OtoRhinoLaryngology News

Τετάρτη 24 Φεβρουαρίου 2016

The effect of ventilation tube insertion or trans-tympanic silicone plug insertion on a patulous Eustachian tube.

The effect of ventilation tube insertion or trans-tympanic silicone plug insertion on a patulous Eustachian tube.

Acta Otolaryngol. 2016 Feb 23;:1-5

Authors: Endo S, Mizuta K, Takahashi G, Nakanishi H, Yamatodani T, Misawa K, Hosokawa S, Mineta H

Abstract
Conclusions This study suggests that long-term ventilation tube insertion is the first-choice surgical treatment for a 'sniff-type' patulous Eustachian tube (PET). When treating a refractory PET, it is important to determine whether the patient had a habitual sniff. Objectives PET patients were divided into two groups: patients with a habitual sniff (sniff-type PET) and those without a habitual sniff (non-sniff-type PET). This study examined the effects of ventilation tube insertion or silicone plug insertion in each group. Methods Surgical procedures such as ventilation tube insertion or trans-tympanic silicone plug insertion were performed for these patients. Tubotympanoaero-dynamic graphy (TTAG) was also performed to determine the mechanisms underlying these treatments. Results There were 11 cases (17 ears) of sniff-type PET and 20 cases (27 ears) of non-sniff-type PET. An improvement in symptoms was found in 72.7% of the patients who underwent silicone plug insertion (66.7% for sniff-type PET and 74.1% for non-sniff-type PET) and in 90.9% of the patients who underwent ventilation tube insertion for sniff-type PET. In TTAG assessments, many sniff-type PET patients showed significant synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx when performing a slight Valsalva manoeuvre (below 200 daPa).

PMID: 26903085 [PubMed - as supplied by publisher]

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A new safe and cost-effective percutaneous dilatational tracheotomy: SafeTrach.

A new safe and cost-effective percutaneous dilatational tracheotomy: SafeTrach.

Acta Otolaryngol. 2016 Feb 23;:1-8

Authors: Ullman J, Karling J, Margolin G

Abstract
Conclusion SafeTrach is a new simplified and safe technique to perform percutaneous dilatational tracheotomy (PDT) that eliminates known risk factors compared with existing percutaneous techniques. In the present clinical study, also patients with disadvantageous anatomy not suitable for conventional PDT (CPDT) were treated without complications using SafeTrach. PDT with SafeTrach (STPDT) offers an excellent solution for patients who need tracheotomy in connection with elective ear, nose, and throat (ENT) surgery. Objectives To assess a new technique for percutaneous tracheotomy. Methods Seventeen patients were tracheotomized with STPDT using SafeTrach for the initial penetration sequence and single step dilatational techniques for the dilatational sequence. The patients represented a variety of different neck anatomies. Fifteen patients were head- and neck cancer patients that were subjects of free flap transplants. Results This study showed that STPDT was safe and easy to perform and time-efficient. The median duration of the procedure was 11.5 min and the puncture was in all cases located in the midline of the trachea either between the 2nd and 3rd tracheal ring (n = 13) or between the 3rd and 4th ring (n = 4).

PMID: 26902954 [PubMed - as supplied by publisher]

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Effect of inhaled steroids on laryngeal microflora.

Effect of inhaled steroids on laryngeal microflora.

Acta Otolaryngol. 2016 Feb 22;:1-4

Authors: Turan M, Ekin S, Ucler R, Arısoy A, Bayram Y, Yalınkılıç A, Bozan N, Garca MF, Çankaya H

Abstract
Conclusions As is known, this study is the first study to evaluate the effect of inhaled steroids on laryngeal microflora. The data support that ICS usage causes changes in the larynx microflora. Purpose The aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of a control group. In addition, laryngeal microflora was compared to the smears obtained from the vallecula and pharynx. Materials and methods The study included 39 patients (mean age = 45.56 ± 12.76 years) who had been using a corticosteroid inhaler and control group consisting of 27 persons (mean age = 43.07 ± 13.23 years). Culture samples were obtained from the pharynx, larynx, and vallecula in the patient and control groups, and they were evaluated in the microbiology laboratory. Obtained culture results were named by the same microbiologist according to the basic microorganism classification method. Results Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS) and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared to the control group. Neisseria spp, basillus spp, and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared to the patient group.

PMID: 26901427 [PubMed - as supplied by publisher]

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Obstructive sleep apnea in preschool-aged Japanese children - efficiency of screening using lateral neck radiography.

Obstructive sleep apnea in preschool-aged Japanese children - efficiency of screening using lateral neck radiography.

Acta Otolaryngol. 2016 Feb 22;:1-7

Authors: Kitamura T, Miyazaki S, Kobayashi R, Kadotani H, Kanemura T, Komada I, Nishikawa M, Okawa M, Koizumi H, Takeuchi S, Suzuki H

Abstract
Conclusions The prevalence of obstructive sleep apnea (OSA) in preschool-aged children diagnosed by the International Classification of Sleep Disorders (ICSD) version 3 criteria was relatively higher than that diagnosed by ICSD-2. Although the assessment of the upper airway by lateral neck radiography was effective for detecting OSA in this age group, this assessment is not recommended for all children as a screening method because of parental concern related to radiation exposure. Objective This study investigated the prevalence of OSA and the screening capacity of lateral neck radiography in community-based preschool-aged children. Methods Parents of 211 children aged 3-6 years were requested to complete the sleep-related questionnaire. Subjects who agreed to further investigations were invited to undergo home type 3 portable monitoring and clinical examination, including radiography. We estimated the prevalence of OSA and evaluated the detection power of radiography for predicting OSA. Results One hundred and eighty-eight (89.1%) subjects completed the questionnaire and 67 (31.8%) agreed to further examinations. The weighted prevalence was 7.3% and 12.8% by ICSD-2 and 3, respectively. Area under the receiver operator curve for the adenoidal/nasopharyngeal and tonsil/pharyngeal ratios measured using radiography was slightly larger than that for tonsil size graded by visual inspection.

PMID: 26901288 [PubMed - as supplied by publisher]

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Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery.

Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery.

Acta Otolaryngol. 2016 Feb 22;:1-5

Authors: Ozawa H, Tomita T, Watanabe Y, Sekimizu M, Ito F, Ikari Y, Saito S, Toda M, Ogawa K

Abstract
Conclusion The sigmoid-incision (S-I) rescue flap technique has the advantage of both reduced-invasiveness and providing a sufficient surgical corridor for endoscopic endonasal skull base surgery (EESBS). Objective Skull base reconstruction with nasoseptal flap (NSF) is critically important in managing post-operative cerebrospinal fluid (CSF) leakage after tumor removal by EESBS. The NSF needs to be elevated before sphenoidotomy and posterior septectomy to preserve the pedicle. However, most extradural surgery without CSF leakage does not require NSF and, therefore, NSF preparation is often futile. As a result, a rescue flap technique to overcome this problem has been developed, whereby a new S-I rescue flap method is used that enables wide exposure of the sphenoidal rostrum and smooth manipulation of surgical instruments to preserve the NSF pedicle. Materials and methods Starting in April 2014, 19 cases underwent EESBS with S-I rescue flap. Results All patients underwent tumor resection under an adequate operative field with smooth manipulation of surgical instruments. Two complications were experienced. One patient had CSF leak after removal of the nasal packing, but the leakage was successfully closed by conventional NSF. Another patient had epistaxis from the septal wall, but this was controlled by electrocautery.

PMID: 26901123 [PubMed - as supplied by publisher]

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Cochlear re-implantation: lessons learnt and the way ahead.

Cochlear re-implantation: lessons learnt and the way ahead.

Acta Otolaryngol. 2016 Feb 22;:1-4

Authors: Patnaik U, Sikka K, Agarwal S, Kumar R, Thakar A, Sharma SC

Abstract
Conclusion A cochlear re-implantation procedure is undesirable; however, the cochlear implant surgeon may have to perform a re-implantation procedure occasionally for various reasons. Following standard techniques, implant performance comparable with primary implantation may be achieved. Objective To study the causes and outcomes of cochlear re-implantation in an Asian Indian population. Study design Retrospective analysis of clinical charts over an 18-year period with prospective follow-up of patients. Methods The charts of 534 patients, who underwent cochlear implant, at an Otorhinolaryngology institutional Centre, from January 1997 to January 2015 were studied. Of these, the charts of 18 patients who underwent cochlear re-implantation were studied. The causes and audiological and speech outcomes were analysed. Results Eighteen patients (3.4%) underwent cochlear re-implantation for various reasons. The commonest indication was device failure in seven patients (39%), followed by electrode extrusion in five (28%), trauma in three (11%), electrode migration in two (11%) and improper electrode placement in one (6%) patient. The audiological performance tests and speech tests either remained the same or improved from those achieved for patients undergoing primary implantation, in 87% patients.

PMID: 26898701 [PubMed - as supplied by publisher]

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Complications Related to Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients.

Complications Related to Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients.

