Psychometric Testing of the Fear of Cancer Recurrence Inventory- Caregiver Chinese Version in Cancer Family Caregivers in Taiwan

Abstract

Objective

The purposes of this study were to develop a Chinese version of the Fear of Cancer Recurrence Inventory-caregiver (FCRI-c Chinese) and assess the psychometrics of this test in the family caregivers (FCs) of Taiwanese patients with head and neck cancer (HNC).

Methods

An instrument testing study was conducted at a major medical center in Taiwan. HNC patients and their major FCs were recruited as dyads from the radiation outpatient department. The FCRI-c Chinese was tested for internal consistency reliability, test-retest reliability, and construct validity (including theoretically supported correlation, discriminant validity, and factor structure).

Results

We recruited 300 patient-caregiver dyads. The test had good internal consistency (Cronbach's alpha = 0.94) and a 2-week test-retest reliability of 0.88. Confirmatory factor analysis (CFA) indicated an acceptable fit of the model to the data. The construct validity was also satisfactory, as indicated by the significant positive correlations of the test with depression and anxiety in FCs, and the significant negative correlation of the test with patients' quality of life. A significantly higher test score was present in FCs caring for patients with metastasis and patients who completed treatment a longer time ago.

Conclusions

The FCRI-c Chinese is a valid instrument for examination of the FCR in the FCs of patients with HNC. Clinicians can use this multi-dimensional instrument to assess important clinical care issues and improve the quality of care provided by FCs.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oX8FWH

Beyond using composite measures to analyze the effect of unmet supportive care needs on caregivers' anxiety and depression

Abstract

Objective

Caregiver research has relied on composite measures (e.g., count) of unmet supportive care needs to determine relationships with anxiety and depression. Such composite measures assume that all unmet needs have a similar impact on outcomes. The purpose of this study is to identify individual unmet needs most associated with caregivers' anxiety and depression.

Methods

219 Caregivers completed the 44-item Supportive Care Needs Survey and the Hospital Anxiety and Depression scale [minimal clinically important difference (MCID)=1.5] at 6-8 months, 1, 2, 3.5, and 5 years following the patients' cancer diagnosis. The list of needs was reduced using Partial Least Square regression and those with a Variance Importance in Projection > 1 were analyzed using Bayesian Model Averaging.

Results

Across time, eight items remained in the top 10 based on prevalence and were labelled "core". Three additional ones were labelled "frequent", as they remained in the top 10 from 1-year onwards. Bayesian Model Averaging identified a maximum of four significant unmet needs per time point – all leading to a difference greater than the MCID. For depression, none of the core unmet needs were significant, rather significance was noted for frequent needs and needs that were not prevalent. For anxiety, 3/8 core and 3/3 frequent unmet needs were significant.

Conclusions

Prevalent Those unmet needs that are most prevalent are not necessarily the most significant ones, and findings provide an evidence-based framework to guide the development of caregiver interventions. A broader contribution is proposing a different approach to identify significant unmet needs.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I5a0Dt

Hypothesizing the potential implications of exposing known carcinogens on normal stem cells

Publication date: Available online 5 March 2018
Source:Oral Oncology
Author(s): A. Thirumal Raj, Supriya Kheur




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ft6uEd

Pyloric metaplasia, pseudopyloric metaplasia, ulcer-associated cell lineage and spasmolytic polypeptide-expressing metaplasia: reparative lineages in the gastrointestinal mucosa.

Summary

The gastrointestinal mucosae provide a critical barrier between the external and internal milieu. Thus, damage to the mucosa requires an immediate response to provide appropriate wound closure and healing. Metaplastic lineages with phenotypes similar to the mucous glands of the distal stomach or Brunner's glands have been associated with various injurious scenarios in the stomach, small bowel and colon. These lineages have been assigned various names including pyloric metaplasia, pseudopyloric metaplasia, ulcer-associated cell lineage (UACL) and spasmolytic polypeptide-expressing metaplasia (SPEM). A re-examination of the literature on these various forms of mucous cell metaplasia suggests that pyloric type mucosal gland lineages may provide a ubiquitous response to mucosal injury throughout the gastrointestinal tract as well as in the pancreas, esophagus and other mucosal surfaces. While the cellular origin of these putative reparative lineages likely varies in different regions of the gut, their final phenotypes may converge on a pyloric type gland dedicated to mucous secretion. In addition to their healing properties in the setting of acute injury, these pyloric type lineages may also represent precursors to neoplastic transitions in the face of chronic inflammatory influences. Further investigations are needed to determine how discrete molecular profiles relate to the origin and function of pyloric-type metaplasias previously described by histological characteristics in multiple epithelial mucosal systems in the setting of acute and chronic damage.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FqsLmq

Stigma and its influencing factors among Chinese patients with stoma

Abstract

Background

Although stomas are necessary for disease treatment, they unavoidably affect patients' lives from physical, psychological, social, spiritual and familial perspectives and contribute to feelings of embarrassment and shame. This study explored the current status and factors influencing stigma among Chinese patients with stoma.

Methods

A total of 209 patients with stoma at the stoma clinic of a tertiary cancer centre in Guangzhou, China, were recruited and investigated using the Social Impact Scale, the Coping Self-Efficacy Scale, the State Self-Esteem Scale, and a demographic questionnaire. Multivariate linear regression was used to identify the factors influencing stigma.

Results

The mean Social Impact Scale score was 69.65±13.18, which represents a moderate effect; specifically, 44% of the patients experienced high levels of stigma. Stoma patients with the following characteristics had high levels of stigma: young, low coping self-efficacy, low stoma acceptance by one's spouse or other family members, poor perceived body image, stool leakage, no experience of participating in activities with other stoma patients.

Conclusions

Medical staff members should pay more attention to stigma in stoma patients. Coping self-efficacy, family members' acceptance of the stoma and participation in activities with other stoma patients are influencing factors that protect these patients against stigma, whereas body image loss and stool leakage place them at higher risk for stigma. Interventions aimed at improving protective factors and decreasing risk factors should be considered to reduce the level of stigma in patients with stoma.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H7BmaB

Issue Information

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuQams

Cover Image

The cover image, by Selene Xu et al., is based on the Paper Cognition, quality-of-life and symptom clusters in breast cancer: Using Bayesian networks to elucidate complex relationships, DOI 10.1002/pon.4571.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H7BerD

Physical Properties, Film Thickness, and Bond Strengths of Resin-Modified Glass Ionomer Cements According to Their Delivery Method

Abstract

Purpose

To determine the effect of changing the dispensing or mixing method of resin-modified glass ionomer (RMGI) cements on their water sorption, solubility, film thickness, and shear bond strength.

Materials and Methods

Disc-shaped specimens of RMGI cements (RelyX: Luting [handmix], Luting Plus [clicker-handmix], Luting Plus [automix], GC: Fuji PLUS [capsule-automix], FujiCEM 2 [automix], [n = 10]) were prepared according to ISO standard 4049 for water sorption and solubility tests. Furthermore, the percentage of mass change, percentage of solubility, and percentage of water absorbed was also determined. Film thickness was measured according to ISO standard 9917-2; the mean of 5 measurements for each cement was calculated. Shear bond strength for each cement was determined according to ISO standard 29022 before and after thermocycling at 20,000 cycles, temperatures 5 to 55°C with a 15-second dwell time (n = 10/subgroup). Two- and one-way ANOVA were used to analyze data for statistical significance (p < 0.05).

Results

Water sorptions of the RMGI cements were in close range (214-250 μg/mm³) with no statistical differences between counterparts (p > 0.05). RelyX Luting Plus (clicker-handmix) displayed lower solubility than its handmix and automix counterparts (p < 0.05). Film thickness of RelyX cements was significantly different (p < 0.05). RelyX Luting Plus (automix) had the lowest film thickness (19 μm) compared to its handmix (48 μm) and clicker-handmix (117 μm) counterparts (p < 0.05). GC Fuji PLUS (capsule-automix, 22 μm) was significantly lower than the automix version (GC FujiCEM 2, 127 μm) (p < 0.05). Shear bond strength of RelyX Luting Plus (automix) was significantly lower than its handmix and clicker-handmix versions (p < 0.05). GC Fuji PLUS (capsule-automix) was significantly higher than GC FujiCEM 2 (automix) (p < 0.05). The binary interaction of the two independent variables (dispensing/mixing method and thermocycling) was significant for the shear bond strengths of the GC cements only (p < 0.05).

Conclusions

Change in the dispensing/mixing method of RMGI cement from the same brand may have an effect on its physical properties, in addition to its film thickness and shear bond strength. Newer, easier, and faster cement delivery systems are not necessarily better. Clinical outcomes of these differences are yet to be confirmed.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oSknBL

In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions

Abstract

Purpose

Molar MOD (mesial-occlusal-distal) cavity preparation weakens relative cuspal stiffness by up to 63%, often resulting in cuspal fracture. This investigation inspects fracture resistance of MOD cavities restored using direct composite restoration.

Materials and Methods

120 extracted, intact mandibular molars were selected. MOD cavities with different depth/wall thickness were prepared in 9 groups (n = 12): A: 3 mm/3.5 mm, B: 3 mm/2.5 mm, C: 3 mm/1.5 mm, D: 5 mm/3.5 mm, E: 5 mm/2.5 mm, F: 5 mm/1.5 mm, G: 7 mm/3.5 mm, H: 7 mm/2.5 mm, I: 7 mm/1.5 mm. Specimens with 7 mm deep cavities received root canal treatment. The teeth were restored with dental composite. Maximal fracture strength test was conducted. Intact natural teeth were used as control. For statistical analysis Kruskal-Wallis ANOVA with post-hoc pairwise comparisons was used (α = 0.05).

Results

Significant difference was indicated between the control and groups D, E, F, G, H, and I. No significant differences were found between the A, B, C groups and the control. Comparing the 5 and 7 mm cavity depth groups, there was no statistical difference between any of them.

