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Δευτέρα 25 Ιανουαρίου 2021

Meningitis due to CSF leak after Nasal Swab Testing for Covid-19.

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Meningitis due to CSF leak after Nasal Swab Testing for Covid-19.

Eur J Neurol. 2021 Jan 21;:

Authors: Alberola-Amores FJ, Valdeolivas-Urbelz E, Torregrosa-Ortiz M, Álvarez-Sauco M, Alom-Poveda J

Abstract
A 41 year-old woman presented to the Emergency department (ED), in October 2020, with holocraneal headache worsened by position changes and fever up to 37,7ºC, that started the 12 prior hours. She had no medical history of cephalea, visual loss or traumatic brain injury, not other secondary causes of CSF fistula. The patient had completed a nasal RT-PCR COVID-19 testing in March 2020 which came back negative. One week after, she developed unilateral continuous rhinorrhea with metallic taste. She was then diagnosed of allergic rhinitis by her general practitioner, who prescribed antihistaminics and a short-term antibiotherapy (Amoxicillin-Clavulanic), with no resolution of the symptoms. In July 2020 a nasal drainage tested positive for β2-transferrin and a head-CT was performed identifying a cerebrospinal fluid (CSF) fistula at the lamina cribrosa.

PMID: 33480112 [PubMed - as supplied by publisher]

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Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: Prospective Study on Safety and Accuracy.

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Three-Dimensional Custom-Made Surgical Guides in Facial Feminization Surgery: Prospective Study on Safety and Accuracy.

Aesthet Surg J. 2021 Jan 22;:

Authors: Tawa P, Brault N, Luca-Pozner V, Ganry L, Chebbi G, Atlan M, Qassemyar Q

Abstract
BACKGROUND: Facial feminization surgery (FFS) includes several osseous modifications of the forehead, mandible and chin, procedures which require precision in order to provide the patient with a satisfactory result. Mispositioned osteotomies can lead to serious complications and bad aesthetic outcomes. Surgical cutting guides are commonly used in plastic and maxillofacial surgery to improve safety and accuracy. Yet, there is no report in the literature on the clinical application of cutting guides in FFS.
OBJECTIVES: The aim of this paper is to assess the safety and accuracy of custom surgical cutting guides in FFS procedures.
METHODS: A prospective follow-up of forty-five patients regarding FFS with preoperative virtual planning and 3D custom-made surgical guides for anterior frontal sinus wall setback, mandibular angle reduction and/or osseous genioplasty was conducted. Accuracy (superimposing preoperative data on postoperative data by global registration with a 1 mm margin of error), safety (intradural intrusion for the forehead procedures and injury of the infra alveolar nerve for chin and mandibular angles) and patient satisfaction were assessed.
RESULTS: A total of 133 procedures were documented. There was no cerebrospinal fluid leak on the forehead procedures nor any infra alveolar nerve or tooth root injury on both chin and mandibular angle operations (safety, 100%). Accuracy was 90.80 % on the forehead (n=25), 85.72% on the mandibular angles (n=44) and 96.20% on the chin (n=26). An overall satisfaction of 94.40% was recorded.
CONCLUSIONS: Custom-made surgical cutting guides could be a safe and accurate tool for forehead, mandibular angles and chin procedures for FFS.

PMID: 33480977 [PubMed - as supplied by publisher]

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Impact of Reconstruction With Hydroxyapatite Bone Cement on CSF Leak Rate in Retrosigmoid Approach to Vestibular Schwannoma Resection: A Review of 196 Cases.

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Impact of Reconstruction With Hydroxyapatite Bone Cement on CSF Leak Rate in Retrosigmoid Approach to Vestibular Schwannoma Resection: A Review of 196 Cases.