World Neurosurg. 2016 Feb 19;

Authors: Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E, Fuentes S, Velly L, Gras R, Dufour H

Abstract
OBJECTIVE: The study aimed to analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary adenomas (NFPAs).
METHODS: A retrospective study of 300 NFPAs was carried out. Complications and factors that could influence these complications were analyzed.
RESULTS: Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. It was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (p = 0.01), postoperative CSF leaks (p = 0.0001), and operation times of more than 1 hour (p = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique cause of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (p = 0.007) and permanent diabetes insipidus (p = 0.028). The rate of CSF leak fell from 4% to 0.8% (p = 0.01) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis fell from 6.7% to 1.25% after we stopped using the monopolar coagulation (p = 0.013).
CONCLUSIONS: ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.

PMID: 26902781 [PubMed - as supplied by publisher]

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Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery.

Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery.

Acta Otolaryngol. 2016 Feb 22;:1-5

Authors: Ozawa H, Tomita T, Watanabe Y, Sekimizu M, Ito F, Ikari Y, Saito S, Toda M, Ogawa K

PMID: 26901123 [PubMed - as supplied by publisher]

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Reconstructive techniques in skull base surgery after resection of malignant lesions: a wide array of choices.

Reconstructive techniques in skull base surgery after resection of malignant lesions: a wide array of choices.

Curr Opin Otolaryngol Head Neck Surg. 2016 Feb 17;

Authors: Hachem RA, Elkhatib A, Beer-Furlan A, Prevedello D, Carrau R

Abstract
PURPOSE OF REVIEW: In this manuscript, we will provide a panorama of the current status of skull base reconstruction following endoscopic endonasal or open resection of malignant lesions, focusing on novel options and recent modifications of previously described techniques.
RECENT FINDINGS: New developments in skull base reconstruction continue to arise, mostly as in the form of vascularized pedicled flaps that can be used following endoscopic and open resections of the skull base.
SUMMARY: Resection of skull base tumors, often creating large dural defects that couple with extensive intradural dissection, involving multiple cisterns or the third ventricle, may lead to high-flow cerebrospinal fluid leaks. Reconstruction of the skull base is paramount to achieve an uncomplicated postoperative course. Repair of small dural defects can be reliably achieved using a multilayer grafting technique, which yields a high success rate (>90%). Repair of larger defects associated with a high-flow cerebrospinal fluid leak, or defects in previously irradiated fields, often requires a local or regional pedicled vascularized graft as the first reconstructive choice. When these are unavailable, free microvascular tissue transfer remains an option.

PMID: 26900820 [PubMed - as supplied by publisher]

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The water penetration of different ventilation tubes.

The water penetration of different ventilation tubes.

Eur Arch Otorhinolaryngol. 2016 Feb 22;

Authors: Ricks RG, Easto R, Reddy VM

Abstract
The insertion of middle ear ventilation tubes remains one of the most common procedures for ENT surgeons. A common concern amongst patients undergoing such procedures is the effect on their ability to partake in swimming and other water sports. Currently there is little evidence comparing the penetration ability of different water solutions encountered by swimmers. This study compares the water penetration of four different water solutions for Shah, mini-Shah, T tube and titanium bobbin ventilation tubes. A model was constructed to replicate a grommet inserted through a tympanic membrane using a syringe barrel, latex membrane and one of the ventilation tubes. Four solutions (sea water, chlorinated water, freshwater and soapy water) were then pipetted down the barrel until penetration of the tube occurred. The volume required for penetration was recorded. For all tubes soapy water was the most penetrating, followed by seawater. Titanium bobbins required significantly less of each solution for penetration. Mini-Shah grommets required significantly more of all solutions except soapy water for penetration to occur. Shah grommets were more resistant to chlorinated and sea water than T tubes. Mini-Shah grommets appear to protect against water penetration into the middle ear cleft and their use should be considered in patients who are keen water-sport enthusiasts. Furthermore, swimmers in sea or chlorinated water seem to be at higher risk than freshwater swimmers. Titanium bobbins were relatively easily penetrated by all four solutions and should be avoided in keen swimmers.

PMID: 26902089 [PubMed - as supplied by publisher]

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The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy.

The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy.

Eur Arch Otorhinolaryngol. 2016 Feb 22;

Authors: Pang KP, Rotenberg BW

PMID: 26902088 [PubMed - as supplied by publisher]

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Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.

Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.

Eur J Neurol. 2016 Feb 22;

Authors: Galovic M, Leisi N, Müller M, Weber J, Tettenborn B, Brugger F, Abela E, Weder B, Kägi G

Abstract
BACKGROUND AND PURPOSE: Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed.
METHODS: Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake.
RESULTS: Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex.
CONCLUSIONS: Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.

PMID: 26901451 [PubMed - as supplied by publisher]

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Differential response properties of peripherally and cortically evoked swallows by electrical stimulation in anesthetized rats.

Differential response properties of peripherally and cortically evoked swallows by electrical stimulation in anesthetized rats.

Brain Res Bull. 2016 Feb 17;

Authors: Tsujimura T, Tsuji K, Magara J, Sakai S, Suzuki T, Nakamura Y, Nozawa-Inoue K, Inoue M

Abstract
We compared onset latency, motor-response patterns, and the effect of electrical stimulation of the cortical masticatory area between peripherally and cortically evoked swallows by electrical stimulation in anesthetized rats. The number of swallows and the motor patterns were determined using electromyographic recordings from the thyrohyoid, digastric, and masseter muscles. The onset latency of the first swallow evoked by electrical stimulation of the cortical swallowing area (Cx) was significantly longer than that evoked by stimulation of the superior laryngeal nerve (SLN). The duration of thyrohyoid burst activity associated with SLN-evoked swallows was significantly longer than that associated with either Cx-evoked or spontaneous swallows. Combining Cx with SLN stimulation increased the number of swallows at low levels of SLN stimulation. Finally, A-area (the orofacial motor cortex) stimulation inhibited Cx-evoked swallows significantly more than it inhibited SLN-evoked swallows. These findings suggest that peripherally and cortically evoked swallows have different response properties and are affected differently by the mastication network.

PMID: 26899586 [PubMed - as supplied by publisher]

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Associations between tongue strength and swallowing difficulty in the older adults receiving long-term care.

Associations between tongue strength and swallowing difficulty in the older adults receiving long-term care.

Clin Nutr. 2016 Feb 8;

Authors: Maeda K, Wakabayashi H, Shamoto H

PMID: 26898136 [PubMed - as supplied by publisher]

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Cortical Reorganisation during a 30-Week Tinnitus Treatment Program.

Cortical Reorganisation during a 30-Week Tinnitus Treatment Program.

PLoS One. 2016;11(2):e0148828

Authors: McMahon CM, Ibrahim RK, Mathur A

Abstract
Subjective tinnitus is characterised by the conscious perception of a phantom sound. Previous studies have shown that individuals with chronic tinnitus have disrupted sound-evoked cortical tonotopic maps, time-shifted evoked auditory responses, and altered oscillatory cortical activity. The main objectives of this study were to: (i) compare sound-evoked brain responses and cortical tonotopic maps in individuals with bilateral tinnitus and those without tinnitus; and (ii) investigate whether changes in these sound-evoked responses occur with amelioration of the tinnitus percept during a 30-week tinnitus treatment program. Magnetoencephalography (MEG) recordings of 12 bilateral tinnitus participants and 10 control normal-hearing subjects reporting no tinnitus were recorded at baseline, using 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz tones presented monaurally at 70 dBSPL through insert tube phones. For the tinnitus participants, MEG recordings were obtained at 5-, 10-, 20- and 30- week time points during tinnitus treatment. Results for the 500 Hz and 1000 Hz sources (where hearing thresholds were within normal limits for all participants) showed that the tinnitus participants had a significantly larger and more anteriorly located source strengths when compared to the non-tinnitus participants. During the 30-week tinnitus treatment, the participants' 500 Hz and 1000 Hz source strengths remained higher than the non-tinnitus participants; however, the source locations shifted towards the direction recorded from the non-tinnitus control group. Further, in the left hemisphere, there was a time-shifted association between the trajectory of change of the individual's objective (source strength and anterior-posterior source location) and subjective measures (using tinnitus reaction questionnaire, TRQ). The differences in source strength between the two groups suggest that individuals with tinnitus have enhanced central gain which is not significantly influenced by the tinnitus treatment, and may result from the hearing loss per se. On the other hand, the shifts in the tonotopic map towards the non-tinnitus participants' source location suggests that the tinnitus treatment might reduce the disruptions in the map, presumably produced by the tinnitus percept directly or indirectly. Further, the similarity in the trajectory of change across the objective and subjective parameters after time-shifting the perceptual changes by 5 weeks suggests that during or following treatment, perceptual changes in the tinnitus percept may precede neurophysiological changes. Subgroup analyses conducted by magnitude of hearing loss suggest that there were no differences in the 500 Hz and 1000 Hz source strength amplitudes for the mild-moderate compared with the mild-severe hearing loss subgroup, although the mean source strength was consistently higher for the mild-severe subgroup. Further, the mild-severe subgroup had 500 Hz and 1000 Hz source locations located more anteriorly (i.e., more disrupted compared to the control group) compared to the mild-moderate group, although this was trending towards significance only for the 500Hz left hemisphere source. While the small numbers of participants within the subgroup analyses reduce the statistical power, this study suggests that those with greater magnitudes of hearing loss show greater cortical disruptions with tinnitus and that tinnitus treatment appears to reduce the tonotopic map disruptions but not the source strength (or central gain).

