OtoRhinoLaryngology News

Τρίτη 9 Αυγούστου 2016

Tinnitus- related distress: evidence from fMRI of an emotional stroop task.

Tinnitus- related distress: evidence from fMRI of an emotional stroop task.

BMC Ear Nose Throat Disord. 2016;16:10

Authors: Golm D, Schmidt-Samoa C, Dechent P, Kröner-Herwig B

Abstract
BACKGROUND: Chronic tinnitus affects 5 % of the population, 17 % suffer under the condition. This distress seems mainly to be dependent on negative cognitive-emotional evaluation of the tinnitus and selective attention to the tinnitus. A well-established paradigm to examine selective attention and emotional processing is the Emotional Stroop Task (EST). Recent models of tinnitus distress propose limbic, frontal and parietal regions to be more active in highly distressed tinnitus patients. Only a few studies have compared high and low distressed tinnitus patients. Thus, this study aimed to explore neural correlates of tinnitus-related distress.
METHODS: Highly distressed tinnitus patients (HDT, n = 16), low distressed tinnitus patients (LDT, n = 16) and healthy controls (HC, n = 16) underwent functional magnetic resonance imaging (fMRI) during an EST, that used tinnitus-related words and neutral words as stimuli. A random effects analysis of the fMRI data was conducted on the basis of the general linear model. Furthermore correlational analyses between the blood oxygen level dependent response and tinnitus distress, loudness, depression, anxiety, vocabulary and hypersensitivity to sound were performed.
RESULTS: Contradictory to the hypothesis, highly distressed patients showed no Stroop effect in their reaction times. As hypothesized HDT and LDT differed in the activation of the right insula and the orbitofrontal cortex. There were no hypothesized differences between HDT and HC. Activation of the orbitofrontal cortex and the right insula were found to correlate with tinnitus distress.
CONCLUSIONS: The results are partially supported by earlier resting-state studies and corroborate the role of the insula and the orbitofrontal cortex in tinnitus distress.

PMID: 27499700 [PubMed]

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A dural arteriovenous fistula detected during the chronic phase of cerebral venous sinus thrombosis.

A dural arteriovenous fistula detected during the chronic phase of cerebral venous sinus thrombosis.

Rinsho Shinkeigaku. 2016 Aug 6;

Authors: Suzuki Y, Inatomi Y, Yonehara T

Abstract
A 47-year-old woman developed a headache and tinnitus in her right ear followed by sudden-onset left hemiparesis. She had no history of trauma or thrombophilia. Arteriography showed an occlusion of the superior sagittal sinus, and a stenosis of the right transverse sinus. She was treated with anticoagulants; thereafter her deficits and sinus thrombosis immediately improved. However, 7 months after the onset, she noticed tinnitus in her left ear. Arteriography showed a dural arteriovenous fistula extending from the left occipital artery to the left transverse and sigmoid sinus, but no recurrence of the cerebral venous sinus thrombosis. After manual compression of the left occipital artery was initiated, the tinnitus and dural arteriovenous fistula did not worsen. A dural arteriovenous fistula may be detected in patients with cerebral venous sinus thrombosis during the chronic phase.

PMID: 27498817 [PubMed - as supplied by publisher]

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Different infusion durations for preventing platinum-induced hearing loss in children with cancer.

Different infusion durations for preventing platinum-induced hearing loss in children with cancer.

Cochrane Database Syst Rev. 2016 Aug 8;8:CD010885

Authors: van As JW, van den Berg H, van Dalen EC

Abstract
BACKGROUND: Platinum-based therapy, including cisplatin, carboplatin or oxaliplatin, or a combination of these, is used to treat a variety of paediatric malignancies. Unfortunately, one of the most important adverse effects is the occurrence of hearing loss or ototoxicity. In an effort to prevent this ototoxicity, different platinum infusion durations have been studied. This review is an update of a previously published Cochrane review.
OBJECTIVES: To assess the effects of different durations of platinum infusion to prevent hearing loss or tinnitus, or both, in children with cancer. Secondary objectives were to assess possible effects of these infusion durations on: a) anti-tumour efficacy of platinum-based therapy, b) adverse effects other than hearing loss or tinnitus, and c) quality of life.
SEARCH METHODS: We searched the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 4), MEDLINE (PubMed) (1945 to 18 May 2016) and EMBASE (Ovid) (1980 to 18 May 2016). In addition, we handsearched reference lists of relevant articles and we assessed the conference proceedings of the International Society for Paediatric Oncology (2009 up to and including 2015) and the American Society of Pediatric Hematology/Oncology (2014 and 2015). We scanned ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP; http://ift.tt/1VXDXYs) for ongoing trials (searched on 20 May 2016 and 24 May 2016 respectively).
SELECTION CRITERIA: Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing different platinum infusion durations in children with cancer. Only the platinum infusion duration could differ between the treatment groups.
DATA COLLECTION AND ANALYSIS: Two review authors independently performed the study selection, risk of bias assessment and GRADE assessment of included studies, and data extraction including adverse effects. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS: We identified one RCT and no CCTs; in this update no additional studies were identified. The RCT (total number of children = 91) evaluated the use of a continuous cisplatin infusion (N = 43) versus a one-hour bolus cisplatin infusion (N = 48) in children with neuroblastoma. For the continuous infusion, cisplatin was administered on days 1 to 5 of the cycle but it is unclear if the infusion duration was a total of 5 days. Methodological limitations were present. Only results from shortly after induction therapy were provided. No clear evidence of a difference in hearing loss (defined as asymptomatic and symptomatic disease combined) between the different infusion durations was identified as results were imprecise (risk ratio (RR) 1.39, 95% confidence interval (CI) 0.47 to 4.13, low quality evidence). Although the numbers of children were not provided, it was stated that tumour response was equivalent in both treatment arms. With regard to adverse effects other than ototoxicity we were only able to assess toxic deaths. Again, the confidence interval of the estimated effect was too wide to exclude differences between the treatment groups (RR 1.12, 95% CI 0.07 to 17.31, low quality evidence). No data were available for the other outcomes of interest (i.e. tinnitus, overall survival, event-free survival and quality of life) or for other (combinations of) infusion durations or other platinum analogues.
AUTHORS' CONCLUSIONS: Since only one eligible RCT evaluating the use of a continuous cisplatin infusion versus a one-hour bolus cisplatin infusion was found, and that had methodological limitations, no definitive conclusions can be made. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. For other (combinations of) infusion durations and other platinum analogues no eligible studies were identified. More high quality research is needed.

PMID: 27498707 [PubMed - as supplied by publisher]

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Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children.

Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children.

Int J Pediatr Otorhinolaryngol. 2016 Sep;88:208-12

Authors: Dedhia K, Chi DH

Abstract
OBJECTIVES: 1. To report our experience in children with sudden-onset sensorineural hearing loss (SSNHL). 2. To describe the etiology and management of children with SSNHL.
METHODS: Retrospective review of 20 children with SSNHL, from 2000 to 2013 at a tertiary pediatric facility. Patients had the following inclusion criteria: history of normal hearing, hearing loss occurring in less than 3 days, and audiogram documentation.
RESULTS: The average age of patients presenting with SSNHL is 11 years 3 months (22months-18years). Only 6 (30%) children presented prior to 2 weeks. Tinnitus (55%) was the most common associated symptoms followed by otalgia (25%), and vertigo (20%). Eight patients had bilateral hearing loss, 6 only right and 6 only left. Hearing loss severity ranged from profound (45%) being most common to mild. Etiology was unknown (30%), viral (25%), anatomic abnormality (25%), Meniere's disease (5%), autoimmune (5%), perilymphatic fistula (5%), and suppurative labyrinthitis (5%). Eight patients had initial treatment with oral steroids of which 50% had improvement on audiograms. Two patients underwent intratympanic injections, both showed improvement. Of the 12 patients with no treatment, only 1 had improved hearing.
CONCLUSIONS: The true incidence of pediatric SSNHL is not well established in our literature. Unique aspects of pediatric SSNHL are delayed presentation and higher percent of anatomic findings. In our study 70% presented more than 2 weeks after experiencing symptoms. Anatomic abnormalities are in 40% of patients. Hearing improvement occurred in 50% of children treated with oral steroids. Intratympanic steroid treatment is another option but may have practical limitation in the pediatric population.

PMID: 27497416 [PubMed - in process]

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How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?

How Commonly Is Stroke Found in Patients with Isolated Vertigo or Dizziness Attack?

