintenance beyond their visible parts in working memory

Completion of a partially occluded object requires that a representation of the whole is constructed based on the information provided by the physically specified parts of the stimulus. Such processes of amodal completion rely on the generation and maintenance of a mental image that renders the completed object in visual working memory (VWM). The present study examined this relationship between VWM storage and processes of object completion. We recorded event-related potentials to track VWM maintenance by means of the contralateral delay activity (CDA) during a change detection task in which to-be-memorized composite objects (notched shapes abutting an occluding shape) were primed to induce either a globally completed object or a non-completed, mosaic representation. The results revealed an effect of completion in VWM despite physically identical visual input: Change detection was more accurate for completed as compared to mosaic representations when observers were required to memorize two objects, and these differences were reduced with four memorized items. At the electrophysiological level, globally completed (versus mosaic) objects gave rise to a corresponding increase in CDA amplitudes. These results indicate that, while incorporating the occluded portions of the presented shapes requires mnemonic resources, the complete-object representations thus formed in VWM improve change detection performance by providing a more simple, regular shape. Overall, these findings demonstrate that mechanisms of object completion modulate VWM, with the memory load being determined by the structured representations of the memorized stimuli.

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Retracing your footsteps: developmental insights to spinal network plasticity following injury.

During development of the spinal cord, a precise interaction occurs between descending projections and sensory afferents with spinal networks that lead to expression of coordinated motor output. In the rodent, during the last embryonic week, motor output first occurs as regular bursts of spontaneous activity progressing to stochastic patterns of episodes that express bouts of coordinated rhythmic activity perinatally. Locomotor activity becomes functionally mature in the second postnatal week and is heralded by the onset of weight-bearing locomotion on the 8th-9th postnatal day. Concomitantly there is a maturation of intrinsic properties and key conductances mediating plateau potentials. In this review, we discuss spinal neuronal excitability, descending modulation, and afferent modulation in the developing rodent spinal cord. In the adult, plastic mechanisms are much more constrained but become more permissive following neurotrauma such as spinal cord injury. We discuss parallel mechanisms that contribute to maturation of network function during development to mechanisms of pathological plasticity that contribute to aberrant motor patterns such as spasticity and clonus that emerge following central injury.

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Experience-Dependent Trends in CA1 Theta and Slow Gamma Rhythms in Freely Behaving Mice

CA1 place cells become more anticipatory with experience, an effect thought to be caused by NMDA receptor-dependent plasticity in the CA3-CA1 network. Theta (~5-12 Hz), slow gamma (~25-50 Hz), and fast gamma (~50-100 Hz) rhythms are thought to route spatial information in the hippocampal formation and to coordinate place cell ensembles. Yet, it is unknown whether these rhythms exhibit experience-dependent changes concurrent with those observed in place cells. Slow gamma rhythms are thought to indicate inputs from CA3 to CA1, and such inputs are thought to be strengthened with experience. Thus, we hypothesized that slow gamma rhythms would become more evident with experience. We tested this hypothesis using mice freely traversing a familiar circular track for three ten-minute sessions per day. We found that slow gamma amplitude was reduced in the early minutes of the first session of each day, even though both theta and fast gamma amplitudes were elevated during this same period. However, in the first minutes of the second and third sessions of each day, all three rhythms were elevated. Interestingly, theta was elevated to a greater degree in the first minutes of the first session than in the first minutes of later sessions. Additionally, all three rhythms were strongly influenced by running speed in dynamic ways, with the influence of running speed on theta and slow gamma changing over time within and across sessions. These results raise the possibility that experience-dependent changes in hippocampal rhythms relate to changes in place cell activity that emerge with experience.

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The Kolliker-Fuse orchestrates the timing of expiratory abdominal nerve bursting

Coordination of respiratory pump and valve muscle activity is essential for normal breathing. A hallmark respiratory responses to hypercapnia and hypoxia is the emergence of active exhalation, characterized by abdominal muscle pumping during the late one-third of expiration (late-E phase). Late-E abdominal activity during hypercapnia has been attributed to the activation of expiratory neurons located within the parafacial respiratory group (pFRG). However, the mechanisms that control emergence of active exhalation, and its silencing in restful breathing, are not completely understood. We hypothesized that inputs from the Kölliker-Fuse nucleus (KF) control the emergence of late E activity during hypercapnia. Previously, we reported that reversible inhibition of the KF reduced post-inspiratory (post-I) motor output to laryngeal adductor muscles and brought forward the onset of hypercapnia-induced late-E abdominal activity. Herein, we explored the contribution of the KF for late-E abdominal recruitment during hypercapnia by pharmacologically disinhibiting the KF in in situ decerebrate arterially-perfused rat preparations. These data were combined with previous results and incorporated into a computational model of the respiratory central pattern generator. Disinhibition of the KF through local parenchymal microinjections of gabazine (GABA_A receptor antagonist) prolonged vagal post-I activity and inhibited late-E abdominal output during hypercapnia. In silico, we reproduced this behavior and predicted a mechanism where the KF provides excitatory drive to post-I inhibitory neurons, which, in turn, inhibit late-E neurons of the pFRG. Although the exact mechanism proposed by the model requires testing, our data confirm that the KF modulates the formation of late-E abdominal activity during hypercapnia.