PMID: 26901425 [PubMed - as supplied by publisher]

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Reply to: Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population.

Reply to: Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population.

Hear Res. 2016 Feb 17;

Authors: Folmer RL

PMID: 26900071 [PubMed - as supplied by publisher]

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Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.

Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.

Neuromodulation. 2016 Feb 21;

Authors: De Ridder D, Vanneste S, Gillett G, Manning P, Glue P, Langguth B

Abstract
OBJECTIVE: A definition of free will is the ability to select for or against a course of action to fulfill a desire, without extrinsic or intrinsic constraints that compel the choice. Free will has been linked to the evolutionary development of flexible decision making. In order to develop flexibility in thoughts and behavioral responses, learning mechanisms have evolved as a modification of reflexive behavioral strategies. The ultimate goal of the brain is to reduce uncertainty inherently present in a changing environment. A way to reduce the uncertainty, which is encoded by the rostral anterior cingulate, is to make multiple predictions about the environment which are updated in parallel by sensory inputs. The prediction/behavioral strategy that fits the sensory input best is then selected, becomes the next percept/behavioral strategy, and is stored as a basis for future predictions. Acceptance of predictions (positive feedback) is mediated via the accumbens, and switching to other predictions by the dorsal anterior cingulate cortex (ACC) (negative feedback). Maintenance of a prediction is encoded by the pregenual ACC. Different cingulate territories are involved in rejection, acceptance and maintenance of predictions. Free will is known to be decreased in multiple psychopathologies, including obsessive compulsive disorder and addictions.
METHODOLOGY: In modern psychosurgery three target structures exist for obsessive compulsive disorder and addiction: the dorsal ACC, the nucleus accumbens, and/or the anterior limb of the internal capsula. Research in all three areas reports favorable results with acceptable side effects. Psychosurgical interventions seem to exert their effect by a common final common pathway mediated via the pregenual ACC.
CONCLUSION: Successful neuromodulation increases the capacity to choose from different options for the affected individual, as well as inhibiting unwanted options, therefore increasing free will and free won't.

PMID: 26899938 [PubMed - as supplied by publisher]

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Increased mean platelet volume in patients with idiopathic subjective tinnitus.

Increased mean platelet volume in patients with idiopathic subjective tinnitus.

Eur Arch Otorhinolaryngol. 2016 Feb 22;

Authors: Sarıkaya Y, Bayraktar C, Karataş M, Doğan S, Olt S, Kaskalan E, Türkbeyler İH

Abstract
Tinnitus is the perception of sound with no external stimulus and idiopathic subjective tinnitus is the most common type in adults. Mean platelet volume (MPV) alterations were shown in some inflammatory diseases and were evaluated as a clinically useful marker. Our aim was to investigate MPV alterations in idiopathic subjective tinnitus patients. A total of 101 patients and 54 age- and sex-matched healthy control subjects were enrolled in the study. Patients included in the study had complaints of tinnitus for at least 3 months. All patients underwent detailed otolaryngologic examination, blood sampling, pure tone audiometry, magnetic resonance imaging of ear, and vertebrobasilar artery Doppler ultrasonography to make the differential diagnosis of tinnitus. Blood sampling consisted of renal-liver-thyroid function tests, lipid profile, and complete blood count. All tests and examinations except the imaging modalities were also performed for the control group. There were no differences in age and sex distribution of groups. Mean platelet volume values were significantly increased in tinnitus patients when compared with controls (p = 0.001). We think that MPV can be qualified as a useful marker in tinnitus patients.

PMID: 26899282 [PubMed - as supplied by publisher]

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Clinical study on mandibular fracture after marginal resection of the mandible.

Clinical study on mandibular fracture after marginal resection of the mandible.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 17;

Authors: Okuyama K, Michi Y, Mizutani M, Yamashiro M, Kaida A, Harada K

Abstract
OBJECTIVES: Postoperative mandibular fracture (PMF) after marginal resection (MR) of the mandible remains an unresolved issue, and it has been reported that at least 10 mm of postoperative mandibular body height (PMBH) is required to prevent PMF. This study evaluated the clinical, physical, and structural risk factors for PMF in MR patients and determined appropriate preventive measures for PMF.
STUDY DESIGN: This retrospective study included 44 patients with lower gingival carcinoma who underwent MR. PMF occurred in four of these patients. Thirteen associated factors identified from medical records and radiographs were statistically analyzed.
RESULTS: Mandibular body height (MBH) preservation ratio originally evaluated as less than 0.3, more than 20 remaining teeth after surgery, and inferior alveolar canal (IAC) exposure were significant risk factors for PMF. Prostheses and number of remaining teeth were also correlated with PMF.
CONCLUSIONS: The preserved mandibular bone should be reinforced in patients with an MBH preservation ratio of less than 0.3, more than 20 remaining teeth after surgery, and intraoperative IAC exposure. Patients with prostheses are at an increased risk of PMF compared with those without because of stable occlusion and a strong occlusal force. Our novel findings provide useful reference standards for PMF prevention in MR patients.

PMID: 26899295 [PubMed - as supplied by publisher]

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Aggressive radiolucent lesion of the mandible.

Aggressive radiolucent lesion of the mandible.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 14;

Authors: Valente VB, Barreto IS, Furuse C, Biasoli ÉR, Miyahara GI, Bernabé DG

PMID: 26899294 [PubMed - as supplied by publisher]

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Adenomatoid odontogenic tumor with peripheral cemento-osseous reactive proliferation: report of 2 cases and review of the literature.

Adenomatoid odontogenic tumor with peripheral cemento-osseous reactive proliferation: report of 2 cases and review of the literature.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Dec 19;

Authors: Naidu A, Slater LJ, Hamao-Sakamoto A, Waters P, Kessler HP, Wright JM

Abstract
Two cases of a rare variant of adenomatoid odontogenic tumor encompassed by a prominent reactive cemento-osseous proliferation are reported. This unique variant of adenomatoid odontogenic tumor has only been seen twice in the authors' collective experience. Literature documenting the histopathologic patterns of adenomatoid odontogenic tumor and the occurrence of other combined lesions other is reviewed and discussed.

PMID: 26899293 [PubMed - as supplied by publisher]

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Ameloblastic neoplasia spectrum: a cross-sectional study of MMPS expression and proliferative activity.

Ameloblastic neoplasia spectrum: a cross-sectional study of MMPS expression and proliferative activity.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 24;

Authors: da Silva AD, Nóbrega TG, Saudades AW, Otero MI, Danilevicz CK, Magnusson AS, Saraiva Homem de Carvalho AL, Rados PV, Carrard VC, Visioli F, Sant'Ana Filho M

Abstract
OBJECTIVE: To compare the proliferation and the expression of matrix metalloproteinases (MMPs; MMP-2 and MMP-9) in solid and unicystic ameloblastomas with ameloblastic carcinomas.
STUDY DESIGN: Five cases of ameloblastic carcinoma (AC), 18 cases of solid ameloblastoma (SA), and seven of unicystic ameloblastoma (UA) were selected. The immunohistochemical expression of MMPs was assessed by the percentage of positive tumor cells and stained stroma. The mean argyrophilic nucleolar organizer region (AgNOR) and the percentage of cells with more than one AgNOR per nucleus were evaluated.
RESULTS: Statistically significant higher mean AgNOR was observed in AC than in SA and UA. MMP-2 was expressed similarly in tumor and stroma among groups. MMP-9 was higher in the stroma of SA than that of UA (P = .0484).
CONCLUSIONS: The cell proliferation was related to the greater aggressiveness of AC. High expression of MMP-2 and MMP-9 in all lesions highlighted the importance of these enzymes in the biology of ameloblastic tumors.

PMID: 26899292 [PubMed - as supplied by publisher]

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Risk factors for patients with multiple synchronous primary cancers involving oral and oropharyngeal subsites.

Risk factors for patients with multiple synchronous primary cancers involving oral and oropharyngeal subsites.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 14;

Authors: Feng Z, Xu QS, Niu QF, Qin LZ, Li JZ, Su M, Li H, Han Z

Abstract
OBJECTIVE: To evaluate risk factors and prognosis for multiple synchronous primary cancers (MSPCs) associated with head and neck squamous cell carcinoma.
STUDY DESIGN: The retrospective study included 1623 patients.
RESULTS: The most common MSPC site involved was the head and neck region. The presence of multiple oral dysplastic lesions (P < .001) was the sole risk factor for the occurrence of MSPCs. A multivariate survival analysis showed that the pathologic grade (P = .003) was an independent predictive factor for the 5-year disease-specific survival of patients with MSPCs. A Kaplan-Meier analysis showed that the 5-year disease-specific survival of patients who developed MSPCs was worse than that of patients who did not develop MSPCs (P = .020).
CONCLUSIONS: MSPCs are a significant negative prognostic factor for patients with head and neck squamous cell carcinoma. However, a worse prognosis is predicted for patients with MSPCs with several features: a higher pathologic grade, a more aggressive growth pattern, male gender plus a tobacco or alcohol habit, and no multiple oral dysplastic lesions.