J Stroke Cerebrovasc Dis. 2016 Aug 2;

Authors: Doijiri R, Uno H, Miyashita K, Ihara M, Nagatsuka K

Abstract
BACKGROUND: The sudden development of vertigo or dizziness without focal neurological symptoms is generally attributable to vestibular diseases such as benign paroxysmal positional vertigo. Isolated vertigo or dizziness attack needs more attention than vestibular diseases. This retrospective study was performed to elucidate the frequency of strokes in patients with isolated vertigo or dizziness attack.
SUBJECTS AND METHODS: We enrolled 221 patients (men, 119; women, 102; mean age, 68.4 ± 10.3 years) who were admitted to our hospital over the last 10 years because of sudden isolated vertigo or dizziness attack without other neurological symptoms except for nystagmus, deafness, or tinnitus. We investigated the clinical features, final diagnosis, neuroimaging findings, and short- or long-term outcome of these patients.
RESULTS: One hundred eighteen patients had vertigo whereas the other 103 had dizziness. Brain computed tomography or magnetic resonance imaging revealed recent stroke lesions in 25 patients (11.3%) (ischemic, 21; hemorrhagic, 4).The lesions were generally small and localized in the cerebellum (n = 21), pons (n = 1), medulla oblongata (n = 1), or corona radiata (n = 1). Of the 25 patients, 19 (76%) had dizzy-type spells; none had neurological dysfunction at the time of discharge. In the remaining 196 patients, no stroke was detected on computed tomography or magnetic resonance imaging.
CONCLUSIONS: Stroke was found in 11% of patients with isolated vertigo or dizziness attack. The posterior inferior cerebellar artery area was the most frequently implicated for isolated vertigo or dizziness.

PMID: 27495834 [PubMed - as supplied by publisher]

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CSF hypotension: A review of its manifestations, investigation and management.

CSF hypotension: A review of its manifestations, investigation and management.

J Clin Neurosci. 2016 Aug 4;

Authors: Pattichis AA, Slee M

Abstract
Intracranial cerebrospinal fluid (CSF) hypotension usually arises in the context of known or suspected leak of CSF. This can be spontaneous, or due to central nervous system trauma or dural defects created during lumbar puncture or epidural anaesthesia. Spontaneous intracranial hypotension (SIH) is increasingly being recognised as a cause for orthostatic headache or spontaneous subdural haematoma where no other obvious cause is found. We review CSF physiology, the mechanism of symptom generation in CSF hypotension and the investigation and management of the syndrome. Whilst commonly mild and self-limiting, CSF hypotension may result in life threatening complications and is most often treatable. When the syndrome is severe, prolonged or complicated, epidural blood patching (EBP) is the mainstay of treatment.

PMID: 27499119 [PubMed - as supplied by publisher]

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Risk factors associated with postcraniotomy meningitis: A retrospective study.

Risk factors associated with postcraniotomy meningitis: A retrospective study.

Medicine (Baltimore). 2016 Aug;95(31):e4329

Authors: Chen CH, Chang CY, Lin LJ, Chen WL, Chang YJ, Wang SH, Cheng CY, Yen HC

Abstract
Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

PMID: 27495035 [PubMed - in process]

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Vestibular-dependent inter-stimulus interval effects on sound evoked potentials of central origin.

Vestibular-dependent inter-stimulus interval effects on sound evoked potentials of central origin.

Hear Res. 2016 Aug 3;

Authors: Todd NP, Govender S, Colebatch JG

Abstract
Todd et al. (2014ab) have recently demonstrated the presence of vestibular-dependent contributions to auditory evoked potentials (AEPs) when passing through the vestibular threshold as determined by vestibular evoked myogenic potentials (VEMPs), including a particular deflection labeled as an N42/P52 prior to the long-latency AEPs N1 and P2. In this paper we report the results of an experiment to determine the effect of inter-stimulus interval (ISI) and regularity on potentials recorded above and below VEMP threshold. Five healthy, right-handed subjects were recruited and evoked potentials were recorded to binaurally presented sound stimulation, above and below vestibular threshold, at seven stimulus rates with ISIs of 212, 300, 424, 600, 848, 1200 and 1696 ms. The inner five intervals, i.e. 300, 424, 600, 848, 1200 ms, were presented twice in both regular and irregular conditions. ANOVA on the global field power (GFP) were conducted for each of four waves, N42, P52, N1 and P2 with factors of intensity, ISI and regularity. Both N42 and P52 waves showed significant ANOVA effects of intensity but no other main effects or interactions. In contrast both N1 and P2 showed additional effects of ISI, as well as intensity, and evidence of non-linear interactions between ISI and intensity. A source analysis was carried out consistent with prior work suggesting that when above vestibular threshold, in addition to bilateral superior temporal cortex, ocular, cerebellar and cingulate sources are recruited. Further statistical analysis of the source currents indicated that the origin of the interactions with intensity may be the ISI sensitivity of the vestibular-dependent sources. This in turn may reflect a specific vestibular preference for stimulus rates associated with locomotion, i.e. rates close to 2 Hz, or ISIs close to 500 ms, where saccular afferents show increased gain and the corresponding reflexes are most sensitive.

PMID: 27498399 [PubMed - as supplied by publisher]

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Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report.

http:--pt.wkhealth.com-pt-pt-core-templa

Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report.

Ear Hear. 2015 Nov-Dec;36(6):e364-72

Authors: Janky KL, Givens D

Abstract
OBJECTIVES: There is a high incidence of vestibular loss in children with cochlear implants (CCI). However, the relationship between vestibular loss and various outcomes is unknown in children. The objectives of this study are to (1) determine whether age-related changes in peripheral vestibular tests occur; (2) quantify peripheral vestibular function in children with normal hearing and CCI; and (3) determine whether amount of vestibular loss predicts visual acuity and balance performance.
DESIGN: Eleven CCI and 12 children with normal hearing completed the following tests of vestibular function: ocular and cervical vestibular-evoked myogenic potential to assess utricle and saccule function and the video head impulse test to assess semicircular canal function. The relationship between amount of vestibular loss and the following balance and visual acuity outcomes was assessed: dynamic gait index, single-leg stance, the sensory organization test, and tests of visual acuity, including dynamic visual acuity and the gaze stabilization test.
RESULTS: (1) There were no significant age-related changes in peripheral vestibular testing with the exception of the n23 cervical vestibular-evoked myogenic potential latency, which was moderately correlated with age. (2) CCI had significantly higher rates of vestibular loss for each test of canal and otolith function. (3) Amount of vestibular loss predicted performance on single-leg stance, the dynamic gait index, some conditions of the sensory organization test, and the dynamic visual acuity test. Age was also a contributing factor for predicting the performance of almost all outcomes.
CONCLUSIONS: Preliminarily, children with vestibular loss do not recover naturally to levels of their healthy peers, particularly with activities that utilize vestibular input; they have poorer visual acuity and balance function.

PMID: 26182202 [PubMed - indexed for MEDLINE]

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Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer.

Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer.

Eur Arch Otorhinolaryngol. 2016 Aug 6;

Authors: Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI

Abstract
A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.

PMID: 27498203 [PubMed - as supplied by publisher]

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Management of locoregional recurrence in cutaneous squamous cell carcinoma of the head and neck.

Management of locoregional recurrence in cutaneous squamous cell carcinoma of the head and neck.

Eur Arch Otorhinolaryngol. 2016 Aug 6;

Authors: Strassen U, Hofauer B, Jacobi C, Knopf A

Abstract
Cutaneous squamous cell carcinomas often affect elderly patients. Follow-up monitoring is difficult in these patients due to their multi-morbidity and reduced compliance. Tumour recurrence is consequently diagnosed in advanced tumour stages. Surgical therapy with curative intention often requires extended resections. The study at hand should determine whether surgical concepts are warranted in this collective. Sixty-seven patients who underwent surgical procedure due to recurrent disease of cutaneous head and neck squamous cell carcinoma were included. The cohort was divided in patients with/without adjuvant therapeutic regimens. Data were assessed retrospectively. Complete tumour resection was achieved in 85 % of our patients. Patients with adjuvant treatment demonstrated a favorable 5-year-recurrence-free interval (78 vs 30 %) and overall survival (79 vs 46 %). Complete surgical resection of advanced recurrent head and neck cutaneous squamous cell carcinomas is possible and yields favorable results in terms of survival, especially if combined with adjuvant treatment.

PMID: 27498202 [PubMed - as supplied by publisher]

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Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study.

Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: a randomized study.

Eur Arch Otorhinolaryngol. 2016 Aug 5;

Authors: Jantharapattana K, Maethasith J

Abstract
The objective of this study is to compare the outcomes of transaxillary gasless endoscopic thyroidectomy (TGET) and conventional open thyroidectomy (COT). Thirty-three patients with thyroid nodule were enrolled. All patients were randomized into two different groups. Sixteen patients underwent TGET and 17 patients underwent COT. We analyzed the patients' characteristics, wound satisfaction, the intraoperative phase, hospitalization, pain, and costs. The operative time for the TGET group was significantly longer than in the COT group. The estimated blood loss, the hospitalized days, and pain between the two groups were not significantly different. The drainage content was significantly more in the TGET group. The patients' wound satisfaction and mean total cost per case were significantly greater in the TGET group. The TGET provided better cosmetic outcomes and was comparable regarding the estimated blood loss, pain, complication, and hospitalization. However, the TGET required a longer operative time which determines the higher costs.

