Transient asystole related to carbon dioxide embolism during transoral endoscopic parathyroidectomy vestibular approach

xlomafota13 shared this article with you from Inoreader Transient asystole related to carbon dioxide embolism during transoral endoscopic parathyroidectomy vestibular approach Via Head & Neck Abstract Background Rarely, during the endoscopic thyroidectomy, carbon dioxide (CO2) embolism may occur. Methods Case 1: A 65-year-old female who was seen with prolonged fatigue and generalized bone pain was diagnosed primary hyperparathyroidism (PHPT) based on her preoperative biochemical profile. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) was planned. Case 2: A 52-year-old male patient was seen with weakness and hepatosteatosis and was diagnosed PHPT based on the laboratory workup. TOEPVA was planned. Results After subplatysmal dissection with vascular tunnel probe, both of the patients developed severe bradycardia and hypotension leading to asystole during the CO2 insufflation. The possibility of CO2 embolism was considered and insufflation was terminated. After a successful cardiac massage, sinus rhythm returned. Conclusion TOEPVA may develop CO2 embolism leading to asystole during the CO2 insufflation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pooled analysis of nivolumab treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck in the United States and Germany

xlomafota13 shared this article with you from Inoreader Pooled analysis of nivolumab treatment in patients with recurrent/metastatic squamous cell carcinoma of the head and neck in the United States and Germany Via Head & Neck Abstract Background In the Phase-III clinical trial, CheckMate 141, nivolumab significantly improved survival versus standard of care in patients with platinum-refractory recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). Methods This pooled analysis investigated the real-world effectiveness of nivolumab, following prior platinum-based therapy, in patients with R/M SCCHN from the United States (US) Flatiron Health database and German HANNA prospective observational study. Results Overall, 782 patients (56% US; 44% Germany) were included. Median overall survival (OS) was 8.71 months, and progression-free survival was 4.11 months. Eastern Cooperative Oncology Group Performance Status 0 or 1, platinum sensitivity, and older age were associated with longer OS, in which number of prior lines of therapy had no significant effect. Conclusion These findings demonstrate survival benefits of nivolumab in patients with R/M SCCHN in the real-world setting. The observed real-world effectiveness of nivolumab aligns with the efficacy of nivolumab in CheckMate 141. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic endonasal management of skull base defects in pediatric patients

xlomafota13 shared this article with you from Inoreader Endoscopic endonasal management of skull base defects in pediatric patients Via leak of cerebrospinal fluid Int J Pediatr Otorhinolaryngol. 2021 Sep 1;150:110902. doi: 10.1016/j.ijporl.2021.110902. Online ahead of print. ABSTRACT PURPOSE: Skull base defects in children may be the result of congenital anomalies or trauma. They often present as cerebrospinal fluid (CSF) rhinorrhea, meningitis, brain abscess or nasal obstruction. Surgical intervention is predominantly the treatment of choice. Our goal is to assess the efficacy of endoscopic endonasal approach in treating skull base defects in pediatric patients. MATERIAL AND METHODS: In this retrospective study we identified 38 patients (mean age 8.7 ± 5.6 years old, ranging 2 months-18 years) who underwent endoscopic endonasal repair of skull base defects, between March 2010 and February 2020. Patients who had skull base reconstruction after tumor resection, those who were lost to follow-up or did not sign the consent forms were excluded from the study. RESULTS: The clinical indications for endoscopic endonasal repair were trauma (n = 24, 63.1%) and congenital defects (n = 14, 36.9%). Congenital skull base defects included basal meningoencephalocele (n = 5, 35.7%) and frontoethmoidal defects (n = 9, 64.3%). Mean follow up time was 32 ± 29.04 months, ranging 2-103 months. Fat graft (alone or in combination) was the most commonly used material to repair the skull base defects. Thirty-seven patients (97%) showed successful results after endoscopic endonasal surgery and were symptom free. CONCLUSION: The endoscopic endonasal repair of CSF leak and skull base defects proved to be safe and feasible with 97% success rate. PMID:34488041 | DOI:10.1016/j.ijporl.2021.110902 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma

xlomafota13 shared this article with you from Inoreader The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma Via The Laryngoscope Objectives Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma. Study Design Prospective observational study. Methods Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. Results Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P = .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up. Conclusion The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Stratifying the Risk of Cardiovascular Disease in Obstructive Sleep Apnea Using Machine Learning

xlomafota13 shared this article with you from Inoreader Stratifying the Risk of Cardiovascular Disease in Obstructive Sleep Apnea Using Machine Learning Via The Laryngoscope Objectives/Hypothesis Obstructive sleep apnea (OSA) is associated with higher risk of morbidity and mortality related to cardiovascular disease (CVD). Due to overlapping clinical risk factors, identifying high-risk patients with OSA who are likely to develop CVD remains challenging. We aimed to identify baseline clinical factors associated with the future development of CVD in patients with OSA. Study Design Retrospective analysis of prospectively collected data. Methods We performed a retrospective analysis of 967 adults aged 45 to 84 years and enrolled in the Multi-Ethnic Study of Atherosclerosis. Six machine learning models were created using baseline clinical factors initially identified by stepwise variable selection. The performance of these models for the prediction of additional risk of CVD in OSA was calculated. Additionally, these models were evaluated for interpretability using locally interpretable model-agnostic explanations. Results Of the 967 adults without baseline OSA or CVD, 116 were diagnosed with OSA and CVD and 851 with OSA alone 10 years after enrollment. The best performing models included random forest (sensitivity 84%, specificity 99%, balanced accuracy 91%) and bootstrap aggregation (sensitivity 84%, specificity 100%, balanced accuracy 92%). The strongest predictors of OSA and CVD versus OSA alone were fasting glucose >91 mg/dL, diastolic pressure >73 mm Hg, and age >59 years. Conclusion In the selected study population of adults without OSA or CVD at baseline, the strongest predictors of CVD in patients with OSA include fasting glucose, diastolic pressure, and age. These results may shape a strategy for cardiovascular risk stratification in patients with OSA and early intervention to mitigate CVD-related morbidity. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of Superior Laryngeal Nerve Block for the Treatment of Neurogenic Cough: a Retrospective Review

xlomafota13 shared this article with you from Inoreader Efficacy of Superior Laryngeal Nerve Block for the Treatment of Neurogenic Cough: a Retrospective Review Via Clinical Otolaryngology Abstract Chronic cough may be multifactorial. A subset of patients may have a neurogenic cough, secondary to irritation of the superior laryngeal nerve. Superior laryngeal nerve blocks may be an efficacious treatment for neurogenic cough. Neuromodulating medications may be used in the treatment of chronic cough, but may have side effects. There are no reported serious adverse effects from superior laryngeal nerve blocks. Prospective, placebo-controlled studies are needed to confirm the efficacy of superior laryngeal nerve blocks for the treatment of chronic cough. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma; a prospective study of 91 cases with three year follow up

xlomafota13 shared this article with you from Inoreader Comparison of outcomes of endoscopic ear surgery with microsurgery for cholesteatoma; a prospective study of 91 cases with three year follow up Via Clinical Otolaryngology Abstract Trans-canal endoscopic ear surgery (TEES) is a relatively new concept, but endoscopes have been used previously as an adjunct to microsurgery (MEES) in patients with cholesteatoma (1). TEES has the added benefit of reduced morbidity and increased likelihood that the patients will tolerate the procedure as a day-case, but this can variate according to local practise and protocols. It also allows for close inspection of "hidden" areas such as sinus tympani with angled scopes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Application of different imaging methods for the localization of cerebrospinal fluid rhinorrhea: a comparative study