Conclusions

Within the limitations of this investigation, the following conclusions can be drawn regarding molar teeth with a MOD cavity: 3 mm or shallower cavities can be restored to the physiological fracture strength with direct composite restorations; 5 mm or deeper cavities cannot be restored to the physiological fracture strength with direct composite restorations. Cusp thickness does not significantly influence fracture strength in molar MOD cavities with a direct composite restoration.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I5LClh

The Development of Nonanatomic Denture Occlusion: Part III

Abstract

Part III of this four-part series about nonanatomic denture tooth development traces the evolution of this movement from the mid-1930s through the World War II era up to the early 1950s. By this time, the general preference for posterior denture occlusion had shifted from anatomic to nonanatomic teeth, and all the major denture tooth manufacturing companies listed at least one nonanatomic design in their inventories.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oSkGMV

Risk of Dental Implant Failure Associated With Medication Use

Abstract

Purpose

The probability of achieving important clinical outcomes is an increasingly important factor for patients considering various treatment options for tooth loss. For oral reconstruction involving dental implants, the patient-specific risks of implant failure may be influenced by the patient's medication profile. The purpose of this study was to identify associations between dental implant failure and medication use in a consecutive series of patients seen from October 1983 through December 2014 at the Department of Dental Specialties, Mayo Clinic (Rochester, Minnesota).

Materials and Methods

In this patient-level analysis, demographic, implant-specific, and medical profile data were abstracted from a prospective clinical database and individual medical records and used to determine the time to first implant failure. Implant failure-free survival at the patient level was estimated using the Kaplan-Meier method. Associations of demographic characteristics and medication use with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals.

Results

In the 31-year study period, 6358 patients received their first dental implant (median age, 53 years). The median follow-up duration of the 5645 patients whose implants did not fail was 5.8 years, and 713 patients had implant failure (median, 0.6 years). All associations were adjusted for age, sex, and era of implantation because these features strongly influence medication use and implant failure. After adjustment, no medication increased the risk of implant failure in the cohort; specifically, medication use at the time of implant placement or starting a medication after implant placement did not increase the risk of implant failure. Among the medications used at the time of implant placement, corticosteroids were associated with a reduced risk of implant failure (hazard ratio, 0.82; 95% CI, 0.67-0.99; p = 0.04). This association was not seen when corticosteroids were started after implant placement.

Conclusion

In the population studied, medication use was not associated with an increased risk of dental implant failure.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I5X7ZC

The “Pectoral-Gap Phenomenon”: A Hypothesis on Origin and Mechanism

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D1UJPV

Pituitary height at magnetic resonance imaging in pediatric isolated growth hormone deficiency

Abstract

Background

Magnetic resonance imaging (MRI) is used for neuroradiologic evaluation of patients with idiopathic growth hormone deficiency (IGHD).

Objectives

To compare pituitary height and morphology at MRI between patients with IGHD and controls.

Materials and methods

This retrospective study was conducted in pediatric patients, 3 years–15 years old, who had had brain MRI with non-contrast-enhanced midsagittal T1-weighted images. These images were measured for pituitary height and morphology of the pituitary gland including shape, stalk and posterior pituitary bright spot was evaluated.

Results

One hundred and nineteen patients were included, with 49 and 70 patients assigned to the study and control groups, respectively. Mean pituitary height was significantly less in the IGHD group than in the control group (3.81 mm±1.38 vs. 4.92 mm±1.13, retrospectively; P<0.001). Subgroup analysis revealed a significant difference in the pituitary height between groups in the prepubertal (8–10 years) and pubertal (11–13 years) periods (P=0.039 and P=0.006, respectively) and a trend toward significance in the postpubertal period (P=0.053). There was a significant difference in pituitary shape between IGHD and controls when combining grades III, IV and V (P=0.007). Other abnormal MRI findings of the pituitary stalk and posterior bright spot were significantly more often observed in the IGHD group (P<0.05).

Conclusion

Pituitary height was significantly smaller in patients with IGHD than in controls during prepuberty and puberty. Abnormal concave superior contour, hypoplastic stalk and absent/ectopic posterior bright spot were observed significantly more often among patients with IGHD.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FWMwzM

Long-term Outcomes After Stereotactic Radiosurgery for Spine Metastases: Radiation Dose-Response for Late Toxicity

Publication date: Available online 6 March 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Diane C. Ling, John C. Flickinger, Steven A. Burton, Dwight E. Heron, Annette E. Quinn, Ghassan K. Bejjani, Johnathan A. Engh, Peter C. Gerszten, Nduka M. Amankulor, John A. Vargo
BackgroundWhile a large body of data supports the safety and efficacy of stereotactic radiosurgery (SRS) for the primary treatment and re-irradiation of spine metastases, concerns over late toxicity inherent to hypofractionation remain, as follow-up in most series is limited to 1-2 years.MethodsA retrospective review was performed on 562 patients treated with SRS for spine metastases between April 2001 and July 2011. Selecting those with at least 5-year survival after SRS, included were 43 patients who collectively underwent 84 treatments at 54 spine sites. Most were treated with single-fraction SRS to a median dose of 16Gy (range: 12-24), and 56% of sites had received prior external beam radiation therapy. Late toxicities and vertebral compression fractures (VCF) occurring in the absence of tumor progression were recorded. Binary logistic regression was used to identify predictors of late complications.ResultsNine patients (17% of treatment sites) developed grade ≥2 late toxicities at a median time of 12.8 months (range: 4.2-59.0). Actuarial 5- and 10-year rates of grade ≥2 late toxicity were 17% and 17%, respectively. On multivariate analysis, only cumulative BED3 >200Gy (or EQD22Gy >130Gy) was associated with grade ≥2 late toxicity (p=0.036). Maximum point BED3 >110Gy (or EQD22Gy >70Gy) to spinal cord or cauda equina was associated with grade ≥2 late neuropathy (p=0.017). Nine (18%) VCFs occurred at a median time of 10.2 months (range: 3.2-57.2), with 5- and 10-year VCF rates of 17% and 17%, respectively.ConclusionSRS for primary treatment and re-irradiation of spinal metastases is associated with a moderate risk of late toxicity with 10-year follow-up. Risk of late toxicity significantly increases with cumulative BED3 >200Gy and spinal cord or cauda equina point BED3 >110Gy. Patients remain at moderate risk of VCF up to 5-years following treatment, with a plateau in incidence thereafter up to 10 years.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FlCSW0

Otoemisiones en los niños tratados con gentamicina de un hospital comarcal

Publication date: Available online 5 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): Jose Miguel Sequi Canet, Carlos Miguel Angelats Romero, Jose Miguel Sequi Sabater, Ana Miralles Torres, Miguel Boronat Garcia, Marta Gomez Delgado
IntroducciónLas recomendaciones de la Comisión Nacional para la Detección Precoz de la Hipoacusia (CODEPEH) aconsejan re-valorar la audición de aquellos niños que hayan sufrido algún evento potencialmente dañino para la audición como es la utilización de antibióticos ototóxicos como la gentamicina. Las otoemisiones evocadas son un buen método de evaluación de la integridad de la función coclear.Material y métodoSe presenta un estudio prospectivo que incluye a 92 niños, sin otros factores de riesgo auditivo, en los que se pautó tratamiento con gentamicina intravenosa por riesgo séptico/sepsis o infección urinaria y en los que se realizaron otoemisiones seriadas: al ingreso, al finalizar el tratamiento y al mes del alta (si estaban alteradas).ResultadosNingún sujeto presentó otoemisiones alteradas al final del seguimiento.ConclusiónLa gentamicina parece un antibiótico seguro en tratamientos con una duración <10días y a las dosis descritas. Las otoemisiones son un método barato, rápido, incruento y fiable para comprobar la posible ototoxicidad por gentamicina. Su realización podría ahorrar la determinación de niveles del fármaco.IntroductionThe National Commission for the Early Detection of Hearing Loss (CODEPEH) recommends the re-evaluation of hearing in children who have suffered any potentially harmful event, such as the prescription of ototoxic antibiotics such as gentamicin. The evoked otoacoustic emissions (EOAE) are a good method for assessing the integrity of cochlear functionality.Material and methodA prospective study is presented, including 92 children who were treated with intravenous gentamicin for septic risk/sepsis or urinary tract infection. The children underwent serial EOAE: on admission, at the end of treatment and one month later (if altered on discharge).ResultsIn the end, none of the subjects were affected by the treatment.ConclusionGentamicin appears to be a safe antibiotic in treatments lasting <10days and at the doses described. EOAE are an inexpensive, fast, non-invasive and reliable method to check for gentamicin ototoxicity. This could save in the determination of drug levels.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oSEakB

Charting the Future of Cancer Health Disparities Research—Letter

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oRXXR3

Combination immune checkpoint inhibitor therapy nivolumab and ipilimumab associated with multiple endocrinopathies

Summary

Immune checkpoint inhibitors are the mainstay of treatment for advanced melanoma, and their use is being increasingly implicated in the development of autoimmune endocrinopathies. We present a case of a 52-year-old man with metastatic melanoma on combination nivolumab and ipilumimab therapy who developed concurrent hypophysitis, type 1 diabetes mellitus (T1DM) and diabetes insipidus. He presented prior to third cycle of combination treatment with a headache, myalgias and fatigue. Biochemistry and MRI pituitary confirmed anterior pituitary dysfunction with a TSH: 0.02 mU/L (0.5–5.5 mU/L), fT4: 5.2 pmol/L (11–22 pmol/L), fT3: 4.0 pmol/L (3.2–6.4 pmol/L), cortisol (12:00 h): <9 nmol/L (74–286 nmol/L), FSH: 0.7 IU/L (1.5–9.7 IU/L), LH: <0.1 IU/L (1.8–9.2 IU/L), PRL: 1 mIU/L (90–400 mIU/L), SHBG: 34 nmol/L (19–764 nmol/L) and total testosterone: <0.4 nmol/L (9.9–27.8 nmol/L). High-dose dexamethasone (8 mg) was administered followed by hydrocortisone, thyroxine and topical testosterone replacement. Two weeks post administration of the third cycle, he became unwell with lethargy, weight loss and nocturia. Central diabetes insipidus was diagnosed on the basis of symptoms and sodium of 149 mmol/L (135–145 mmol/L). Desmopressin nasal spray was instituted with symptom resolution and normalization of serum sodium. Three weeks later, he presented again polyuric and polydipsic. His capillary glucose was 20.8 mmol/L (ketones of 2.4 mmol), low C-peptide 0.05 nmol/L (0.4–1.5 nmol/L) and HbA1c of 7.7%. T1DM was suspected, and he was commenced on an insulin infusion with rapid symptom resolution. Insulin antibodies glutamic acid decarboxylase (GAD), insulin antibody-2 (IA-2) and zinc transporter-8 (ZnT8) were negative. A follow-up MRI pituitary revealed findings consistent with recovering autoimmune hypophysitis. Immunotherapy was discontinued based on the extent of these autoimmune endocrinopathies.