PMID: 27496209 [PubMed - as supplied by publisher]

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Polypropylene mesh for nasal septal perforation repair: an experimental study.

Polypropylene mesh for nasal septal perforation repair: an experimental study.

Eur Arch Otorhinolaryngol. 2016 Aug 5;

Authors: Yücebaş K, Taşkın Ü, Oktay MF, Tansuker HD, Erdil M, Altınay S, Kozanoğlu E, Kuvat SV

Abstract
The aim of this study is to determine the effectiveness and biocompatibility of polypropylene mesh for the repair of nasal septal perforations in an animal model on rabbits. A full-thickness nasal septal perforation with a diameter of nearly 10 × 10 mm was created on 12 rabbits, and then the perforation was reconstructed with two different methods. We used mucosal flaps and polypropylene mesh as an interpositional graft in group 1. Only mucosal flaps were used for reconstruction and are identified as group 2. After 4 weeks, we removed the nasal septum of the rabbits and performed histopathological examinations for acute rejection, infection, inflammatory response, fibrosis, and granuloma formation. We found perforation closure rates of 75 and 25 % in groups 1 and 2, respectively. Inflammatory response was seen in all specimens of group 1 (100 %). The inflammatory response was +1 in five of the specimens (62.5 %), +2 in one specimen (12.5 %), and +3 in two specimens (25 %). Mild fibrosis around the mesh was detected in four specimens (50 %), medium-level fibrosis was detected in one (12.5 %), and no fibrosis was detected in three (37.5 %). Severe fibrosis was not seen in any specimens. The foreign-body reaction was limited to a few giant cells, and granuloma formation was seen in two specimens (25 %). The propylene mesh showed excellent biocompatibility with the septal mucosa, and it can, therefore, be used for the repair of septal perforation as an interpositional graft safely.

PMID: 27496208 [PubMed - as supplied by publisher]

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Extended lateral thoracic fasciocutaneous biosynthetic flap for reconstruction of full-thickness partial external ear defects: an experimental study.

Extended lateral thoracic fasciocutaneous biosynthetic flap for reconstruction of full-thickness partial external ear defects: an experimental study.

Eur Arch Otorhinolaryngol. 2016 Aug 5;

Authors: Kuvat SV, Taşkın Ü, Yücebaş K, Tansuker HD, Oktay MF, Kozanoğlu E, Aydın S

Abstract
External ear reconstruction is a controversial topic in reconstructive plastic surgery. Here, we prepared a pedicled biosynthetic flap for full-thickness, partial ear defects in rabbits. We operated on six adult female New Zealand rabbits weighing 3-4 kg. The dimensions of the lateral thoracic fasciocutaneous flap were 7 × 6 cm. The flap was elevated based on one of the bilaterally located internal thoracic arteries, which were dissected proximally. The pedicled flap was folded in two, and polypropylene mesh was sandwiched in the middle. The flap was adapted to a defect of 3.5 × 3 cm in diameter. In fact, the defect was created before elevation of the flap. Rabbits were followed up for 4 weeks, at the end of which they were killed and their ears were evaluated histopathologically. The survival rate of the rabbits was 100 %. All pedicled biosynthetic flaps were viable, but one showed partial (20 %) necrosis (1/6) and one was partially detached (1/6). Macroscopic (color, thickness, texture) and histological (polymorphonuclear leukocyte invasion in the skin, subcutaneous tissue, and at the junction between the polypropylene mesh and the flap) features of the flap were compared to the ipsilateral ear. A new technique was developed for partial external ear reconstruction with sufficient inner skeletal support and outer skin lining. Level of evidence Level NA.

PMID: 27496207 [PubMed - as supplied by publisher]

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Modified partial maxillary swing approach for myxofibrosarcoma in pterygopalatine fossa.

Modified partial maxillary swing approach for myxofibrosarcoma in pterygopalatine fossa.

Head Neck. 2016 Aug 8;

Authors: Shimoda H, Yonezawa K, Shinomiya H, Otsuki N, Hashikawa K, Sasaki R, Komura E, Nibu KI

Abstract
BACKGROUND: Extirpation of tumors arising in the pterygopalatine fossa is challenging because of its anatomic complexity.
METHODS AND RESULTS: A 67-year-old man was referred to our department with a diagnosis of a tumor in his left pterygoid fossa. An incisional biopsy through the canine fossa was diagnosed as myxofibrosarcoma. The upper part of the maxilla was swung laterally to remove the tumor while the hard plate was preserved. The defect was reconstructed using rectus abdominis musculocutaneous free and ipsilateral temporal. The postoperative course was uneventful, without facial palsy or mastication disorders.
CONCLUSION: Our experience with this case suggests that the modified partial maxillary swing approach with preservation of the hard palate and orbital floor in combination with infratemporal and cervical approaches is useful for lesions in the pterygoid process without causing severe complications. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 27501198 [PubMed - as supplied by publisher]

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Endoscopic management of congenital anterior glottic stenosis.

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

Endoscopic management of congenital anterior glottic stenosis.

Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2056-8

Authors: Yoo MJ, Roy S, Smith LP

Abstract
INTRODUCTION: Congenital anterior glottic stenosis (web) is a rare condition usually presenting with airway obstruction, stridor or dysphonia. Symptomatic infants may require tracheotomy to bridge the neonatal period. Early open surgical reconstruction may have significant risks and failure may still result in tracheotomy. We introduce an endoscopic surgical approach with balloon dilation for primary management of congenital anterior glottic stenosis.
METHODS: We present three cases of congenital anterior glottic stenosis in children 7, 14, and 90 days old presenting with stridor, dyspnea, and dysphonia. The larynx was exposed by suspension microlaryngoscopy. The glottic stenosis was incised from a posterior to anterior direction using a laryngeal sickle knife. Subsequently, an airway balloon was guided through the stenotic lumen. Once the balloon was inflated, the balloon pressure was maintained for 30s or until the patient's oxygen saturation dropped below 92%. The dilation was repeated two or three times. The patients were kept intubated with an uncuffed endotracheal tube and monitored in the pediatric intensive care unit following surgery.
RESULTS: All three patients were extubated within 72h without complications. One patient failed the first extubation attempt and was reintubated and successfully extubated 24h later. Patients were re-evaluated with direct microlaryngoscopy within two weeks. All patients had symptomatic relief and did not require further surgical intervention.
CONCLUSION: Endoscopic balloon dilation laryngoplasty may be a safe and effective primary procedure for pediatric patients with congenital anterior glottic stenosis. It is technically simple and obviates the potential morbidities associated with an open surgical procedure or tracheotomy.

PMID: 26412460 [PubMed - indexed for MEDLINE]

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[Mini-orbitozygomatic craniotomy in surgery for supratentorial aneurysms and tumors of the anterior and middle cranial fossae].

[Mini-orbitozygomatic craniotomy in surgery for supratentorial aneurysms and tumors of the anterior and middle cranial fossae].

Zh Vopr Neirokhir Im N N Burdenko. 2016;80(4):40-47

Authors: Dzhindzhikhadze RS, Dreval' ON, Lazarev VA, Kambiev RL

Abstract
Progress in microneurosurgical techniques, neuroanesthesiology, and intraoperative imaging enables surgery using small incisions and craniotomy, in accordance with the keyhole surgery concept. Supraorbital craniotomy is the most widespread minimally invasive approach. There are a number of supraorbital craniotomy modifications, regarding different soft tissue incisions and the extent of craniotomy. We present the first results of using mini-orbitozygomatic craniotomy for aneurysms of the anterior circle of Willis and space-occupying lesions of the anterior and middle cranial fossae performed through an eyebrow incision.
MATERIAL AND METHODS: Forty five patients were operated on using mini-orbitozygomatic (MOZ) craniotomy in the period between March 2014 and December 2015. Fifteen supratentorial aneurysms were clipped, and 30 space-occupying lesions were resected. Most patients had unruptured aneurysms (10 patients). Five patients had a history of SAH. The aneurysm localization was as follows: 8 anterior communicating artery aneurysms, 4 aneurysms of the internal carotid artery in the area of the posterior communicating artery orifice, and 3 ophthalmic aneurysms. The Hunt-Hess scale was used to evaluate the patients' condition, and the Fisher scale was used to quantify SAH volume. Surgery was performed 14 days after SAH, on average. Contrast-enhanced MRI of the brain was the diagnostic method of choice in a group of patients with space-occupying lesions within the anterior and middle cranial fossae. In some cases, patients underwent CT with reconstruction for assessment of the skull base bone structures. The mean age of patients was 58.3 years.
RESULTS: All aneurysms were completely excluded from the cerebral blood flow. No serious complications and deaths in a group of aneurysm patients occurred. Complete tumor removal was performed in 28 patients. Two patients having pituitary macroadenomas with supra- and parasellar spread underwent subtotal resection due to adenoma invasion into the cavernous sinus. Mortality in this group was 3.3% (1 patient). Postoperative complications were evaluated after 2 weeks and 6 months. The postoperative cosmetic result after 3 and 6 months after surgery was assessed by patients as excellent.
CONCLUSION: Mini-orbitozygomatic craniotomy is an alternative to classic approaches and can be assistive in surgery for skull base aneurysms and tumors. Selection of candidates for this keyhole surgery should be based on their critical assessment.