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FUNCTIONAL ROLES OF THREE CUES THAT "PERVADE" THE BRAIN: ELECTRO-MAGNETIC FIELD, OXYGEN AND CARBON DIOXIDE

The brain integrative actions depend on the exchange of information among its computational elements. Hence, such a phenomenon plays the key role in driving the complex dynamics of central nervous system (CNS), in which true computations interact with non-computational dynamical processes to generate brain representations of the body in the external world, hence the finalistic behaviour of the organism. In this context, it should be pointed out that beside the intercellular interactions mediated by classical electro-chemical signals also other types of interactions, namely 'cue' and 'coercion' appear to be exploited by the system to achieve its function. Actually, the main focus of the present paper will be on cues present in the environment as well as produced by cells of the body, that "pervade" the brain contributing to its dynamics. These cues can also be metabolic substrates and in most cases, they are of a fundamental importance for the brain function and for the entire organism survival. Three of these highly pervasive cues will be analysed more in detail, namely oxygen, carbon dioxide and electromagnetic fields (EMF). A special emphasis will be given to EMF since it has been proposed by several authors that these highly pervasive energy fluctuations could play an important role in the global integrative actions of the brain, hence EMF signalling may transcend purely connectionist models of brain function. Thus, the new concept of "Broadcasted Neuro-Connectomics" (BNC) has been introduced that transcends the current connectomics view of the brain.

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Momentary level of slow default mode network activity is associated with distinct propagation and connectivity patterns in the anesthetized mouse cortex

Complex spatiotemporal changes of slow spontaneous activity occur in the form of propagating waves in the cortex, leading to the transient formation of a specific activation topography, followed by a transition in the topography. The topographies resemble the stimulation-induced activation patterns and the underlying structural projections, suggesting that they contain motifs of task-related activation. However, little is known about how propagation-mediated transitions between topographies are structured in terms of functional connectivity. Therefore, we investigated whether specific topographies or regions are associated with transitions involving long-range connections and hub modulation. We hypothesized that the activity level of the default mode network (DMN) at a given topography would affect the pattern of upcoming transitions, since high activity levels of the DMN are a distinct feature of the brain at rest. Using mesoscale voltage-sensitive dye imaging in the cortex of lightly anesthetized mice, we revealed that momentary levels of DMN activity are associated with distinct patterns of activity propagation and functional connectivity. High levels of DMN activity led to activity propagation across secondary and association cortices, increasing the centrality of a main hub region, while low level activity led to global, diffuse, yet efficient changes in functional connectivity. Furthermore, low levels of activity resulted in increased long-range connectivity between frontal and posterior regions of the cortex. Our results indicate that DMN activity is associated with functional connectivity and wave propagation patterns, raising the possibility that the DMN may be involved in the modulation of long-range information processing associated with upcoming transitions.

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Individualized tracking of self-directed motor learning in group-housed mice performing a skilled lever positioning task in the home cage

Skilled forelimb function in mice is traditionally studied through behavioural paradigms that require extensive training by investigators, and are limited by the number of trials individual animals are able to perform within supervised session. We developed a skilled lever positioning task that mice can perform within their home cage. The task requires mice to use their forelimb to precisely hold a lever mounted on a rotary encoder within a rewarded position in order to dispense a water reward. A Raspberry Pi microcomputer is used to record lever position during trials, and to control task parameters, thus making this low-footprint apparatus ideal for use within animal housing facilities. Custom Python software automatically increments task difficulty by requiring a longer hold duration, or a more accurate hold position in order to dispense a reward. The performance of individual animals within group-housed mice is tracked through RFID implants, and data stored on the microcomputer may be accessed remotely through an active internet connection. Mice continuously engage in the task for over 2.5 months, and perform ~500 trials/24 hrs. Mice required approximately 15,000 trials to learn to hold the lever within a 10° range for 1.5s, and were able to further refine movement accuracy by limiting their error to a 5° range within each trial. These results demonstrate the feasibility of autonomously training group housed mice on a forelimb motor task. This paradigm may be used in the future to assess functional recovery after injury or cortical reorganization induced by self-directed motor learning.

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Six-legged walking in insects: how CPGs, peripheral feedback, and descending signals generate coordinated and adaptive motor rhythms

Walking is a rhythmic locomotor behavior of legged animals and its underlying mechanisms have been the subject of neurobiological research for more than 100 years. In this article, we review relevant historical aspects and contemporary studies in this field of research with a particular focus on the role of central pattern generating networks (CPGs) and their role in the generation of the six-legged walking in insects. Aspects of importance are the generation of single leg stepping, the generation of interleg coordination, and how descending signals influence walking. We first review how CPGs interact with sensory signals from the leg in the generation of leg stepping. Next, we summarize how these interactions are modified in the generation of motor flexibility for forward and backward walking, curve walking, and speed changes. We then review the present state of knowledge with regard to the role of CPGs in intersegmental coordination and how CPGs might be involved in mediating descending influences from the brain for the initiation, maintenance, modification, and cessation of the motor output for walking. In all chapters, we aim to specifically address gaps in knowledge and we describe potential future avenues and approaches, conceptual and methodological, with the latter emphasizing in particular options arising from the advent of neurogenetic approaches to this field of research and its combination with traditional approaches.

