OtoRhinoLaryngology by Alexandros G.Sfakianakis

Κυριακή 31 Δεκεμβρίου 2017

[Monitoring of hypertension in patients orally treated by angiogenesis inhibitor in daily practice].

[Monitoring of hypertension in patients orally treated by angiogenesis inhibitor in daily practice].

Nephrol Ther. 2017 Dec 26;:

Authors: Belaid L, Bayat-Makoei S, Laguerre B, Vigneau C

Abstract
OBJECTIVE: The aim of this study is to measure the monitoring and the incidence of renovascular effects of angiogenesis inhibitors in real population.
METHOD: Are included in this descriptive, monocentric, practical study, patients of 18 years old and more, orally treated by angiogenesis inhibitors and monitored in consultation by clinician nurses. The main interest variable is the incidence of hypertension at three months of treatment.
RESULTS: From January, 2011 to July, 2014, 324 patients have been included, whose 53% are men. Mean age is 62±13 years old. Antecedents are: 37% of hypertension, 17% of chronic renal insufficiency, 21% of nephrectomy, 13% of diabetes. Most frequent cancers are kidney (31%), liver (23%) and breast (16%). Most used molecules are: sorafenib (30%), sunitinib (23%) and everolimus (16%). Blood pressure has been measured at the beginning of the treatment in 157 patients (48%). Among them, during the first three months of treatment, 55 (35%) present hypertension according to the oncological definition and 59 (38%) according to the classical definition; 30 patients (19%) are considered as hypertensive according to only one of the two definitions. In multivariable analysis, variables significantly associated with hypertension are: age (OR=1.04; 95% CI 1.02-1.08; P<0.01) and antecedent of nephrectomy (OR=4.29; 95%CI 1.86-9.92; P<0.01).
CONCLUSION: In this cohort, only 48% of the patients had blood pressure determination before treatment. Hypertension under angiogenesis inhibitors is probably underestimated. Age and antecedent of nephrectomy seem to be correlated with the occurrence of hypertension.

PMID: 29287894 [PubMed - as supplied by publisher]

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Salivary gland epithelial neoplasms in pediatric population: a single-institute experience with a focus on the histologic spectrum and clinical outcome.

Salivary gland epithelial neoplasms in pediatric population: a single-institute experience with a focus on the histologic spectrum and clinical outcome.

Hum Pathol. 2017 Dec 27;:

Authors: Andreasen S, Stevens E, Bjørndal K, Homøe P

PMID: 29288694 [PubMed - as supplied by publisher]

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What Factors Necessitate Removal of Retained Ballistic Fragments in the Head and Neck?

What Factors Necessitate Removal of Retained Ballistic Fragments in the Head and Neck?

J Oral Maxillofac Surg. 2017 Dec 05;:

Authors: Vorrasi J, Calvi R, Lv M, Hammond R

Abstract
PURPOSE: The purpose of this study was to estimate the frequency of retained ballistic fragment (RBF) removal and to identify factors associated with an increased risk for RBF removal. To date, there are no studies focused on identifying factors associated with removal of RBFs localized to the maxillofacial region.
MATERIALS AND METHODS: Using a retrospective cohort study design, the authors enrolled a sample composed of patients with RBFs localized to the maxillofacial region. The predictor variables included bullet size, location, involvement of bone, involvement of sinus, antibiotics, multiple antibiotics, and multiple locations. The primary outcome variable was RBF retrieval. The secondary outcome variables were timing of operative retrieval, fragment site infection, and migration of RBF. Appropriate uni- and bivariate statistics were computed and logistic regression modeling was used.
RESULTS: The sample was composed of 20 patients (mean age, 30 yr; 80% male) and 55% (11 patients) required or desired object removal overall. The number of projectiles ranged from 1 to 19 (total, 48) in the 20 patients. The logistic model identified larger size, final location of bone, final location of soft tissue, and final location of sinus as having a higher probability of removal that was statistically significant (P < .05); however, size was the only variable with a substantial odds ratio (OR; 1.96; P < .05). There was no evidence of migration and a low rate (2.3%) of infection was noted at subsequent follow-up radiography and clinical examination.
CONCLUSION: Size was the only statistically significant predictor variable with a substantial OR (1.96; 95% confidence interval, 1.31-3.40; P < .05). There was a low risk of infection even when considering oral pharyngeal contamination and low risk of migration. Further studies could focus on prudent antibiotic use and larger patient populations.