xlomafota13 shared this article with you from Inoreader Application of different imaging methods for the localization of cerebrospinal fluid rhinorrhea: a comparative study Via leak of cerebrospinal fluid Ann Palliat Med. 2021 Aug;10(8):8797-8807. doi: 10.21037/apm-21-1994. ABSTRACT BACKGROUND: CSF rhinorrhea is a type of CSF leakage caused by an aseptic abnormal passage between the subarachnoid space and the adjacent sinus and nasal cavity due to a cranial dural defect. At present, the value of computed tomography cisternography (CTC) in locating CSF rhinorrhea has been widely recognized, and magnetic resonance hydrography (MRH), as a heavy T2-weighted water imaging, plays a pivotal role in showing the location of the leak. In this paper, we retrospectively summarize the imaging manifestations seen at our hospital of patients with clinically confirmed CSF rhinorrhea at the skull base and evaluate the diagnostic value of different imaging methods in the localization of CSF rhinorrhea by means of preoperative imaging analysis using CTC and MRH. METHODS: Fifty-five patients with CSF rhinorrhea admitted to our department from October 2016 t o January 2021 were retrospectively analyzed. The patients' conventional CT, CTC, and MRH imaging data were compared, and the location of the leak determined preoperatively matched the location of the leak found during surgery. Moreover, there was no recurrence during the follow-up period of 4 months to 3 years. RESULTS: There were statistically significant differences between the diagnostic positivity rate of CTC and spiral CT (χ2=16.755, P<0.00), and between the diagnostic positivity rate of cranial MRH and spiral CT (χ2=6.338, 6.338=0.01), and no statistically significant difference between the diagnostic positivity rate of CTC and cranial MRH (χ2=2.625, P=0.1). CONCLUSIONS: The combined use of imaging techniques has important practical significance for the proper treatment and prognostic evaluation of CSF rhinorrhea. CTC has the highest positive rate for the diagnosis of CSF rhinorrhea, followed by MRH, while spiral CT is safer. CTC and MRH can promote the diag nostic rate in determining the location of CSF rhinorrhea, and selective combined application can be an important guide to surgery. PMID:34488368 | DOI:10.21037/apm-21-1994 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lateralized Readiness Potentials Recorded with Near-Threshold Auditory Stimuli in Subjects Simulating Hearing Loss

xlomafota13 shared this article with you from Inoreader Lateralized Readiness Potentials Recorded with Near-Threshold Auditory Stimuli in Subjects Simulating Hearing Loss Via cortical auditory Audiol Neurootol. 2021 Sep 6:1-9. doi: 10.1159/000517451. Online ahead of print. ABSTRACT INTRODUCTION: Preparatory motor cortical responses like the lateralized readiness potential (LRP) may be useful in revealing persistent attempts to feign hearing loss. Previous studies suggest only a marginal effect of stimulus intensity on the amplitude of the LRP. However, this has not been investigated using low-intensity auditory stimuli to cue NoGo trials. We address this in an experiment where subjects were instructed not to give a manual response to low-instensity stimuli, a situation that is akin to simulating hearing loss. METHODS: The LRP was recorded from normal hearing listeners (N = 10) with 500 and 4,000-Hz pure tones and trains of 4,000 Hz (2-1-2) tonebursts. Electrophysiologic data underwent processing to (i) analyze the effect of the stimulus type on the LRP, (ii) classify results according to manual response with both logistic reg ression and linear support vector machine (SVM) models, and (iii) derive auditory brainstem responses (ABRs) from the tonebursts. RESULTS: The amplitude of the LRP did not differ between the 3 stimuli used to elicit the response. Single-trial electrode data from Go and NoGo trials were submitted to supervised binary classification, and the logistic regression model gave a mean accuracy of close to 0.7. The Jewett wave V latencies of the resultant ABRs from some subjects were found to increase between the high (Go) and low (NoGo) intensity tonebursts. CONCLUSION: This study shows that auditory stimulus type does not affect the amplitude of the LRP and that the response can be recorded with stimuli that are near the auditory threshold. It can also be recorded with transient stimuli, and this allows for the possibility of simultaneously recording other confirmatory measurements, like ABR. PMID:34488217 | DOI:10.1159/000517451 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Significance of a Scoring System Combining p16, Smoking, and Drinking Status in a Series of 131 Patients with Oropharyngeal Cancers