PMID: 27500773 [PubMed - as supplied by publisher]

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Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children.

Pediatric sudden sensorineural hearing loss: Etiology, diagnosis and treatment in 20 children.

Int J Pediatr Otorhinolaryngol. 2016 Sep;88:208-12

Authors: Dedhia K, Chi DH

PMID: 27497416 [PubMed - in process]

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Real-time computer-based visual feedback improves visual acuity in downbeat nystagmus - a pilot study.

Real-time computer-based visual feedback improves visual acuity in downbeat nystagmus - a pilot study.

J Neuroeng Rehabil. 2016;13:1

Authors: Teufel J, Bardins S, Spiegel R, Kremmyda O, Schneider E, Strupp M, Kalla R

Abstract
BACKGROUND: Patients with downbeat nystagmus syndrome suffer from oscillopsia, which leads to an unstable visual perception and therefore impaired visual acuity. The aim of this study was to use real-time computer-based visual feedback to compensate for the destabilizing slow phase eye movements.
METHODS: The patients were sitting in front of a computer screen with the head fixed on a chin rest. The eye movements were recorded by an eye tracking system (EyeSeeCam®). We tested the visual acuity with a fixed Landolt C (static) and during real-time feedback driven condition (dynamic) in gaze straight ahead and (20°) sideward gaze. In the dynamic condition, the Landolt C moved according to the slow phase eye velocity of the downbeat nystagmus. The Shapiro-Wilk test was used to test for normal distribution and one-way ANOVA for comparison.
RESULTS: Ten patients with downbeat nystagmus were included in the study. Median age was 76 years and the median duration of symptoms was 6.3 years (SD +/- 3.1y). The mean slow phase velocity was moderate during gaze straight ahead (1.44°/s, SD +/- 1.18°/s) and increased significantly in sideward gaze (mean left 3.36°/s; right 3.58°/s). In gaze straight ahead, we found no difference between the static and feedback driven condition. In sideward gaze, visual acuity improved in five out of ten subjects during the feedback-driven condition (p = 0.043).
CONCLUSIONS: This study provides proof of concept that non-invasive real-time computer-based visual feedback compensates for the SPV in DBN. Therefore, real-time visual feedback may be a promising aid for patients suffering from oscillopsia and impaired text reading on screen. Recent technological advances in the area of virtual reality displays might soon render this approach feasible in fully mobile settings.

PMID: 26728632 [PubMed - indexed for MEDLINE]

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Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo.

http:--production.springer.de-OnlineReso

Recent advances in orthostatic hypotension presenting orthostatic dizziness or vertigo.

Neurol Sci. 2015 Nov;36(11):1995-2002

Authors: Kim HA, Yi HA, Lee H

Abstract
Orthostatic hypotension (OH), a proxy for sympathetic adrenergic failure, is the most incapacitating sign of autonomic failure. Orthostatic dizziness (OD) is known to be the most common symptom of OH. However, recent studies have demonstrated that 30-39 % of patients with OH experienced rotatory vertigo during upright posture (i.e., orthostatic vertigo, OV), which challenges the dogma that OH induces dizziness and not vertigo. A recent population-based study on spontaneously occurring OD across a wide age range showed that the one-year and lifetime prevalence of OD was 10.9 and 12.5 %, respectively. Approximately 83 % of patients with OD had at least one abnormal autonomic function test result. So far, 11 subtypes of OD have been proposed according to the pattern of autonomic dysfunction, and generalized autonomic failure of sympathetic adrenergic and parasympathetic cardiovagal functions was the most common type. Four different patterns of OH, such as classic, delayed, early, and transient type have been found in patients with OD. The head-up tilt test and Valsalva maneuver should be performed for a comprehensive evaluation of sympathetic adrenergic failure in patients with OD/OV. This review summarizes current advances in OH presenting OD/OV, with a particular focus on the autonomic dysfunction associated with OD.

PMID: 26292788 [PubMed - indexed for MEDLINE]

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Opsoclonus-myoclonus syndrome associated with non-small cell lung cancer.

Opsoclonus-myoclonus syndrome associated with non-small cell lung cancer.

Asian Cardiovasc Thorac Ann. 2015 Nov;23(9):1113-5

Authors: Karasaki T, Tanaka M

Abstract
A 68-year-old man developed progressive vertigo, saccadic eye movements, and tremors. Computed tomography showed multiple lung nodules. Surgery was performed and the pathological diagnosis was large cell neuroendocrine carcinoma in the left upper lobe with ipsilobar metastases, and adenocarcinoma in the left lower lobe. The neurological symptoms resolved dramatically after complete resection of the tumors. Opsoclonus-myoclonus syndrome associated with non-small-cell lung carcinoma is extremely rare. Surgery should not be delayed if a complete resection is expected.

PMID: 26038602 [PubMed - indexed for MEDLINE]

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Stress hormonal changes in the brain and plasma after acute noise exposure in mice.

Stress hormonal changes in the brain and plasma after acute noise exposure in mice.

Auris Nasus Larynx. 2016 Aug 2;

Authors: Jin SG, Kim MJ, Park SY, Park SN

Abstract
OBJECTIVE: To investigate the effects of acute noise stress on two amine stress hormones, norepinephrine (NE) and 5-hydroxyindoleacetic acid (5-HIAA) in the brain and plasma of mice after noise exposure.
METHODS: Mice were grouped into the control and noise groups. Mice in the noise group were exposed to white noise of 110dB sound pressure level for 60min. Auditory brainstem response thresholds, distortion product otoacoustic emissions, the organ of Corti grading scores, western blots of NE/5-HIAA in the whole brain and hippocampus, and the plasma levels of NE/5-HIAA were compared between the two groups.
RESULTS: Significant hearing loss and cochlear damage were demonstrated in the noise group. NE and 5-HIAA in the hippocampus were elevated in the noise group (p=0.019/0.022 for NE/5-HIAA vs. the control). Plasma levels of NE and 5-HIAA were not statistically different between the groups (p=0.052/0.671 for NE/5-HIAA).
CONCLUSION: Hearing loss with outer hair cell dysfunction and morphological changes of the organ of Corti after noise exposure in C57BL/6 mice proved the reliability of our animal model as an acute noise stress model. NE and 5-HIAA are suggested to be the potential biomarkers for acute noise stress in the hippocampus.

PMID: 27496010 [PubMed - as supplied by publisher]

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Primary combined small cell carcinoma and squamous cell carcinoma of the oropharynx with special reference to EGFR status of small cell carcinoma component: Case report and review of the literature.

Primary combined small cell carcinoma and squamous cell carcinoma of the oropharynx with special reference to EGFR status of small cell carcinoma component: Case report and review of the literature.

Auris Nasus Larynx. 2016 Aug 2;

Authors: Nakano T, Motoshita J, Tanaka R, Okabe M, Tamae A, Shiratsuchi H, Yasumatsu R, Nakashima T, Nakagawa T

Abstract
Combined small cell carcinoma (SCC) and squamous cell carcinoma (SqCC) of the oropharynx is extremely rare and shows an aggressive clinical course. There are only 5 reported cases of combined SCC and SqCC in the English language literature. Here, we report a 59-year-old male presenting with a right tonsillar mass. The mass was biopsied, and the histological findings showed a proliferation of small-sized tumor cells with scant cytoplasm. Immunohistochemically, the tumor cells were positive for neuroendocrine markers (synaptophysin, chromogranin A, and CD56). Our first diagnosis was tonsillar small cell carcinoma. We treated the patient with concurrent chemoradiotherapy together with cisplatin followed by surgery. The resected tonsillar specimen showed a residual tumor composed of SCC and SqCC, and lymph nodes showed metastatic tumor cells of the SCC component. Immunohistochemically, the SCC component was positive for all neuroendocrine markers and p16; on the other hand, the SqCC component was positive for p40, p63, p16, and EGFR. Fluorescence in situ hybridization revealed that neither component showed any EGFR gene copy number gain. The patient was treated with adjuvant chemotherapy consisting of irinotecan and cisplatin. Liver and bone metastases developed, resulting in the death of the patient. We discuss the present case and review similar cases. Most cases of combined SCC and SqCC occur regardless of p16 status, and a therapeutic strategy has yet to be determined. Further examination of this kind of combined tumor is necessary.

