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Πέμπτη 31 Αυγούστου 2017
Will Fitbit’s Sleep Apnea Tracking Actually Work?
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The hydroxyapatite Turkish Delight: a technical note
Abstract
Nasal dorsum augmentation is commonly performed using autologous cartilage grafts, also in the Turkish Delight technique. The aim of this study was to describe a modification of the Turkish Delight technique for dorsal augmentation consisting of small hydroxyapatite-calcium carbonate granules (0.5–1 mm) that were wrapped in layers of oxidized cellulose and glued with 1–2-cm3 fibrin sealant and to compare its utility with that of other techniques. Clinically stable and satisfactory results were achieved in the four cases examined. Cone-beam computerized tomography (CBCT) imaging revealed that there was no degradation of the graft up to 2 years after surgery. The use of a modified Turkish Delight method using hydroxyapatite granules promises to be a valuable option for the correction of nasal dorsum deficiency.
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The hydroxyapatite Turkish Delight: a technical note
Abstract
Nasal dorsum augmentation is commonly performed using autologous cartilage grafts, also in the Turkish Delight technique. The aim of this study was to describe a modification of the Turkish Delight technique for dorsal augmentation consisting of small hydroxyapatite-calcium carbonate granules (0.5–1 mm) that were wrapped in layers of oxidized cellulose and glued with 1–2-cm3 fibrin sealant and to compare its utility with that of other techniques. Clinically stable and satisfactory results were achieved in the four cases examined. Cone-beam computerized tomography (CBCT) imaging revealed that there was no degradation of the graft up to 2 years after surgery. The use of a modified Turkish Delight method using hydroxyapatite granules promises to be a valuable option for the correction of nasal dorsum deficiency.
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Tympanometric assessment of Eustachian tube function as a prognostic indicator in myringoplasty
Suresh Babu Undavalli, Narayan Hanumanth Rao Kulkarni, Sukrit Bose, Anuradha Ananthaneni
Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):14-18
Aim To determine eustachian tube function in tubo-tympanic type of chronic ear disease and correlate it with pathological changes in middle ear. Objective To ascertain whether eustachian tube function had any demeanor upon the outcome of myringoplasty. Backgound The prevailing interest in the patho-physiology of the eustachian tube has been stimulated by the persistent incidence of middle ear effusion and chronic otitis media. The ongoing sophistication in current middle ear reconstructive surgery has added more dimensions to the study of eustachian tube and its effects in the course of reconstructive middle ear surgery. One of the prime elements accountable for failure of reconstructive middle ear surgery has been tubal dysfunction. Method In the present study eustachian tube function was evaluated in in 30 patients who were undergoing myringoplasty for tubo-tympanic type of chronic suppurative otitis media having central perforation by tuning fork tests, microscopic evaluation of the middle ear mucosa and Impedance audiometry. Results 70% of the myringoplasty cases had good surgical outcome and of the 24 cases that had good eustation tube function 87.5% had successful surgical outcome remaining cases had recurrence of otorrhea. Conclusion The results were validating good eustachain tube function as a criterion for electing cases under middle ear reconstructive surgery and Impedance audiometer assures a superlative means of appraising Eustachain tube function.
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Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):14-18
Aim To determine eustachian tube function in tubo-tympanic type of chronic ear disease and correlate it with pathological changes in middle ear. Objective To ascertain whether eustachian tube function had any demeanor upon the outcome of myringoplasty. Backgound The prevailing interest in the patho-physiology of the eustachian tube has been stimulated by the persistent incidence of middle ear effusion and chronic otitis media. The ongoing sophistication in current middle ear reconstructive surgery has added more dimensions to the study of eustachian tube and its effects in the course of reconstructive middle ear surgery. One of the prime elements accountable for failure of reconstructive middle ear surgery has been tubal dysfunction. Method In the present study eustachian tube function was evaluated in in 30 patients who were undergoing myringoplasty for tubo-tympanic type of chronic suppurative otitis media having central perforation by tuning fork tests, microscopic evaluation of the middle ear mucosa and Impedance audiometry. Results 70% of the myringoplasty cases had good surgical outcome and of the 24 cases that had good eustation tube function 87.5% had successful surgical outcome remaining cases had recurrence of otorrhea. Conclusion The results were validating good eustachain tube function as a criterion for electing cases under middle ear reconstructive surgery and Impedance audiometer assures a superlative means of appraising Eustachain tube function.