Learning points:

The most effective regime for treatment of metastatic melanoma is combination immunotherapy with nivolumab and ipilumimab, and this therapy is associated with a high incidence of autoimmune endocrinopathies.

Given the high prevalence of immune-related adverse events, the threshold for functional testing should be low.

Traditional antibody testing may not be reliable to identify early-onset endocrinopathy.

Routine screening pathways have yet to be adequately validated through clinical trials.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I6oPWm

A phase II trial to evaluate the efficacy of panitumumab combined with fluorouracil-based chemotherapy for metastatic colorectal cancer: the PF trial

Abstract

Purpose

Fluorouracil monotherapy, instead of the FOLFOX or FOLFIRI regimen, is administered to patients intolerant to oxaliplatin or irinotecan because of their adverse effects. A prospective clinical trial was designed to evaluate the efficacy and safety of fluorouracil monotherapy combined with panitumumab administered to patients with KRAS wild-type (WT) metastatic colorectal cancer (mCRC) intolerant to oxaliplatin and irinotecan. Screening for potential serum biomarkers to predict early therapeutic responses was conducted.

Methods

This single-arm, open-label multicenter phase II trial recruited patients with KRAS WT mCRC from 16 institutes between January 2012 and October 2014. Panitumumab (6 mg/kg) was intravenously administered every 2 weeks, combined with fluorouracil monotherapy, in 2-week cycles. The primary objective was overall response rate, and secondary endpoints included disease-control rate, progression-free survival, overall survival, toxicity, and blood-test data.

Results

Forty patients (male, 65.0%; median age, 74 years; colon cancer, 72.5%) met eligibility criteria and received 7 cycles (median) of fluorouracil chemotherapy combined with panitumumab. There were no treatment-related deaths. Median time to treatment failure was 3.2 months. 23 (57.5%) patients experienced at least one adverse effect ≥ grade 3. The response rate was 10.0% (95% confidence interval 2.8–23.7%). Median progression-free survival and overall survival were 4.3 and 11.3 months, respectively. Total lactase dehydrogenase (LDH) levels and those of LDH-4 and LDH-5, quickly changed with disease reduction or progression.

Conclusions

Fluorouracil monotherapy combined with panitumumab was safely administered to patients with KRAS WT mCRC intolerant to oxaliplatin and irinotecan. Serum LDH levels may predict early responses.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fh6uEc

The importance of body mass normalisation for ultrasound measurements of the morphology of oblique abdominis muscles: the effect of age, gender, and sport practice

Some studies have not considered body mass as a confounder in analysis of oblique abdominis muscles (OAM) (including the oblique externus [OE] and oblique internus [OI]), which may have led to improper interpretation of results. To assess the differences in the effect of age, gender, and physical activity between normalised for body mass and actual values of the OAM as well as to establish the effect of age, gender, and physical activity on normalised for body mass OAM thicknesses in adolescents. A real-time ultrasound was used to obtain images of the OAM. Body mass normalisation for OAM thicknesses was performed with allometric scaling and the following equations: Allometric-scaled OE = OE thickness/body mass0.88; Allometric-scaled OI = OI thickness/body mass0.72. Analysis showed that boys have significantly thicker OAM than girls, and those who practise sports have thicker OAM than non-active individuals. For allometric-scaled OAM, there was only a significant gender effect, where boys have thicker allometric-scaled OAM than girls. There was a significant correlation between participants' age and the actual value of the OAM. The correlations between age and allometric-scaled OAM were insignificant. An analysis of OAM without body mass normalisation can lead to improper interpretation of study results. Thus, future studies should analyse OE and OI thickness measurements after normalisation rather than actual values. In the adolescent population, there is no effect of age and physical activity on allometric-scaled OAM; males have thicker allometric-scaled OAM than females. (Folia Morphol 2018; 77, 1: 123–130)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fggfq2

Protective effect of garlic extract against maternal and foetal cerebellar damage induced by lead administration during pregnancy in rats

Background: In spite of its industrial usefulness and varied daily uses, lead (Pb) pollution is a widespread ecological problem that faces the humans in the 21th century. Pb was found to produces a wide range of toxic effects including neurotoxicity especially to the developing and young offspring. Recently, the utilisation of herbal plants has received a significant attention where there has been rising awareness in their therapeutic use; among these is the garlic. In light of the above, the current study is designed experimentally in female pregnant rats in order to investigate the beneficial role of garlic extract in the protection from the maternal and foetal cerebellar damage produced by administration of different doses of Pb during pregnancy.

Materials and methods: Positively pregnant female rats were divided into five groups; one control group, two Pb-treated groups (exposed to 160 and 320 mg/kg b.w. of Pb, respectively) and two groups treated with both Pb and garlic (exposed to Pb as previous groups together with 250 mg/kg b.w./day of garlic extract). Treatments started from day 1 to day 20 of pregnancy, where the mother rats of different experimental groups were sacrificed to obtain the foetuses. Pb level in the maternal and foetal blood and cerebellum was estimated by spectrophotometry. Specimens of the cerebellum of different mother and foetal groups were processed to histological and immunohistochemical staining for microscopic examination.

Results: The results showed that administration of Pb to pregnant rats resulted in a dose-dependent toxicity for both mothers and foetuses in the form of decrease in maternal weight gain, placental and foetal weights, brain weight and diminished foetal growth parameters, which were prominent in rat's group treated with larger dose of Pb. In Pb-treated rats, Pb level in blood and cerebellum was high when compared with the control group. The histopathological examination of the cerebellum of treated dams and foetuses showed marked alterations mainly in the form of Purkinje cell degeneration and lack of development of foetal cerebellum. Co-treatment of garlic extract along with Pb resulted in a significant decrease in Pb levels as compared with those treated with Pb alone with improvement of the histopathological changes.

Conclusions: This study was useful in evaluating the hazardous effects of uncontrolled use of Pb in general and in assessing the developmental and neurotoxicity of foetuses due to exposure during pregnancy in particular. Co-administration of garlic has beneficial effects in amelioration of Pb-induced neurotoxicity and reversing the histopathological changes of the cerebellum of mother rats and foetuses. (Folia Morphol 2018; 77, 1: 1–15)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FieuZq

Co-existence of the double inferior vena cava with complex interiliac venous communication and aberrant common hepatic artery arising from superior mesenteric artery: a case report

Variations of the arterial and venous system of the abdomen and pelvis have important clinical significance in hepatobiliary surgery, abdominal laparoscopy, and radiological intervention. A case of double inferior vena cava (IVC) with complex interiliac communication and variation of the common hepatic artery (CHA) arising from superior mesenteric artery (SMA) in a 79-year-old male cadaver is presented. Both IVCs ascended on either side of the abdominal aorta. The left-sided IVC crossed anterior to the aorta at the level of the left renal vein. The union of both IVCs was at the level just above the right renal vein. The diameter of right-sided IVC, left-sided IVC and the common IVC were 16.73 mm, 21.57 mm and 28.75 mm, respectively. In the pelvic cavity, the right common iliac vein was formed by a union of right external and internal iliac veins while the formation of left common iliac vein was from the external iliac vein and two internal iliac veins. An interiliac vein ran from right internal iliac vein to left common iliac vein with an additional communicating vein running from the middle of this interiliac vein to the right common iliac vein. Another co-existence variation in this case was the origin of the CHA arising from the SMA with a suprapancreatic retroportal course. Clinical importance of double IVC are observed in retroperitoneal surgery, whole organ transplantation or radical nephrectomy, surgical ligation of the IVC or the placement of an IVC filter for thromboembolic disease. The variation of CHA has an important clinical significance in liver transplantation, abdominal laparoscopy and radiological abdominal intervention. (Folia Morphol 2018; 77, 1: 151–155)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FierwI

An algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion-weighted magnetic resonance images: a retrospective analysis of 158 cases

Background: To verify the usefulness of a new algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion- -weighted magnetic resonance imaging (MRI).

Materials and methods: The retrospective analysis included 158 consecutive surgical patients with parotid tumours. Aside from ultrasound-guided fine needle biopsy, the protocol of preoperative evaluation included dynamic and diffusion-weighted MRI. According to the new diagnostic algorithm, the result of fine needle biopsy was considered only in the case of lesions with time to peak enhancement (Tpeak) > 60 s and washout rate (WR) ≤ 30% on dynamic MRI and apparent diffusion coefficient (ADC) ≤ 1.7 × 103 mm/s2 on diffusion-weighted MRI, or those presenting with concomitant lymphadenopathy. The accuracy of this algorithm was verified against final histopathological diagnoses.

