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Πέμπτη 18 Μαρτίου 2021

Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair

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J Neuroophthalmol. 2021 Mar 12. doi: 10.1097/WNO.0000000000001118. Online ahead of print.

ABSTRACT

BACKGROUND: A relationship between idiopathic intracranial hypertension and spontaneous skull base cerebrospinal fluid (CSF) leaks has been proposed, by which CSF leak decreases intracranial pressure (ICP) and masks the symptoms and signs of elevated ICP. These patients are at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak after CSF leak repair. The objective of this study was to assess whether radiographic signs of raised ICP on preoperative magnetic resonance or computed venography (MRI or CTV) are predictors of postoperative papilledema, recurrence of CSF leak, or need for CSF shunt surgery.

METHODS: We performed a retrospective review of systematically collected demographics, fundus examination, and presurgical brain MRI and magnetic resonance venography/computed tomography venography (MRV/CTV) in pat ients seen at 1 institution between 2013 and 2019 with spontaneous skull base CSF leak repair. Patients were divided into 2 groups depending on whether they developed papilledema, recurrent CSF leak, or required CSF shunting (Group 1) or not (Group 2).

RESULTS: Fifty-seven patients were included, among whom 19 were in Group 1. There was no difference in demographic characteristics or clinical features between patients in Group 1 and Group 2. Controlling for other imaging features, bilateral transverse venous sinus stenosis (TVSS) on preoperative imaging increased the odds of being in Group 1 by 4.2 times (95% confidence interval [CI], 1.04-21.2, P = 0.04), optic nerve tortuosity decreased the odds of being in Group 1 by 8.3 times (95% CI: 1.4-74.6, P = 0.02).

CONCLUSION: Imaging of the intracranial venous system with MRV or CTV is warranted before repair of spontaneous CSF leak, as bilateral TVSS is an independent risk factor for postoperative papilledema, CSF leak recur rence, or need for a CSF shunting procedure.

PMID:33734152 | DOI:10.1097/WNO.0000000000001118

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Allergic rhinitis is associated with atmospheric SO2: Follow-up study of children from elementary schools in Ulsan, Korea

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journal.pone.0248624.g004&size=inline

by Suk Hwan Kim, Jiho Lee, Inbo Oh, Yeonsuh Oh, Chang Sun Sim, Jin-Hee Bang, Jungsun Park, Yangho Kim

Objectives

The purpose of this study was to examine the association of allergic rhinitis with air pollutant concentrations using the follow-up data of elementary school children in Ulsan, Korea.

Methods

All students of four elementary schools in Ulsan, South Korea were surveyed at two-year intervals. The survey used data collected five times, over a nine-year period from June 2009 to April 2018. The questionnaire used in the survey was a modified version of the ISAAC (International society of asthma and allergy of children) questionnaire. A skin prick test (SPT) was performed with 24 standard antigens. To estimate the levels of exposure to outdoor air pollution, the concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and particulate matter 10 μm or less in diameter (PM10) were used. As a dependent variable, a history of allergic rhinitis diagnosed by a doctor during the last 1-year was considere d. Logistic regression analysis was used to select variables suitable for the statistical model. The selected variables were then used to assess their association with the dependent variable using the generalized estimation equation.

Results

Among environmental factors, SO2 was associated with a high risk and PM10 was associated with a low risk of allergic rhinitis. The risk of allergic rhinitis from living in a house built within the last year was high, and the risk from living in a multi-family house or apartment was higher than that from living in a segregated house. History of allergic diseases in the family was a high-risk factor for allergic rhinitis. There was a relationship between a history of bronchiolitis at less than 2 years of age and a high risk of allergic rhinitis. Boys were at a higher risk than girls.

Conclusion

From the follow-up data of elementary school students in Ulsan, Korea, the concentration of SO2, which is an indicator of the degree of industrialization, was related to the prevalence of allergic rhinitis. Among all the risk factors, history of allergic disease in the parents was the most important factor, and the study reconfirmed the results of the previous studies.