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Dietary Patterns and Cardiovascular Disease Prevention among Patients with Diabetes

Abstract

Purpose of Review

This review summarizes the most recent literature on dietary patterns and their effects on cardiovascular health among patients with diabetes.

Recent Findings

Studies identified examined low-fat, low-carbohydrate, low-glycemic index, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean dietary patterns. A limited number of short-term studies showed that intake of low-fat, low-carbohydrate, and low-glycemic index dietary patterns reduced body weight and blood pressure among individuals with diabetes. Short-term consumption of the DASH dietary pattern reduced blood pressure, low-density lipoprotein cholesterol, and triglyceride levels in patients with diabetes. Most convincing evidence supports the effectiveness of Mediterranean dietary patterns in cardiovascular disease prevention by reducing cardiovascular risk factors and mortality among patients with diabetes, as supported by a prospective cohort study, randomized controlled trials, and meta-analyses.

Summary

Among the dietary patterns identified, Mediterranean dietary patterns should be considered as primary nutritional recommendation for cardiovascular disease prevention among individuals with diabetes.

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Pancreatic Metastases of Rectal Cancer—Case Report and Literature Review

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Anti myelin oligodendrocyte glycoprotein associated immunoglobulin G (AntiMOG-IgG)-associated neuromyelitis optica spectrum disorder with persistent disease activity and residual cognitive impairment

Lekha Pandit, Ichiro Nakashima, Sharik Mustafa, Toshiyuki Takahashi, Kimhiko Kaneko

Annals of Indian Academy of Neurology 2017 20(4):411-413

Antibodies targeting myelin oligodendrocyte glycoprotein (MOG) have been recently reported in association with idiopathic inflammatory central nervous system disorders. Initially believed to be a benign disorder, anti MOG-IgG was noted to cause steroid responsive recurrent optic neuritis and isolated longitudinally extensive myelitis. However, there is growing evidence that the disease may be predominantly relapsing, often producing severe visual loss and involving regions other than the spinal cord and optic nerve. We report an adolescent male with an aggressive disease course previously undescribed in anti MOG-IgG-associated disease that left him with residual cognitive dysfunction.

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Status of cognitive testing of adults in India

AP Porrselvi, V Shankar

Annals of Indian Academy of Neurology 2017 20(4):334-340

The assessment of cognitive function is a challenging yet an integral component of psychological, psychiatric, and neurological evaluation. Cognitive assessment tools either can be administered quickly for screening for neurocognitive disorders or can be comprehensive and detailed to identify cognitive deficits for the purpose of localization, diagnosis, and rehabilitation. This article is a comprehensive review of published research that discusses the current challenges for cognitive testing in India, available tools used for the assessment of cognitive function in India, and future directions for cognitive testing in India.

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Clinico-Electrophysiological and genetic overlaps and magnetic resonance imaging findings in Charcot–Marie– Tooth disease: A pilot study from Western India

Satish Vasant Khadilkar, Nahush D Patil, Nikhil Dhananjay Kadam, Khushnuma A Mansukhani, Bhagyadhan A Patel

Annals of Indian Academy of Neurology 2017 20(4):425-429

Background: Charcot–Marie–Tooth (CMT) disease is clinically and genetically heterogeneous. There are no published series describing clinical, electrophysiological, and genetic information on CMT from the Indian subcontinent. Magnetic resonance imaging (MRI) neurography technique provides useful information about the plexus and roots and can be employed in patients with CMT. Settings and Design: A prospective, observational study carried out at a tertiary care hospital in Western India. Subjects and Methods: CMT patients fulfilling the UK Genetic Testing Network criteria were included. They underwent clinical, electrophysiological, radiological, and multigene panel testing. Results: Totally 22 patients (19 males, 3 females; 18 sporadic and 4 familial cases) were studied. Pes cavus (19), hammer toes (16), and scoliosis was seen in 1 patient. Electrophysiology revealed motor predominant neuropathy with 15 demyelinating (10 uniform and 5 multifocal) and 7 axonal patterns. Thickened lumbosacral plexuses on MRI neurography were evident in 6/10 studied patients, all 6 having demyelinating neuropathy. Genetic analysis identified PMP22, GJB1, SH3TC2, HSPB1, SPTLC2, MPZ, AARS, and NEFH gene mutations. Conclusions: This small series documents the pattern of CMT neuropathies as seen in Western India. Clinico-electrophysiological and genetic diagnosis showed general concordance some overlaps and reiterated advantages of gene panel testing in this heterogeneous group of neuropathies. MRI neurography was useful as an additional investigation to detect nerve enlargement in patients with demyelinating neuropathies.