Results: The new algorithm gave 10 true positive and 2 false positive results, as well as 132 and 14 true and false negative results, respectively. Its sensitivity and specificity (41.7% and 98.5%, respectively) were the same as in the case of fine needle biopsy alone. None of the 59 tumours that were qualified as benign solely on the basis of preoperative MRI turned out to be malignant on postoperative histopathological examination.

Conclusions: Interpreted together, dynamic and diffusion-weighted MRIs provide the same accuracy in preoperative differential diagnostics of parotid tumours as fine needle biopsy. This substantiates the use of diagnostic algorithms in which biopsy would serve mostly as a secondary test to verify selected ambiguous radiological diagnoses. (Folia Morphol 2018; 77, 1: 29–35)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D2xbdC

Variability and constraint of vertebral formulae and proportions in colugos, tree shrews, and rodents, with special reference to vertebral modification by aerodynamic adaptation

Background: The aim of the present study is to provide the first large data set on vertebral formulae and proportions, and examine their relationship with different locomotive modes in colugos (Dermoptera), tree shrews (Scandentia), and rodents (Rodentia), which have been considered less variable because they were thought to have a plesiomorphic number of 19 thoracolumbar vertebrae.

Materials and methods: The data included 33 colugos and 112 tree shrews, which are phylogenetically sister taxa, and 288 additional skeletons from 29 other mammalian species adapted to different locomotive modes, flying, gliding, arboreal, terrestrial, digging, and semi-aquatic habitats.

Results: The following results were obtained: (1) intra-/interspecies variability and geographical variation in thoracic, lumbar, and thoracolumbar counts were present in two gliding colugo species and 12 terrestrial/arboreal tree shrew species; (2) in our examined mammals, some aerodynamic mammals, such as colugos, southern flying squirrels, scaly-tailed squirrels, and bats, showed exceptionally high amounts of intraspecific variation of thoracic, lumbar, and thoracolumbar counts, and sugar gliders and some semi-aquatic rodents also showed some variation; (3) longer thoracic and shorter lumbar vertebrae were typically shared traits among the examined mammals, except for flying squirrels (Pteromyini) and scaly-tailed squirrels (Anomaluridae).

Conclusions: Our study reveals that aerodynamic adaptation could potentially lead to strong selection and modification of vertebral formulae and/or proportions based on locomotive mode despite evolutionary and developmental constraints. (Folia Morphol 2018; 77, 1: 44–56) Background: The aim of the present study is to provide the first large data set on vertebral formulae and proportions, and examine their relationship with different locomotive modes in colugos (Dermoptera), tree shrews (Scandentia), and rodents (Rodentia), which have been considered less variable because they were thought to have a plesiomorphic number of 19 thoracolumbar vertebrae. Materials and methods: The data included 33 colugos and 112 tree shrews, which are phylogenetically sister taxa, and 288 additional skeletons from 29 other mammalian species adapted to different locomotive modes, flying, gliding, arboreal, terrestrial, digging, and semi-aquatic habitats.

Results: The following results were obtained: (1) intra-/interspecies variability and geographical variation in thoracic, lumbar, and thoracolumbar counts were present in two gliding colugo species and 12 terrestrial/arboreal tree shrew species; (2) in our examined mammals, some aerodynamic mammals, such as colugos, southern flying squirrels, scaly-tailed squirrels, and bats, showed exceptionally high amounts of intraspecific variation of thoracic, lumbar, and thoracolumbar counts, and sugar gliders and some semi-aquatic rodents also showed some variation; (3) longer thoracic and shorter lumbar vertebrae were typically shared traits among the examined mammals, except for flying squirrels (Pteromyini) and scaly-tailed squirrels (Anomaluridae). Conclusions: Our study reveals that aerodynamic adaptation could potentially lead to strong selection and modification of vertebral formulae and/or proportions based on locomotive mode despite evolutionary and developmental constraints. (Folia Morphol 2018; 77, 1: 44–56)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FhgFZi

A rare vascular anomaly in the form of double left brachiocephalic vein detected incidentally during cardiac implantable electronic device (CIED) placement

The growing number of transvenous cardiac implantable electronic device (CIED) implantation procedures helps detect rare vascular anomalies. Genetic disturbances in vascular development can produce systemic vein anomalies, including the left brachiocephalic vein (BCV). BCV anomalies commonly coexist with a persistent left superior vena cava (PLSVC), detected in 0.3–0.5% of the general population. The three known anatomical variations of PLSVC are two variations involving a BCV bridge and the third with BCV agenesis. BCV anomalies occur in 1% of patients with congenital heart defects, whereas the estimated proportion of BCV anomalies in the population with no cardiovascular symptoms is below 0.4%. A rarely observed, and thus rarely reported, BCV variation is a double left BCV, with the additional vessel typically found inferior and posterior to the ascending aorta prior to draining into the superior vena cava. This case report presents a previously unreported variation of double left BCV, with both vessels coursing parallel to each other, superior to the aortic arch. (Folia Morphol 2018; 77, 1: 161–165)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FcosvD

Volumetric evaluation of temporal bone structures in the cases with bilateral tinnitus: clinical and morphometrical study

Background: Tinnitus is the recognition of sound in the absence of any external auditory stimulus to the noise of ringing in the ears. Middle ear aeration carries important role for ossicular coupling and normal hearing. There is restricted morphometric data on the cases with bilateral tinnitus.

Materials and methods: In this study we evaluated hearing findings of 18 cases with subjective nonpulsatile bilateral tinnitus and also morphometry and volumetry of temporal bone substructures on the computed tomography images using stereological method compared with the gender and age matched 12 healthy subjects. Duration of tinnitus, exposing acoustic trauma or/and high level noise levels, evaluation of middle ear volume, jugular bulb levels, distances between jugular bulb and both oval window and middle ear were evaluated.

Results: Both males and females with tinnitus showed worse hearing thresholds through bone and air conductions than healthy subjects but it was not statistically significant. Pure tone thresholds through bone and air conductions were not statistically different in both sexes with bilateral tinnitus. Right middle ear volume of the cases with bilateral tinnitus was mean 5.57 cm3 for males and 5.64 cm3 for females; and also the left middle ear volume of the cases with bilateral tinnitus was mean 5.87 cm3 for males and 5.65 cm3 for females. There were no significant differences between the cases with bilateral tinnitus and the control subjects according to the side of the body.

Conclusions: The data on the hearing findings and morphometrical evaluation of the cases with bilateral tinnitus may be important for anatomists and clinicians. (Folia Morphol 2018; 77, 1: 57–64)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D3lovL

Assessment of the orbit morphometry on West Anatolian dry skulls

The orbit is very frequently damaged by traumas which result in not only bone deficits, but also functional deformities if reconstruction is not appropriate. Anatomical exposure of the bony orbit is of importance for both anatomists and surgeons who perform operation on this area. The current study evaluated the group of morphometrical parameters on 74 adult West Anatolian dry skulls and stereological surface area on the dry skull orbits while describing the clinical importance. Surface areas on the orbital base of the skulls were also evaluated using stereological method, bilaterally. Anthropological assessment of orbital base (in terms of width and height) revealed no significant difference between right and left sides. Both width and height of the optic foramen were significantly higher on the right side compared to left. The distances between the margins (medial, lateral, superior, inferior) of the orbital base and the optic foramen were longer on the right side compared to left, except the distances between the lateral margins. There was no significant difference among the subjects between right and left sides with respect to the orbital base in terms of stereological area calculation. The results are significant because there are no recorded anatomical data on West Anatolian skulls at previous researches. (Folia Morphol 2018; 77, 1: 105–109)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FfaAAH

Ponticulus posticus in a cohort of orthodontic children and adolescent patients with different sagittal skeletal anomalies: a comparative cone beam computed tomography investigation

Background: The objective of this study was to evaluate the prevalence and characteristics of ponticulus posticus (PP) in groups with sagittal skeletal anomalies in a Turkish population using cone beam computed tomography (CBCT).

Materials and methods: A total of 181 CBCT images were evaluated according to gender, side and characteristics of PP in the three different sagittal skeletal groups.

Results: The average age of the patients was 13.88 ± 2.99 years (ranging 8–18 years). The study population consisted of 104 (57.5%) females and 77 (42.5%) males. PP was detected in 66 (36.5%) patients. Unilateral and bilateral PP was identified in 29 (43.9%) and 37 (56.1%) patients, respectively. The prevalence of PP in the atlas vertebrae was found to be higher in males than in females and this was statistically significant (p ≤ 0.05). PP was most frequently detected in class III patients (25, 13.8%). Statistically significant differences between the different sagittal skeletal groups were observed (p ≤ 0.05).

Conclusions: Ponticulus posticus is a common anomaly in Turkish populations and is associated with different sagittal skeletal patterns. The highest frequency of PP was found in angle class III patients. (Folia Morphol 2018; 77, 1: 65–71)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FhgCN6

The value of dual-source multidetector-row computed tomography in determining pulmonary blood supply in patients with pulmonary atresia with ventricular septal defect

Background: Primary evaluation of patients with pulmonary atresia with ventricular septal defect (PA-VSD) traditionally relies upon echocardiography and conventional cardiac angiography (CCA). Cardiac angiography is considered the gold standard for delineation of anatomy in children with PA-VSD. Data comparing CCA and dual-source multidetector-row computed tomography angiography (MDCT) in PA-VSD patients is limited. The objective of this study was to test the hypothesis that MDCT is equivalent to CCA for anatomic delineation in these patients.

Materials and methods: Twenty-eight patients with PA-VSD underwent CCA and MDCT in close proximity to each other without interval therapy. A retrospective review of these 28 patients was performed. All MDCT data of pulmonary artery morphology, major aortopulmonary collateral arteries (MAPCAs) and type of blood supply (dual vs. single supply) were evaluated by blinded experts and results were compared with CCA.