PMID: 26899291 [PubMed - as supplied by publisher]

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Comment on 'International collegium of rehabilitative audiology (ICRA) recommendations for the construction of multilingual speech tests', by Akeroyd et al.

Comment on 'International collegium of rehabilitative audiology (ICRA) recommendations for the construction of multilingual speech tests', by Akeroyd et al.

Int J Audiol. 2016 Apr;55(4):268-271

Authors: Smits C

PMID: 26903088 [PubMed - as supplied by publisher]

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Efficacy of earphones for 12- to 24-month-old children during visual reinforcement audiometry.

Efficacy of earphones for 12- to 24-month-old children during visual reinforcement audiometry.

Int J Audiol. 2016 Apr;55(4):248-253

Authors: Weiss AD, Karzon RK, Ead B, Lieu JE

Abstract
OBJECTIVE: Efficacy of insert and supra-aural earphones during visual reinforcement audiometry (VRA) was investigated for 12- to 24-month-old children.
DESIGN: VRA testing began in the soundfield and transitioned to either insert or supra-aural earphones. Audiologists recorded threshold estimates, participant behaviors, and an overall subjective rating of earphone acceptance.
STUDY SAMPLE: One hundred and eighty-six 12- to 24-month-old children referred to the Department of Audiology at St. Louis Children's Hospital for a variety of reasons.
RESULTS: Subjective ratings indicated high acceptance of insert earphones (84%) and supra-aural earphones (80%) despite negative behaviors. There was no significant difference in the number of threshold estimates based on earphone type for 12- to 17-month-old participants. Participants in the 18- to 24-month-old age group provided significantly more threshold estimates with insert earphones (mean = 5.3 threshold estimates, SD = 3.5) than with supra-aural earphones (mean = 2.9 threshold estimates, SD = 2.9). All seven participants who rejected earphone placement were successfully reconditioned for soundfield testing.
CONCLUSIONS: Data support the use of insert earphones during VRA, especially with 18-to 24-month-old children, to obtain ear-specific information.

PMID: 26903087 [PubMed - as supplied by publisher]

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Review of differential diagnosis and management of spasmodic dysphonia.

Review of differential diagnosis and management of spasmodic dysphonia.

Curr Opin Otolaryngol Head Neck Surg. 2016 Feb 17;

Authors: Whurr R, Lorch M

Abstract
PURPOSE OF REVIEW: The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management.
RECENT FINDINGS: Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care.
SUMMARY: Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

PMID: 26900821 [PubMed - as supplied by publisher]

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Word structures of Granada Spanish-speaking preschoolers with typical versus protracted phonological development.

http:--media.wiley.com-assets-7315-19-Wi

Word structures of Granada Spanish-speaking preschoolers with typical versus protracted phonological development.

Int J Lang Commun Disord. 2015 May-Jun;50(3):298-311

Authors: Bernhardt BM, Hanson R, Perez D, Ávila C, Lleó C, Stemberger JP, Carballo G, Mendoza E, Fresneda D, Chávez-Peón M

Abstract
BACKGROUND: Research on children's word structure development is limited. Yet, phonological intervention aims to accelerate the acquisition of both speech-sounds and word structure, such as word length, stress or shapes in CV sequences. Until normative studies and meta-analyses provide in-depth information on this topic, smaller investigations can provide initial benchmarks for clinical purposes.
AIMS: To provide preliminary reference data for word structure development in a variety of Spanish with highly restricted coda use: Granada Spanish (similar to many Hispano-American varieties). To be clinically applicable, such data would need to show differences by age, developmental typicality and word structure complexity. Thus, older typically developing (TD) children were expected to show higher accuracy than younger children and those with protracted phonological development (PPD). Complex or phonologically marked forms (e.g. multisyllabic words, clusters) were expected to be late developing.
METHODS & PROCEDURES: Participants were 59 children aged 3-5 years in Granada, Spain: 30 TD children, and 29 with PPD and no additional language impairments. Single words were digitally recorded by a native Spanish speaker using a 103-word list and transcribed by native Spanish speakers, with confirmation by a second transcriber team and acoustic analysis. The program Phon 1.5 provided quantitative data.
OUTCOMES & RESULTS: In accordance with expectations, the TD and older age groups had better-established word structures than the younger children and those with PPD. Complexity was also relevant: more structural mismatches occurred in multisyllabic words, initial unstressed syllables and clusters. Heterosyllabic consonant sequences were more accurate than syllable-initial sequences. The most common structural mismatch pattern overall was consonant deletion, with syllable deletion most common in 3-year-olds and children with PPD.
CONCLUSIONS & IMPLICATIONS: The current study provides preliminary reference data for word structure development in a Spanish variety with restricted coda use, both by age and types of word structures. Between ages 3 and 5 years, global measures (whole word match, word shape match) distinguished children with typical versus protracted phonological development. By age 4, children with typical development showed near-mastery of word structures, whereas 4- and 5-year-olds with PPD continued to show syllable deletion and cluster reduction, especially in multisyllabic words. The results underline the relevance of multisyllabic words and words with clusters in Spanish phonological assessment and the utility of word structure data for identification of protracted phonological development.

PMID: 25521065 [PubMed - indexed for MEDLINE]

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Sinonasal and rhinopharyngeal solitary fibrous tumour: a case report and review of the literature.

Sinonasal and rhinopharyngeal solitary fibrous tumour: a case report and review of the literature.

Acta Otorhinolaryngol Ital. 2015 Dec;35(6):455-8

Authors: Rizzo S, Giunta AA, Pennacchi A

Abstract
Solitary fibrous tumours are rare neoplasms that arise mostly from the pleura. Much more rarely they can also be found in extrapleural sites, including the head and neck. We report a rare case of a sinonasal and rhinopharyngeal solitary fibrous tumour. The tumour, measuring 67 x 28 x 55 mm, was first embolised and then successfully removed through endonasal endoscopic surgery. Histopathologic analysis confirmed the nature of the lesion, which was positive for CD34 and vimentin. A post-operative CT scan and endoscopic follow-up demonstrated total resection and absence of recurrence after 13 months.

PMID: 26900253 [PubMed - in process]

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The GOCCLES® medical device is effective in detecting oral cancer and dysplasia in dental clinical setting. Results from a multicentre clinical trial.

The GOCCLES® medical device is effective in detecting oral cancer and dysplasia in dental clinical setting. Results from a multicentre clinical trial.

Acta Otorhinolaryngol Ital. 2015 Dec;35(6):449-54

Authors: Moro A, DE Waure C, DI Nardo F, Spadari F, Mignogna MD, Giuliani M, Califano L, Giannì AB, Cardarelli L, Celentano A, Bombeccari G, Pelo S

Abstract
The purpose of this study is to demonstrate that the GOCCLES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the GOCCLES® spectacles while the light from a dental curing light irradiated the oral mucosa. Lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. Data from 64 biopsies were analysed. Of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. One lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. In 56.7% of cases, true positive lesions showed greater extension when observed through the device. The GOCCLES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. It allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections.

PMID: 26900252 [PubMed - in process]

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Role of bimodal stimulation for auditory-perceptual skills development in children with a unilateral cochlear implant.

Role of bimodal stimulation for auditory-perceptual skills development in children with a unilateral cochlear implant.

Acta Otorhinolaryngol Ital. 2015 Dec;35(6):442-8

Authors: Marsella P, Giannantonio S, Scorpecci A, Pianesi F, Micardi M, Resca A

Abstract
This is a prospective randomised study that evaluated the differences arising from a bimodal stimulation compared to a monaural electrical stimulation in deaf children, particularly in terms of auditory-perceptual skills development. We enrolled 39 children aged 12 to 36 months, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side. All were unilaterally implanted: 21 wore only the cochlear implant (CI) (unilateral CI group), while the other 18 used the CI and a contralateral hearing aid at the same time (bimodal group). They were assessed with a test battery designed to appraise preverbal and verbal auditory-perceptual skills immediately before and 6 and 12 months after implantation. No statistically significant differences were observed between groups at time 0, while at 6 and 12 months children in the bimodal group had better scores in each test than peers in the unilateral CI group. Therefore, although unilateral deafness/hearing does not undermine hearing acuity in normal listening, the simultaneous use of a CI and a contralateral hearing aid (binaural hearing through a bimodal stimulation) provides an advantage in terms of acquisition of auditory-perceptual skills, allowing children to achieve the basic milestones of auditory perception faster and in greater number than children with only one CI. Thus, "keeping awake" the contralateral auditory pathway, albeit not crucial in determining auditory acuity, guarantees benefits compared with the use of the implant alone. These findings provide initial evidence to establish shared guidelines for better rehabilitation of patients undergoing unilateral cochlear implantation, and add more evidence regarding the correct indications for bilateral cochlear implantation.