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As I sign off

Satish V Khadilkar

Annals of Indian Academy of Neurology 2017 20(4):333-333



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Speech signal analysis and pattern recognition in diagnosis of dysarthria

Minu George Thoppil, C Santhosh Kumar, Anand Kumar, John Amose

Annals of Indian Academy of Neurology 2017 20(4):352-357

Background: Dysarthria refers to a group of disorders resulting from disturbances in muscular control over the speech mechanism due to damage of central or peripheral nervous system. There is wide subjective variability in assessment of dysarthria between different clinicians. In our study, we tried to identify a pattern among types of dysarthria by acoustic analysis and to prevent intersubject variability. Objectives: (1) Pattern recognition among types of dysarthria with software tool and to compare with normal subjects. (2) To assess the severity of dysarthria with software tool. Materials and Methods: Speech of seventy subjects were recorded, both normal subjects and the dysarthric patients who attended the outpatient department/admitted in AIMS. Speech waveforms were analyzed using Praat and MATHLAB toolkit. The pitch contour, formant variation, and speech duration of the extracted graphs were analyzed. Results: Study population included 25 normal subjects and 45 dysarthric patients. Dysarthric subjects included 24 patients with extrapyramidal dysarthria, 14 cases of spastic dysarthria, and 7 cases of ataxic dysarthria. Analysis of pitch of the study population showed a specific pattern in each type. F0 jitter was found in spastic dysarthria, pitch break with ataxic dysarthria, and pitch monotonicity with extrapyramidal dysarthria. By pattern recognition, we identified 19 cases in which one or more recognized patterns coexisted. There was a significant correlation between the severity of dysarthria and formant range. Conclusions: Specific patterns were identified for types of dysarthria so that this software tool will help clinicians to identify the types of dysarthria in a better way and could prevent intersubject variability. We also assessed the severity of dysarthria by formant range. Mixed dysarthria can be more common than clinically expected.

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A rare presentation of a nondiscogenic cause of acute lumbar radiculopathy

Lobo Manuel Alexander, Vivek Jacob Philip

Annals of Indian Academy of Neurology 2017 20(4):416-417



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Optical coherence tomography and subclinical optical neuritis in longitudinally extensive transverse myelitis

Prakash Kumar Sinha, Deepika Joshi, Virendra Pratap Singh, Sujit Deshmukh, Usha Singh, Abhishek Pathak, Vijay Nath Mishra, Rameshwar Nath Chaurasia, Vivek Sharda, Garima Gupta

Annals of Indian Academy of Neurology 2017 20(4):358-362

Objective: The aim is to compare the retinal nerve fiber layer (RNFL) thickness of longitudinally extensive transverse myelitis (LETM) eyes without previous optic neuritis with that of healthy control subjects. Methods: Over 20 LETM eyes and 20 normal control eyes were included in the study and subjected to optical coherence tomography to evaluate and compare the RNFL thickness. Result: Significant RNFL thinning was observed at 8 o'clock position in LETM eyes as compared to the control eyes (P = 0.038). No significant differences were seen in other RNFL measurements. Conclusion: Even in the absence of previous optic neuritis LETM can lead to subclinical axonal damage leading to focal RNFL thinning.

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Rapid clinical score for the diagnosis of tuberculous meningitis: A retrospective cohort study

Raluca Jipa, Ioana D Olaru, Eliza Manea, Simona Merisor, Adriana Hristea

Annals of Indian Academy of Neurology 2017 20(4):363-366

Objective: The aim of our study was to retrospectively validate a previously described rapid clinical score (RCS) in distinguishing tuberculous meningitis (TBM) from viral meningitis (VM) in people who are at increased risk of tuberculosis, as well as from cryptococcal meningitis (CM) in HIV-infected patients. Methods: We performed a retrospective study of patients admitted with a diagnosis of aseptic meningitis between January 2012 and December 2015, to a referral hospital for infectious diseases. The variables included in RCS were duration of symptoms before admission, neurological stage, cerebrospinal fluid (CSF) to blood glucose ratio, and CSF protein. We included in this retrospective study 31 patients with definite or probable TBM including 14 HIV-infected patients, 62 HIV-noninfected patients with VM, and 18 HIV-infected patients with CM. Results: The sensitivity of RCS to distinguish TBM from VM was 96.7%, with a specificity of 81.1% and the area under the receiver operating characteristic (ROC) curve was 0.949 (0.90–0.99). When all four criteria from the RCS were present, the specificity increased at 100%. In HIV-infected patients, the sensitivity and specificity of RCS in differentiating TBM from CM were 86.6% and 27.7%, respectively, and the area under the ROC curve was 0.669 (0.48–0.85). Conclusion: This easy-to-use RCS was found to be helpful in differentiating TBM from VM, with a better sensitivity than molecular amplification techniques and a relatively good specificity. However, the RCS was not useful to differentiate between TBM and CM in HIV-infected patients.