Results: Twenty-eight patients had adequate size right and left pulmonary arteries (21 confluent and 7 non-confluent). Seven patients had complete absence of native pulmonary artery and 3 patients had stenosis of distal branches of pulmonary arteries; all had MAPCAs from descending thoracic aorta and/or subclavian arteries. Sensitivity, specificity, positive and negative predictive value of MDCT for detecting confluent of pulmonary arteries, absence of native pulmonary artery and stenosis of pulmonary arteries were all 100%. Moreover, accuracy of detecting MAPCAs was excellent.

Conclusions: These results suggest that MDCT and CCA are equivalent in their ability to delineate pulmonary artery anatomy and MAPCAs. Dual source MDCT provides high diagnostic accuracy in evaluation of pulmonary blood supply in patients with PA-VSD and allows precise characterisation of the condition of pulmonary arteries and MAPCAs which is of paramount importance in managing patients with PA-VSD. (Folia Morphol 2018; 77, 1: 116–122)  

 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FimVnO

Cone beam computed tomography evaluation of ponticulus posticus in patients with cleft lip and palate: a retrospective radio-anatomic study

Background: Ponticulus posticus (PP) is an abnormal bony bridge on the atlas. It plays a significant role in patients undergoing C1 lateral mass screw procedure. Patients with cleft lip and palate (CLP) have higher risk than patients in general population for the appearance of cervical vertebral anomalies. The purpose of the this study was twofold: to determine the prevalence and characteristics of PP in patients with CLP, and to compare the findings with patients in general population using cone beam computed tomography.

Materials and methods: Cone beam computed tomography images from 54 individuals who had undergone surgical repair of cleft lip and/or palate were analysed as the study group. For comparison purposes a control group was randomly selected from 108 patients and matched with the CLP subjects.

Results: Although 12 of the 54 (22.3%) patients with surgically repaired cleft lip and/or palate in the study group were identified to have PP, only 10 of the 108 (9.2%) patients in the control group had PP. The distribution of the presence of PP between the groups was statistically significant.

Conclusions: Ponticulus posticus is an important anomaly and the presence of PP is important for patients. PP can have clinical significance in cervical spine surgery as this study has indicated that the likelihood of encountering PP is higher in patients with CLP. We suggest that PP should be taken into account prior to cervical vertebral surgery in patients with CLP. (Folia Morphol 2018; 77, 1: 72–78)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FiPGwt

Distal root curvatures in mandibular molars: analysis using digital panoramic X-rays

Background: The aim of this study was to describe the degree of curvature in distal roots in the first and second permanent mandibular molars in a Chilean patient sample. A cross-sectional descriptive study was conducted in which digital panoramic X-rays were analysed.

Materials and methods: Examinations of patients under 18 years, with signs of distortion or alteration in the contrast or the presence of pathologies that affected visualisation of the roots and pulp-chamber floor of the teeth to be analysed were excluded. Using the AutoCad software, an angle was drawn to represent the curve of the root in its different thirds, drawing lines inside the root canal from the pulp-chamber floor to the dental apex. Using the classic definition of dilaceration (root curvature > 90°), its prevalence was established. 412 teeth and roots were analysed, finding a dilaceration prevalence of 0.73% (n = 3). 84.72% of the roots presented some type of curvature.

Results: The middle third had the highest percentage of curvatures and the greatest average of angular curvature, whereas the cervical third was the straightest. No significant differences were found between the degree of curvature and the gender of the subjects, except for the apical third of tooth 3.6. The analysis of curvature by root third offers to the clinician a better perspective of the directional change of the roots and does not limit it to just the presence of curves in the apical third.

Conclusions: The report of the angular degree of the curvatures, in addition to the prevalence of dilacerations, informs to the clinicians about the likelihood of finding difficulties when treating root canals. (Folia Morphol 2018; 77, 1: 131–137)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fie9WE

Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population

Background: The aim of this investigation was to evaluate the length, thickness, sagittal and transverse angulations and the morphological variations of the stylohyoid complex (SHC), to assess their probable associations with age and gender, and to investigate the prevalence of it in a wide range of a Turkish sub-population by using cone beam computed tomography (CBCT).

Materials and methods: The CBCT images of the 1000 patients were evaluated retrospectively. The length, thickness, sagittal and transverse angulations, morphological variations and ossification degrees of SHC were evaluated on multiplanar reconstructions (MPR) adnd three-dimensional (3D) volume rendering (3DVR) images. The data were analysed statistically by using nonparametric tests, Pearson's correlation coefficient, Student's t test, c2 test and one-way ANOVA. Statistical significance was considered at p < 0.05.

Results: It was determined that 684 (34.2%) of all 2000 SHCs were elongated (> 35 mm). The mean sagittal angle value was measured to be 72.24° and the mean transverse angle value was 70.81°. Scalariform shape, elongated type and nodular calcification pattern have the highest mean age values between the morphological groups, respectively. Calcified outline was the most prevalent calcification pattern in males. There was no correlation between length and the calcification pattern groups while scalariform shape and pseudoarticular type were the longest variations.

Conclusions: We observed that as the anterior sagittal angle gets wider, SHC tends to get longer. The most observed morphological variations were linear shape, elongated type and calcified outline pattern. Detailed studies on the classification will contribute to the literature. (Folia Morphol 2018; 77, 1: 79–89)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D0hcwV

Foetal development of the human gluteus maximus muscle with special reference to its fascial insertion

The human gluteus maximus muscle (GMX) is characterised by its insertion to the iliotibial tract (a lateral thick fascia of the thigh beneath the fascia lata), which plays a critical role in lateral stabilisation of the hip joint during walking. In contrast, in non-human primates, the GMX and biceps femoris muscle provide a flexor complex. According to our observations of 15 human embryos and 11 foetuses at 7–10 weeks of gestation (21–55 mm), the GMX anlage was divided into 1) a superior part that developed earlier and 2) a small inferior part that developed later. The latter was adjacent to, or even continuous with, the biceps femoris. At 8 weeks, both parts inserted into the femur, possibly the future gluteal tuberosity. However, depending on traction by the developing inferior part as well as pressure from the developing major trochanter of the femur, most of the original femoral insertion of the GMX appeared to be detached from the femur. Therefore, at 9–10 weeks, the GMX had a digastric muscle-like appearance with an intermediate band connecting the major superior part to the small inferior mass. This band, most likely corresponding to the initial iliotibial tract, extended laterally and distally far from the muscle fibres. The fascia lata was still thin and the tensor fasciae latae seemed to develop much later. It seems likely that the evolutionary transition from quadripedality to bipedality and a permanently upright posture would require the development of a new GMX complex with the iliotibial tract that differs from that in non-human primates. (Folia Morphol 2018; 77, 1: 144–150)

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FgXLpL

The size of the foramen ovale regarding to the presence and absence of the emissary sphenoidal foramen: is there any relationship between them?

Background: The study investigates the size of the foramen ovale (FO) in relation to the presence and absence of the emissary sphenoidal foramen (ESF). Any possible alteration of the FO size in relation to the ESF (unilateral or bilateral) presence and absence was also examined.

Materials and methods: One-hundred and ninety-five (117 male and 78 female) Greek adult dry skulls were investigated.

Results: The ESF was present in 40% of the skulls (21.5% bilaterally and 18.5% unilaterally). No statistical significant difference was detected between ESF presence or absence and its unilateral or bilateral occurrence. The ESF existence had no relation to the FO size.

Conclusions: The ESF absence or presence has no effect on FO size. The emissary sphenoidal vein is an additional venous pathway connecting cavernous sinus with the pterygoid venous plexus. These findings enhance that the venous plexus of the FO is a constant trait. The meticulous knowledge of the middle cranial fossa anatomy is of paramount importance during transovale procedures, as the outcome of cannulation may be affected by the existence of ESF, the confluence FO-ESF, the existence of osseous spurs and bridging into the FO. (Folia Morphol 2018; 77, 1: 90–98)  

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D1nL2l

Minimally invasive resection of large dumbbell tumors of the lumbar spine: advantages and pitfalls

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Fahed Zairi, Camille Troux, Tarek Sunna, Mélodie-Anne Karnoub, Ghassan Boubez, Daniel Shedid
ObjectivesThe surgical management of dumbbell tumors of the lumbar spine remains controversial, because of their large volume and complex location, involving both the spinal canal and the retro peritoneum. While sporadically reported, our study aims to confirm the value of minimally invasive posterior access for the complete resection of large lumbar dumbbell tumors.Patients and MethodsIn this prospective study, we included all consecutive patients who underwent the resection of a voluminous dumbbell tumor at the lumbar spine through a minimally invasive approach, between March 2015 and August 2017. There were 4 men and 4 women, with a mean age at diagnosis of 40.6 years (range 29-58 years). The resection was performed through a trans muscular tubular retractor by the same surgical team. Operative parameters and initial postoperative course were systematically reported. Clinical and radiological monitoring was scheduled at 3 months, 1 year and 2 years.ResultsThe mean operative time was 144 minutes (range 58 to 300 minutes) and the mean estimated blood loss was 250 ml (range 100 to 500 ml). Gross total resection was achieved in all patients. No major complication was reported. The mean length of hospital stay was 3.1 days (range 2 to 6 days). Histological analysis confirmed the diagnosis of grade 1 schwannoma in all patients. The mean follow up period was 14.9 months (range 6 to 26 months), and 5 patients completed at least 1-year follow-up. At 6 months the Macnab was excellent in 6 patients, good in one patient and fair in one patient because of residual neuropathic pain requiring the maintenance of a long-term treatment. No tumor recurrence was noted to dateConclusionLumbar dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure, in a trained team.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FoAZeN

Atypical Presentation of Probable Creutzfeldt-Jakob Disease Associated with Anti-Zic4 Antibody: Literature Review of Neuronal Antibodies in Creutzfeldt-Jakob Disease

