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Πέμπτη 12 Αυγούστου 2021

A Spontaneous Chyle Leak

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This case report describes a woman in her 40s who presented with a rapidly enlarging neck mass and was subsequently diagnosed with a chyle leak.
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Bell Palsy and COVID-19

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The emergency use authorization of the first 2 messenger RNA COVID-19 vaccines in the US has given rise to a fascinating study of otolaryngological medical and social influence issues. As of May 1, 2020, the COVID-19 pandemic has resulted in more than 151 million cases and 3.2 million deaths worldwide. In the US, these statistics include 32.4 million cases (9757 per 100 000 population) and 576 000 deaths (173 per 100 000 population). The cold sterility of numbers is difficult to put into context. Likewise, when Pfizer-BioNTech and Moderna revealed cases of Bell palsy in their vaccine trials, concerns grew regarding the potential of the vaccines to cause Bell palsy. Numbers thrown out to either demonstrate or refute safety are likewise difficult for the public to contextualize. Epidemiologically, linking the vaccine with an adverse event requires accurate estimation of event incidence in association with the vaccine, comparison with a nonvaccinated group, and understanding of the background incidence.
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Perineural Spread of Melanoma Into the Orbit With Inflammatory Response and Nonsurgical Treatment

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This case report describes a patient with glabellar melanoma who was previously treated with immune therapy and presented with perineural spread recurrence with inflammatory features associated with prior immune therapy.
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Instrumented Gait Analysis to Identify Persistent Deficits in Adults With Chronic Vestibular Loss

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This cross-sectional study investigates the use of an instrumented 2-minute walk test in adults with vestibular loss to assess whether those with chronic vestibular loss have enduring gait deficits.
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Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation

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To the Editor We read with great interest the recently published article by Lowery AS et al in JAMA Otolaryngology–Head & Neck Surgery, where it was shown that early intervention for patients with postintubation laryngeal injury was associated with a decreased duration of tracheostomy dependence, a higher rate of decannulation, and fewer surgical procedures compared with late intervention. Patients who underwent early intervention also avoided open reconstruction. We appreciate the important information presented in this study and we wish to comment on some associated issues.
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Associations Between Tinnitus and Mental Health in Middle-aged and Elderly Persons

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This cohort study with cross-sectional analyses and 4-year follow-up assesses whether the presence of tinnitus that interferes or does not interfere with daily life is associated with symptoms of depression, anxiety, or poor sleep quality in a population-based sample of individuals 40 years or older who reside in the Netherlands.
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Aberrant Hypoglossal Nerve During Neck Dissection

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This case report describes a woman in her 50s who presented with a right buccal squamous cell carcinoma and was found to have an abnormal course of the hypoglossal nerve.
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Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation—Excellent Outcomes With Low Risk?—Reply

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In Reply Aretha et al offer support for our recent observations detailing the importance of early intervention for the treatment of acute laryngeal injury after prolonged mechanical ventilation. In addition, the authors raise several good points that will shape future questions surrounding laryngeal functional recovery after critical illness. Their letter also highlights the inherent limitations involved in a retrospective cohort study. These limitations are salient, as evidenced by their mention and thorough discussion in our initial manuscript.
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Normative and Pathological Ranges of Cervical Vestibular Evoked Myogenic Potentials in Normal Subjects and Patients with Complete Compensated Unilateral Vestibular Loss: A Cross Sectional Study

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Abstract

To know the normative ranges of VEMP response metrics in healthy young adults. To know the pathological cutoff of VEMP metrics in unilateral vestibular loss patients. To compare our VEMP metrics with the normative values of other studies from the western world. Prospective cross-sectional study. Tertiary care audiovestibular laboratory. 30 healthy subjects and 15 cases with a unilateral complete compensated loss. Various VEMP parameters-p1 latency, n1 latency, p1-n1 amplitude and Interaural asymmetry ratio (IAR) were entered into databases and analyzed. We compared our parameters with the most cited scientific data on VEMP available in the PubMed database, and we analyzed the results. 90% of controls and 80% of cases got VEMP responses at 95 dB HL threshold, 500 Hz with subject/patient placed in sitting upright with head turned to opposite side position. The normative data of VEMP response metrics in young adults for p1, n1 latencies, p1-n1 amplitude , and IAR are 13 ± 2 ms, 21 ± 2 ms, 91 ± 33 uV, and 9.25 ± 7.3, respectively. As the VEMP test has 100% sensitivity and 100% (95% CI 87–100%) negative predictive value in detecting the saccular dysfunction, we recommend the VEMP test as a mandatory tool in the vestibular test battery. There is no statistically significant difference in various VEMP parameters between the control and normal sides of the case group.

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Middle Fossa Encephaloceles Treated via the Transmastoid Approach: A Case Series and Review of the Literature

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Oper Neurosurg (Hagerstown). 2021 Aug 12:opab276. doi: 10.1093/ons/opab276. Online ahead of print.