PMID: 29288648 [PubMed - as supplied by publisher]

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Assessing the Different Oncologic Disease Distribution and Postoperative Complications of Octogenarian and Nonagenarian Head and Neck Oncology Patients.

Assessing the Different Oncologic Disease Distribution and Postoperative Complications of Octogenarian and Nonagenarian Head and Neck Oncology Patients.

J Oral Maxillofac Surg. 2017 Dec 07;:

Authors: Sagiv D, Nadel S, Talmi YP, Yahalom R, Wolf M, Alon EE

Abstract
PURPOSE: The admission rate of patients aged 80 years or older (oldest-old) with head and neck (HN) oncologic disease is on the rise. Our goal was to study the demographic characteristics, reasons for admission, types of surgical procedures, and postoperative complications of the oldest-old patients with HN malignancy.
MATERIALS AND METHODS: We conducted a retrospective cohort study including all inpatients aged 80 years or older who were admitted to the department of otolaryngology-head and neck surgery or department of oral and maxillofacial surgery because of HN oncologic disease between 2009 and 2013. The control group was composed of a matched number of randomly selected patients aged 60 to 79 years. We compared the demographic characteristics, diagnoses, comorbidities, surgical interventions, and postoperative complications of the 2 age groups to characterize the oldest-old patients' admissions and determine whether age alone increases the risk of postoperative complications.
RESULTS: The study included 109 oldest-old patients (median age, 83 years) and 107 patients in the control group (median age, 68 years). Although the oldest-old patients had significantly more underlying diseases (4.41 vs 2.86) and drugs prescribed (4.76 vs 3.21), similar rates of postoperative complications occurred in both groups. An important finding was that ischemic heart disease and chronic lung disease were the only significant risk factors for postoperative complications among the oldest-old patients (odds ratio on multivariate analysis of 5.5 and 4.5, respectively).
CONCLUSIONS: Although comorbidities and prescribed drugs are more prevalent in the oldest-old patients, the rate of postoperative complications did not differ between the age groups, suggesting that age alone should not be a factor in the surgical treatment of HN malignancies.

PMID: 29288647 [PubMed - as supplied by publisher]

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Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid.

Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid.

J Ultrasound Med. 2017 Dec 30;:

Authors: Frank SJ, Koenigsberg T, Gutman D, Koenigsberg M

Abstract
Ultrasonography (US) of the neck is an accepted, useful imaging modality for many applications beyond its usefulness in thyroid disease. Two-dimensional US has been effectively used for evaluation of many types of neck conditions, and now, 3-dimensional US can be added to the imaging armamentaria. Three-dimensional US is useful in the evaluation of cervical lymph nodes, recurrent/residual thyroid neoplasia, parathyroid glands, parotid and submandibular glands, as well as thyroglossal duct cysts and other assorted palpable and visible abnormalities because of its unique capabilities, including multiplanar reconstruction, accessibility of the coronal view, volume calculation, and regularly spaced incremental slice evaluation.

PMID: 29288583 [PubMed - as supplied by publisher]

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Double Suspension Sutures: a simple Surgical Technique for Selected Cases of obstructive Sleep Apnea: our experience with twenty two patients.

Double Suspension Sutures: a simple Surgical Technique for Selected Cases of obstructive Sleep Apnea: our experience with twenty two patients.