Otol Neurotol. 2021 Jan 19;:

Authors: Hwa TP, Luu N, Henry LE, Naples JG, Kaufman AC, Brant JA, Lee JYK, Ruckenstein MJ, Bigelow DC

Abstract
OBJECTIVE: To assess the impact of reconstructive technique on the incidence of cerebrospinal fluid (CSF) leak following retrosigmoid approach to acoustic neuroma resection.
STUDY DESIGN: Retrospective case series.
SETTING: Academic medical center.
PATIENTS: A total of 1,200 patients with acoustic neuromas presented to our institution from 2005 to 2018. Of these, 196 patients underwent surgical resection via a retrosigmoid approach.
INTERVENTION: At our institution, internal auditory canal (IAC) reconstruction following a retrosigmoid approach was performed with bone wax and muscle plug or Norian hydroxyapatite bone cement from 2005 to 2013. Starting in 2014, a newer model of bone cement, Cranios hydroxyapatite, was used exclusively for reconstruction.
MAIN OUTCOME MEASURES: Rates of CSF leak were evaluated across different methods of IAC reconstruction and types of bone cement. Patients whose leaks were attributable to the craniectomy site were excluded from analysis.
RESULTS: The postoperative CSF leak rate among patients who did not receive bone cement for IAC reconstruction was 15.6% (n.5). The leak rate amongst patients who received Norian bone cement was 6.3% (n.4). After introduction of Cranios bone cement, the total leak rate decreased to 1% (n.1). Compared with all other types of closure, Cranios had a significantly reduced rate of postoperative CSF leak (p < 0.005). The leak rate following Cranios versus Norian was also significantly reduced (p < 0.05). Leak rate was not affected by tumor size (p.0.30) or age (p.0.43).
CONCLUSION: CSF leak rate following acoustic neuroma resection was significantly reduced by introduction of Cranios hydroxyapatite bone cement.

PMID: 33481543 [PubMed - as supplied by publisher]

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LINC01433 targets miR-506-3p to promote the biological progress of nasopharyngeal carcinoma cells.

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LINC01433 targets miR-506-3p to promote the biological progress of nasopharyngeal carcinoma cells.

Eur Arch Otorhinolaryngol. 2021 Jan 21;:

Authors: Zhou M, Dong Z, Hu S, Xiao M

Abstract
PURPOSE: The current study aimed to investigate the role of long intergenic noncoding 01433 (LINC01433) in the proliferation, migration and invasion of nasopharyngeal carcinoma (NPC).
METHODS: Real-time quantitative PCR (RT-qPCR) was performed to determine the expressions of LINC01433 and miR-506-3p in NPC samples and cell lines. The effects of LINC01433 on cell proliferation, migration and invasion were measured by CCK-8, wound healing assay and Transwell, respectively. In addition, Pearson correlation analysis, starBase, RNA immunoprecipitation, luciferase assay, Western blot and functional experiments were conducted to detect and confirm the relationship between LINC01433 and miR-506-3p.
RESULTS: LINC01433 level was noticeably elevated in NPC tissues and cell lines. As the expression of LINC01433 in 5-8F cells was the highest in NPC cell lines and the expression of LINC01433 in SUNE1 cells was the lowest, 5-8F and SUNE1 cells were therefore selected as the target cells for following experiments. Furthermore, miR-506-3p was predicted as the target of LINC01433, and the two were negatively correlated with each other. Interestingly, overexpression of LINC01433 promoted proliferation, migration and invasion of NPC cells, while miR-506-3p reversed such effects of LINC01433. Moreover, LINC01433 silencing had the opposite effects to LINC01433 overexpression. Furthermore, miR-506-3p overexpression inhibited the expressions of MMP2, N-cadherin, p-PI3K and p-Akt, and promoted the expressions of E-cadherin and TIMP-2, and partially reversed the role of LINC01433 in promoting cancer development.
CONCLUSION: The current findings reveal that LINC01433 regulates NPC cell biological progress through miR-506-3p.

PMID: 33479848 [PubMed - as supplied by publisher]

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Risk stratification in endoscopic type I. tympanoplasty.

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Risk stratification in endoscopic type I. tympanoplasty.