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Richard Salazar
IntroductionSporadic Creutzfeldt-Jakob disease is a prion disease characterized by rapidly progressive dementia, ataxia and myoclonus. Atypical phenotype masquerading as stroke, movement disorders or autoimmune encephalitis have been described. Here, I report a probable case of sCJD with an atypical presentation associated with anti-Zic4 antibody and review the literature of neuronal antibodies in CJD.Case ReportA 70 year-old gentleman is admitted with a 2-month history of recurrent stroke-like symptoms associated with behavioral disturbances, gait ataxia and rapidly progressive dementia. His initial examination demonstrated akinetic mutism, diffuse rigidity, dysautononia, and Cheyne-Stokes respiration. Over the following weeks his condition progressed to profound coma. A comprehensive infectious, metabolic, inflammatory and autoimmune work-up yielded negative results. Empiric immunosuppressive therapy ensued. He expired three months after symptoms onset. Autopsy was not performed. After his demise, prion tests came back abnormal for elevated 14-3-3 protein, total tau and positive RTQuIC. Later on, anti-Zic4 antibodies were found in serum.ConclusionThis case underscores the importance of a high index of suspicion for CJD even in case of atypical features or the concurrence of neuronal antibodies. Further larger prospective studies on the prevalence of these neuronal antibodies in CJD and the contribution of these autoantibodies to disease pathophysiology are necessary.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H8gJuS

A Systematic and Quantitative Evaluation of Plantar Stimulation: The effect of type, pattern, force of stimulation in eliciting an accurate plantar response

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Satish V. Khadilkar, Akash H. Chheda
ObjectivesSystematic and quantitative evaluation of the plantar reflex has been infrequently studied in the past and can help assess the vexing variables encountered in its elicitation. The objective of this study was to determine the effect of type, pattern and force of stimulation in eliciting an accurate plantar response in patients with pyramidal dysfunction and healthy individuals.Patients and Methods: A special instrument was designed to give a predesigned force of stimulus. The plantar surface of foot was divided into nine parts and point and stroke stimulations were studied systematically in pyramidal weakness feet (cases) and healthy control feet (controls) with predefined forces. Results were tabulated and statistically analysed.ResultsStroke stimulation was superior to point stimulation in eliciting plantar response. There was no significant difference in the responses to the three predefined forces used for stroke stimulations. Sensitivity of Babinski sign was 72.9% and specificity was 100%. In pyramidal weakness feet, extensor responses were significantly elicited from lateral starting stroke patterns (67%) and on moving medially they were replaced by flexor responses (44%). Withdrawal responses increased with the stimulations reaching the distal foot and with the curvilinear component of stimulations. Sensitivity responses (related to the sensitivity of an individual) contaminate the plantar response and occasionally make its interpretation difficult. In subjects with bilateral sensitivity with unilateral disease, knowing the sensitivity pattern on the normal side improved the interpretation of plantar response on the abnormal side.ConclusionsBased on this study, the optimal method for eliciting Babinski sign accurately is to stroke the lateral aspect of the sole of the foot in a straight line up to mid foot. This should be performed in both feet three times, and if the weakness is unilateral, it should be performed in the normal leg first to aid interpretation of the affected leg.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FerD5N

Patients with neutral lipid storage disease with myopathy (NLSDM) in Southwestern China

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Jiaze Tan, Haitao Yang, Jingchuan Fan, Yulan Fan, Fei Xiao
ObjectivesNeutral lipid storage disease with myopathy (NLSDM) is a rare metabolic myopathy occurring owing to mutations in the patatin like phospholipase domain containing 2 (PNPLA2) gene. Till date, less than 50 patients with PNPLA2 mutations have been reported. In this study, we describe the clinical, pathological, and genetic findings, and muscle magnetic resonance imaging (MRI) changes in four Chinese patients with NLSDM.Patients and methodsPeripheral blood smears were stained using Wright's stain. Muscle biopsies, muscle MRI, and sequence analysis of PNPLA2 gene were performed.ResultsAll patients exhibited slowly progressive myopathy during adulthood. Cardiomyopathy, sensorineural hearing loss, hepatic adipose infiltration, and hypertriglyceridemia were observed in some patients. Jordan's anomaly was detected in the blood smears of all patients. Muscle biopsies revealed the presence of massive lipid droplets and rimmed vacuoles in two patients. MR images of the lower lumbar, pelvis, and lower extremities showed the involvement of posterior compartment muscles. The anterior compartment muscles were found to be less affected. Gene analysis for PNPLA2 revealed an identical homozygous mutation c.757+1G>T in all patients.ConclusionPatients with NLSDM display clinical heterogeneities despite sharing the same mutation (c.757+1G>T) of the PNPLA2 gene, may suggest a founder effect in the region.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D2x4yM

Progression of vestibular schawnnoma after GammaKnife radiosurgery: A challenge for microsurgical resection

Publication date: Available online 5 March 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Rabih Aboukaïs, Nicolas-Xavier Bonne, Gustavo Touzet, Christophe Vincent, Nicolas Reyns, Jean-Paul Lejeune
ObjectiveWe aimed to evaluate the outcome of patients who underwent salvage microsurgery for vestibular schwannoma (VS) that failed primary Gammaknife radiosurgery (GKS).Patients and Methods: Among the 1098 patients who received GKS for the treatment of VS in our center between January 2004 and December 2012, the follow-up was organized in our institution for 290 patients who lived in our recruitment area. Tumor progression was noted in 23 patients. A salvage microsurgical resection was performed in 11 patients, who were included in our study. Grading of facial function was done according to the House & Brackman scale.ResultsThe mean age at diagnosis was 50.2 years (19–68 years) and the mean follow-up was 9.4 years (4–13 years). The mean dose was 11.8 Gy (11–12 Gy) and the mean volume was 922 mm3 (208–2500 mm3). The mean period between GKS and diagnosis of tumor progression was 32 months (18–72 months). Concerning salvage microsurgery, complete resection was obtained in 8 patients. Small residual tumor on the facial nerve was deliberately left in 3 patients and no tumor progression was noted with a mean follow-up of 26 months. At last follow-up, facial nerve function was grade 1 in 4 patients, grade 2 in 3 patients, grade 3 in 1 patient and grade 4 in 3 patients.ConclusionSalvage surgery of recurrent vestibular schwannoma after failed initial GKS remains a good treatment. However, facial nerve preservation is more challenging in this case and small tumor remnant could be sometimes deliberately left.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FfwML3

Evaluation of Ventilation-Induced Lung Inflammation Through Multi-Scale Simulations

Ventilation-induced lung injury is a common problem faced by patients with respiratory problems who require mechanical ventilation (MV). This injury may lead to a greater chance of developing or exacerbating the acute respiratory distress syndrome which further complicates the therapeutic use of MV. The chain of events begins with the MV initiating an immune response that leads to inflammation induced tissue material alteration (stiffening) and eventually the loss of lung resistance. It is clear from this sequence of events that the phenomenon of ventilation induced injury is multi-scale by nature and, hence, requires holistic analysis involving simulations and informatics. An effective approach to this problem is to break it down into several major physical models. Each physical model is developed separately and can be seen as a component in a larger system that comprises the scale of the problem being investigated. In this paper, a multi-scale system consisting of breathing mechanics, tissue deformation, and cellular mechanics models is developed to assess the immune response. To demonstrate the potential of the model, a fluid–solid model is employed for breathing mechanics, a plane-strain elasticity model is applied to assess tissue deformation, and a cellular automata (CA) model is developed to account for immune response. A case study of three lower airways is presented. The CA model shows that this increased the immune response by five times, which correlates with alteration in the tissue microstructure. This alteration in turn is reflected in the material constant value obtained in the tissue mechanics model. However, the changes in strain rates in the airways after inflammation (and hence, lung compliance) were not as significant as the rates of change in immune response. Finally, results from the fluid–solid model demonstrate its potential for airflow characterization caused by tissue deformation that could lead to dis- ase identification.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2thAM8d

Large Facial Nerve Schwannoma With Extensive Temporal Bone Destruction

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fhd8tT

The Antioxidant Effect of Rosmarinic Acid by Different Delivery Routes in the Animal Model of Noise-Induced Hearing Loss

Hypothesis: Trans-tympanic Rosmarinic Acid (RA), as compared with the systemic administration, protects against noise-induced auditory hair cell and hearing losses in rats in vivo. Background: ROS production, lipoperoxidative damage, and an imbalance of antioxidant defences play a significant role in noise-induced hearing loss. Several molecules with antioxidant properties have been tested to restore redox homeostasis; however, drug delivery system represents a challenge for their effectiveness. In our model, acute and intense noise exposure induces hearing loss, hair cell death, and oxidative stress, with an increase in superoxide production and over-expression of lipid peroxidation in cochlear structures. Methods: RA was administrated in male Wistar rats by trans-tympanic (20 μl) and systemic (10 mg/kg) modality. In systemic administration, RA was injected 1 hour before noise exposure and once daily for the following 3 days. ABRs were measured before and at days 1, 3, 7, and 30 after noise exposure. Rhodamine-phalloidin staining, dihydroethidium and 8-isoprostane immunostainings were performed to assess and quantify outer hair cells loss, superoxide production, and lipid peroxidation in the different experimental groups. Results: Systemic RA administration significantly decreased noise-induced hearing loss and the improvement of auditory function was paralleled by a significant reduction in cochlear oxidative stress. The trans-tympanic modality of drug administration showed a similar degree of protection both at the functional and morphological levels. Conclusion: The effectiveness of RA given via trans-tympanic injection could be interesting for the future application of this minimally-invasive procedure in the treatment of ROS-induced hearing loss.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FeziRK

Systematic Review of Hearing Preservation After Radiotherapy for Vestibular Schwannoma