PMID: 26900251 [PubMed - in process]

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[Clinical manifestations of 20 cases of the superior semicircular canal dehiscence syndrome and the intervention strategies].

[Clinical manifestations of 20 cases of the superior semicircular canal dehiscence syndrome and the intervention strategies].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Feb 7;51(2):81-5

Authors: Zhang XA, Li Y, Dai CF

Abstract
OBJECTIVE: The objective of this study is to investigate the clinical manifestations of the superior semicircular canal dehiscence syndrome(SSCDS) and the treatment strategies.
METHODS: Data from 20 cases diagnosed with SSCDS from September 2004 to December 2014 were retrospectively analyzed in this study. The clinical presentations including symptoms, signs, audiological and vestibular function examination, and their imaging characteristics and treatment strategies were reviewed.
RESULTS: All of the patients demonstrated variable degree of vertigo. Four patients could not tolerate the environmental noise. Autophony was noted in nine cases, among whom, two patients could feel their eye movements and heart beat, one patient could feel his footstep, one patient couldn't endure the singing by himself. Slow component vertical tortional eye movement away from the effected eye were observed in twelve patients when loud noise was given or middle ear or intracranial pressure increased. Head movement was induced by loud noise in one case. Ten patients presented with low frequency hearing loss. One case was concomitance with chronic otitis media and demonstrated severe sensorineural hearing loss. Nine patients demonstrated normal hearing. Decreased thresholds were showed by VEMP examination in six cases. Variable bone defect overlying in the SSCDS was confirmed by CT scans in all of the cases. The surgical repair of the superior semicircular canal dehiscence was performed through the middle cranial fossa approach in three cases and mastoid approach in two cases. The dizziness and the autophony were significantly alleviated after surgery.
CONCLUSIONS: The clinical manifestations of SSCDS mainly demonstrate dizziness, autophony and loss of low frequency hearing. Treatment strategies are mainly composed of avoidance of environmental noise and shouting voice of the patients themselves. Surgical repair of the superior semicircular canal dehiscence was proposed to conduct, either through the middle cranial fossa approach or mastoid approach, when the patient couldn't tolerate the sypmtoms.

PMID: 26898860 [PubMed - in process]

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Effect of inhaled steroids on laryngeal microflora.

Effect of inhaled steroids on laryngeal microflora.

Acta Otolaryngol. 2016 Feb 22;:1-4

Authors: Turan M, Ekin S, Ucler R, Arısoy A, Bayram Y, Yalınkılıç A, Bozan N, Garca MF, Çankaya H

PMID: 26901427 [PubMed - as supplied by publisher]

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Sterile α Motif Domain Containing 9 Is a Novel Cellular Interacting Partner to Low-Risk Type Human Papillomavirus E6 Proteins.

Sterile α Motif Domain Containing 9 Is a Novel Cellular Interacting Partner to Low-Risk Type Human Papillomavirus E6 Proteins.

PLoS One. 2016;11(2):e0149859

Authors: Wang J, Dupuis C, Tyring SK, Underbrink MP

Abstract
Low-risk type human papillomavirus (HPV) 6 and 11 infection causes recurrent respiratory papillomatosis (RRP) and genital warts. RRP is the most common benign tumor of the larynx in children with frequent relapses. Repeated surgeries are often needed to improve vocal function and prevent life-threatening respiratory obstruction. Currently, there are no effective treatments available to completely eliminate these diseases, largely due to limited knowledge regarding their viral molecular pathogenesis. HPV E6 proteins contribute to cell immortalization by interacting with a variety of cellular proteins, which have been well studied for the high-risk type HPVs related to cancer progression. However, the functions of low-risk HPV E6 proteins are largely unknown. In this study, we report GST-pulldown coupled mass spectrometry analysis with low-risk HPV E6 proteins that identified sterile alpha motif domain containing 9 (SAMD9) as a novel interacting partner. We then confirmed the interaction between HPV-E6 and SAMD9 using co-immunoprecipitation, proximity ligation assay, and confocal immunofluorescence staining. The SAMD9 gene is down-regulated in a variety of neoplasms and deleteriously mutated in normophosphatemic familial tumoral calcinosis. Interestingly, SAMD9 also has antiviral functions against poxvirus. Our study adds to the limited knowledge of the molecular properties of low-risk HPVs and describes new potential functions for the low-risk HPV E6 protein.

PMID: 26901061 [PubMed - as supplied by publisher]

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Vocal tract characteristics in Parkinson's disease.

Vocal tract characteristics in Parkinson's disease.

Curr Opin Otolaryngol Head Neck Surg. 2016 Feb 18;

Authors: Gillivan-Murphy P, Carding P, Miller N

Abstract
PURPOSE OF REVIEW: Voice tremor is strongly linked to the Parkinson's disease speech-voice symptom complex. Little is known about the underlying anatomic source(s) of voice tremor when it occurs. We review recent literature addressing this issue. Additionally we report findings from a study we conducted employing rating of vocal tract structures viewed using nasolaryngoscopy during vocal and nonspeech tasks.
RECENT FINDINGS: In Parkinson's disease, using laryngeal electromyography, tremor has not been identified in muscles in the vocal folds even when perceived auditorily. Preliminary findings using nasolaryngoscopy suggest that Parkinson's disease voice tremor is not associated with the vocal folds and may involve the palate, the global larynx, and the arytenoids tremor in the vertical larynx on /a/, and tremor in the arytenoid cartilages on /s/ differentiated patients with Parkinson's disease from neurologically healthy controls. Visual reliable detection of tremor when it is absent or borderline present, is challenging.
SUMMARY: Parkinson's disease voice tremor is likely to be related to oscillatory movement in structures across the vocal tract rather than just the vocal folds. To progress clinical practice, more refined tools for the visual rating of tremor would be beneficial. How far voice tremor represents a functionally significant factor for speakers would also add to the literature.

PMID: 26900819 [PubMed - as supplied by publisher]

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Knowledge About Head and Neck Cancer in the Population of Vojvodina: A Comparative Study.

Knowledge About Head and Neck Cancer in the Population of Vojvodina: A Comparative Study.

Coll Antropol. 2015 Sep;39(3):761-7

Authors: Mumović G, Golijan B, Skrbić R, Kravos A

Abstract
In 2009, the Institute of Oncology of Vojvodina reported the total of 553 newly registered patients with head and neck cancer (HNC) in the Province of Vojvodina, with a lethal outcome in 332 HNC patients. These facts impose the need of investigating the health education of the general population and proposing possible prevention measures. The present prospective study included 200 subjects classified into two groups. Group 1 (100 subjects) consisted of randomly selected adults from urban and rural regions of Vojvodina. Group II (100 subjects) included the adults from the same regions affected by HNC. All subjects answered the anonymous questionnaire which complied with the standards of a similar European Union research project "About Face". The results showed that 96% of the subjects from the Group II and only 77% of the subjects from the Group I were familiar with the term "head and neck cancer" what represented a significant difference. The results from Vojvodina were significantly better than those from the European study (23%). Most subjects were informed about HNC through television programs (60%), hospital leaflets (41%) or internet (37%). Both the patients and the citizens of Vojvodina were better informed about the most common localizations of HNC-pharynx and larynx, but less informed about other HNC localizations than the citizens of seven European countries. The citizens and the HNC patients from Vojvodina were equally well informed about some risk factors (e.g., smoking, alcoholism, aging and sun exposure) as the citizens in Europe. Both the patients and the general population of Vojvodina are mostly worried about the consequences/side effects of the applied surgical treatment. The obtained results may be a good starting point in the prevention and early detection of HNC in Vojvodina.

PMID: 26898078 [PubMed - in process]

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The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management.

http:--linkinghub.elsevier.com-ihub-imag

The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management.

Anesthesiol Clin. 2015 Jun;33(2):357-67

Authors: Akulian JA, Yarmus L, Feller-Kopman D

Abstract
Cricothyrotomy, percutaneous dilation tracheostomy, and surgical tracheostomy are cost-effective and safe techniques employed in the management of critically ill patients requiring insertion of an artificial airway. These procedures have been well characterized and studied in the surgical, emergency medicine, and critical care literature. This article focuses on the role of each of these modalities in airway management, specifically comparing the data for each procedure in regard to procedural outcomes. The authors discuss the techniques available and the relevant background data regarding choice of each method and its integration into clinical practice.

PMID: 25999008 [PubMed - indexed for MEDLINE]

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Δευτέρα 22 Φεβρουαρίου 2016

Repetitive Transcranial Magnetic Stimulation: a Novel Approach for Treating Oropharyngeal Dysphagia.

Repetitive Transcranial Magnetic Stimulation: a Novel Approach for Treating Oropharyngeal Dysphagia.