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The role of antibiotics in treating secretory otitis media in children aged 2–12 years in an accredited teaching hospital in southeast Asia
Sarmishtha De, Kamal Kachhawa, Arun Gambhir, Rajesh K Jain, Rasmirekha Behera, Sanjay K Diwan, Sanjay Kumar
Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):6-9
Introduction Secretory otitis media (SOM) is the most common clinical condition that can cause conductive deafness, especially among school-going children. The outcomes of hearing loss in children include speech problems, behavioral problems, and poor academic performance. Management of SOM therefore remains crucial. We carried out a comparative study of antibiotics versus surgical therapy for the treatment of SOM. Patients and methods The present study included 50 patients. Detailed history taking with ENT examinations was performed and documented in a validated pro forma. Routine investigations such as complete blood count, urine examination, audiological investigation such as impedance audiometry, etc, were carried out. Observation and results About 70% of the patients presented with symptoms of ear block with mouth breathing. Increased incidence was found in the 2–6 years age group. The present showed that surgery can increase the rate of recovery, shorten the duration of therapy, and prevent the recurrence of SOM compared with treatment with antibiotics. Conclusion Both the treatments have complications associated with them. Large, well-controlled studies can help resolve the risk–benefit ratio by measuring SOM recurrence, functional outcome, quality of life, and long-term outcomes.
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Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):6-9
Introduction Secretory otitis media (SOM) is the most common clinical condition that can cause conductive deafness, especially among school-going children. The outcomes of hearing loss in children include speech problems, behavioral problems, and poor academic performance. Management of SOM therefore remains crucial. We carried out a comparative study of antibiotics versus surgical therapy for the treatment of SOM. Patients and methods The present study included 50 patients. Detailed history taking with ENT examinations was performed and documented in a validated pro forma. Routine investigations such as complete blood count, urine examination, audiological investigation such as impedance audiometry, etc, were carried out. Observation and results About 70% of the patients presented with symptoms of ear block with mouth breathing. Increased incidence was found in the 2–6 years age group. The present showed that surgery can increase the rate of recovery, shorten the duration of therapy, and prevent the recurrence of SOM compared with treatment with antibiotics. Conclusion Both the treatments have complications associated with them. Large, well-controlled studies can help resolve the risk–benefit ratio by measuring SOM recurrence, functional outcome, quality of life, and long-term outcomes.
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Sound therapy for tinnitus patients
Mohamed I Shabana, Abeir O Dabbous, Ayman M.M. Abdelkarim
Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):1-5
Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon's Tinnitus "SoundSupport", Phonak's Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient's habituation to tinnitus.
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Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):1-5
Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon's Tinnitus "SoundSupport", Phonak's Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient's habituation to tinnitus.
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Hearing profile in children with allergic rhinitis
Adekunle Adeyemo, Josephine Eziyi, Yemisi Amusa, Sanyaolu Ameye
Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):10-13
Objective We carried out this study to determine the profile of hearing of children with allergic rhinitis compared with normal controls. Patients and methods Children with allergic rhinitis between the ages of 4 and 16 years attending the Otorhinolaryngology Clinics as well as age-matched and sex-matched controls were recruited into this study. We obtained the participants' bio data, symptoms and duration using a structured interviewer questionnaire. We then carried out a pure tone audiometry on the participants. The degree of hearing loss was determined on the basis of the WHO standard classification. Results We recruited 99 children with clinical evidence of allergic rhinitis and an equal number of healthy controls completed the study. The mean age was 9.19±3.98 years in the test participants and 9.35±4.05 years in the controls, respectively. Mild hearing loss on the right side was more than twice as common among patients, 24 (24.2%), compared with the controls, 11(11.1%). Left-sided mild hearing loss was more than four times more prevalent among patients with allergic rhinitis, 26 (26.3%), compared with the controls, six (6.1%). Hearing threshold worse than 25 dB hearing level in the better-hearing ear was found to be significantly more prevalent among patients compared with the controls. Conclusion We could conclude that hearing is significantly worse in allergic children compared with controls, with disabling hearing loss being more significantly associated with allergic rhinitis.
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Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):10-13
Objective We carried out this study to determine the profile of hearing of children with allergic rhinitis compared with normal controls. Patients and methods Children with allergic rhinitis between the ages of 4 and 16 years attending the Otorhinolaryngology Clinics as well as age-matched and sex-matched controls were recruited into this study. We obtained the participants' bio data, symptoms and duration using a structured interviewer questionnaire. We then carried out a pure tone audiometry on the participants. The degree of hearing loss was determined on the basis of the WHO standard classification. Results We recruited 99 children with clinical evidence of allergic rhinitis and an equal number of healthy controls completed the study. The mean age was 9.19±3.98 years in the test participants and 9.35±4.05 years in the controls, respectively. Mild hearing loss on the right side was more than twice as common among patients, 24 (24.2%), compared with the controls, 11(11.1%). Left-sided mild hearing loss was more than four times more prevalent among patients with allergic rhinitis, 26 (26.3%), compared with the controls, six (6.1%). Hearing threshold worse than 25 dB hearing level in the better-hearing ear was found to be significantly more prevalent among patients compared with the controls. Conclusion We could conclude that hearing is significantly worse in allergic children compared with controls, with disabling hearing loss being more significantly associated with allergic rhinitis.