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Bone health in patients with epilepsy: A community-based pilot nested case–control study

Shweta Singla, Sandeep Kaushal, Shalini Arora, Gagandeep Singh

Annals of Indian Academy of Neurology 2017 20(4):367-371

Background: Antiepileptic drugs (AEDs) adversely affect bone health and there are reports describing association of alternations of bone and mineral metabolism in epileptic patients. Objectives: This study was undertaken to evaluate the bone profile (bone mineral parameters and bone mineral density [BMD]) of patients with epilepsy and compare them to their age-, gender-, and socioeconomic status-matched healthy controls in a community. Materials and Methods: This was a nested case–control study conducted in fifty individuals, which included 25 cases (age above 18 years and on AEDs for at least 3 years) for which 25 controls were selected from the same community. Bone mineral parameters (serum calcium, proteins, phosphorous, alkaline phosphate, parathyroid hormone, and Vitamin D) and BMD were measured. Results: There was significant hypocalcemia (P = 0.003), hypoproteinemia (P = 0.014), hyperparathyroidism (P = 0.048), and increased levels of serum alkaline phosphatase (P = 0.019) in cases as compared to controls. The difference was insignificant in the serum levels of Vitamin D and phosphorous among both the groups. Vitamin D was significantly low in female patients as compared to males (P = 0.043). There was no significant difference in BMD at the lumbar spine and femur neck among both the groups. Mean duration of epilepsy was longest in patients with osteoporosis (23.6 years), and increasing duration of epilepsy was associated with reduction in age- and sex-corrected total BMD mean Z-score anteroposterior spine. There was negative correlation between cumulative drug load and T-score of patients with epilepsy. Conclusion: Patients on long-term AED treatment have altered bone profile as evident from biochemical parameters and reduced BMD. There is a need for more extensive research and that too on a larger sample size.

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Treatment-related fluctuations in guillain barre syndrome and the conundrum of additional cycles of plasmapheresis

Subasree Ramakrishnan, Veerendrakumar Mustare, Mariamma Philip, K Thennarasu, Sunder Periyavan

Annals of Indian Academy of Neurology 2017 20(4):372-377

Introduction: In Guillain Barre syndrome (GBS), worsening of weakness or disability after initial period of recovery or stabilization is described as treatment-related fluctuations (TRF). Aim: This study aims to describe the clinical characteristics and outcome of six patients with GBS and TRF. Patients and Methods: Six patients with GBS fulfilling NINCDS criteria, evaluated at a tertiary care university hospital during 2008–2017, were diagnosed to have TRF. They form the basis of this report. Results: All patients were men and their mean age was 40 years. At presentation, mean duration of illness was 15 days; the illness had plateaued in three and progressive in other three patients. Two of the four patients had variant GBS. Initially, five patients were treated with large volume plasmapheresis (LVPP) and one patient with methyl prednisolone. At 17–28 days after disease onset, three patients developed new neurologic deficits (bilateral facial paresis in two; paralytic ileus in one). Other three patients with worsening of limb weakness (medical research council sum score of >5) and disability (Hughes disability grade by ≥1) fulfilled Kleyweg's criteria for TRF. All the six patients were treated with the completion of five cycles or additional cycles of LVPP. Conclusion: Awareness about TRF is essential for correct diagnosis and management of patients with GBS.

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Subdural empyema in disseminated histoplasmosis

Mansoor C Abdulla, Ram Narayan, Neena Mampilly, Prem Kumar

Annals of Indian Academy of Neurology 2017 20(4):414-415



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Atherosclerotic carotid plaques: Multimodality imaging with contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging

Divyata R Hingwala, Kesavadas Chandrasekhakan, Bejoy Thomas, PN Sylaja, M Unnikrishnan, TR Kapilamoorthy

Annals of Indian Academy of Neurology 2017 20(4):378-386

Introduction: The imaging of carotid plaques has undergone a paradigm shift increasing importance being given to plaque characterization. Patients with "vulnerable" plaques are more prone to develop future neurovascular events. Purpose: The purpose of this study is to analyze the role of multimodality imaging techniques in the assessment of carotid atherosclerotic plaques. Materials and Methods: Twenty-six patients were prospectively enrolled in the study. Patients underwent multidetector computed tomography (CT) angiography, ultrasound, contrast-enhanced ultrasound, and high-resolution magnetic resonance imaging (MRI) of the carotid arteries with special emphasis on the carotid bifurcation. Results: The mean age of patients was 65.41 years. Twenty-one were males. Plaque neovascularization was seen in 10 of the 18 plaques studied (55.56%). Based on the predominant components of the plaque, plaques were characterized as lipid (3), lipid with recent hemorrhage (1), fibrous (7), fibrofatty (4), fibrofatty with some hemorrhagic components (3), and recent hemorrhage (2). Conclusions: Together, contrast-enhanced ultrasound, CT, and MRI provide complete information about the plaque characteristics.

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Female caregivers and stroke severity determines caregiver stress in stroke patients

Bindu Menon, P Salini, K Habeeba, Jyoti Conjeevaram, K Munisusmitha

Annals of Indian Academy of Neurology 2017 20(4):418-424

Background: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. Materials and Methods: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] <75) and B (BI >75) according to patient's BI, according to gender (male and female CG) and relation; spouses (wife, husband), daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws). Data were analyzed using SPSS software version–21. Data were analyzed to determine which variables of the patient effects the CG stress. Results: Majority of the CGs (74.62%) were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002) than males (χ2 = 11.931, P = 0.018); wives and daughters than other relations (χ2 = 32.184, P = 0.000), (χ2 = 35.162, P = 0.019). Conclusion: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in patients with severe stroke.