Curr Gastroenterol Rep. 2016 Feb;18(2):10

Authors: Michou E, Raginis-Zborowska A, Watanabe M, Lodhi T, Hamdy S

Abstract
In recent years, repetitive transcranial magnetic stimulation, a technique used to produce human central neurostimulation, has attracted increased interest and been applied experimentally in the treatment of dysphagia. This review presents a synopsis of the current research for the application of repetitive transcranial magnetic stimulation (rTMS) on dysphagia. Here, we review the mechanisms underlying the effects of rTMS and the results from studies on both healthy volunteers and dysphagic patients. The clinical studies on dysphagia have primarily focussed on dysphagia post-stroke. We discuss why it is difficult to draw conclusions for the efficacy of this neurostimulation technique, given the major differences between studies. The intention here is to stimulate potential research questions not yet investigated for the application of rTMS on dysphagic patients prior to their translation into clinical practice for dysphagia rehabilitation.

PMID: 26897756 [PubMed - as supplied by publisher]

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Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

J Voice. 2016 Feb 18;

Authors: Silva WJ, Lopes LW, Macedo AE, Costa DB, Almeida AA

Abstract
OBJECTIVES: The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia.
STUDY DESIGN: This is a descriptive, quantitative, field intervention study.
METHODS: Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test).
RESULTS: The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy.
CONCLUSIONS: This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits.

PMID: 26897544 [PubMed - as supplied by publisher]

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Narrow band imaging endoscopy of the nasopharynx is not more useful than white light endoscopy for suspected nasopharyngeal carcinoma.

Narrow band imaging endoscopy of the nasopharynx is not more useful than white light endoscopy for suspected nasopharyngeal carcinoma.

Eur Arch Otorhinolaryngol. 2016 Feb 20;

Authors: Vlantis AC, Woo JK, Tong MC, King AD, Goggins W, van Hasselt CA

Abstract
Endoscopy is often used to screen for nasopharyngeal carcinoma. A normal nasopharynx on white light endoscopy may yet harbor subclinical or occult malignancy. This study assessed whether the vascular pattern seen on narrow band imaging endoscopy could indicate this and thus be useful for detecting suspected nasopharyngeal carcinoma. The nasopharynx of 156 patients who failed serological screening for or presented with symptoms of nasopharyngeal carcinoma was graded under white light and narrow band imaging endoscopy and a biopsy taken. The accuracy of assessing the nasopharynx as being probably or definitely malignant on white light endoscopy was high (area under the curve = 0.924), as it was of being normal on narrow band imaging endoscopy (=0.799). The sensitivity and specificity of white light and narrow band imaging endoscopy for nasopharyngeal carcinoma was 93 and 22 %, and 92 and 98 %, respectively. Significantly associated with nasopharyngeal carcinoma was a high index of suspicion or definitely malignant grade on white light endoscopy (p < 0.0005, odds 58.978) and vascular tufts on narrow band imaging endoscopy (p = 0.020, odds 41.210). Narrow band imaging endoscopy of vasculature alone for suspected nasopharyngeal carcinoma is not more useful than white light endoscopy of nasopharyngeal morphology, nor does it add to or surpass the diagnostic accuracy of white light endoscopy in this regard.

PMID: 26897607 [PubMed - as supplied by publisher]

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Effect of laryngotracheal topical anesthesia on recurrent laryngeal nerve monitoring during thyroid Surgery.

Effect of laryngotracheal topical anesthesia on recurrent laryngeal nerve monitoring during thyroid Surgery.

J Clin Anesth. 2016 Mar;29:10-13

Authors: Pachuski J, Vaida S, Donahue K, Roberts J, Kunselman A, Oberman B, Patel H, Goldenberg D

Abstract
STUDY OBJECTIVE: Intraoperative neuromonitoring of the recurrent laryngeal nerve (RLN) is often used as an adjunct for RLN identification and preservation during thyroidectomies. Laryngotracheal anesthesia (LTA) with topical lidocaine reduces coughing upon emergence from anesthesia and in the immediate postoperative period; however, its use is prohibited with concerns that it could decrease the sensitivity of the intraoperative neuromonitoring. We hypothesize that there is no difference in measurements of nerve conduction made before and after LTA administration.
DESIGN: An observational study in which all patients were subjected to LTA administration was conducted. Recurrent laryngeal nerve threshold currents were measured before and after the intervention.
SETTING: Tertiary medical center operating room.
PATIENTS: Eighteen patients (total of 25 nerves at risk) with American Society of Anesthesiologists classes 1 to 3 undergoing thyroid surgery.
INTERVENTIONS: After the thyroid was removed and threshold currents at the RLN were obtained, LTA with endotracheal lidocaine was applied on the left and right side of the in situ endotracheal tube (2 cc of 4% lidocaine per side). Threshold currents were reassessed at 5 and 10 minutes after LTA administration.
MEASUREMENTS: Threshold currents (minimum stimulus current applied to the RLN required to generate a discernible electromyographic response at the vocal cords) were recorded along the RLN for a baseline at 5 and 10 mm from the insertion point of the RLN into the larynx. Threshold currents were reassessed at the same 2 positions on the RLN at 5 and 10 minutes after LTA administration. Differences in mean values, between threshold currents recorded at the 3 different times, at 2 positions on the RLN, were used to compare effects of LTA on nerve conduction.
MAIN RESULTS: There were no statistically significant differences when comparing threshold currents before and after LTA administration.
CONCLUSIONS: Laryngotracheal anesthesia had no significant effect on RLN nerve conduction in the period assessed.

PMID: 26897439 [PubMed - as supplied by publisher]

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An anatomical study of the pathophysiology of carotid cavernous sinus fistula associated with Le Fort III osteotomy.

An anatomical study of the pathophysiology of carotid cavernous sinus fistula associated with Le Fort III osteotomy.

J Craniomaxillofac Surg. 2016 Jan 14;

Authors: Uchida Y, Mitsukawa N, Akita S, Suzuki T, Mori C, Satoh K

Abstract
Carotid-cavernous sinus fistula (CCF) is a rare complication occurring after the Le Fort osteotomy. We aimed to elucidate the cause of CCF in the Le Fort osteotomy.
METHODS: Eleven fresh cadavers were used. After craniotomy, a Le Fort III bipartition osteotomy was then performed. On the left side, both the lateral wall of the maxilla and the pterygomaxillary junction (PMJ) were divided, in addition to the conventional osteotomy line. On the right side, those parts were kept intact. After the osteotomy, a tensiometer was fixed to the skull base. The sensor was linked with the wall of the carotid artery in the cavernous portion. A down-fracture was then performed initially from the left, followed by the right. Tensile force data of both sides were recorded.
RESULTS: In all cases, a higher tensile load was observed on the right side compared to the left side. In right side, two skull base fractures complexed with high pterygoid process fractures, and nine pure high fractures of the pterygoid process were identified.
CONCLUSIONS: During down-fracture, the wall of the carotid artery experiences significant tensile load. The tensile load on the arterial wall may collapse the fine branches of the carotid artery in the cavernous portion.

PMID: 26897299 [PubMed - as supplied by publisher]

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Κυριακή 21 Φεβρουαρίου 2016

THYROSIM App for Education and Research Predicts Potential Health Risks of Over-the-Counter (OTC) Thyroid Supplements.

THYROSIM App for Education and Research Predicts Potential Health Risks of Over-the-Counter (OTC) Thyroid Supplements.

Thyroid. 2016 Feb 19;

Authors: Han SX, Eisenberg M, Larsen PR, DiStefano Iii JJ

Abstract
BACKGROUND: Computer simulation tools for education and research are making increasingly effective use of the internet and personal devices. To facilitate these activities in endocrinology and metabolism, we developed and further validated a mechanistically-based simulator of human thyroid hormone and thyrotropin regulation dynamics, implementing it as a facile and freely accessible web-based and personal device application (the THYROSIM app). We elucidate and demonstrate its utility here in a research context by exploring key physiological effects of over-the-counter thyroid supplements.
METHODS: THYROSIM has a simple and intuitive user interface for teaching and conducting simulated "what-if" experiments. User-selectable "experimental" test-input dosages (oral, IV-pulses, IV-infusions) are represented by animated graphical icons integrated with a cartoon of the hypothalamic-pituitary-thyroid axis. Simulations of familiar T3, T4 and TSH temporal dynamic responses to these exogenous stimuli are reported graphically along with normal ranges on the same single interface page; and multiple sets of simulated experimental results are superimposable, to facilitate comparative analyses.
RESULTS AND CONCLUSIONS: We show that THYROSIM accurately reproduces a wide range of published clinical study data reporting hormonal kinetic responses to large and small oral hormone challenges. Simulation examples of partial-thyroidectomies and malabsorption illustrate typical usage, by optionally changing thyroid gland secretion and/or gut absorption rates - expressed as percentages of normal - as well as additions of oral hormone dosing, all directly on the interface, and visualizing the kinetic responses to these challenges. Classroom and patient education usage - with public health implications - is illustrated by predictive simulated responses to nonprescription thyroid health supplements analyzed previously for T3 and T4 content. Notably, we found T3 in supplements has potentially more serious pathological effects than does T4 - concomitant with low-normal TSH levels. Some preparations contain enough T3 to generate thyrotoxic conditions, with supernormal serum T3-spiking and subnormal serum T4 and TSH levels and, in some cases, with normal or low-normal range TSH levels due to thyroidal axis negative feedback. These results suggest that appropriate regulation of these products is needed.