Clin Otolaryngol. 2017 Dec 30;:

Authors: Askar SM, El-Anwar MW

Abstract
This work aimed at presenting a simple modification of expansion pharyngoplasty using bilateral double palatal suspension sutures for the treatment of selected cases of snoring and OSA. Between Marsh 2013 and August 2017, twenty- two patients underwent the double suspension sutures technique as a treatment for retropalatal collapse of obstructive sleep apnea. Postoperatively, the mean AHI and the mean lowest oxygen saturation level showed highly significant improvement. Both the retropalatal and interpillar distances were increased significantly. No persistent postoperative complications were reported. Snoring disappeared in 86.4% of patients. The procedure is simple, well-tolerated by patients and reversible. It is an economic and less traumatic maneuver. It could be applied as a part of multilevel surgery. This article is protected by copyright. All rights reserved.

PMID: 29288566 [PubMed - as supplied by publisher]

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Type III interferons are critical host factors that determine susceptibility to Influenza A viral infection in allergic nasal mucosa.

Type III interferons are critical host factors that determine susceptibility to Influenza A viral infection in allergic nasal mucosa.

Clin Exp Allergy. 2017 Dec 30;:

Authors: Jeon YJ, Lim JH, An S, Jo A, Han DH, Won TB, Kim DY, Rhee CS, Kim HJ

Abstract
BACKGROUND: Allergic respiratory conditions have been associated with increased susceptibility to viral infection due to impaired interferon (IFN)-related immune responses but the mechanisms for reinforcement of mucosal immunity against viral infection in allergic diseases are largely unknown.
OBJECTIVES: To determine whether IFN induction would be impaired in allergic nasal mucosa and to identify if higher loads of influenza A virus (IAV) in allergic nasal mucosa could be controlled with IFN treatment.
METHODS: IAV mRNA, viral titers and IFN expression were compared in IAV-infected normal human nasal epithelial (NHNE, N=10) and allergic rhinitis nasal epithelial (ARNE, N=10) cells. We used in vivo model of allergic rhinitis (BALB/C mouse, N=10) and human nasal mucosa from healthy volunteers (N=72) and allergic rhinitis patients (N=29) to assess the induction of IFNs after IAV infection.
RESULTS: IAV mRNA levels and viral titers were significantly higher in ARNE compared with NHNE cells. IFN-β and -λs were induced in NHNE and ARNE cells up to 3 days after IAV infection. Interestingly, induction of IFN-λs mRNA levels and the amount of secreted proteins were considerably lower in ARNE cells. The mean IFN-λs mRNA level was also significantly lower in the nasal mucosa of AR patients and we found that recombinant IFN-λ treatment attenuated viral mRNA levels and viral titers in IAV-infected ARNE cells. In vivo AR mouse were exhibited higher viral load after IAV infection but intranasal inoculation of IFN-λ completely decreased IAV protein expression and viral titer in nasal mucosa of IAV-infected AR mouse.
CONCLUSION: Higher susceptibility of the allergic nasal mucosa to IAV may depend on impairment of type III IFN induction, and type III IFN is a key mechanistic link between higher viral loads and control of IAV infection in allergic nasal mucosa. This article is protected by copyright. All rights reserved.

PMID: 29288502 [PubMed - as supplied by publisher]

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Jet ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis.

Jet ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis.

Laryngoscope. 2017 Dec 30;:

Authors: Philips R, deSilva B, Matrka L

Abstract
OBJECTIVES/HYPOTHESIS: To assess the feasibility of jet ventilation in obese patients and to compare complications of jet ventilation in obese and nonobese patients.
STUDY DESIGN: Retrospective review of medical records.
METHODS: We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with jet ventilation between March 2014 and January 2017. Adequacy of jet ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and ventilation. Records were reviewed for demographic details, anesthesia records, and complications.
RESULTS: In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178).
CONCLUSIONS: Jet ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients.
LEVEL OF EVIDENCE: 4. Laryngoscope, 00:000-000, 2017.

PMID: 29288493 [PubMed - as supplied by publisher]

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Interactions between bradykinin and plasmin in the endothelial Ca2+ response.

Interactions between bradykinin and plasmin in the endothelial Ca2+ response.