PMID: 27496009 [PubMed - as supplied by publisher]

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Sentinel node biopsy for oral cancer: A prospective multicenter Phase II trial.

Sentinel node biopsy for oral cancer: A prospective multicenter Phase II trial.

Auris Nasus Larynx. 2016 Aug 2;

Authors: Miura K, Hirakawa H, Uemura H, Yoshimoto S, Shiotani A, Sugasawa M, Homma A, Yokoyama J, Tsukahara K, Yoshizaki T, Yatabe Y, Matsuo K, Ohkura Y, Kosuda S, Hasegawa Y

Abstract
OBJECTIVE: A recent study identified a survival benefit with prophylactic neck dissection (ND) at the time of primary surgery as compared with watchful waiting followed by therapeutic neck dissection for nodal relapse, in patients with cN0 oral squamous cell carcinoma (OSCC). Alternative management of cN0 neck cancer is recommended to minimize the adverse effects of ND, indicating the need for sentinel node biopsy (SNB) and limited neck dissection. We conducted a multicenter Phase II study to examine the feasibility of SNB for clinically N0 OSCC.
METHODS: Previously untreated N0 OSCC patients (n=57) with clinical late-T2 or T3 tumors were enrolled across 10 institutions. SNB navigated with multislice frozen section analysis of sentinel nodes (SNs) and SNB supported sentinel node lymphatic basin dissection (SN basin dissection) were performed in a one-stage procedure. The endpoint was to investigate the rate of false-negative metastases after SN basin dissection and SNB alone.
RESULTS: Most tumors were late-T2 lesions (n=50; 87.7%). SNs were identified in all patients. A total of 196 SNs were detected. Among these SNs, 35 (17.8%) were positive for metastasis (9 in level I, 12 in level II, 12 in level III, 1 in level V and 2 in the contralateral region of the neck). The false-negative rate of SNB supported by SN basin dissection and SNB alone was 4.5% and 9.1%, respectively. The concordance of the SN status in intraoperative frozen sections with the permanent histopathology was 97.4% (191/196). The sensitivity and specificity of intraoperative pathological evaluation were 85.7% (30/35) and 100% (30/30), respectively. The 3-year overall survival (OS) and disease-free survival was 89.5% and 82.5%, respectively. The OS of SN-negative patients was significantly longer than that of SN-positive patients (P=0.047).
CONCLUSION: The current study verified that SN basin dissection was a useful back-up procedure for SNB performed as a one-stage procedure, showing a low false-negative rate. SNB alone is an appropriate staging method for patients with clinical N0 staging, and a reliable procedure to determine the appropriate levels for neck dissection.

PMID: 27496008 [PubMed - as supplied by publisher]

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A case of vertebral artery aneurysm presenting with dysphagia.

A case of vertebral artery aneurysm presenting with dysphagia.

Auris Nasus Larynx. 2016 Aug 2;

Authors: Morishita H, Nakamura S, Toma N, Nakatsuka Y, Takeuchi K

Abstract
Here, we report a case of vertebral artery aneurysm causing dysphagia in a 56-year-old man who had no remarkable past history. Two months before the first visit, he developed posterior neck pain followed by difficulty swallowing 1 month later. He was referred to our clinic because of gradually worsening dysphagia. Physical examination showed paralysis of cranial nerves IX, X, and XII; therefore, he was hospitalized. Because enhanced CT and MRI showed a partially thrombosed right vertebral artery aneurysm, he was transferred to the care of the Department of Neurosurgery. Parent artery occlusion of the right vertebral artery aneurysm was performed and it improved his symptoms. After regaining his ability to take in liquid food, he was transferred to another hospital for further rehabilitation. In this case, we attributed the dysphagia to aneurysmal compression of the roots of cranial nerves IX, X, and XII. A partially thrombosed cerebral artery aneurysm may often rupture and cause worsening of neurologic symptoms. The prognosis is generally poor because the rupture rate is extremely high especially with large or giant aneurysms. However, this case had a good clinical course owing to treatment by parent artery occlusion.

PMID: 27496007 [PubMed - as supplied by publisher]

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Endoscopic-modified medial maxillectomy and its limitation for a solitary fibrous tumor of the lacrimal sac and nasolacrimal duct.

Endoscopic-modified medial maxillectomy and its limitation for a solitary fibrous tumor of the lacrimal sac and nasolacrimal duct.

Auris Nasus Larynx. 2016 Aug 2;

Authors: Moriyama M, Kodama S, Hirano T, Suzuki M

Abstract
Solitary fibrous tumor (SFT) is an uncommon neoplasm that usually arises from the pleura. Recently, SFTs have been reported in the head and neck region located in subsites such as the orbit. SFTs of the lacrimal sac are extremely rare, with only six cases reported in the English literature. We describe a SFT arising from the right lacrimal sac and extending along the nasolacrimal duct into the nasal cavity. Although, the tumor could not be removed by endoscopic-modified medial maxillectomy (EMMM) alone, combined approach with EMMM and a small external incision achieved the complete removal of the tumor. The patient has remained disease-free 24 months after surgery.

PMID: 27496006 [PubMed - as supplied by publisher]

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Mast Cell Deficiency Limits the Development of Chronic Rhinosinusitis in Mice.

Mast Cell Deficiency Limits the Development of Chronic Rhinosinusitis in Mice.

Ann Otol Rhinol Laryngol. 2016 Apr;125(4):290-6

Authors: Hua X, Naselsky WC, Jania CM, Chason KD, Huang JJ, Doerschuk CM, Graham SM, Senior BA, Tilley SL

Abstract
BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases in adults in both developing and developed countries. The etiology and pathogenesis of CRS remain poorly understood, and the disease is refractory to therapy in many patients. Mast cell activation has been demonstrated in the sinonasal mucosa of patients with CRS; however, the specific contribution of mast cells to the development and pathogenesis of this disease has not been established.
OBJECTIVE: The objective of this study was to investigate the role of mast cells in the development of CRS.
METHODS: C57BL/6 wild-type and C57BL/6-Kit(W-sh/W-sh) mast cell-deficient mice were immunized by intraperitoneal allergen injection and subsequent chronic low dose intranasal allergen challenges. The sinonasal phenotypes of these groups were then evaluated and compared to saline-treated controls using radiologic, histologic, and immunologic methods.
RESULTS: Wild-type mice exposed to chronic intranasal allergen developed many features seen in human CRS, including mucosal thickening, cystic changes, polyp development, eosinophilia, goblet cell hyperplasia, and mast cell activation. In contrast, sinonasal pathology was significantly attenuated in mast cell-deficient mice subjected to the same chronic allergen protocol. Specifically, tissue eosinophilia and goblet cell hyperplasia were reduced by approximately 50% compared to wild-type levels. Surprisingly, none of the mast cell-deficient mice subjected to chronic allergen challenge developed cystic changes or polypoid changes in the nose or sinuses.
CONCLUSIONS: These data identify a critical role for mast cells in the development of many features of a mouse model of eosinophilic CRS, suggesting that therapeutic strategies targeting mast cells be examined in humans afflicted with this disease.

PMID: 26681624 [PubMed - indexed for MEDLINE]

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Παρασκευή 5 Αυγούστου 2016

A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial.

A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial.

Eur Arch Otorhinolaryngol. 2016 Aug 3;

Authors: Saberi A, Nemati S, Sabnan S, Mollahoseini F, Kazemnejad E

Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Some repositioning maneuvers have been described for its management. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. This randomized clinical trial was performed from September to December 2015. 73 patients with true vertigo diagnosed as BPPV enrolled the study. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. Thirty patients enrolled each group with a mean age of 46.9 ± 13.4 (E group) and 46.7 ± 7.5 year (G group). 23.3 % of E group and 26.7 % of G group were men (p = 0.766). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60 % rate of success (p = 0.02); and 86.7 and 56.7 % of patients exhibited objective improvement, respectively (p = 0.01). After 1 week, the subjective and objective outcomes revealed improvement among 70 % of E group and 46.7 % of G group (p = 0.067). The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. 0.0 %, p = 0.005). These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV. Cervical pain was most frequent complication of Epley maneuver.

PMID: 27488837 [PubMed - as supplied by publisher]

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Evaluating the Epley maneuver.

Evaluating the Epley maneuver.

Can Fam Physician. 2015 Oct;61(10):878

Authors: Braschi E, Ross D, Korownyk C

PMID: 26472794 [PubMed - indexed for MEDLINE]

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Πέμπτη 4 Αυγούστου 2016

An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo.

An Abbreviated Diagnostic Maneuver for Posterior Benign Positional Paroxysmal Vertigo.

