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Δευτέρα 29 Νοεμβρίου 2021

Post headshake nystagmus: further correlation with other vestibular test results

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Eur Arch Otorhinolaryngol. 2021 Nov 28. doi: 10.1007/s00405-021-07155-z. Online ahead of print.

ABSTRACT

BACKGROUND: It is generally accepted that headshake nystagmus (HSN) is generated from an asymmetrical peripheral vestibular input and a correlation exists between HSN and canal paresis. There have been limited reports, however, how HSN correlates with the more recently introduced tests of vestibular function.

AIMS/OBJECTIVES: To evaluate the correlation between HSN and unilateral weakness on caloric testing, high-frequency vestibulo-ocular reflex (VOR) function on video head impulse testing (VHIT) and otolith function determined by vestibular evoked myogenic potentials (VEMPs).

METHODS: A retrospective study of all patients who underwent complete vestibular function testing at our tertiary referral center from 2016 to 2019 was performed. Demographic data, clinical diagnosis (where available), the results of video-nystagm ography, vHIT, and VEMPs were evaluated.

RESULTS: Of the 1499 patients in the study period, 101 (6.7%) had HSN. Vestibular test abnormalities were more common in patients with HSN. The sensitivity of HSN for underlying pathology was low in comparison with vestibular testing. However, HSN demonstrated a high specificity.

CONCLUSIONS AND SIGNIFICANCE: HSN generation is likely more complex than caloric-induced nystagmus, probably due to additional variables within the vestibular system. HSN may provide clinicians with additional information concerning high-frequency VOR function involving lateral semicircular and otolith dysfunction.

PMID:34839406 | DOI:10.1007/s00405-021-07155-z

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Microsurgical Lymphovenous Anastomosis for Pelvic Lymphoceles after Gynecological Cancer Surgery

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J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00497-6. doi: 10.1016/j.bjps.2021.09.056. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for lymphoceles. Here, we report six cases of refractory lymphoceles that were successfully treated using lymphovenous anastomosis (LVA).

METHODS: Six patients underwent surgery for gynecological cancers and developed pelvic lymphoceles, which did not respond to conventional treatment. We mainly performed LVA on the ipsilateral lower limbs, although some procedures were also performed on the contralateral limbs. The change in the lymphocele volume after LVA was examined using computed tomography and compared using the Wilcoxon test.

RESULTS: Five of the six refractory lymphocele cases were successfully treated using LVA, and the remaining case exhibited an 87% reduction in lymphocele volume. The average numbers of anastomoses were 6.7 on the ipsilateral side and 2.8 on the contralateral side (the median numbers: 6 [range: 5-9] vs. 3 [range: 1-4], P = 0.034). The average lymphocele volume decreased significantly from 414.0 mL preoperatively to 8.0 mL postoperatively (the median lymphocele volume: 255.8 [range: 61.5-1,329.2] vs. 0 [range: 0-47.7], P = 0.0313).

CONCLUSION: We found that microsurgical treatment was potentially effective for lymphoceles that did not respond to conventional treatment.

PMID:34840117 | DOI:10.1016/j.bjps.2 021.09.056

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Ectopic thymic tissue in subglottis of children: evaluation and management

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Braz J Otorhinolaryngol. 2021 Nov 5:S1808-8694(21)00179-8. doi: 10.1016/j.bjorl.2021.10.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Ectopic thymic tissue in the subglottis is an extremely rare disease that causes airway obstruction. Few cases reported were accurately diagnosed before surgery.

METHODS: A case of a 2-year-old boy with airway obstruction caused by a left subglottic mass was reported. The presentation of radiological imaging, direct laryngoscopy and bronchoscopy, pathology, and surgical management were reviewed. An extensive search in PubMed, EMBASE, Web of Science, Google Scholar, and EBSCO of English literature was performed without a limit of time.

RESULTS: Besides our case, only six cases were reported since 1987. The definitive diagnosis on these patients were made with the findings of pathology, of which, five were ectopic thymus and two were ectopic thymic cysts. Our case was the only one with a cor rect suspicion preoperatively. Four cases underwent open surgical resection, and two cases underwent microlaryngeal surgery, while one deceased after emergency tracheostomy. No recurrences were found by six patients during the follow-up after successful treatments.

CONCLUSION: Ectopic thymus is a rare condition, infrequently considered in the differential diagnosis of subglottic masses. Modified laryngofissure may be an effective approach to removing the subglottic ectopic thymus and reconstructing the intact subglottic mucosa.