PMID: 26895744 [PubMed - as supplied by publisher]

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WEIGHT LOSS AND VARIATION OF LEVOTHYROXINE (L-T4) REQUIREMENTS IN HYPOTHYROID OBESE PATIENTS AFTER BARIATRIC SURGERY.

WEIGHT LOSS AND VARIATION OF LEVOTHYROXINE (L-T4) REQUIREMENTS IN HYPOTHYROID OBESE PATIENTS AFTER BARIATRIC SURGERY.

Thyroid. 2016 Feb 19;

Authors: Fierabracci P, Martinelli S, Tamberi A, Piaggi P, Basolo A, Pelosini C, Ricco I, Magno S, Querci G, Ceccarini G, Scartabelli G, Salvetti G, Vitti P, Santini F

Abstract
BACKGROUND: Obesity and hypothyroidism are both common disorders within the general population. Obese hypothyroid subjects require higher doses of L-T4 as compared to normal weight individuals. Previous studies on the effects of bariatric surgery on L-T4 dose requirements in hypothyroid subjects provided conflicting results. The aim of this study was to evaluate the L-T4 requirements in a group of obese subjects with acquired hypothyroidism, before and after weight loss achieved by bariatric surgery.
METHODS: Ninety-three obese hypothyroid subjects (age: 48 ± 9 yrs, BMI: 45.9 ± 5.6 kg/m2), were evaluated before and 28 ± 8 months after bariatric surgery. Changes in the L-T4 dose, anthropometric measures, and hormone values were evaluated. In 20 patients data of body composition, assessed by dual energy X-ray absorptiometry, were also analyzed.
RESULTS: On average, after weight loss, a significant reduction of the total dose of L-T4 was documented (from 130.6 ± 48.5 to 116.2 ± 38.6 µg/day, p<0.001). The L-T4 dose had to be reduced in 47 patients, it was unchanged in 34 while it had to be increased in 12 patients affected by autoimmune thyroiditis. Reduction of the L-T4 dose was proportional to reduction of the lean mass.
CONCLUSIONS: The weight loss that is achieved with modern surgical bariatric procedures is associated with a reduction of L-T4 requirements in most hypothyroid subjects, which appears related to a decrease of the lean mass. Occasionally, a concurrent decline of residual thyroid function, as it occurs in autoimmune thyroiditis, can counteract this phenomenon and eventually produce an increase of L-T4 needs. We believe that during the weight loss phase that follows bariatric surgery there is no need for preventive adjustments of the L-T4 dose, but serum thyroid hormones and TSH should be periodically monitored, to detect possible variations of L-T4 requirements and to allow proper corrections of the therapy.

PMID: 26895690 [PubMed - as supplied by publisher]

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Tufted angioma of the maxilla: a rare case with unique clinical presentation.

Tufted angioma of the maxilla: a rare case with unique clinical presentation.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Dec 19;

Authors: Katsoulas N, Nikitakis N, Theologie-Lygidakis N, Lianou V, Tsiklakis K, Iatrou I, Sklavounou-Andrikopoulou A

Abstract
Tufted angioma is an uncommon benign vascular tumor usually presenting in early childhood and affecting mainly the skin. It has been associated with Kasabach-Merritt syndrome, a severe coagulopathy of poor prognosis. There have been very few published cases of oral tufted angiomas, and maxillary bone involvement has not been hitherto reported. We present a case of a 10-year-old Caucasian boy with an erythematous left maxillary gingival mass accompanied by subjacent hard tissue swelling. Radiologic evaluation revealed an irregular mixed radiolucent and radiopaque area in the left maxilla, accompanied by alveolar ridge erosion, cortical plate expansion, and displacement and divergence of the premolars. The histopathologic examination showed scattered irregular tufted lobules of variably sized vascular spaces inside the subepithelial connective tissue and among the underlying bone trabeculae, exhibiting a "cannonball" appearance. Immunohistochemical evaluation found positivity for CD31, CD34, and smooth muscle actin, and a final diagnosis of tufted angioma with osseous involvement was rendered. A thorough review of the pertinent literature revealed only 9 previously published intraoral tufted angioma cases, the salient demographic and clinicopathologic features of which are summarized.

PMID: 26896438 [PubMed - as supplied by publisher]

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Pulsatile tinnitus and a temporal bone mass.

Pulsatile tinnitus and a temporal bone mass.

Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Feb 16;

Authors: Ginat DT, Gluth MB

PMID: 26895763 [PubMed - as supplied by publisher]

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The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. Adults.

The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. Adults.

Prev Med. 2016 Feb 16;

Authors: Wilson SJ, Garner JC, Loprinzi PD

Abstract
OBJECTIVE: Studies have looked at the individual associations of sensory impairment on balance, but no population-based studies have examined their combined association on balance and difficulty with falls. Thus, the purpose of this study was to examine both the independent associations and combined associations of visual impairment, peripheral neuropathy, and self-reported hearing loss with the odds of reporting difficulty with falls and functional balance.
METHODS: Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Vision and peripheral neuropathy were objectively measured, and hearing was self-reported. Balance testing consisted of a modified Romberg test. After exclusions, 1662 (40-85years of age) participants provided complete data on the study variables.
RESULTS: Sensory impairment was associated with perceived difficulty of falls and functional balance. Participants who presented a single sensory impairment had 29% reduced odds of having functional balance (95% CI=0.54-0.93, p=0.01) and increased odds of reporting difficulty with falls by 61% (95% CI=0.99-2.60, p=0.05). Moreover, our multisensory models showed some evidence of a dose-response relationship, in that sensory impairment of multiple sensory systems was associated with worse balance (OR =0.59, CI=0.35-1.00, p=0.05) and perceived difficulty of falls (OR =5.02, 95% CI=1.99-12.66, p=0.002) when compared to those with less sensory impairment.
CONCLUSION: Multiple sensory impairment is associated with significantly higher odds of both reporting difficulty with falls and balance dysfunction, which may lead to a subsequent fall, ultimately compromising the individual's health.

PMID: 26896633 [PubMed - as supplied by publisher]

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Challenges in the pharmacological management of epilepsy and its causes in the elderly.

Challenges in the pharmacological management of epilepsy and its causes in the elderly.

Pharmacol Res. 2016 Feb 16;

Authors: Ferlazzo E, Sueri C, Gasparini S, Aguglia U

Abstract
Epilepsy represents the third most common neurological disorders in the elderly after cerebrovascular disorders and dementias. The incidence of new-onset epilepsy peaks in this age group. The most peculiar aetiologies of late-onset epilepsy are stroke, dementia, and brain tumours. However, aetiology remains unknown in about half of the patients. Diagnosis of epilepsy may be challenging due to the frequent absence of ocular witnesses and the high prevalence of seizure-mimics (i.e. transient ischemic attacks, syncope, transient global amnesia or vertigo) in the elderly. The diagnostic difficulties are even greater when patients have cognitive impairment or cardiac diseases. The management of late-onset epilepsy deserves special considerations. The elderly can reach seizure control with low antiepileptic drugs (AEDs) doses, and seizure-freedom is possible in the vast majority of patients. Pharmacological management should take into account pharmacokinetics and pharmacodynamics of AEDs and the frequent occurrence of comorbidities and polytherapy in this age group. Evidences from double-blind and open-label studies indicate lamotrigine, levetiracetam and controlled-release carbamazepine as first line treatment in late-onset epilepsy.

PMID: 26896787 [PubMed - as supplied by publisher]

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Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo.

Using the Physical Examination to Diagnose Patients with Acute Dizziness and Vertigo.

J Emerg Med. 2016 Feb 16;

Authors: Edlow JA, Newman-Toker D

Abstract
BACKGROUND: Emergency department (ED) patients who present with acute dizziness or vertigo can be challenging to diagnose. Roughly half have general medical disorders that are usually apparent from the context, associated symptoms, or initial laboratory tests. The rest include a mix of common inner ear disorders and uncommon neurologic ones, particularly vertebrobasilar strokes or posterior fossa mass lesions. In these latter cases, misdiagnosis can lead to serious adverse consequences for patients.
OBJECTIVE: Our aim was to assist emergency physicians to use the physical examination effectively to make a specific diagnosis in patients with acute dizziness or vertigo.
DISCUSSION: Recent evidence indicates that the physical examination can help physicians accurately discriminate between benign inner ear conditions and dangerous central ones, enabling correct management of peripheral vestibular disease and avoiding dangerous misdiagnoses of central ones. Patients with the acute vestibular syndrome mostly have vestibular neuritis, but some have stroke. Data suggest that focused eye movement examinations, at least when performed by specialists, are more sensitive for detecting early stroke than brain imaging, including diffusion-weighted magnetic resonance imaging. Patients with the triggered episodic vestibular syndrome mostly have benign paroxysmal positional vertigo (BPPV), but some have posterior fossa mass lesions. Specific positional tests to provoke nystagmus can confirm a BPPV diagnosis at the bedside, enabling immediate curative therapy, or indicate the need for imaging.
CONCLUSIONS: Emergency physicians can effectively use the physical examination to make a specific diagnosis in patients with acute dizziness or vertigo. They must understand the limitations of brain imaging. This may reduce misdiagnosis of serious central causes of dizziness, including posterior circulation stroke and posterior fossa mass lesions, and improve resource utilization.