Front Neurol. 2016;7:115

Authors: Michael P, Oliva CE, Nuñez M, Barraza C, Faúndez JP, Breinbauer HA

Abstract
INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) secondary to canalolithiasis of the posterior semicircular canal is perhaps the most frequent cause of vertigo and dizziness. One of its properties is a high response rate to canalith repositioning maneuvers. However, delays in the diagnosis and treatment of this entity can range from days to years, depending on the setting. Here, we present an abbreviated variation of the Dix-Hallpike maneuver, which can be used to diagnose this disease. It is similar to the standard maneuver but can be performed without an examination bed/table and requires only a backed chair (a difference that we feel is very important in settings where a clinical bed/table is not readily available).
METHODS: A diagnostic assessment study was conducted in 163 patients who presented with vertigo or dizziness.
RESULTS: The abbreviated test had fairly good sensitivity (80%) and high specificity (95%) for diagnosing posterior BPPV.
DISCUSSION: This new diagnostic maneuver may serve as a screening procedure for quickly identifying this pathology. This will allow patients to be more directly treated, without requiring unnecessary referrals or full vestibular testing, and will be especially useful in primary care settings or heavily overloaded otolaryngology or neurology departments.

PMID: 27486432 [PubMed]

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Τρίτη 2 Αυγούστου 2016

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

Abstract
BACKGROUND: Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.
OBJECTIVES: This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.
METHODS: Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.
RESULTS: The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.
CONCLUSION: Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

PMID: 27476336 [PubMed - as supplied by publisher]

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Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.

Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery.

Clin Pract. 2016 Apr 26;6(2):824

Authors: Heymanns V, Oseni AW, Alyeldien A, Maslehaty H, Parvin R, Scholz M, Petridis AK

Abstract
Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

PMID: 27478578 [PubMed]

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The Rhoton Collection.

The Rhoton Collection.

J Neurol Surg B Skull Base. 2016 Aug;77(4):294-6

Authors: Sorenson J

PMID: 27478757 [PubMed]

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Dr. Al Rhoton, Jr.: Friend, Mentor, and Colleague.

Dr. Al Rhoton, Jr.: Friend, Mentor, and Colleague.

J Neurol Surg B Skull Base. 2016 Aug;77(4):291-3

Authors: Robertson JH

PMID: 27478756 [PubMed]

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Prof. Rhoton: Master and Mentor.

Prof. Rhoton: Master and Mentor.

J Neurol Surg B Skull Base. 2016 Aug;77(4):288-90

Authors: Fernandez-Miranda JC

PMID: 27478755 [PubMed]

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Albert L. Rhoton, Jr., M.D., 1932-2016.

Albert L. Rhoton, Jr., M.D., 1932-2016.

J Neurol Surg B Skull Base. 2016 Aug;77(4):283-5

Authors: Link MJ, Graffeo CS

PMID: 27478754 [PubMed]

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Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma.

Systemic Inflammatory Syndrome Associated with a Case of Jugular Paraganglioma.

Intern Med. 2016;55(15):2105-8

Authors: Sokabe A, Mizooka M, Sakemi R, Kobayashi T, Kishikawa N, Yokobayashi K, Kanno K, Tazuma S

Abstract
Jugular paraganlioma is a benign, slow-growing tumor originating from the paraganglion cells and it is associated with catecholamine secretion. Paragangliomas can secrete Interleukin-6 (IL-6) and present as a systemic inflammatory syndrome; these characteristics have not been previously associated with jugular paragangliomas. A 63-year-old man with a jugular tumor in the skull base was referred to our hospital for an evaluation of pyrexia, back pain, and acute inflammation. His serum IL-6 level was elevated on admission and it decreased after radiotherapy. This is the first known case of a jugular paraganglioma exhibiting systemic inflammatory syndrome.

PMID: 27477424 [PubMed - in process]

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[The Base of the Skull. Rudolf Virchow between Pathology and Anthropology].

[The Base of the Skull. Rudolf Virchow between Pathology and Anthropology].

Medizinhist J. 2016;51(2):92-123

Authors: Seemann S

Abstract
Throughout his scientific career, the pathologist and anthropologist Rudolf Virchow (1821-1902) examined countless skulls, gradually changing his perspective on this object of research. Initially, he was mainly concerned with pathologically deformed skulls. From the 1850s onwards, he gradually developed a more anthropological approach, and anthropology increasingly came to dominate his scientific interest. This article shows how different influences became central for the establishment of his specific and dynamic model of the human skull development and its successful application in anthropology. Crucial for this process were Virchow's collaboration with his teacher Robert Froriep (1804-1861) in the department of pathology of the Charité, his research on cretinism and rickets, as well as his description of the base of the skull as the center of skull development. His research work was attended by and showed a reciprocal interaction with the buildup of large skull collections. This article uses Virchow's original publications on skull pathology as well as his still preserved skull specimens from the collection of the Berlin Museum of Medical History at the Charité for an integrated text and object based analysis.

PMID: 27476256 [PubMed - in process]

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Discovery and characterization of a peptide that enhances endosomal escape of delivered proteins in vitro and in vivo.

http:--pubs.acs.org-images-pubmed-acspub

Discovery and characterization of a peptide that enhances endosomal escape of delivered proteins in vitro and in vivo.

J Am Chem Soc. 2015 Nov 11;137(44):14084-93

Authors: Li M, Tao Y, Shu Y, LaRochelle JR, Steinauer A, Thompson D, Schepartz A, Chen ZY, Liu DR

Abstract
The inefficient delivery of proteins into mammalian cells remains a major barrier to realizing the therapeutic potential of many proteins. We and others have previously shown that superpositively charged proteins are efficiently endocytosed and can bring associated proteins and nucleic acids into cells. The vast majority of cargo delivered in this manner, however, remains in endosomes and does not reach the cytosol. In this study we designed and implemented a screen to discover peptides that enhance the endosomal escape of proteins fused to superpositively charged GFP (+36 GFP). From a screen of peptides previously reported to disrupt microbial membranes without known mammalian cell toxicity, we discovered a 13-residue peptide, aurein 1.2, that substantially increases cytosolic protein delivery by up to ∼5-fold in a cytosolic fractionation assay in cultured cells. Four additional independent assays for nonendosomal protein delivery collectively suggest that aurein 1.2 enhances endosomal escape of associated endocytosed protein cargo. Structure-function studies clarified peptide sequence and protein conjugation requirements for endosomal escape activity. When applied to the in vivo delivery of +36 GFP-Cre recombinase fusions into the inner ear of live mice, fusion with aurein 1.2 dramatically increased nonendosomal Cre recombinase delivery potency, resulting in up to 100% recombined inner hair cells and 96% recombined outer hair cells, compared to 0-4% recombined hair cells from +36-GFP-Cre without aurein 1.2. Collectively, these findings describe a genetically encodable, endosome escape-enhancing peptide that can substantially increase the cytoplasmic delivery of cationic proteins in vitro and in vivo.

PMID: 26465072 [PubMed - indexed for MEDLINE]

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Secondary oesophageal or gastric cancer in patients treated for head and neck squamous cell carcinoma.

Secondary oesophageal or gastric cancer in patients treated for head and neck squamous cell carcinoma.

Dan Med J. 2016 Aug;63(8)

Authors: Andersen AR, Bjerring OS, Godballe C, Detlefsen S, Mortensen MB

Abstract
INTRODUCTION: Patients with head and neck squamous cell carcinoma (HNSCC) are at an elevated risk of developing second primary malignancies (SPM). Our objectives were to estimate the excess risk of oesophageal and gastric SPMs in patients with malignancies of the pharynx or larynx and, additionally, to examine possible risk factors of developing SPMs.
METHODS: Data on all patients treated for HNSCC with curative intent in the Region of Southern Denmark in the period between 1 January 2000 and 31 December 2010 were reviewed. A total of 1,172 patients were identified. The combined data from the DAHANCA database, the Danish National Pathology Registry and the patient charts were analysed.
RESULTS: A total of 27 patients developed an SPM in the oesophagus or stomach corresponding to a standardised incidence ratio of 9.5 (95% confidence interval (CI): 6.5-13.9). Supraglottic (odds ratio (OR) = 6.9; p < 0.004) and hypopharyngeal (OR = 3.9; p < 0.049) index tumour sites were significant risk factors for developing SPM. The median survival of patients with SPM was 3.6 years (95% CI: 1.6-5.1; range: 0.7-12.4) from diagnosis of the index cancer compared with 3.4 years (95% CI: 3.1-4.3; range: 0.04-13.7) for patients without SPM.
CONCLUSION: In this study, we confirm that there is an elevated risk of developing oesophageal and gastric cancer in the Danish population of patients with a cancer in the supraglottic or hypopharyngeal region. Therefore, we recommend close follow-up of these patients and a low threshold for examination of the oesophagus and stomach.
FUNDING: not relevant.
TRIAL REGISTRATION: not relevant.

PMID: 27477794 [PubMed - in process]

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Optimal use of CT imaging in pediatric congenital cholesteatoma.