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Hipoacusia: Un nuevo factor de riesgo para demencia

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Sinus Tympani y recidiva en cirugía de colesteatoma

RESUMEN Introducción: El sinus tympani (ST) es una de las áreas que más presenta colesteatoma residual. Recientemente se ha clasificado en 3 tipos de acuerdo a su morfología. Objetivos: Determinar el tipo de ST en los pacientes sometidos a cirugía de colesteatoma y analizar su impacto como factor de recidiva. Material y método: Revisión de fichas clínicas de pacientes sometidos a cirugía de colesteatoma entre los años 2004 y 2015 en el Hospital Regional de Concepción. Análisis de la tomografía axial computarizada (TAC) preoperatoria y posterior evaluación clínica de los pacientes operados mediante mastoidectomía canal wall down (CWD). Resultados: En el periodo descrito se operaron 271 oídos. El 60% de los casos analizados presentó ST tipo A y 40% ST tipo B. Se identificaron 12 casos de recidiva, 3 ST tipo B y 9 ST tipo A, sin diferencia estadísticamente significativa entre ambos. Discusión: Distinto a lo reportado en la literatura el tipo de ST más frecuente en nuestro estudio fue el tipo A, lo que podría corresponder a una variable étnica. Conclusión: El estudio preoperatorio con TAC es una herramienta útil para evaluar el tipo y compromiso del ST. Las diferencias anatómicas entre ST tipo A y B parece no ser un factor determinante de recidiva en mastoidectomías CWD.

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ABSTRACT Introduction: Sinus tympani (ST) is one of the areas with the most residual cholesteatoma. Recently it has been classified in 3 types according to its morphology. Aim: To determine the type of ST in patients undergoing cholesteatoma surgery and to analyze its impact as a relapse factor. Material and method: Review of clinical files of patients submitted to cholesteatoma surgery between 2004 and 2015 at the Regional Hospital of Concepción. Preoperative computed axial tomography (CT) analysis and subsequent clinical evaluation of patients operated by canal wall down mastoidectomy (CWD). Results: In the described period 271 ears were operated. 60% of the cases analyzed had ST type A and 40% ST type B. Twelve cases of relapse were identified, 3 ST type B and 9 ST type A, with no statistically significant difference between the two. Discussion: Unlike to what is reported in the literature, the most common ST type in our study was type A, which could correspond to an ethnic variable. Conclusion: The preoperative study with CT is a useful tool to evaluate the type and commitment of ST. The anatomical differences between ST type A and B seems not to be a determinant factor of relapse in CWD mastoidectomies.

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Revestimiento interno en reconstrucción nasal: Estudio anatómico cadavérico

RESUMEN Introducción: Ante la presencia de un defecto anatómico nasal, se hace necesario considerar alternativas para restituir una correcta función y estética nasal. La estructura osteocartilaginosa nasal debe contar con un soporte o revestimiento interno que aporte una vascularización necesaria. Existen diversas técnicas de colgajos intranasales para lograr reconstituir el revestimiento interno nasal. Objetivos: Describir la técnica quirúrgica de los principales colgajos de revestimiento interno en reconstrucción nasal y su aplicación en modelos ex vivo. Material y método: Se realizó la disección de 7 especímenes de donante cadáver. Se efectuó una resección amplia nasal simulando una pérdida de tejido de las 3 capas de la anatomía nasal para su posterior reconstrucción. Resultados: Se logró replicar las distintas alternativas de técnicas de colgajos intranasales descritas para reconstrucción nasal. Conclusión: El revestimiento interno es de suma importancia en la reconstrucción nasal. Esta es una primera fase en el desarrollo y aprendizaje de la reconstrucción nasal.

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ABSTRACT Introduction: In the presence of a nasal anatomical defect, it is necessary to consider alternatives to restore a correct function and esthetic nasal result. The nasal osteocartilaginous structure must have an internal support or lining that provides a necessary vascularization. There are various techniques of intranasal flaps to achieve reconstitution of the nasal internal lining. Aim: To describe the surgical technique of the main internal lining flaps in nasal reconstruction and its application in ex vivo models. Material and method: We dissected 7 cadaver donor specimens. A broad nasal resection was performed simulating a loss of tissue from the three layers of the nasal anatomy for subsequent reconstruction. Results: It was possible to replicate the different alternatives of intranasal flap techniques described for nasal reconstruction. Conclusion: The inner lining is of paramount importance in nasal reconstruction. This is a first phase in the development and learning of nasal reconstruction.