Objective: To determine the long-term hearing preservation rate for spontaneous vestibular schwannoma treated by primary radiotherapy. Data Sources: The MEDLINE/PubMed, Web of Science, Cochrane Reviews, and EMBASE databases were searched using a comprehensive Boolean keyword search developed in conjunction with a scientific librarian. English language papers published from 2000 to 2016 were evaluated. Study Selection: Inclusion criteria: full articles, pretreatment and posttreatment audiograms or audiogram based scoring system, vestibular schwannoma only tumor type, reported time to follow-up, published after 1999, use of either Gamma Knife or linear accelerator radiotherapy. Exclusion criteria: case report or series with fewer than five cases, inadequate audiometric data, inadequate time to follow-up, neurofibromatosis type 2 exceeding 10% of study population, previous treatment exceeding 10% of study population, repeat datasets, use of proton beam therapy, and non-English language. Data Extraction: Two reviewers independently analyzed papers for inclusion. Class A/B, 1/2 hearing was defined as either pure tone average less than or equal to 50 db with speech discrimination score more than or equal to 50%, American Academy of Otolaryngology–Head & Neck Surgery (AAO-HNS) Hearing Class A or B, or Gardner–Robertson Grade I or II. Aggregate data were used when individual data were not specified. Data Synthesis: Means were compared with student t test. Conclusions: Forty seven articles containing a total of 2,195 patients with preserved Class A/B, 1/2 hearing were identified for analysis. The aggregate crude hearing preservation rate was 58% at an average reporting time of 46.6 months after radiotherapy treatment. Analysis of time-based reporting shows a clear trend of decreased hearing preservation extending to 10-year follow-up. This data encourages a future long-term controlled trial.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D2ehnz

Long-term Administration of Salicylate-induced Changes in BDNF Expression and CREB Phosphorylation in the Auditory Cortex of Rats

Hypothesis: We investigated whether salicylate induces tinnitus through alteration of the expression levels of brain-derived neurotrophic factor (BDNF), proBDNF, tyrosine kinase receptor B (TrkB), cAMP-responsive element-binding protein (CREB), and phosphorylated CREB (p-CREB) in the auditory cortex (AC). Background: Salicylate medication is frequently used for long-term treatment in clinical settings, but it may cause reversible tinnitus. Salicylate-induced tinnitus is associated with changes related to central auditory neuroplasticity. Our previous studies revealed enhanced neural activity and ultrastructural synaptic changes in the central auditory system after long-term salicylate administration. However, the underlying mechanisms remained unclear. Methods: Salicylate-induced tinnitus-like behavior in rats was confirmed using gap prepulse inhibition of acoustic startle and prepulse inhibition testing, followed by comparison of the expression levels of BDNF, proBDNF, TrkB, CREB, and p-CREB. Synaptic ultrastructure was observed under a transmission electron microscope. Results: BDNF and p-CREB were upregulated along with ultrastructural changes at the synapses in the AC of rats treated chronically with salicylate (p  0.05). Conclusion: Long-term administration of salicylate increased BDNF expression and CREB activation, upregulated synaptic efficacy, and changed synaptic ultrastructure in the AC. There may be a relationship between these factors and the mechanism of tinnitus.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D1qx7M

Response to Letter to the Editor: “Long-Term Complications and Surgical Failures After Ossiculoplasty”

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FfKIEX

Gradual Symmetric Progression of DFNA34 Hearing Loss Caused by an NLRP3 Mutation and Cochlear Autoinflammation

Objective: To characterize the audiometric phenotype of autosomal-dominant DFNA34 hearing loss (HL) caused by a missense substitution in the NLRP3 gene. NLRP3 encodes a critical component of the NLRP3 inflammasome that is activated in innate immune responses. Study Design: This study was conducted under protocol 01-DC-0229 approved by the NIH Combined Neurosciences IRB. We performed medical and developmental history interviews and physical and audiological examinations of affected individuals with DFNA34 HL caused by the p.Arg918Gln mutation of NLRP3. We retrospectively reviewed audiological reports, when available, from other health care centers. Setting: Federal biomedical research facility. Subjects: Eleven members of a North American family segregating p.Arg918Gln. Main Outcome Measures: Pure-tone thresholds, rates of pure-tone threshold progression, and speech discrimination scores. Results: Eight subjects had bilateral sensorineural HL with an onset in the late 2nd to 4th decade of life. Slowly progressive HL initially primarily affected high frequencies. Low and middle frequencies were affected with advancing age, resulting in moderate HL with a downsloping audiometric configuration. The average annual threshold deterioration was 0.9 to 1.5 dB/yr. Speech recognition scores ranging from 60 to 100% were consistent with cochlear, but not retrocochlear, etiology. Three subjects (16, 22, and 32 yr old) had normal hearing thresholds. Conclusion: DFNA34 HL has an onset during early adulthood and progresses approximately 1.2 dB/yr.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D3c8aZ

Open Access: Is There a Predator at the Door?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FbKmyW

Preservation of Cells of the Organ of Corti and Innervating Dendritic Processes Following Cochlear Implantation in the Human: An Immunohistochemical Study

Hypothesis: This study evaluates the degree of preservation of hair cells, supporting cells, and innervating dendritic processes after cochlear implantation in the human using immunohistochemical methods. Background: Surgical insertion of a cochlear implant electrode induces various pathologic changes within the cochlea including insertional trauma, foreign body response, inflammation, fibrosis, and neo-osteogenesis. These changes may result in loss of residual acoustic hearing, adversely affecting the use of hybrid implants, and may result in loss of putative precursor cells, limiting the success of future regenerative protocols. Methods: Twenty-eight celloidin-embedded temporal bones from 14 patients with bilateral severe to profound sensorineural hearing loss and unilateral cochlear implants were studied. Two sections including the modiolus or basal turn from each temporal bone were stained using antineurofilament, antimyosin-VIIa, and antitubulin antibodies in both the implanted and unimplanted ears. Results: Inner and outer hair cells: Immunoreactivity was reduced throughout the implanted cochlea and in the unimplanted cochlea with the exception of the apical turn. Dendritic processes in the osseous spiral lamina: Immunoreactivity was significantly less along the electrode of the implanted cochlea than in the other segments. Inner and outer pillars, inner and outer spiral bundles, and Deiters' cells: Immunoreactivity was similar in the implanted and unimplanted cochleae. Conclusion: Insertion of a cochlear implant electrode may significantly affect the inner and outer hair cells both along and apical to the electrode, and dendritic processes in the osseous spiral lamina along the electrode. There was less effect on pillar cells, Deiters' cells, and spiral bundles.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fkm0iM

Cochlear Implantation After Partial or Subtotal Cochleoectomy for Intracochlear Schwannoma Removal—A Technical Report

Objective: To describe the technique for surgical tumor removal, cochlear implant (CI) electrode placement and reconstruction of the surgical defect in patients with intracochlear schwannomas. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Ten patients (five men, five women, mean age 48 ± 12 yr) with profound or severe to profound hearing loss due to intralabyrinthine schwannomas with intracochlear location. Interventions: Surgical tumor removal through extended round window approach, partial or subtotal cochleoectomy with or without labyrinthectomy and reconstruction of the surgical defect with cartilage, perichondrium or temporal muscle fascia, and bone pâté. Eight patients received a cochlear implant in the same procedure. Main Outcome Measures: Retrospective evaluation of clinical outcome including safety aspects (adverse events) and audiological performance at early follow up in cases of cochlear implantation. Results: The tumor was successfully removed in all cases without macroscopic (operation microscope and endoscope) tumor remnants in the bony labyrinth apart from one case with initial transmodiolar growth. One patient needed revision surgery for labyrinthine fistula. At short-term follow up (3-month post-surgery), good hearing results with the cochlear implant were obtained in all but one patient with a word recognition score of 100% for numbers, and 64 ± 14% for monosyllables (at 65 dB SPL in quiet). Conclusions: Surgical tumor removal and cochlear implantation is a promising treatment strategy in the management of intralabyrinthine schwannoma with intracochlear location, further extending the indication range for cochlear implantation. It is, however, of importance to observe the long-term outcome in these patients and to address challenges like follow up with magnetic resonance imaging.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fec6D7

Response to “Breaking the Myth of Central Neurological Complications in Stapedial Artery Surgery”

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ff23Ob

Multicenter US Clinical Trial With an Electric-Acoustic Stimulation (EAS) System in Adults: Final Outcomes

Objective: To demonstrate the safety and effectiveness of the MED-EL Electric-Acoustic Stimulation (EAS) System, for adults with residual low-frequency hearing and severe-to-profound hearing loss in the mid to high frequencies. Study Design: Prospective, repeated measures. Setting: Multicenter, hospital. Patients: Seventy-three subjects implanted with PULSAR or SONATA cochlear implants with FLEX24 electrode arrays. Intervention: Subjects were fit postoperatively with an audio processor, combining electric stimulation and acoustic amplification. Main Outcome Measures: Unaided thresholds were measured preoperatively and at 3, 6, and 12 months postactivation. Speech perception was assessed at these intervals using City University of New York sentences in noise and consonant–nucleus–consonant words in quiet. Subjective benefit was assessed at these intervals via the Abbreviated Profile of Hearing Aid Benefit and Hearing Device Satisfaction Scale questionnaires. Results: Sixty-seven of 73 subjects (92%) completed outcome measures for all study intervals. Of those 67 subjects, 79% experienced less than a 30 dB HL low-frequency pure-tone average (250–1000 Hz) shift, and 97% were able to use the acoustic unit at 12 months postactivation. In the EAS condition, 94% of subjects performed similarly to or better than their preoperative performance on City University of New York sentences in noise at 12 months postactivation, with 85% demonstrating improvement. Ninety-seven percent of subjects performed similarly or better on consonant–nucleus–consonant words in quiet, with 84% demonstrating improvement. Conclusion: The MED-EL EAS System is a safe and effective treatment option for adults with normal hearing to moderate sensorineural hearing loss in the low frequencies and severe-to-profound sensorineural hearing loss in the high frequencies who do not benefit from traditional amplification.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2CZoVet

