Medicine by Alexandros G. Sfakianakis

Παρασκευή 8 Φεβρουαρίου 2019

Deep Neck Space Infection: Study of 52 Cases

Abstract

Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.

http://bit.ly/2SHy3Ak

Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

Abstract

Background

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible.

Methods

The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software.

Results

At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased.

Conclusions

This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.

http://bit.ly/2SlSGmr

Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

Abstract

Purpose

Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.

Methods

This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.

Results

The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.

Conclusion

Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

http://bit.ly/2Bsrgk6

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review

Abstract

Background

Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

Methods

A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

Results

By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

Discussion

The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.

http://bit.ly/2UNmWmQ

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

http://bit.ly/2SJDfUi

Sonografie von Schilddrüsenknoten

Laryngo-Rhino-Otol 2019; 98: 79-84
DOI: 10.1055/a-0790-0849

Die Sonografie gehört zu den Standardverfahren bei der Evaluation von Schilddrüsenknoten. Verschiedene sonografische Veränderungen sind mit einem erhöhten Malignitätsrisiko assoziiert. Basierend hierauf wurden in den letzten Jahren Klassifizierungssysteme entwickelt, um leichter diejenigen Knoten zu selektieren, welche einer weiteren Abklärung bedürfen (TI-RADS: thyroid imaging and reporting systems). Bis jetzt werden in diesen Systemen nur morphologische Kriterien eingeschlossen. Resultate einer Farbdoppler-Sonografie als ergänzendem Verfahren werden in diesen Klassifizierungen nicht berücksichtigt, obwohl eine erhöhte intranoduläre Vaskularisation bei follikulären Neoplasien mit einem erhöhten Malignitätsrisiko assoziiert ist. Aktuell werden die neuen Systeme evaluiert und müssen gegebenenfalls für die klinische Praxis optimiert werden. Außerdem gibt es erste Ansätze, die Dokumentation der Ultraschallergebnisse weiter zu standardisieren, um die diagnostischen Möglichkeiten der Ultraschalluntersuchung im Sinne der Verbesserung der Patientenversorgung zu optimieren.
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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2019; 98: 68-69
DOI: 10.1055/a-0784-9800

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Nachruf Prof. Dr. Heinz R. Stammberger

Laryngo-Rhino-Otol 2019; 98: 76-76
DOI: 10.1055/a-0828-5454

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Kehlkopf-Karzinom: Wundbettbiopsien nach TLM-Behandlung sinnvoll

Laryngo-Rhino-Otol 2019; 98: 71-72
DOI: 10.1055/a-0785-0981

Hendriksma M et al. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275: 2333–2340 Bei Patienten mit primärem Kehlkopf-Plattenepithelkarzinom (Tis-T2) beurteilten niederländische Kopf- und Hals-Chirurgen den Effekt des Resektionsrand-Status auf die lokale Kontrollrate nach Behandlung mit transoraler CO2-Laser-Mikrochirurgie (TLM). Darüber hinaus überprüften die Bedeutung zusätzlicher Wundbettbiopsien.
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Assoziation von allergischer Rhinitis und Hypertonie untersucht

Laryngo-Rhino-Otol 2019; 98: 74-75
DOI: 10.1055/a-0651-4041

Sakallioglu O et al. Allergic rhinitis and arterial blood pressure: a population-based study. J Laryngol Otol 2018; 132: 418–422 Gibt es einen Zusammenhang von allergischer Rhinitis und arteriellem Blutdruck sowie Bluthochdruck? In einer bevölkerungsbasierten Untersuchung wollten türkische Ärzte diese Frage klären.
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Beurteilung der Tubenfunktionsstörung mit dem ETDQ-7

Laryngo-Rhino-Otol 2019; 98: 72-74
DOI: 10.1055/a-0621-2000

Harju T et al. Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement. Ann Otol Rhinol Laryngol 2017; 126: 798–803 Ärzte des Universitätskrankenhauses von Tampere, Finnland, beurteilten den Zusammenhang zwischen chronischer Nasenverstopfung durch Vergrößerung der unteren Nasenmuschel und Symptomen, die durch eine Eustachi-Tubendysfunktion bedingt sind, mit Hilfe des „Eustachian Tube Dysfunction Questionnaire" (ETDQ-7) als Instrument zur Evaluation einer Tubenfunktionsstörung.
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Spiegeluntersuchung in der HNO