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Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

RESUMEN Las anomalías de cuarto arco branquial corresponden a una entidad patológica infrecuente. Para su manejo existen distintas alternativas terapéuticas siendo una de ellas la cauterización endoscópica. Reportamos 3 casos de senos de cuarto arco branquial tratados mediante cauterización endoscópica en el Hospital Regional de Concepción luego de una revisión de fichas clínicas de todos los pacientes con diagnóstico de anomalías de cuarto arco branquial. Se identificaron tres casos de senos de cuarto arco branquial. Todos corresponden a pacientes de sexo masculino que presentaron cuadro de absceso cervical, diagnosticándose 2 de ellos al presentar recurrencia. Todos fueron tratados mediante cauterización endoscópica de la apertura fistulosa en seno piriforme. Estas anomalías representan vestigios de un trayecto que se origina desde el vértice del seno piriforme. La cauterización endoscópica presenta una serie de ventajas con tasas de recurrencia similares a la cirugía abierta de cuello, menores tasas de complicaciones y costo económico. Las anomalias de cuarto arco branquial constituyen una patología infrecuente y el diagnóstico requiere alta sospecha clínica. El manejo endoscópico ha demostrado ser una alternativa segura y efectiva con menor tasa de complicaciones.

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ABSTRACT Anomalies of the fourth branchial arch correspond to an uncommon pathological entity. There are different therapeutic alternatives being one of them the endoscopic cauterization. We report 3 cases of fourth branchial arch anomalies treated by endoscopic cauterization in the Regional Hospital of Concepción. Review of clinical records of all patients with diagnosis of fourth branchial anomalies operated by endoscopic cauterization at the Regional Hospital of Concepción. Cases: Three cases of fourth branchial arch sinus were identified. All of them were male patients who presented with a cervical abscess, diagnosing 2 of them when they recurred. All 3 cases were treated by endoscopic cauterization of the fistulous opening in the piriform sinus. These anomalies represent vestiges of a path that originates from the apex of the piriform sinus. Endoscopic cauterization presents a number of advantages with recurrence rates similar to open neck surgery, with lower complication rates and economic cost. Fourth branchial anomalies constitute an uncommon pathology and the diagnosis requires high clinical suspicion. Endoscopic management has proven to be a safe and effective alternative with a lower rate of complications.

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Manejo endoscópico de osteoma etmoidal con extensión orbitaria: A propósito de un caso

RESUMEN El osteoma es el tumor más frecuente de los senos paranasales, habitualmente asintomático debido a su lento crecimiento, sin embargo, pueden desarrollarse síntomas dependiendo del tamaño, localización y extensión, con potencial compromiso de órbita y cerebro. La cirugía está indicada en casos sintomáticos pudiendo realizarse abordaje externo, endoscópico o combinado. Presentamos un caso de osteoma etmoidal con compromiso orbitario resuelto, manejado por medio de la cirugía endoscópica nasal, con apoyo de navegación.

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ABSTRACT The osteoma is the most common tumor of the paranasal sinuses, is usually asymptomatic because of their slow growth, however, may develop symptoms depending on the size, location and extent, with potential compromise of orbit and brain. Surgery is indicated in symptomatic cases, with external, endoscopic or combined approach. We present a case of ethmoidal osteoma with orbital involvement managed by endoscopic image guided surgery.

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Paroxismia vestibular: Reporte de un caso

RESUMEN Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

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ABSTRACT We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

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Carcinoma parotídeo epitelial-mioepitelial: Presentación de un caso y revisión de la literatura

RESUMEN Se presenta caso de paciente de sexo femenino de 53 años de edad con tumor parotídeo izquierdo de larvada evolución, con crecimiento progresivo y otalgia ipsilateral en los últimos meses, estudiado previamente con tomografía de cuello con contraste y resonancia magnética que destacan masa del lóbulo profundo de la parótida de características imagenológicas benignas. Se realizó parotidectomía del lóbulo profundo con resección tumoral preservando el nervio facial casi en su totalidad con excepción de rama marginal, la biopsia de la pieza quirúrgica fue informada como carcinoma epitelialmioepitelial de bajo grado, un tumor infrecuente de las glándulas salivales. Se decidió completar la parotidectomía superficial y realizar vaciamiento ganglionar selectivo lateral ipsilateral, complementando el tratamiento con radioterapia. Además se presenta una revisión de la literatura correspondiente.

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ABSTRACT We present a case of a 53 years old female patient with a left parotid tumor, with slow evolution, progressive growth and ipsilateral otalgia during later months. She was previously studied by tomography of the neck with contrast and magnetic resonance, which showed the mass of the deep lobe to have benign imaging characteristics. A parotidectomy of deep lobe was performed, with tumoral resection, preserving the facial nerve with the exception of the marginal branch. The biopsy was informed as epithelial-myoephitelial carcinoma, a rare salivary gland tumor. We completed the parotidectomy with neck dissection and Radiotherapy complementary was made. Besides we presented a literature review.