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The Effect of the Mother's Participation in Therapy on Children with Vocal Fold Nodules

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Ann Otol Rhinol Laryngol. 2021 Mar 18:34894211002430. doi: 10.1177/00034894211002430. Online ahead of print.

ABSTRACT

OBJECTIVES: Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when th eir mothers also take part in therapy.

METHODS: Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well.

RESULTS: The two groups' measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1.

C ONCLUSIONS: Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family's involvement increases the child's motivation in therapy. The mother's presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother's involvement increases the child's compliance with and interest in therapy.

PMID:33733874 | DOI:10.1177/00034894211002430

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Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

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Ann Otol Rhinol Laryngol. 2021 Mar 18:34894211001065. doi: 10.1177/00034894211001065. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence.

METHOD: A web-based survey was distributed to SLP s via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses.

RESULTS: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making.

CONCLUSION: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

PMID:33733876 | DOI:10.1177/00034894211001065

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Treatment of Paranasal Sinus Fungus Ball: A Systematic Review and Meta-Analysis

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Ann Otol Rhinol Laryngol. 2021 Mar 18:34894211002431. doi: 10.1177/00034894211002431. Online ahead of print.

ABSTRACT

OBJECTIVES: Paranasal sinus fungus ball is a common non-invasive mycosis with excellent long-term surgical treatment results. The present systematic review and meta-analysis were undertaken to define current treatment concepts and success rates in paranasal sinus fungus ball treatment.

METHODS: Systematic searches were performed in multiple databases wi th criteria designed to include all studies published until May 2020 focusing on paranasal sinuses fungus ball treatment in humans. We selected studies including at least 10 patients, specifying treatment modalities, providing a minimum 6-month follow-up, and objectivating treatment success. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates. Success rates were pooled in a random effect meta-analysis and compared according to the use of intraoperative sinus lavages and postoperative antibiotics.

RESULTS: Among 740 unique citations, 14 studies were deemed eligible. Most (n = 11) were retrospective case series. All studies relied on endoscopic sinus surgery. Intraoperative lavages were proposed in 10 studies and postoperative antibiotics in 7 (for all patients in 5 studies and for selected patients in 2). No significant heterogeneity was observed between results (Cochran's Q P = .639, I2 test = 0). Treatment success rate was 98.4% (95% confidence interval 97.4%-99.3%). Intraoperative sinus toilette and postoperative antibiotics didn't significantly improve the success rate.

CONCLUSION: Endoscopic sinus surgery shows excellent results in fungus ball treatment. Further prospective studies might help further reducing antibiotics prescriptions in these patients and improve their management.

PMID:33733891 | DOI:10.1177/00034894211002431

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In Memoriam: Professor Francisco Hernández-Calvo (1931-2020)

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Histol Histopathol. 2021 Jan;36(1):1-2. doi: 10.14670/HH-18-313. Epub 2021 Feb 16.

ABSTRACT

Francisco Hernández Calvo, Professor of Histology at the Faculty of Medicine of the University of Murcia, and founder and editor of the Journal "Histology and Histopathology", passed away in 2020. Through these words we wish to honour the memory of an eminent histologist, teacher and researcher, whose considerable efforts and wisdom contributed much to scientific communication in his field.

PMID:33734424 | DOI:10.14670/HH-18-313

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VEGF-A/VEGF-B/VEGF-C expressions in non-hereditary, non-metastatic phaeochromocytoma

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Histol Histopathol. 2021 Mar 18:18329. doi: 10.14670/HH-18-329. Online ahead of print.