External Ear Arteriovenous Malformation

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Fi6He8

American Otological Society Preliminary Program

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Feinia

Intraoperative Cochlear Implant Device Testing Utilizing an Automated Remote System: A Prospective Pilot Study

Introduction: Intraoperative cochlear implant device testing provides valuable information regarding device integrity, electrode position, and may assist with determining initial stimulation settings. Manual intraoperative device testing during cochlear implantation requires the time and expertise of a trained audiologist. The purpose of the current study is to investigate the feasibility of using automated remote intraoperative cochlear implant reverse telemetry testing as an alternative to standard testing. Methods: Prospective pilot study evaluating intraoperative remote automated impedance and Automatic Neural Response Telemetry (AutoNRT) testing in 34 consecutive cochlear implant surgeries using the Intraoperative Remote Assistant (Cochlear Nucleus CR120). In all cases, remote intraoperative device testing was performed by trained operating room staff. A comparison was made to the "gold standard" of manual testing by an experienced cochlear implant audiologist. Electrode position and absence of tip fold-over was confirmed using plain film x-ray. Results: Automated remote reverse telemetry testing was successfully completed in all patients. Intraoperative x-ray demonstrated normal electrode position without tip fold-over. Average impedance values were significantly higher using standard testing versus CR120 remote testing (standard mean 10.7 kΩ, SD 1.2 vs. CR120 mean 7.5 kΩ, SD 0.7, p 

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D2egjv

Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation

Objective: This study was performed to reevaluate the diagnostic significance of clinically well-accepted audiological tests in indicating endolymphatic hydrops (EH) in Menière's disease (MD). Study Design: Retrospective case review. Settings: Hospital. Patients: Fifty patients (52 affected ears) diagnosed with MD were enrolled. Intervention: Diagnostic. Main Outcome Measure: To analyze the correlations between endolymphatic hydrops and results of audiological test including the pure-tone audiometry threshold, suprathreshold function tests, electrocochleogram, and glycerol test. Results: Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging demonstrated EH in either the vestibule or cochlea to various degrees in all of the MD patients, 24 hours after intratympanic gadolinium chelate injection. Both vestibular and cochlear EH were significantly correlated with PTA threshold. However, EH was not associated with alternate binaural loudness balance or the tone decay test, although a correlation was observed with the short-increment sensitivity index. There was also a correlation between vestibular EH, but not cochlear EH, and the negative summating potential/action potential (–SP/AP) ratio. Neither vestibular EH nor cochlear EH was correlated with the glycerol test results. In addition, the frequency of vertigo attacks, the existence of tinnitus, and aural fullness did not correlate with EH. Conclusions: Disrupted ionic homeostasis in the inner ear, but not the EH, may contribute to changes in the –SP/AP ratio. The relevance of glycerol test in identifying EH through detection of hearing changes needs further investigation in the future.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Ffr9MV

Preauricular Approach for Cholesteatoma Resection After Surgical Overclosure of the External Auditory Canal and Cochlear Implantation

Chronic suppurative otitis media can have long-term effects on hearing if not managed effectively. When combined with cholesteatoma the condition may require creation of an open mastoid cavity. Recurrence of cholesteatoma is a concern when cochlear implantation is performed with overclosure of the external auditory meatus. A 61-year-old female with recurrent cholesteatoma in this setting was treated using a preauricular approach to provide adequate visualization while preventing the need to remove the implant or risking injury to the internal components. This technique would be useful in similar patients to prevent morbidity from removal and reinsertion of a cochlear implant.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D2ph3W

Audiologic Natural History of Small Volume Cochleovestibular Schwannomas in Neurofibromatosis Type 2

Objective: To characterize the audiometric natural progression in patient-ears with small volume (

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FfKI7V

Predicting one repetition maximum using hand-held dynamometry

Isometric assessment of muscular function using a hand held dynamometer (HHD) is frequently used in clinic environments. However, there is controversy in terms of the validity of isometric assessment to monitor changes in dynamic performance. One repetition maximum (1RM) is considered the gold standard for evaluating dynamic strength, though clinician's do not often use 1RM testing, preferring to be cautious with clients who have pre-existing impairments. If strength testing using a HHD could be used to predict 1RM, this may have significant implications for the use of isometric testing to prescribe exercise in clinical environments.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FeRgDz

Ultrasound Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient with Post-Polio Syndrome: A Case Report

The prevalence of carpal tunnel syndrome(CTS) in patients that suffer from post-polio syndrome occurs at a rate of 22%.[1] Irrespective of those with CTS, 74% of post-polio patients weight bear through their arms for ambulation or transfers.[1] As open carpal tunnel release is performed along the weight bearing region of the wrist, their functional independence may be altered while recovering. This case demonstrates that ultrasound guided carpal tunnel release(USCTR) was successfully performed in a patient with post-polio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D1Mvrh

Examination of factors related to the effect of improving gait speed with functional electrical stimulation intervention for patients with stroke

Functional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and non-responders have not been clarified.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Feaj0R

Sonographic Changes Following Ultrasound-guided Release of the Transverse Carpal Ligament- A Case Report

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy, resulting in 500,000 carpal tunnel release (CTR) surgeries and a total cost of over 2 billion dollars annually in the United States.1,2 Although initially performed via a large (3-5 cm), palmar incision, CTR techniques have continually evolved to reduce recovery times and post-operative pain, and improve cosmesis and clinical outcomes.2,3 More recently, multiple authors have reported excellent results following ultrasound-guided carpal tunnel release (USCTR) using a variety techniques, and one prospective randomized trial reported faster recovery following USCTR compared to traditional mini-open CTR.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D0JTK8

The Utility of the Total Neuropathy Score as an Instrument to Assess Neuropathy Severity in Chronic Kidney Disease: A Validation Study

To demonstrate construct validity of the Total Neuropathy Score (TNS) in assessing peripheral neuropathy in subjects with chronic kidney disease (CKD).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I52f0h

Precision of perceived direction of gravity in partial bilateral vestibulopathy correlates with residual utricular function

Bilateral-vestibular deficiency (BVD) results from functional impairment of both vestibular organs, leading to gait unsteadiness in almost all patients (Zingler et al., 2007) and oscillopsia (illusionary movement of the visual surroundings during head movements) (Hain et al., 2013), which is found less consistently (from 44% (Zingler et al., 2007) to 97% (Black et al., 2004)). These complaints have been linked to a reduced angular vestibulo-ocular reflex (aVOR), which normally stabilizes gaze during head movements, and to impairment of the otolith organs (utriculus, sacculus), which are key for sensing linear acceleration and gravity (Schoene, 1964; Hain et al., 2013).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2oQ8Ti2

Mapping lexical-semantic networks and determining hemispheric language dominance: Do task design, sex, age, and language performance make a difference?

Publication date: April 2018
Source:Brain and Language, Volume 179
Author(s): Yu-Hsuan A. Chang, Sogol S. Javadi, Naeim Bahrami, Vedang S. Uttarwar, Anny Reyes, Carrie R. McDonald
Blocked and event-related fMRI designs are both commonly used to localize language networks and determine hemispheric dominance in research and clinical settings. We compared activation profiles on a semantic monitoring task using one of the two designs in a total of 43 healthy individual to determine whether task design or subject-specific factors (i.e., age, sex, or language performance) influence activation patterns. We found high concordance between the two designs within core language regions, including the inferior frontal, posterior temporal, and basal temporal region. However, differences emerged within inferior parietal cortex. Subject-specific factors did not influence activation patterns, nor did they interact with task design. These results suggest that despite high concordance within perisylvian regions that are robust to subject-specific factors, methodological differences between blocked and event-related designs may contribute to parietal activations. These findings provide important information for researchers incorporating fMRI results into meta-analytic studies, as well as for clinicians using fMRI to guide pre-surgical planning.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2D0xs0X

Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy

Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FtdUri

Audiological profiling in postmenopausal women with osteoporosis

To compare the audiological profiles in postmenopausal women with and without osteoporosis and to study the pattern of hearing loss in osteoporotic patients.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H4oj9O

Corrigendum to “Retropharyngeal abscess as a result of hyaluronic acid injection pharyngoplasy: A first of its kind” [Am J Otolaryngol 38(6) (Nov–Dec 2017) 718–719]

The authors regret that we accidentally did not include Dr. Sivakumar Cinnadurai as an author for our manuscript submission. He has an integral role in the case report, and thus, we are requesting that he is added as an author.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FrNV3q

The clinical value of the RGB value of an image of the interarytenoid area for diagnosis of laryngopharyngeal reflux

I read with great interest the excellent article entitled "Image analysis of interarytenoid area to detect cases of laryngopharyngeal reflux: An objective method" by Nayak et al. [1] This is a meaningful work. The authors attempted to objectively diagnose laryngopharyngeal reflux (LPR) by analyzing the change in the RGB (red, green, blue) value of an image of the interarytenoid area. The authors found strong correlations between R and G values and both the reflux finding score (RFS) and reflux symptom index (RSI).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H6E54e

Cortactin expression in nasal polyps of aspirin-exacerbated respiratory disease (aerd) patients

The term aspirin-exacerbated respiratory disease (AERD) refers to a combination of asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute respiratory tract reactions to nonsteroidal anti-inflammatory drugs. AERD has now been included among the CRSwNP endotypes, and is considered one of the most aggressive in terms of disease recurrence.Cortactin is a multi-domain protein with a part in several cellular mechanisms involving actin assembly and cytoskeleton arrangement. Cortactin seems to have a role in inflammatory responses and to be implicated in human airway secretion and contraction mechanisms.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FuUClv

Effect of allergic rhinitis on nasal obstruction outcomes after functional open Septorhinoplasty

To evaluate whether a diagnosis of allergic rhinitis affects surgical outcomes of open septorhinoplasty (OSR) and to examine whether OSR provides the same level of improvement in quality of life to patients with and without allergic rhinitis.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2H4o7HC

Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review

A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2FtyhVh