Optimal use of CT imaging in pediatric congenital cholesteatoma.

Auris Nasus Larynx. 2016 Jul 28;

Authors: Kim SY, Kim HS, Park MH, Lee JH, Oh SH, Chang SO, Kim CS, Jung AY, Kim YH

Abstract
OBJECTIVE: This study aimed to determine the radiation dose of temporal bone computed tomography (TBCT) to detect pediatric congenital cholesteatoma (CC), and suggests strategy for lowering perioperative radiation dose.
METHODS: Fifty-three CC patients followed up for more than 12 months after surgery. Perioperative clinical findings and the effective radiation dose (ERD) of TBCT were investigated. Patients' mean age at initial TBCT was 60 months; the mean follow-up period was 43 months.
RESULTS: In 33 (62.3%) of 53 patients, only one TBCT was performed postoperatively. Postoperative CT imaging was performed to evaluate before second-stage ossiculoplasty, due to suspicion of CC recurrence on examinations, or as part of follow-up. When TBCT was performed on more than two occasions after surgery as a part of follow-up, there was no difference in the distribution of stage or type of CC compared to patients subjected to TBCT on less than three occasions (p=0.093 and p=0.744, respectively). During the most-recent follow-up of these 53 cases, there was no CC recurrence. The mean ERD of a single TBCT was 1.2mSv, and the mean cumulative ERD of TBCT was 2mSv per patient.
CONCLUSION: Mean and cumulative ERD of TBCT performed in CC cases was not too high to consider radiation hazard. However, efforts to minimize the number of CT scans should be taken basically.

PMID: 27477570 [PubMed - as supplied by publisher]

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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

PMID: 27476336 [PubMed - as supplied by publisher]

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Comprehensive, Population-Based Sensitivity Analysis of a Two-Mass Vocal Fold Model.

Comprehensive, Population-Based Sensitivity Analysis of a Two-Mass Vocal Fold Model.

PLoS One. 2016;11(2):e0148309

Authors: Robertson D, Zañartu M, Cook D

Abstract
Previous vocal fold modeling studies have generally focused on generating detailed data regarding a narrow subset of possible model configurations. These studies can be interpreted to be the investigation of a single subject under one or more vocal conditions. In this study, a broad population-based sensitivity analysis is employed to examine the behavior of a virtual population of subjects and to identify trends between virtual individuals as opposed to investigating a single subject or model instance. Four different sensitivity analysis techniques were used in accomplishing this task. Influential relationships between model input parameters and model outputs were identified, and an exploration of the model's parameter space was conducted. Results indicate that the behavior of the selected two-mass model is largely dominated by complex interactions, and that few input-output pairs have a consistent effect on the model. Results from the analysis can be used to increase the efficiency of optimization routines of reduced-order models used to investigate voice abnormalities. Results also demonstrate the types of challenges and difficulties to be expected when applying sensitivity analyses to more complex vocal fold models. Such challenges are discussed and recommendations are made for future studies.

PMID: 26845452 [PubMed - indexed for MEDLINE]

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Immunohistochemical Characterization of the Ectopic Epithelium Devoid of Goblet Cells From a Posttraumatic Iris Cyst Causing Mucogenic Glaucoma.

Immunohistochemical Characterization of the Ectopic Epithelium Devoid of Goblet Cells From a Posttraumatic Iris Cyst Causing Mucogenic Glaucoma.

J Glaucoma. 2016 Mar;25(3):e291-4

Authors: Wakae H, Higashide T, Tsuneyama K, Nakamura T, Takahashi K, Sugiyama K

Abstract
PURPOSE: Mucogenic glaucoma is an unusual form of secondary open-angle glaucoma caused by intracameral ectopic mucus-producing epithelium. To date, only 3 cases have been described in detail. Numerous goblet cells in the specimens indicated a possible conjunctival origin. We immunohistochemically characterized the implanted epithelium from an iris cyst responsible for mucogenic glaucoma.
METHODS: A series of immunostaining analyses were performed on a sector-iridectomy specimen derived from an eye with mucogenic glaucoma and a history of limbal penetrating injury. An iris cyst was present in the inferonasal quadrant of the right eye of a 58-year-old man. The anterior chamber was filled with hazy, translucent material, and the chamber angle was gonioscopically open. The cyst was resected due to medically uncontrollable high intraocular pressure.
RESULTS: The ectopic epithelium was mostly positive for CK19, a corneal and conjunctival epithelial marker. Negative staining for MUC5AC, a secretory mucin, and positive staining for MUC1, a membrane-bound mucin, corroborated the absence of goblet cells. Ectopic epithelial cells were abundantly positive for CK15, a limbal basal cell marker, but there was patchy immunostaining of CK13, a conjunctival epithelial marker, and sparse labeling with CK12, a corneal epithelial marker. Immunostaining patterns of CK15, CK13, and CK12 were nearly mutually exclusive.
CONCLUSIONS: The ectopic epithelium of an iris cyst causing mucogenic glaucoma was most likely to originate from limbal basal cells, which showed dual direction of differentiation toward both the conjunctival and corneal epithelia. The membrane-bound mucin may have caused mucogenic glaucoma in the absence of goblet cells.

PMID: 26550968 [PubMed - indexed for MEDLINE]

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Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial.

Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial.

J Laryngol Otol. 2016 Aug 1;:1-5

Authors: Romsaithong S, Tomanakan K, Tangsawad W, Thanaviratananich S

Abstract
OBJECTIVES: To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis.
METHODS: A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment.
RESULTS: After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable.
CONCLUSION: One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.

PMID: 27477534 [PubMed - as supplied by publisher]

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Nasal airflow and brain activity: is there a link?

Nasal airflow and brain activity: is there a link?

J Laryngol Otol. 2016 Aug 1;:1-6

Authors: Price A, Eccles R

Abstract
BACKGROUND: Over the past few decades, evidence has emerged suggesting that nasal airflow asymmetry and brain asymmetry are linked. The nose exhibits asymmetrical airflow, with the dominant airflow alternating from one nasal passage to the other over a period of hours. Some authors have suggested a correlation between cerebral hemisphere dominance and nostril dominance. Others have proposed an association between rhythmic fluctuations in nasal airflow and corresponding fluctuations in cerebral hemisphere activity. Based on ancient yoga breathing techniques, newer evidence suggests that altering nasal airflow can influence brain activity, with reports of improved cognitive function caused by unilateral forced nostril breathing. It seems that a nasal airflow stimulus may have an activating effect on the brain, as it has also been shown to trigger seizure activity in epileptic patients.
OBJECTIVES: This article explores these theories in detail, reviews the evidence, and presents new models linking nasal airflow and brain activity.

PMID: 27477330 [PubMed - as supplied by publisher]

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Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes.

J Laryngol Otol. 2016 Aug 1;:1-10

Authors: Stavrakas M, Nixon I, Andi K, Oakley R, Jeannon JP, Lyons A, McGurk M, Urbano TG, Thavaraj S, Simo R

PMID: 27476336 [PubMed - as supplied by publisher]

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Comment on "Partially Cystic Thyroid Nodules on Ultrasound: Probability of Malignancy and Sonographic Differentiation".

Comment on "Partially Cystic Thyroid Nodules on Ultrasound: Probability of Malignancy and Sonographic Differentiation".

Thyroid. 2016 Jul 31;

Authors: Cui K, Zhang M, Fu C, Ma X, Li J

PMID: 27477239 [PubMed - as supplied by publisher]

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Κυριακή 31 Ιουλίου 2016

Efficacy and safety of tribendimidine against Opisthorchis viverrini: two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials.

Efficacy and safety of tribendimidine against Opisthorchis viverrini: two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials.