ABSTRACT

Vascular endothelial growth factor (VEGF) is important in pathogenesis of different cancers. The aim of this study is to investigate the relationships between different VEGFs and clinicopathological factors in patients with phaeochromocytomas. Twenty patients (10 men; 10 women) with non-hereditary, non-metastatic phaeochromocytomas were examined for VEGF mRNA expressions by polymerase chain reaction. The expressions were correlated with the clinical and pathological factors of the patients. In addition, mouse double minute 2 (MDM2) expression in these tumours were studied by immunohistochemistry. High expressions of VEGF-A, VEGF-B, and VEGF-C mRNA were detected in 11 (55%), 9 (45%), and 9 (45%) of the tumours respectively. High expression of VEGF-A in phaeochromocytomas was significantly correlated with the tumour size (p=0.025) but did not correlate with patients' age, gender, and tumour laterality. Besides, there was a trend of VEGF-A expression correlated with MDM2 expression (p = 0.064). On the other hand, expressions of VEGF-B and VEGF-C were not significantly correlated with tumour size, patients' age, gender, tumour laterality, and MDM2 expression. In addition, high expressions of VEGF-B and VEGF-A were associated with increase of tumour size (p = 0.042). Co-expression of different VEGFs did not correlate with MDM2 expression. To conclude, there is a role for VEGF-A/VEGF-B/VEGF-C in the pathogenesis of non-hereditary, non-metastatic phaeochromocytomas.

PMID:33734425 | DOI:10.14670/HH-18-329

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Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea

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Ear Nose Throat J. 2021 Mar 18:1455613211001132. doi: 10.1177/01455613211001132. Online ahead of print.

ABSTRACT

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

PMID:33734881 | DOI:10.1177/01455613211001132

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Pathology Clinic: Nodular Fasciitis Involving the External Ear

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Ear Nose Throat J. 2021 Mar 18:1455613211001958. doi: 10.1177/01455613211001958. Online ahead of print.

ABSTRACT

Nodular fasciitis is a rare, benign lesion characterized by the pseudosarcomatous proliferation of fibroblasts and myofibroblasts. Accurate diagnosis presents a unique challenge for otolaryngologists, as nodular fasciitis frequently mimics malignancy clinically; however, it can be distinguished from malignancy by subtle findings on pathology. A diagnosis of nodula r fasciitis should be considered for any irregular or rapidly growing lesion of the head and neck area, as accurate diagnosis is particularly important to avoid overtreatment in cosmetically sensitive regions.

PMID:33734879 | DOI:10.1177/01455613211001958

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Use of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy

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Ear Nose Throat J. 2021 Mar 18:1455613211000599. doi: 10.1177/01455613211000599. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical students for manipulation of a nasal endoscope on a cadaveric model.

MATERIAL AND METHOD: We randomly selected 39 medical students who had never handled a nasal endoscope and subjected them to the MRT. Ge neral information including experience in manual, technical, or surgical activities and testing of anatomical knowledge were collected to exclude possible confounding factors. They were then asked to perform series of cadaveric model exercises using a nasal endoscope. Their cadaver performance was evaluated by 2 blinded observers, using a standardized scale.

RESULTS: We found that medical students with higher mental rotation skills had significantly increased endoscopic sinus performance (P = .0002 using multivariate regression adjusted for specialty choice, previous surgical exposure, and anatomy knowledge). Higher anatomy knowledge was also associated with better endoscopic sinus performance (P = .0141). Other parameters had no impact on endoscopic sinus performance measured by the endoscopic scale (P > .05).

CONCLUSION: The score obtained on the MRT was correlated with the practical performance of manipulating the nasal endoscope in cadaver. It could therefore be a useful spatial ability tool for directing targeted training in rhinology.

PMID:33734883 | DOI:10.1177/01455613211000599

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A Case Report of Spontaneous Nasal Septal Abscess in a Child

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Ear Nose Throat J. 2021 Mar 18:1455613211000613. doi: 10.1177/01455613211000613. Online ahead of print.

ABSTRACT

We describe a case of spontaneous nasal septal abscess (NSA) in a 9-year-old child. We also reviewed the literatures in recent years and summarized the characteristics of NSA, such as gender, age, inducement, pathogenic bacteria, treatment, and prognosis. We found that this boy reported by us has the most extensive abscess. May be the delay of treatment was relate d to the recent fluctuation of COVID-19 epidemic in China. Fortunately, with the help of surgery and anti-infection treatment, the boy was discharged from the hospital without septal perforation or saddle nose.

PMID:33734887 | DOI:10.1177/01455613211000613

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