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Comparison of two hearing aid fitting formulae in improving the patients’ satisfaction with amplification for experienced hearing aid users
Mohamed Shabana, Mona H Selim, Salwa M Abd El-Latif, Mona M Hamdy, Mai M El-Gohary
Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):19-25
Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient's five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve 'aversiveness' conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.
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Advanced Arab Academy of Audio-Vestibulogy Journal 2017 4(1):19-25
Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient's five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve 'aversiveness' conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.
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Pancreas sparing duodenectomy for duodenal trauma
Abstract
Background
Although blunt abdominal trauma is frequently encountered, isolated duodenal injury is relatively uncommon. The management of such patients is challenging and various surgical procedures are described for their management.
Methods
Two patients presented to our emergency department with isolated duodenal injuries (transection and devascularisation) secondary to blunt abdominal trauma.
Results
Both patients underwent exploratory laparotomy, revealing transection of the duodenum along with proximal devascularization and detachment of mesentery at duodeno-jejunal junction without any other intra-abdominal injury (especially pancreas, colon, vena cava) for which pancreas-sparing duodenectomy (infra-ampullary) was performed.
Conclusion
Pancreas-sparing duodenectomy is a valuable tool in the management of duodenal trauma, allowing the surgeon (and the patient) to avoid the complications of major surgical resections.
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Exophytic gastrointestinal stromal tumor of the stomach. Report of two cases
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Most GISTs occur in the stomach (60-70%). Their diagnosis is established immunohistochemically and reveals that the tumor cells are immunoreactive for the antigens CD117 and CD34. The infiltration of the adjacent organs, the large tumor size (>5cm) and the mitosis count of the cells (>5/50 CHPFs) are typical characteristics of GIST malignancy. GISTs rarely infiltrate adjacent organs and usually push them back. The clinical behaviour of GISTs is highly variable and tumor size mitotic rate and location are prognostic determinants.
The biologic behaviour of GIST is variable. The majority were previously thought to be benign due to their characteristically bland histopathologic features. However, it is becoming increasingly clear that with long follow-up, virtually all GISTs have the potential for malignant behaviour, even those 2 cm or less with bland histologic features. Thus, it is not appropriate to define any GIST as "benign" per se.
We present two cases of exophytic gastric GIST which were recently treated successfully in our Clinic with "wedge" gastric resection. The margins were negative and there was neither rupture of the tumor, nor spillage.
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Our case reports a component of acute care surgery
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Gastric outlet obstruction with perforation. A rare presentation of left-sided adult Morgagni hernia
Abstract
Adult presentation of congenital diaphragmatic hernia (CDH) is rare. Out of the three varieties of CDH, Morgagni hernia is the rarest of all. Though most of them are asymptomatic and may be incidentally detected, they may also present in the emergency setting with respiratory or gastrointestinal features like obstruction or strangulation. Gastric outlet obstruction is a rare manifestation of adult Morgagni hernia. We present a case of adult left-sided Morgagni hernia with features of gastric outlet obstruction complicated with perforation.
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The anatomy of a surgeon
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Coexistence of Hashimoto’s thyroiditis and papillary thyroid carcinoma
Abstract
Aim
The coexistence of Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) has been a widely debated issue. In view of the current controversy, as well as the high prevalence of both diseases, the objective of the present paper is to evaluate the association between them and to propose the proper therapeutic management.
Methods
We herein review previous pertinent literature on the subject of concomitant HT and PTC, with respect to epidemiology, clinical presentation, carcinogenesis, and appropriate treatment.
Results
Studies to date establish 6.5-43.8% of patients with PTC and coexisting HT, while 11-58.3% of all HT patients will develop PTC. Coexistence of the diseases is significantly related to younger women. Malignant lesions tend to be microcarcinomas, at times multifocal (13.5-44%) and occasionally metastasising to the central cervical compartment (10.8-49%). Mostly, patients have a good prognosis with total thyroidectomy, accompanied by central compartment node dissection in cases with nodal involvement. Many issues, including molecular biological characteristics of carcinogenesis in Hashimoto's thyroiditis, remain to be clarified and further studies need to be undertaken.
Conclusions
The close relationship between HT and PTC lends credence to the hypothesis that autoimmune thyroiditis is a predisposing factor to the development of thyroid carcinoma but patients tend to have favorable clinicopathological characteristics and long recurrence-free survival. A careful surveillance of these patients is required for an early detection of malignant lesions, which should constitute indication for radical surgical treatment.