Mol Cell Biochem. 2017 Dec 29;:

Authors: Obata Y, Takeuchi K, Wei J, Hakamata A, Odagiri K, Nakajima Y, Watanabe H

Abstract
Plasmin is a fibrinolytic factor and a serine protease that activates protease-activated receptors (PARs) to produce endothelium-derived relaxing factors such as nitric oxide and prostacyclin. Nitric oxide and prostacyclin production is regulated, at least in part, by the intracellular Ca2+ concentration in various blood vessel types. Bradykinin and plasmin stimulate vascular endothelial cells and work simultaneously in pathophysiological conditions such as thrombosis and inflammation. Here, we explored the interactions between bradykinin and plasmin in the endothelial Ca2+ response using the fluorescent indicator, Fura-2/AM, in primary cultures of porcine aortic endothelial cells (PAECs). Plasmin (0.15-15 µg/ml) and bradykinin (0.1-10 nM) increased intracellular Ca2+ concentrations in PAECs in a dose-dependent manner, and the plasmin-induced endothelial Ca2+ response occurred only once. Bradykinin (0.1-10 nM) inhibited the plasmin-induced endothelial Ca2+ response in a dose-dependent manner, however, plasmin did not affect the bradykinin-induced endothelial Ca2+ response. Pretreatment with gabexate mesilate (GM, 100 µM), a serine protease inhibitor, that blocks plasmin's proteolytic activity, fully suppressed the plasmin-induced Ca2+ response. After washout of GM and the first plasmin, the second administration of plasmin caused Ca2+ increases. However, when the first plasmin-induced Ca2+ response was blocked by pretreatment with bradykinin, the second plasmin (15 µg/ml) application did not cause any Ca2+ response, even 30 min after the washout of the first plasmin and bradykinin. Our data suggested that bradykinin regulated the plasmin-induced endothelial Ca2+ response by inhibiting the pathway downstream of the PARs' N-terminus cleavage.

PMID: 29288468 [PubMed - as supplied by publisher]

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A cadaveric study of aortic arch variation in an Irish population.

A cadaveric study of aortic arch variation in an Irish population.

Ir J Med Sci. 2017 Dec 29;:

Authors: O'Malley AM, El Kininy WH, Debebe H, Burukan AB, Davy SW

Abstract
AIM: The aim of this study is to investigate the incidence of variation in the branching pattern of aortic arch (AA) vessels in an Irish population.
METHOD: A cadaveric study of 24 subjects was conducted. The vessels of the AA were identified, their branching patterns were noted and photographed and the following measurements were recorded: the angle of the AA to the coronal plane, the distance from the midline to the brachiocephalic trunk (BCT); the left common carotid artery (LCC) ; the left subclavian artery (LSC), the distance between the BCT and the right subclavian artery (RSC); the RSC and the right vertebral artery (RVA), and between the LSC and left vertebral artery (LVA).
RESULTS: The 'normal' branching pattern (BCT, LCC, LSC) was observed in 79%. Thirteen percent had a two-branched AA (bovine variant), while the remainder had an aberrant left vertebral artery (LVA) originating from the AA. The mean distances from the midline to the BCT, LCC and LSC were 9.1, 10.8 and 21.4 mm, respectively. Mean distance from BCT to RSC was 34.09 mm. The mean distance from LSC to LVA was 39.79 mm, and the mean distance from RSC to RVA was 23.38 mm. The mean angle of the AA to the coronal plane was 59.02°.
CONCLUSION: This is the first study documenting the rates of variation of the AA in Ireland. Variation of AA branching is of radiological and surgical significance, particularly in the diagnosis and treatment of thoracic and head and neck diseases. Awareness of these variations is particularly relevant for interventionalists who access these vessels during endovascular surgery.

PMID: 29288397 [PubMed - as supplied by publisher]

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Repetitive nonpersistent protrusion of the tongue on prenatal ultrasound.

Repetitive nonpersistent protrusion of the tongue on prenatal ultrasound.

Arch Gynecol Obstet. 2017 Dec 29;:

Authors: Kesrouani A, AbdelKhalek Y, Nasr B, Torbey PH, Hachem R, Rassi S

PMID: 29288319 [PubMed - as supplied by publisher]

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Factors Predicting the Recovery of Unilateral Vocal Fold Paralysis After Thyroidectomy.