PMID:34840123 | DOI:10.1016/j.bjorl.2021.10.001

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The importance of vascular epithelial growth factor (VEGF) and inducible nitric oxide synthase (INOS) in rhinitis medicamentosa pathogenesis: An experimental rat model study

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Histol Histopathol. 2021 Nov 29:18399. doi: 10.14670/HH-18-399. Online ahead of print.

ABSTRACT

OBJECTIVE: Our aim in this study is to reveal the expression of Vascular Endothelial Growth Factor (VEGF) and Inducible Nitric Oxide Synthase (iNOS) in the pathogenesis of rhinitis medicamentosa (RM), which occurs as a result of the overdose and long-term use of topical nasal decongestants.

METHODS: In this study, 24 Wistar albino rats were divided into two groups as experimental and control groups. In the experimental group, 50 µl of 0.05% oxymetazoline (iliadin® merck) was applied intranasally to each nostril three times a day for 2 months with the help of a micropipette. 50 µl saline was applied to the control group. At the end of the second month, the rats were examined. RM was detected in the experimental group. Then the nasal tissues of the rats were removed and fixed with 10% phosphate buffered neutral formaldehyde (pH=7.4). Nasal tissues were decalcified in Morse's solution (10% sodium citrate and 22.5% formic acid). Histopathological evaluations of the preparations were stained using Masson Trichrome (TCM) and Hematoxylin Eosin (H&E) techniques and immunohistochemical examinations of the preparations were stained with VEGF and iNOS antibodies and photographed using the Leica DM6000B microscope and the Leica Application Suite Program.

RESULTS: In the RM group, we found a significant increase in VEGF and iNOS expression in the nasal mucosa compared to the control group (p<0.001). We also observed the main histopathological changes in the nasal mucosa under a light microscope, including squamous metaplasia in the epithelium of the tunica mucosa, submucosal perivascular edema and degeneration of the submucosal glands.

CONCLUSIONS: According to these results, increased expression levels of VEGF and iNOS play an important role in rebound swelling in RM pathogenesis.

PMID:34842278 | DOI:10.14670/HH-18-399

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Can Multi-Dimensional Voice Program (MDVP) Be Used as A Diagnostic Tool for Precocious Puberty?

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Voice is the one of the sexual maturation characteristics that differs between boys and girls. Voice analysis is a non-invasive diagnostic tool and well-tolerated by children. Our aim is to investigate the capability of MDVP to predict precocious puberty (PP). To our knowledge, this is the only study to assess the voice parameters in the diagnosis of PP.
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Correlation of airway ultrasonography and laryngoscopy findings in adults with subglottic stenosis: a pilot study

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Eur Arch Otorhinolaryngol. 2021 Nov 29. doi: 10.1007/s00405-021-07195-5. Online ahead of print.

ABSTRACT

PURPOSE: Ultrasonography of the airway has potential as an alternative, non-invasive, method to monitor patients with subglottic stenosis in an outpatient setting. This prospective, interventional, double-blinded study aimed to correlate ultrasound-based and laryngoscopy-based subglottic stenosis assessment in adults.

METHODS: The study was conducted between July 2020 and March 2021 at a tertiary referral center. Consecutive adult patients with subglottic stenosis were evaluated using airway ultrasonography 1 day prior to scheduled laryngoscopy. The radiologist was blinded to the preoperative endoscopic findings, and the primary surgeon was blinded to the ultrasonographic measurements. The intraoperative subglottic diameter was defined as the outer diameter of an endotracheal tube passing through the subglottis without produci ng an air leak.

RESULTS: Sixteen patients (11 females; age range, 17-66 years; mean = 44.06, SD = 12.79) were included. The ultrasonographic subglottic diameter ranged from 5.20 mm to 8.00 mm (mean = 6.24 mm, SD = 0.90). In 15 of 16 patients, the diameter difference between the ultrasonographic and intraoperative measurements ranged from -0.80 mm to 0.30 mm (mean = -0.20 mm, SD = 0.35). However, patient 6 had a difference of - 2.10 mm between the two measurements, which was attributed to thick laryngotracheal secretions interfering with the ultrasonographic air shadow. Data analysis of all 16 patients showed a statistically significant correlation between the readings obtained by the two techniques (r = 0.84, P = 0.000051).

CONCLUSION: This study found a significant correlation between ultrasonography-based and laryngoscopy-based subglottic stenosis assessment in adult patients. It provides a basis for an alternative and potentially reliable method to monitor patients wi th subglottic stenosis.

PMID:34842971 | DOI:10.1007/s00405-021-07195-5

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