xlomafota13 shared this article with you from Inoreader Prognostic Significance of a Scoring System Combining p16, Smoking, and Drinking Status in a Series of 131 Patients with Oropharyngeal Cancers Via International Journal of Otolaryngology Background. Tobacco and alcohol are two main risk factors associated with head and neck squamous cell carcinoma (HNSCC). Studies showed that human papillomavirus (HPV) plays a role in the etiology of this cancer. HPV-positive oropharyngeal squamous cell carcinoma (OSCC) patients present in general a better response to conventional therapy and better overall survival (OS). However, OSCC is a heterogeneous disease regarding treatment. This study aimed to identify more effective prognostic factors associated with a poor clinical outcome for OSCC patients to improve treatment selection. Materials and Methods. OSCC patients diagnosed between 2007 and 2017, in two Belgian hospitals, were included. Demographic and clinicopathologic data were extracted from medical records. HPV status was determine d through p16 immunohistochemistry. Univariable and multivariable Cox proportional hazard regression analyses allowed to identify variables prognostic for OS and recurrence-free survival (RFS). Kaplan–Meier survival curves have been assessed for survival. Results. The study included 131 patients. Statistics showed that monotherapies were significantly associated with a shorter OS; p16 overexpression was significantly associated with a weak consumption of tobacco or alcohol, and a high p16 expression was significantly associated with both longer RFS and OS. The study validated that tobacco and alcohol consumption were significantly correlated with poorer RFS and poorer OS. Only p16 expression trended to be significant for RFS when compared to smoking and drinking habits, while p16 upregulation and alcohol use were both vital for OS indicating that p16 is an independent and significant prognostic factor in OSCC patients. Finally, a scoring system combining p16, tobacco, and alcohol status was defined and was significantly associated with longer RFS and longer OS for nonsmoker and nondrinker p16-positive OSCC patients. Conclusions. This study confirmed that the overexpression of the p16 protein could be viewed as a factor of good prognosis for RFS and OS of OSCC patients. The prognostic significance of a scoring system combining p16 expression, smoking, and drinking status was evaluated and concluded to be a more effective tool to determine therapeutic orientations based on the risk factors for better treatment relevance and survival. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Risk Factors of Difficult Pharyngeal Accidental Fishbones Ingestion

xlomafota13 shared this article with you from Inoreader Risk Factors of Difficult Pharyngeal Accidental Fishbones Ingestion Via ear nose throat Ear Nose Throat J. 2021 Sep 7:1455613211036770. doi: 10.1177/01455613211036770. Online ahead of print. ABSTRACT OBJECTIVE: Accidental pharyngeal fishbone ingestion is a common complaint in ear, nose, and throat clinics. Approximately two-thirds of the accidentally ingested fishbones can be removed using tongue depressors and indirect laryngoscopy. However, the remaining third is challenging to identify and remove using these methods. These difficult fishbones require identif ication and removal via more advanced approaches. Video-guided laryngoscope is used to deal with difficult fishbones in our center. This study aimed to explore the risk factors for difficult fishbones. METHODS: A prospective study was performed at a teaching hospital on 2080 patients. Univariate and multivariate analyses were performed to identify the risk factors. RESULTS: The common fishbone locations were the tonsils (39.8%; defined as STEP-I), tongue base (37.1%), vallecula (13.3%; STEP-II), and hypopharynx (9.8%; STEP-III). With increasing STEP level, the ratio of difficult fishbones correspondingly increased (Z = 13.919, P < .001), and the proportions were 21.1%, 41.9%, and 70% in STEP-I, II, and III, respectively. In particular, fishbones in STEP-III (vs STEP-I) had a higher risk of difficult fishbones (odds ratio [OR]: 11.573, 95% CI: 7.987-16.769). Complaints of neck pain (yes vs no), foreign body sensation (yes vs no), and shorter length of fishbones always had a lower risk of difficult fishbones (OR: 0.455, 95% CI: 0.367-0.564; OR: 0.284, 95% CI: 0.191-0.422; OR: 0.727, 95% CI: 0.622-0.85). Missing teeth (yes vs no), swallowing behavior after fishbone ingestion (yes vs no), and male patients (vs female) had a higher risk of difficult fishbones (OR: 1.9, 95% CI: 1.47-2.456; OR: 1.631, 95% CI: 1.293-2.059; OR: 1.278, 95% CI: 1.047-1.56). CONCLUSIONS: Neck pain, foreign body sensation, fishbone length, patient age and sex, tooth status, and swallowing behavior after fishbone ingestion are independent risk factors for difficult fishbones. PMID:34490795 | DOI:10 .1177/01455613211036770 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.