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Carcinosarcoma de laringe: Reporte de dos casos

RESUMEN El carcinosarcoma de laringe es un tumor bifásico raro que representa menos del 1% de todos los tumores malignos de laringe. Debido a su doble naturaleza epitelial y mesenquimal esta neoplasia ha sido denominada de distintas maneras en la literatura, siendo indispensable el estudio mediante inmunohistoquímica para establecer un diagnóstico correcto. Se presentan 2 casos de carcinosarcoma de laringe, confirmados mediante estudio con inmunohistoquímica, ambos tratados mediante laringectomía total. Se elabora una discusión de los principales aspectos clínicos, histopatológicos y terapéuticos de esta infrecuente neoplasia.

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ABSTRACT The larynx carcinosarcoma is a rare biphasic tumor that represents less than 1% of all malignant tumors of the larynx. Because of its biphasic epithelial and mesenchymal nature this neoplasm has been called in different ways in the literature being indispensable the study by immunohistochemistry to establish a proper diagnosis. We present 2 cases of larynx carcinosarcoma confirmed by immunohistochemical study, both treated with total laryngectomy. A discussion of the main clinical, histopathological and therapeutic aspects of this rare neoplasm is made.

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Enfisema subcutáneo masivo, nemotórax a tensión y neumomediastino tras traqueotomía percutánea

RESUMEN Mujer de 68 años que ingresa en la Unidad de Cuidados Intensivos por shock séptico. En el posoperatorio la paciente se mantiene inestable y se decide realizar traqueotomía percutánea (TP) por intubación prolongada. Al inicio la paciente presenta un enfisema subcutáneo que progresa hasta convertirse en masivo. Se realiza TC torácico donde se observa pérdida de la morfología habitual de la pared posterior traqueal con solución de continuidad. Tras revisión mediante traqueobroncoscopía se decide colocar cánula de traqueotomía larga para dejar la lesión proximal al neumotaponamiento y así evitar la fuga de aire. Desde la colocación de la nueva cánula, la paciente presenta una disminución progresiva del enfisema hasta su total resolución. La TP es un procedimiento seguro que se realiza con mucha frecuencia en los servicios de medicina intensiva, sin embargo, no está exenta de complicaciones. En la revisión de Powell y cols describen las complicaciones de la TP destacando la inserción peritraqueal, la hemorragia, las infecciones de la herida, el neumotórax y la muerte. El rango de complicaciones en la literatura oscila entre 3% y 18%. Además, no se encuentran diferencias significativas respecto a las complicaciones entre la TP y la técnica abierta.

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ABSTRACT A 68-year-old woman who enter in intensive care unit due to septic shock. In the postoperative period, the patient remained unstable and decided to perform a percutaneous tracheotomy (PT) because prolonged intubation. In the first, the patient presents subcutaneous emphysema that progresses until becoming massive. Thoracic CT is performed where loss of the usual morphology of the posterior tracheal wall with continuity solution is observed. After revision by means of tracheobroncoscopia, it is decided to place a long tracheotomy cannula to leave the lesion proximal to pneumotaponamiento and thus avoid air leakage. From the placement of the new cannula, the patient presents a progressive decrease of the emphysema until its total resolution. PD is a safe procedure that is performed very frequently in the Intensive Care Services3, however, it is not without its complications. The review of Powell et al4 describes the complications of PT emphasizing peritracheal insertion, hemorrhage, wound infections, pneumothorax, and death. The range of complications in the literature ranges from 3 to 18% 5. In addition, no significant differences were found regarding the complications between the TP and the open technique.

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Tuberculosis como causa de adenopatías cervicales

RESUMEN La tuberculosis (TBC) es una enfermedad infecto-contagiosa de distribución mundial causada por Mycobacterium tuberculosis, y otras micobacterias atípicas. La afectación ganglionar es tardía y sus manifestaciones clínicas asociadas suelen ser inespecíficas, por eso, el diagnóstico de tuberculosis ganglionar a menudo se retrasa y es un hallazgo inesperado en numerosas ocasiones. Este artículo pretende realizar una revisión bibliográfica sobre la tuberculosis ganglionar y hacer hincapié en que la TBC ha de ser tenida en cuenta como diagnóstico diferencial en las masas cervicales, que muchas veces se presentan con escasa sintomatología acompañante. En este artículo presentamos dos casos de TBC ganglionar diagnosticados en nuestro servicio en los últimos meses, ambos casos se manifestaron exclusivamente como masa cervical de crecimiento lento, sin síntomas pulmonares acompañante y fueron diagnosticados de TBC tras el estudio anatomopatológico resultante de la exéresis quirúrgica de la lesión.

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ABSTRACT The tuberculosis (TB) is an infect-contagious worldwide distribution disease caused by Mycobacterium Tuberculosis and other atypical Mycobacteria. Lymph node involvement is late, and its associated clinical manifestations are usually unspecifics, therefore the diagnosis of tuberculosis lymph node is often delayed and is an unexpected finding in numerous occasions. This article aims to carry out a literature review of lymph node tuberculosis and to emphasize that TB must be taken into account as differential diagnosis in cervical masses, which often occur with few associated symptoms. In this article we present two cases of lymph node TB diagnosed in our department in last months, both cases presented exclusively as cervical mass of slow growth, without any accompanying pulmonary symptoms and were diagnosed as TB after the surgical removal of the lesion and its histopathological study.

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