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Use of idarucizumab for dabigatran reversal in patients with non-valvular atrial fibrillation undergoing emergency surgical repair of strangulated femoral hernia
Abstract
Non-vitamin-K oral anticoagulants (NOACs) are approved for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and dabigatran exetilate, a direct thrombin inhibitor, was the first one to be approved. While anticoagulated, patients can experience serious perioperative bleeding so idarucizumab, a specific for dabigatran reversal agent was developed, in order to remove anticoagulant action and restore normal haemostasis. We report a case of a 61-year-old woman with history of NVAF on dabigatran, presented to the emergency department with a strangulated right femoral hernia causing small bowel obstruction, where idarucizumab was administered before surgery. The patient had received her last dose of dabigatran 4 hours before presenting to the emergency department and her activated partial thromboplastin time was over the upper limit of reference. Surgery followed about one hour after the administration of idarucizumab and surgeon reported normal perioperative haemostasis. The patient had a normal recovery, received parenteral anticoagulation until her hospital discharge when she was advised to restart dabigatran. To our knowledge, this is the first case of successful reversal of anticoagulation, with the use of idarucizumab, to a patient in need for an emergency surgery, in Greece.
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Intestinal obstruction in appendicitis: A retrospective cohort study
Abstract
Background
Appendicitis as a cause of intestinal obstruction is an infrequent condition. The purpose of this study was to define the incidence and frequency of intestinal obstruction, according to the classification of intestinal obstruction secondary to appendicitis, and to characterise their severity.
Methods
A retrospective cohort study analysing all patients operated on for intestinal obstruction secondary to appendicitis within a 15-year period was designed. Continuous and categorical variables including age, gender, time interval between onset of symptoms and diagnosis, C-reactive protein and white blood cells values, type of intestinal obstruction and WSES Sepsis Severity Score, were included.
Results
During the period of study 3626 patients were operated on for appendicitis and 44 cases had associated intestinal obstruction (1.2%). According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical ileus with strangulation (48%) and a WSES Sepsis Severity Score of 3 or less points (77%).
Conclusions
The incidence of intestinal obstruction in appendicitis was higher than expected. These patients have a severe inflammatory response with a WSES Sepsis Severity Score of 3 points. According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical obstruction with strangulation.
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Current concepts on GIST
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The inaugural letter
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Gallstone obstructing the duodenum. Report of two cases of Bouveret’s syndrome
Abstract
Bouveret's syndrome is the obstruction of the duodenum due to a gallstone. It is a rare condition, known for over a century that continues to confound emergency room physicians and surgeons to this day. We present two cases of Bouveret's syndrome. The first is a 63-year-old female patient with a 4 cm gallstone obstructing the third part of the duodenum. The patient underwent prompt surgery and the gallstone was removed through the jejunum. The other patient's course, an 88–year-old male, was more complicated. After fluid resuscitation and an attempt at endoscopic removal, a gallstone obstructing the first part of the duodenum was surgically removed through a gastrotomy. Both patients recovered fully and were discharged. Both cases presented many dilemmas and challenges from the diagnosis to the final management.
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Acute surgical abdomen as presentation of undiagnosed midgut malrotation in adults
Abstract
Aim-Background
Acute presentation in adulthood of the indolent developmental midgut malformations constitutes a diagnostic problem and emergent surgery may result to an operative surprise.
Methods
In the last five years two women (case I: 46 years, case II: 88 years) and two men (case III: 42 years, case IV: 50 years) underwent urgent laparotomy for acute abdomen due to bowel obstruction (all cases) and peritonitis (cases II, III). Right colon volvulus in cases I, II and IV, ileocolonic intussusception in case II, gaseous distension of bowel loops and abdominal abscess in case III, and enlargement of the entire colon and megasigmoid in case IV were revealed by preoperative imaging. Symptoms of severe abdominal pain, abdominal distension with tenderness, vomiting and complete constipation were evident in all cases. At surgery, features of malrotation, mainly lack of fixation of the right colon which was volvulised, were found in all cases. Right-sided small intestine and Meckel's diverticulum abscess were found in case III, and an incompletely volvulised megasigmoid coexisted in case IV. We performed resection of peritoneal bands, right hemicolectomy with ileotransversostomy in cases I, II and IV, and enterectomy and right colon fixation in case III. A Hartmann's sigmoidectomy completed the operation in case IV.
Results
All cases had uneventful outcome, except for some delay in wound healing in a diabetic patient. Histology revealed ischaemia in all segments excised, ileocolonic intussusception associated with a caecal adenocarcinoma in case II, and inflammed Meckel's diverticulum in case III.
Conclusions
Adult bowel malrotation complicated with right colon volvulus and/or ileocolonic intussusception requires emergent surgery.
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