Laryngo-Rhino-Otol 2019; 98: 77-78
DOI: 10.1055/a-0784-9833

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Wenn gehörlose Kinder hörend werden – Auswirkungen der CI-Versorgung von gehörlosen Kindern gehörloser Eltern auf deren Familiensituation

Laryngo-Rhino-Otol 2019; 98: 85-90
DOI: 10.1055/a-0790-0934

1993 wurden erstmalig gehörlose Kinder von gehörlosen Eltern mit CI versorgt. Die Situation dieser Kinder und ihrer Eltern ist immer wieder Gegenstand von Forschungen des seit 2000 bestehenden Münchner Forschungsprogramms „Gehörlose Eltern und Kinder mit CI". Zu diesem gehört die Teilstudie „Familiensituation von gehörlosen Eltern mit CI-Kindern". Eines der Ergebnisse dieser Studie ist, dass die implantierten Kinder die Rolle von Codas übernehmen. Das zeigt sich insbesondere in der Übernahme von Dolmetschleistungen für die Eltern.
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Faziale Hauttumore: Resektion und plastische Defektrekonstruktion – Teil 1

Laryngo-Rhino-Otol 2019; 98: 117-128
DOI: 10.1055/a-0784-9844

Die Häufigkeit von Tumoren der Gesichtshaut nimmt aufgrund der steigenden UV-Exposition und der zunehmenden Alterung der Bevölkerung zu. Gleichzeitig steigen die Ansprüche an die Funktion und Ästhetik der rekonstruktiven Chirurgie im Gesicht. Die In-sano-Resektion mit Sicherheitsabstand ist der entscheidende erste Schritt eines operativen Vorgehens. Die anschließende Rekonstruktion ist von patientenspezifischen und weiteren Faktoren abhängig.
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Retinovaskuläre Zeichen des Susac-Syndroms

Laryngo-Rhino-Otol 2019; 98: 108-113
DOI: 10.1055/a-0747-6968

Hintergrund Das Susac-Syndrom ist eine Vaskulopathie mit Manifestationen am zentralen Nervensystem, an der Retina und am Innenohr und ist gekennzeichnet durch die klinische Trias aus Enzephalopathie und/oder fokalen neurologischen Symptomen, Hörminderung und retinalen Arterienastverschlüssen. Bisher wurden nur etwa 300 Fälle in der medizinischen Literatur beschrieben. Patienten/Methoden Drei Patienten mit gesichertem Susac-Syndrom wurden retrospektiv auf das Vorhandensein krankheitstypischer retinaler Veränderungen untersucht. Ergänzend wurde der Krankheitsverlauf analysiert mit der Zielsetzung, ein besseres Krankheitsverständnis zu erreichen. Ergebnisse In allen 3 beschriebenen Fällen besteht eine okklusive retinale Mikroangiopathie mit einhergehenden Arterienastverschlüssen. In der cMRT zeigen sich bei 2 von 3 Fällen krankheitstypische, umschriebene „snowball"-artige Läsionen des Corpus callosum, die gemeinsam mit dem Netzhautbefund die diagnostische Zuordnung ermöglichten. Die klassische Trias aus Innenohrschwerhörigkeit, retinalen Arterienastverschlüssen und ZNS-Symptomatik war allerdings in keinem der Fälle bei ärztlichem Erstkontakt vollständig ausgeprägt. Schlussfolgerung Die Diagnosesicherung setzt eine enge interdisziplinäre Zusammenarbeit zwischen Neurologen, Psychiatern, HNO- und Augenärzten voraus. Die typischen okulären Zeichen einer segmentalen Mikrovaskulopathie mit Okklusion kleiner Arterien sollten auch bei isoliertem Auftreten Anlass dazu geben, das Krankheitsbild in die Differenzialdiagnose einer okklusiven retinalen Vaskulopathie mit einzubeziehen.
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