Eur Arch Otorhinolaryngol. 2021 Jan 22;:

Authors: Horváth T, Horváth B, Liktor B, Zrubka Z, Liktor B

Abstract
PURPOSE: Several risk factors were studied in endoscopic type I. tympanoplasty, however, an easy-to-use risk stratification model is still missing.
METHODS: Retrospective chart review, focusing on individual risk factors and middle ear risk index (MERI). Patients who underwent endoscopic type I. tympanoplasty were included.
RESULTS: Closed tympanic cavity was succesfully created in 88.1% of the 42 cases, the overall 21,5 dB air-bone gap (ABG) was reduced by 9,8 dB. The average MERI score of the patients was 2.1 ± 1.5. 78.6% of the patients were categorised into the mild, while 21.4% into the moderate risk group. The perforation was considered small in 81.0% of the cases, while large in 19.0%. The size of the perforation and the preoperative ABG, but not the MERI status were the only single predictors of success. Using a risk stratification model that is based on the size of the perforation, the preoperative ABG and MERI status, patients could be referred into two distinct groups of risk: the majority expecting excellent outcomes with maximum one risk factor present, and patients with deteriorated rate of success when having two or three risk factors.
CONCLUSIONS: Endoscopic type I. tympanoplasty with underlay perichondrium graft can be performed with good chance of success. However, if more than one risk factors are present, the chance of residual perforation becomes great. In addition to the established risk factors, our results point out that despite its strong correlation with perforation size, ABG may have a predictive role.

PMID: 33481078 [PubMed - as supplied by publisher]

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Endoscopic maxillectomy: anatomo-radiological description of the 'double' maxillary sinus window.

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Endoscopic maxillectomy: anatomo-radiological description of the "double" maxillary sinus window.

Eur Arch Otorhinolaryngol. 2021 Jan 22;:

Authors: Vicario-Quiñones F, Santamaría-Gadea A, Bedoya D, López-Chacón M, Langdon C, Bernal-Sprekelsen M, Alobid I

Abstract
OBJECTIVES/HYPOTHESIS: To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies.
METHODS: MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8).
RESULTS: The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up.
CONCLUSION: The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.

PMID: 33481079 [PubMed - as supplied by publisher]

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Clinical trial readiness study of distal myopathy and dysphagia in nephropathic cystinosis.

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Clinical trial readiness study of distal myopathy and dysphagia in nephropathic cystinosis.

Muscle Nerve. 2020 12;62(6):681-687

Authors: Sadjadi R, Sullivan S, Grant N, Thomas SE, Doyle M, Hammond C, Corre C, Mello N, David WS, Eichler F

Abstract
BACKGROUND: Nephropathic cystinosis is a lysosomal storage disorder with late-onset systemic complications, such as myopathy and dysphagia. Currently employed outcome measures lack sensitivity and responsiveness for dysphagia and myopathy, a limitation to clinical trial readiness.
METHODS: We evaluated 20 patients with nephropathic cystinosis in two visits over the course of a year to identify outcomes sensitive to detect changes over time. Patients also underwent an expiratory muscle strength training program to assess any effects on aspiration and dysphagia.
RESULTS: There were significant differences in the Timed Up and Go Test (TUG) and Timed 25-Foot Walk (25-FW) between baseline and 1-y follow-up (P < .05). Maximum expiratory pressure (MEP) and peak cough flow (PCF) significantly improved following respiratory training (P < .05).
CONCLUSIONS: Improved respiratory outcomes may enhance patients ability to expel aspirated material from the airway, stave off pulmonary sequelae associated with chronic aspiration, and yield an overall improvement in physical health and well-being.