Factors Predicting the Recovery of Unilateral Vocal Fold Paralysis After Thyroidectomy.

World J Surg. 2017 Dec 30;:

Authors: Choi YS, Joo YH, Park YH, Kim SY, Sun DI

Abstract
BACKGROUND: We used voice analysis and clinicopathological factors to explore the prognosis of unilateral vocal fold paralysis after thyroid surgery.
METHODS: The medical records of 63 females who developed unilateral vocal fold paralysis after thyroidectomy were reviewed. All patients were divided into two groups: those who recovered from vocal fold paralysis and those who did not. We analyzed clinical parameters and voice analysis results in a search for correlations with recovery from paralysis.
RESULTS: Of the 63 patients, 37 (58%) recovered from paralysis. A small tumor size, incomplete paralysis, the absence of arytenoid tilting, no compensatory movement of the normal side, lower postoperative shimmer, a higher postoperative maximum phonation time (MPT), and lower postoperative subglottic pressure correlated significantly with recovery from vocal fold paralysis. Multivariate analysis confirmed that the absence of compensatory movement of the normal side on videostroboscopy was independently prognostic. A postoperative MPT of 6.86 appeared to be optimal for prediction of recovery. Most patients recovered within 6 months, but those with incomplete paralysis recovered about 3 months earlier. At the 12-month follow-up, the thyroidectomy-related voice questionnaire scores had returned to preoperative values in only 12 patients (19.0%); 51 patients (81.0%) did not fully recover.
CONCLUSION: Compensatory movement of the normal side evident on videostroboscopy was a poor prognostic factor. Voice analysis can be helpful in counseling vocal fold paralysis patients after thyroidectomy, and early intervention may be considered in patients who are expected to have a poor prognosis.

PMID: 29288312 [PubMed - as supplied by publisher]

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Long-Lasting Voice-Related Symptoms in Patients Without Vocal Cord Palsy After Thyroidectomy.

Long-Lasting Voice-Related Symptoms in Patients Without Vocal Cord Palsy After Thyroidectomy.

World J Surg. 2017 Dec 29;:

Authors: Kim CS, Park JO, Bae JS, Lee SH, Joo YH, Park YH, Hwang YS, Shim MR, Sun DI

Abstract
BACKGROUND: Some patients complain of long-lasting voice symptoms after thyroid surgery without objective vocal fold pathology. We assessed the factors that may influence voice symptoms more than 12 months after thyroidectomy.
METHODS: We performed a retrospective analysis of 68 patients from July 2010 to May 2012. The voices of all patients were analyzed before and after thyroid surgery (2 weeks and 2, 4, 6, 8, 10, and 12 months after surgery). According to the recovery of postoperative voice symptoms, patients were divided into two groups: the non-recovery group and the recovery group. Voice symptoms were measured using a thyroidectomy-related voice questionnaire (TVQ). We compared voice analysis data for each group and investigated the factors related to long-lasting postoperative voice symptoms.
RESULTS: Forty-nine patients were included in the recovery group, and 19 patients were included in the non-recovery group. No differences in sex ratio, tumor size, and surgical extent were found between the groups. However, the proportion of professional voice users (odds ratio 4.121; 95% confidence interval 0.983-17.267; p < 0.043) was significantly higher in the non-recovery group. The cutoff score of the TVQ, at 2 months after thyroid surgery, for the differentiation of the recovery and non-recovery groups was 25, and the sensitivity and specificity values were 84.2 and 87.8%, respectively.
CONCLUSIONS: Professional voice users may be presented long-lasting voice symptoms after thyroid surgery. The cutoff TVQ score of 25, at 2 months after thyroid surgery, may be a guideline for counseling patients who have voice symptoms.

PMID: 29288310 [PubMed - as supplied by publisher]

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Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study.

Anterolateral Thigh Flap Combined with Reconstruction Plate Versus Double Free Flaps for Composite Mandibular Reconstruction: A Propensity Score-Matched Study.