ABSTRACT

BACKGROUND: Middle fossa (MF) encephaloceles are rare lesions resulting from herniation through defects in the tegmen tympani or mastoideum. Underlying etiologies and clinical presentations are variable. Surgical goals include fistula obliteration, resection of nonfunctioning parenchyma, and dehiscence repair. The middle cranial fossa approach (MCFA), transmastoid approach (TMA), and combined (MCFA + TMA) approaches have been described. The minimally invasive TMA provides excellent exposure of the pathology and allows for ample working room to repair the defect.

OBJECTIVE: We present short-term follow-up results in patients treated via the TM repair at our institution.

METHODS: A retrospective review of patients with symptomatic encephaloceles treated via the TMA by our multidisciplinary team. Patient demographics, clinical presentations, intraoperative findings, repair technique, and outcomes were highlighted.

RESULTS: A total of 16 encephaloceles in 13 patients were treated. Defect etiologies included spontaneous (50.0%), secondary to chronic infection (25.0%), or cholesteatoma (18.8%). Defects were most often within the tegmen mastoideum (68.8%). Average length of surgery was 3.3 h (95% CI: 2.86-3.67) and length of stay 3.9 d (95% CI: 3.09-4.79). On short-term follow-up (average 11.5 mo), no patients experienced postoperative cerebrospinal fluid leak or recurrence. The majority of patients (83.3%) experienced confirmed improvement or stabilization of hearing.

CONCLUSION: MF encephaloceles present with various clinical manifestations and result from multiple underlying etiologies. The TMA is an alternative to craniotomy and our short-term results suggest that this approach may be utilized effectively in appropriately selected cases.

PMID:34382089 | DOI:10.1093/ons/opab276

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A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines

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Endocr Connect. 2021 Aug 1:EC-21-0340.R1. doi: 10.1530/EC-21-0340. Online ahead of print.

ABSTRACT

OBJECTIVE: To conduct a questionnaire survey of the current clinical practice for overt hyperthyroidism in China.

METHODS: An online questionnaire survey was conducted in July 2020. The two questionnaires covered 35 and 8 questions about nonpregnancy and pregnancy clinical practice for overt hyperthyroidism, respectively.

RESULTS: One thousand, two hundred fifty-six physic ians participated. Chief physicians and associate chief physicians accounted for 58.6% of the participants. Approximately 95.2% of the respondents chose the thyrotropin receptor antibody (TRAb) test to clarify the etiology of thyrotoxicosis, while only 27.0% of them chose radioactive iodine uptake (RAIU). In terms of the treatment for nonpregnant patients, antithyroid drugs (ATDs) were the first choice, and most of the clinicians chose methimazole. Compared with clinicians in recent studies, Chinese physicians used serum TRAb to diagnose Graves' disease more commonly, and there were obviously more physicians preferring ATDs. For maternal hyperthyroidism, most physicians preferred propylthiouracil administration before or during the first trimester, which is consistent with the 2016 American Thyroid Association (ATA) guidelines. In terms of the initial ATD dose, monitoring of the treatment process, indications for ATD withdrawal, and treatment of special cases, the preferences of Chi nese physicians were generally consistent with the guidelines.

CONCLUSION: Chinese physicians can generally follow the ATA guidelines for the diagnosis and treatment of hyperthyroidism. Moreover, there are small differences from foreign studies or the guidelines with respect to particular problems. These findings provide evidence for future clinical research in China.

PMID:34382578 | DOI:10.1530/EC-21-0340

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Multifunctional Hybrid Hydrogel Enhanced Antitumor Therapy through Multiple Destroying DNA Functions by a Triple-Combination Synergistic Therapy

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Adv Healthc Mater. 2021 Aug 12:e2101190. doi: 10.1002/adhm.202101190. Online ahead of print.

ABSTRACT

Brachytherapy, as an effective setting for precise cancer therapy in clinic, can lead to serious DNA damage. However, its therapeutic efficacy is always limited by the DNA self-repair property, tumor hypoxia-associated radiation resistance as well as inhomogeneous distribution of the radioactive material. Herein, a multifunctional hybrid hydrogel (131 I-hydrogel/DOX/GNPs aggregates) is developed by loading gold nanoparticle aggregates (GNPs aggregates) and DOX into a radionuclide iodine-131 (131 I) labelled polymeric hydrogels (131 I-PEG-P(Tyr)8 ) for tumor destruction by completely damaging DNA self-repair functions. This hybrid hydrogel exhibits excellent photothermal/radiolabel stability, biocompatibility, and fluorescence/photothermal /SPECT imaging properties. After local injection, the sustained releasing DOX within tumor greatly inhibits the DNA replication. Meanwhile, GNPs aggregates as a radiosensitizer and photosensitizer show a significant improvement of brachytherapeutic efficacy and cause serious DNA damage. Simultaneously, GNPs aggregates induce mild photothermal therapy under 808 nm laser irradiation, which not only inhibits self-repair of the damaged DNA but also effectively relieves tumor hypoxic condition to enhance the therapeutic effects of brachytherapy, leading to a triple-synergistic destructi on of DNA functions. Therefore, this study provides a highly efficient tumor synergistic therapy platform and insight into the synergistic antitumor mechanism in DNA level.

PMID:34382378 | DOI:10.1002/adhm.202101190

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