PMID: 32737993 [PubMed - indexed for MEDLINE]

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Management of Mandibular Angle Fractures Using Single Y-Shaped Titanium Miniplate at the Superior Border: A Prospective Clinical Study

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Abstract

Treatment of angle fractures remains controversial. The various techniques documented for the treatment are: wire osteosynthesis, one miniplate at superior border (2.0 mm), a single plate on inferior border (2.3 or 2.7 mm) along with tension band in the form of arch bar at the upper border, 2 miniplates (1 at superior border and 1 at inferior border), 3-D strut plates or lag screw. To evaluate the efficacy of single Y-shaped titanium miniplate at the superior border in the management of mandibular angle fractures. Total of 15 healthy adult patients reporting to the department of Oral and Maxillofacial Surgery for the treatment of mandibular angle fractures was randomly selected. All the cases were assessed clinically at 1st post-operative day, 1st, 3rd, 6th and 12th week post-operatively for pain, status of occlusion, neurosensory deficit and postoperative hard & soft tissue healing. Radiographic assessment was also done at 1st postoperative day, 6& nbsp;weeks and 12 weeks. Postoperative pain, infection, wound dehiscence, neurosensory deficit were not evident during the follow- up periods. Radiographically, the fracture reduction was good and plate fracture was not seen in any case. Y- shaped titanium miniplate is an effective method in the management of the mandibular angle fractures and provided satisfactory results.

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Spindle Cell Carcinoma of the Larynx with Tracheobronchial Aspergillosis: A Rare Coincidence

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Abstract

We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.

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Head and Neck Manifestations of Multiple Myeloma

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Abstract

Plasma cell dyscrasia is the term used to describe the disorders characterized by neoplastic proliferations of plasma cells with production of immuno globulins. Of all the plasma cell dyscrasias, multiple myeloma is the commonest and clinically important. Multiple myeloma accounts for 1% of all malignancies and 10–20% of all hematologic malignancies. Mostly the patients present with bone pain, pathological fractures, renal insufficiency or infections. Here we present two cases of multiple myeloma with unusual presentations admitted in the otorhinolaryngology department of a tertiary care center. One 50-year old male presented with a mass in the left external auditory canal along with left facial palsy and the other a 45 yr old female, who presented with painful deglutition, multiple mucosal erosion in oral cavity, throat tightness and left side facial pain. Both cases are examined and evaluated and found to have multiple myeloma. They were referr ed to the Hematology department for further management.

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Association of pepsin and DNA damage in laryngopharyngeal reflux-related vocal fold polyps.

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Association of pepsin and DNA damage in laryngopharyngeal reflux-related vocal fold polyps.

Am J Otolaryngol. 2020 Nov - Dec;41(6):102681

Authors: Dai YF, Tan JJ, Deng CQ, Liu X, Lv ZH, Li XP

Abstract
PURPOSE: This study aimed to evaluate if laryngopharyngeal reflux (LPR) plays a role as a risk factor for vocal fold polyps (VFPs), and if pepsin is associated with higher oxidative DNA damage of VFPs in the presence of LPR.
METHODS: Thirty patients with VFPs were recruited between 2017 and 2018. Prior to surgery, a laryngoscopy was performed on all subjects to evaluate VFPs. Polyp tissue and saliva samples were obtained scrupulously. Hematoxylin-eosin staining was performed for pathologic analysis. Immunohistochemistry and ELISA were used to detect pepsin in tissue and saliva of VFP patients. 8-OHdG and p-H2AX expression was detected to measure oxidative DNA damage in tissue. DNA damage was investigated in human immortalized laryngeal epithelial cells exposed to pepsin.
RESULTS: The pepsin concentration in saliva was significantly higher (t = 2.38, P = .024) in the pepsin positive group. There was no significant difference in pepsin expression at different sites and pathological subtypes of VFPs. The levels of 8-OHdG and p-H2AX were significantly higher in the pepsin positive group and positively correlated with the tissue expression of pepsin. The concentration of pepsin in saliva also showed a significant correlation with 8-OHdG levels. Expression of 8-OHdG and p-H2AX, and tail moment of the comet assay were elevated in human immortalized laryngeal epithelial cells following treatment with pepsin.
CONCLUSION: Patients with VFPs have higher levels of oxidative DNA damage in the presence of pepsin reflux. Pepsin may induce DNA damage in laryngeal epithelial cells and participate in the pathogenesis of VFPs.

PMID: 32889371 [PubMed - indexed for MEDLINE]

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