PMID: 26896289 [PubMed - as supplied by publisher]

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Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching.

Oncologic outcomes of robotic thyroidectomy: 5-year experience with propensity score matching.

Surg Endosc. 2016 Feb 19;

Authors: Tae K, Song CM, Ji YB, Sung ES, Jeong JH, Kim DS

Abstract
BACKGROUND: The oncologic outcome of robotic thyroidectomy is not yet well established. The aim of this study was to evaluate the recurrence rate after robotic thyroidectomy in comparison with conventional thyroidectomy for papillary thyroid carcinoma (PTC).
METHODS: We analyzed 896 patients with PTC who either underwent robotic (212 patients using a gasless unilateral axillary or an axillo-breast approach) or conventional cervical thyroidectomy (684 patients) with/without central neck dissection between October 2008 and February 2014. We excluded patients who underwent concomitant lateral neck dissection or completion thyroidectomy, and cases with T4 tumor, tumor lager than 4 cm, other types of thyroid cancer, recurrent cancer, and distant metastasis. A propensity score matching analysis was done with ten covariates including age, gender, body mass index, tumor size, multifocality, bilaterality, extrathyroidal extension, type of thyroidectomy, extent of central neck dissection, and RAI ablation to reduce selection bias.
RESULTS: In baseline data, the male ratio and the mean age were lower in the robotic group. Stage, multifocality, and bilaterality were higher in the conventional group. The rate of total thyroidectomy was higher in the conventional group. The two matched groups of each 185 patients were produced and well balanced by propensity score matching. In the comparison of propensity score matched groups, operative time was longer in the robotic group (P < 0.001), and postoperative complications did not differ between the two groups, except for transient hypoparathyroidism and formation of seroma. The recurrence rate did not differ between the two groups after a mean follow-up of 43.6 months (0.5 and 1.1 % in the robotic and conventional groups, respectively, P = 0.375).
CONCLUSION: The oncologic outcome of robotic thyroidectomy in 5-year experience is comparable to that of conventional thyroidectomy in selected patients with PTC.

PMID: 26895921 [PubMed - as supplied by publisher]

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Σάββατο 20 Φεβρουαρίου 2016

"B-ENT"[jour]; +23 new citations

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[Neuronavigation-guided pure endoscopic endonasai transsphenoidal approach for pituitary adenomas].

[Neuronavigation-guided pure endoscopic endonasai transsphenoidal approach for pituitary adenomas].

Zhonghua Yi Xue Za Zhi. 2015 Feb 3;95(5):339-43

Authors: Hu C, Ji H, Zhang S, Hao X, Shen B, Su L

Abstract
OBJECTIVE: To explore the efficacies of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for removing pituitary adenomas.
METHODS: Retrospective analyses were conducted for the clinical data of 139 patients undergoing pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between July 2011 and July 2014. There were 55 males and 84 females with a mean age of 48. 9 (21 - 73) years. The classifications of Hardy-Wilson were I (n =16), II (n = 39), III (n = 48) and IV (n = 36). Neuronavigation was used in all patients. And neuro-ophthalmological, neuroimaging and endocrinological follow-ups were conducted postoperatively.
RESULTS: Total (n = 95, 68. 3%), subtotal (n = 33, 23. 7%) and partial (n = 11, 7. 9%) removals were achieved. For Hardy-Wilson I, gross total removal was achieved (n = 16, 100%); Hardy-Wilson II (n = 35, 89. 7%), Hardy-Wilson III (n = 34, 70. 8%) and Hardy-Wilson IV (n = 10, 27. 8%). Postoperative visual acuity improved (92. 1%, 70/76) and endocrine remission was observed (59. 6%, 53/89). The postoperative complications included cerebrospinal fluid (CSF) leakage (n = 8, 5. 8%), meningitis (n = 3), sellar hematoma (n = 5) and delayed carotid artery rupture (n = 1). And the patient of hemorrhagic shock underwent emergency interventional procedures and was discharged successfully.
CONCLUSION: Pure endoscopic endonasal transsphenoidal approach for removing pituitary adenoma is both safe and effective. And its efficacies may further increased through combined neuronavigation.

PMID: 26168667 [PubMed - indexed for MEDLINE]

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A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal "Rule of Nine" on axial computed tomography.

http:--production.springer.de-OnlineReso

A new method to determine whether ossified posterior longitudinal ligament can be resected completely and safely: spinal canal "Rule of Nine" on axial computed tomography.

Eur Spine J. 2015 Aug;24(8):1673-80

Authors: Yang H, Lu X, Wang X, Chen D, Yuan W, Yang L, Liu Y

Abstract
PURPOSE: To introduce the new method of spinal canal "Rule of Nine" on axial computed tomography (CT) to determine whether ossified posterior longitudinal ligament (OPLL) can be resected completely and safely.
METHODS: From January 2008 to January 2013, we retrospectively analyzed 308 patients with cervical OPLL who underwent anterior corpectomy. Patients were examined by cervical plain X-ray, CT, and magnetic resonance imaging. The characteristics of OPLL on axial CT, dural mater adhesion and ossification, complete resection of the ossified mass, cerebrospinal fluid (CSF) leakage, spinal cord injury (SCI), and postoperative outcome were all studied. OPLL was characterized at the maximum ossified level using spinal canal "Rule of Nine" on axial CT.
RESULTS: OPLL was completely and safely resected in 129 patients, whose ossified mass was within the safety zone. No CSF leakage or SCI occurred. The most ossified material was resected when OPLL was within the danger zone in 21 patients. There were two cases of SCI and seven of CSF leakage. In the other 158 patients, the ossified mass was within the intermediate zone. In 96 patients the width of the ossified mass was <2 resection units. It was completely resected and one case had CSF leakage. In the other 62 cases, the ossified mass was >2 resection units and there were nine cases of CSF leakage. CSF leakage and SCI increased significantly when the ossified mass was ≥6 units. The inter- and intraobserver κ values were 0.76 and 0.84, respectively, showing a good reliability.
CONCLUSIONS: Our new method can be used to determine whether OPLL can be resected completely and safely, and identify potential risks and complications.

PMID: 25192727 [PubMed - indexed for MEDLINE]

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Mobile Phone Usage and its Health Effects Among Adults in a Semi-Urban Area of Southern India.

Mobile Phone Usage and its Health Effects Among Adults in a Semi-Urban Area of Southern India.

J Clin Diagn Res. 2016 Jan;10(1):LC14-6

Authors: Stalin P, Abraham SB, Kanimozhy K, Prasad RV, Singh Z, Purty AJ

Abstract
INTRODUCTION: Worldwide, mobile phone usage has been increased dramatically which could affect the health of the people. India has the second largest number of mobile phone users. However there are only few studies conducted in India to assess its effects on health.
AIM: To determine the prevalence and pattern of mobile phone usage and to assess the relationship between certain selected health problems and mobile phone usage among adults.
SETTINGS AND DESIGN: Community-based cross-sectional study was conducted in Kottakuppam, a town panchayat in Villupuram district of Coastal Tamil Nadu, Southern India. It is a semi-urban area with a population of about 16,000. Majority of the residents are Muslim by religion and belong to different socio economic status.
MATERIALS AND METHODS: The study was approved by the Institutional Ethics Committee. A total of 2121 study participants were interviewed by the pre-final medical students through house-to-house survey using a pretested structured questionnaire. The questionnaire included the variables such as socio demographic profile, mobile phone usage and pattern, selected health problems, perceived benefits and threats and blood pressure. Selected health problems included headache, earache, neck pain, tinnitus, painful fingers, restlessness, morning tiredness, tingling fingers, fatigue, eye symptoms, sleep disturbance and hypertension.
STATISTICAL ANALYSIS USED: Only 2054 were included for data analysis using SPSS 17 version. Proportions were calculated. Chi-square test was used to measure the p-value. The p-value < 0.05 was considered as statistically significant.
RESULTS: The prevalence of mobile phone usage was 70%. Calling facility (94.2%) was used more than the SMS (67.6%). Health problems like headache, earache, tinnitus, painful fingers and restlessness etc., were found to be positively associated with mobile phone usage. There was negative association between hypertension and mobile phone usage.
CONCLUSION: The prevalence of mobile phone usage was high. There was significant association between selected health problems and mobile phone usage. In future, higher studies are required to confirm our findings.

PMID: 26894095 [PubMed]

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Αρχειοθήκη ιστολογίου

Τετάρτη 24 Φεβρουαρίου 2016

Δευτέρα 22 Φεβρουαρίου 2016

Κυριακή 21 Φεβρουαρίου 2016

Σάββατο 20 Φεβρουαρίου 2016