Lancet Infect Dis. 2016 Jul 26;

Authors: Sayasone S, Odermatt P, Vonghachack Y, Xayavong S, Senggnam K, Duthaler U, Akkhavong K, Hattendorf J, Keiser J

Abstract
BACKGROUND: Treatment of the liver fluke infection Opisthorchis viverrini relies exclusively on praziquantel. Tribendimidine could be an alternative treatment option. We aimed to assess the efficacy and safety of ascending single, oral doses of tribendimidine in patients with O viverrini infection.
METHODS: We did two randomised, parallel-group, single-blind, dose-ranging, phase 2 trials in children (aged 8-14 years) and adults and adolescents (≥15 years) in three O viverrini endemic villages in Champasack province, southern Laos. Patients with O viverrini infection were randomly assigned, via a computer-generated central block-randomisation procedure, with block sizes of three (study 1) and four, eight, and 12 (study 2), to receive oral tribendimidine at doses of 200 mg, 400 mg, or 600 mg in a 1:1:1 ratio (adults and adolescents in study 1); 25 mg, 50 mg, 100 mg, or 200 mg (four 50 mg tablets) in a 1:1:1:1 ratio (adults and adolescents in study 2); or 100 mg, 200 mg, or 400 mg in a 1:1:1 ratio (children in study 1). One non-randomised group of children received tribendimidine 50 mg (study 2). Participants, investigators, and laboratory technicians doing the diagnostic assessments were masked to group assignment, but the investigator administering treatment could have recognised the treatment group based on the number of tablets. The primary objective was to estimate the dose-response relation in terms of cure rate and egg reduction rate. We did available-case analysis of all patients with primary endpoint data. We predicted dose-response associations with Emax models. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN96948551.
FINDINGS: Between Oct 25, 2012, and Nov 5, 2013, 318 adolescents and adults were randomly assigned to seven tribendimidine dose groups: 200 mg (n=51), 400 mg (n=49), or 600 mg (n=47) in study 1, and 25 mg (n=39), 50 mg (n=47), 100 mg (n=44), or 200 mg (four 50 mg tablets; n=41) in study 2. 128 children were randomly assigned to receive tribendimidine 100 mg (n=44), 200 mg (n=40), or 400 mg (n=44) in study 1; 39 children were enrolled and received tribendimidine 50 mg in study 2. In adolescents and adults, the number of patients cured increased with increasing tribendimidine doses up to 100 mg: ten of 39 patients (25·6%, 95% CI 13·0-42·1) were cured in the 25 mg group, 20 of 47 patients (42·6%, 28·3-57·8) were cured in the 50 mg group, and 34 of 44 patients (77·3%, 62·2-88·5) were cured in the 100 mg group; geometric mean egg reduction rates were 86·9% (95% CI 74·8-93·4), 95·9% (92·7-97·7), and 99·1% (98·2-99·7), respectively. The 200 mg dose resulted in cure in 40 of 47 (83·0%, 69·2-92·5) adolescents and adults given the 200 mg tablet and 25 of 41 (61·0%, 95% CI 44·5-75·8) of those given four 50 mg tablets; the 400 mg dose resulted in cure in 43 of 47 patients (91·5%, 79·6-97·6) and the 600 mg dose resulted in cure in 36 of 45 patients (80·0%, 65·4-90·4). Corresponding egg reduction rates were 99·8% (95% CI 99·7-100·0) with one 200 mg tablet, 97·9% (95·9-99·2) with four 50 mg tablets, 99·9% (99·8-100·0) with 400 mg, and 99·8% (99·6-99·9) with 600 mg. The Emax model predicted an egg reduction rate of 99·0% (95% CI 95·7-99·8) at 111 mg in adolescents and adults. 50 mg tribendimidine had moderate efficacy in children, with cure recorded in 16 of 39 patients (41·0%, 95% CI 25·6-57·9). The 100 mg dose resulted in cure in 40 of 44 children (98·9%, 95% CI 78·3-97·5) and an egg reduction rate of 99·7% (95% CI 99·0-100·0), with no increased efficacy at higher doses. The Emax model predicted an egg reduction rate of 99·0% (95% CI 92·2-99·9) at 215 mg. Few adverse events were reported and were mostly mild, with few moderate and no serious events. The most common adverse events 3 h after treatment in adolescents and adults were vertigo (n=35 [11%]), headache (n=9 [3%]), nausea (n=6 [2%]), and fatigue (n=4 [1%]), and in children were headache (n=3 [2%]), vertigo (n=2 [1%]), and fatigue (n=2 [1%]).
INTERPRETATION: Tribendimidine has excellent efficacy and tolerability at doses of 100 mg and above. Our study included mainly adults and children with low-intensity O viverrini infection; future studies should assess the efficacy of tribendimidine in patients with infections of moderate and high intensity.
FUNDING: Department for International Development, Medical Research Council, Wellcome Trust Joint Global Health Trials Scheme.

PMID: 27472949 [PubMed - as supplied by publisher]

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Σάββατο 30 Ιουλίου 2016

'Open access' and the International Journal of Audiology.

'Open access' and the International Journal of Audiology.

Int J Audiol. 2016 Jul 29;:1-2

Authors:

PMID: 27472297 [PubMed - as supplied by publisher]

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Facial tremors in patients with and without parkinsonism.

Facial tremors in patients with and without parkinsonism.

Neurol Sci. 2016 Jul 28;

Authors: Rossi M, Wilken M, Morisset P, Fariña S, Cerquetti D, Merello M

Abstract
Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.

PMID: 27470304 [PubMed - as supplied by publisher]

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Line of Sight in Hominoids.

Line of Sight in Hominoids.

J Clin Pediatr Dent. 2016;40(3):251-258

Authors: Stock MK, Reynolds DG, Masters AJ, Bromage TG, Enlow DH

Abstract
OBJECTIVES: It remains unclear how the realignments of the face and basicranium that characterize humans were acquired, both phylogenetically and ontogenetically. The developmentally constrained nature of the skull has been previously demonstrated in other primates using Donald H. Enlow's mammalian craniofacial architectural relationships. Here, we compare crania of our closest relatives to gain greater understanding of how and why the relationship of the face and cranial base is developmentally constrained in order to inform instances of abnormal growth and clinical intervention.
STUDY DESIGN: A method for evaluating these fundamental architectural relationships using 3D landmark data was developed, thereby taking overall size and the geometric relationships among points into account. A sample of cone-beam computed tomography scans derived from humans and extant apes were analyzed (n=10 and n=6, respectively), as well as fossil hominid crania (n=7). Landmarks for 23 craniofacial architectural points were identified and recorded.
RESULTS AND CONCLUSIONS: Principal components analyses reveal that despite the similarities in craniofacial architecture between humans, extant apes and fossil hominids, appreciable trends in variation between the extant species suggest that the repositioning of the foramen magnum was only one of a constellation of traits that realigned the basicranium and face during the transition to bipedalism.

PMID: 27472575 [PubMed - as supplied by publisher]

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Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

Endoscopic versus microscopic microvascular decompression for trigeminal neuralgia: equivalent pain outcomes with possibly decreased postoperative headache after endoscopic surgery.

J Neurosurg. 2016 Jul 29;:1-9

Authors: Lee JY, Pierce JT, Sandhu SK, Petrov D, Yang AI

Abstract
OBJECTIVE Endoscopic surgery has revolutionized surgery of the ventral skull base but has not yet been widely adopted for use in the cerebellopontine angle. Given the relatively normal anatomy of the cerebellopontine angle in patients with trigeminal neuralgia (TN), the authors hypothesized that a fully endoscopic microvascular decompression (E-MVD) might provide pain outcomes equivalent to those of microscopic MVD (M-MVD) but with fewer complications. METHODS The authors conducted a single-institution, single-surgeon retrospective study with patients treated in the period of 2006-2013. Before surgery, all patients completed a questionnaire that included a validated multidimensional pain-outcome tool, the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory-Facial), an 11-point scale that measures pain intensity, interference with general activities of daily living (ADLs), and facial-specific ADLs. Using a standardized script, independent research assistants conducted follow-up telephone interviews. RESULTS In total, 167 patients were available for follow-ups (66.5% female; 93 patients underwent M-MVD and 74 underwent E-MVD). Preoperative characteristics (i.e., TN classification, PFPS components, and medication use) were similar for the 2 surgical groups except for 2 variables. Patients in the M-MVD group had slightly higher incidence of V3 pain, and the 2 groups differed in the date of surgery and hence in the length of follow-up (2.4 years for the M-MVD group and 1.3 years for the E-MVD group, p < 0.05). There was a trend toward not finding neurovascular conflict at the time of surgery more frequently in the M-MVD than in the E-MVD group (11% vs 7%, p = 0.052). Internal neurolysis was more often performed in the E-MVD group (26% vs 7%, p = 0.001). The 2 groups did not significantly differ in the length of the MVD procedure (approximately 2 hours). Self-reported headaches at 1 month postoperatively were present in 21% of the patients in the M-MVD group versus 7% in the E-MVD group (p = 0.01). Pain outcomes at the most recent followup were equivalent, with patients reporting a 5- to 6-point (70%-80%) improvement in pain intensity, a 5-point (85%) improvement in pain interference with ADLs, and a 6-point (85%) improvement in interference with facial-specific ADLs. Actuarial freedom from pain recurrence was equivalent in the 2 groups, with 80% pain control at 3 years. CONCLUSIONS Both the fully endoscopic MVD and the conventional M-MVD appear to provide patients with equivalent pain outcomes. Complication rates were also similar between the groups, with the exception of the rate of headaches, which was significantly lower in the E-MVD group 1 month postoperatively.

PMID: 27471895 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Τρίτη 9 Αυγούστου 2016

Παρασκευή 5 Αυγούστου 2016

Πέμπτη 4 Αυγούστου 2016

Τρίτη 2 Αυγούστου 2016

Κυριακή 31 Ιουλίου 2016

Σάββατο 30 Ιουλίου 2016