Ann Surg Oncol. 2017 Dec 30;:

Authors: Offodile AC, Lin JA, Chang KP, Abdelrahman M, Kou HW, Loh CYY, Aycart MA, Kao HK

Abstract
OBJECTIVE: This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications.
METHODS: A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i.e., ALT only and DFF, were created. Incidence and subsequent management strategies for postoperative plate exposure were evaluated along with complications, overall survival, and postoperative quality of life (QoL).
RESULTS: Sixty-two patients were 1:1 propensity matched (31 per group). The DFF group had a significantly larger soft tissue and bone defect than the single-flap group. The 5-year probability of not having a plate exposure was 45.5 and 47.4% for the double-flaps and single-flap groups, respectively (p = 0.186). The ALT-only group had a significantly higher rate of wound infections (38.7% vs. 12.9%, p = 0.02). The incidence of flap loss, reexploration, inpatient mortality, plate fracture, medical complications, and overall survival were not significantly different. Although mean score for pain was significantly worse in the ALT-only group (75.2 vs. 88.5, p < 0.001), the remainder of our QoL assessments (cosmesis, swallow, employment, and speech) were comparable.
CONCLUSIONS: The utilization of an ALT with plate strategy is associated with competitive rates of plate exposure and overall survival relative to DFF but higher wound infections and long-term pain. These results have considerable salience for patient-counseling regarding expectations for functional and clinical outcomes.

PMID: 29288289 [PubMed - as supplied by publisher]

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The top 50 most-cited articles on acoustic neuroma.

The top 50 most-cited articles on acoustic neuroma.

World Neurosurg. 2017 Dec 26;:

Authors: Alfaifi A, Almutairi O, Allhaidan M, Alsaleh S, Ajlan A

Abstract
BACKGROUND: Acoustic neuroma is the most common extra-axial primary cerebellopontine angle tumour in adults. A plethora of studies have been published about acoustic neuroma, but none of the previous works have highlighted the most influential articles.
OBJECTIVES: Our objective was to perform a bibliometric analysis on the 50 most-cited articles concerning acoustic neuroma.
METHODS: We performed a title-specific search on the Scopus database, using the following terms: 'acoustic neuroma,' 'vestibular schwannoma,' and 'cerebellopontine angle' as search queries. Through this, we recorded the 50 most-cited articles and reviewed them.
RESULTS: Overall, the 50 most-cited articles had an average of 175 citations per paper. All articles were published between 1980 and 2006, with 1997 the most prolific year, when seven articles were published. In publication medium, the journals Neurosurgery and Laryngoscope published 10 and eight of these articles, respectively. The most common study categories were nonsurgical management (17 of 50) and surgical management (13 of 50). The studies were predominantly published by otolaryngologists (22 of 50) and neurosurgeons (14 of 50). The author with the highest number of contributions was Douglas Kondziolka, with seven publications. Finally, the majority of the most-cited articles were produced in the United States (64%).
CONCLUSIONS: Identifying the works with the most impact concerning acoustic neuroma provides an important overview of the historical development of treatment methods and publication trends related to this condition. A finalised, comprehensive list of the most important works represents an excellent tool that can serve as a guide for evidence-based clinical practice.

PMID: 29288105 [PubMed - as supplied by publisher]

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Immunoglobulin G4-related Chronic Rhinosinusitis: A Pitfall in the Differential Diagnosis of Granulomatosis with Polyangiitis, Rosai-Dorfman Disease and Fungal Rhinosinusitis.

Immunoglobulin G4-related Chronic Rhinosinusitis: A Pitfall in the Differential Diagnosis of Granulomatosis with Polyangiitis, Rosai-Dorfman Disease and Fungal Rhinosinusitis.

Hum Pathol. 2017 Dec 26;:

Authors: Piao Y, Zhang Y, Yue C, Wang C, Zhang L

Abstract
Immunoglobulin G4 (IgG4)-related chronic rhinosinusitis (CRS) has recently been proposed to be a new clinical entity of nasal disease, with no consensually agreed criteria for diagnosis. Moreover, the pathological features if IgG4-related CRS often overlap with other sinonasal inflammatory and autoimmune diseases such as Granulomatosis with Polyangiitis (GPA), Rosai-Dorfman disease (RDD) and Fungal Rhinosinusitis (FRS). We aimed to explore the specific similarities and differences in clinicopathologic features between IgG4-related CRS, and GPA, RDD and FRS, in order that these conditions can be diagnosed more accurately. Biopsy specimens collected from nasal mucosa of 20 IgG4-related CRS, 10 GPA, 10 RDD and 10 FRS patients were assessed by haematoxylin and eosin staining and immunohistochemical techniques for specific histochemical differences. The number of IgG4-positive plasma cells /high-power fields (HPF) in biopsies from IgG4-related CRS patients (mean= 79.6±51.59; range= 15/HPF to 230/HPF) was significantly higher than in biopsies from GPA (mean= 13±9.428; p<0.0001) and RDD (mean= 12.5±8.267; p<0.0001) patients, but not from FRS (mean=47.4±26.48; p>0.05) patients. Similarly, the ratio of IgG4/IgG-positive plasmacytes was>40% in 90% (18/20) of IgG4-related CRS patients, compared to >40% in 10% (1/10) GPA patients, 20% (2/10) RDD patients and 20% (2/10) FRS patients. The sinonasal diseases GPA, RDD and FRS might present with similar histopathologic features such as the increased numbers of plasma cells and fibrosis which are characteristic of IgG4-related CRS. A comprehensive consideration combining the clinical signs and symptoms with a histopathological assessment of IgG4- positive plasma cells may provide accurate diagnoses of these conditions.

PMID: 29288039 [PubMed - as supplied by publisher]

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When and how to treat an IMRT patient on a second accelerator without replanning?

When and how to treat an IMRT patient on a second accelerator without replanning?

Med Dosim. 2017 Dec 26;:

Authors: Lin T, Hossain M, Fan J, Ma CC

Abstract
When a linear accelerator is unavailable for treatment, a clinical decision is imminent regarding whether a patient should be treated on a linear accelerator other than the machine the patient was scheduled on, or whether treatment should be postponed until the original Linac becomes available. This work investigates the feasibility of switching patients to different accelerators for intensity-modulated radiation therapy (IMRT). We have performed Monte Carlo simulations of photon beams from different Linac models and vendors. Prostate and head and neck (H&N) treatment plans for Siemens Primus, Primart, and Varian 21EX accelerators are studied in this work. Dose distributions for given plans are recalculated using different beam data with the same nominal energy from different Linacs. We have compared dose-volume histograms (DVHs) and the maximum, the minimum, and the mean doses to the target and critical structures because of switching accelerators. In the process of switching a treatment plan to a different accelerator, issues exist, including optimum penumbra compensation, dose distribution at the boundary of target and critical structures, and multileaf collimator (MLC) leaf-width effects, which need to be considered and verified with measurements. Our Monte Carlo simulation results confirm that, for the cases we tested, the dose received by 95% of the planning target volume differs by 0.2% to 1.5% between Siemens Primus and Varian 21EX Linacs. The discrepancy is within our clinical acceptance criteria of 3% for IMRT treatments. In making the final decision on whether to switch machines or not, the tumor control probabilities (TCPs) based on a linear-quadratic model are compared. Based on the analyses performed in this work, it is therapeutically more beneficial to switch a patient to a different machine than to postpone a treatment until the original machine is available, especially for fast-growing tumors such as H&N cancers.

PMID: 29287919 [PubMed - as supplied by publisher]

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Characteristics of electrically evoked auditory brainstem responses in patients with cochlear nerve canal stenosis receiving cochlear implants.

Characteristics of electrically evoked auditory brainstem responses in patients with cochlear nerve canal stenosis receiving cochlear implants.

Int J Pediatr Otorhinolaryngol. 2018 Jan;104:98-103

Authors: Wang Z, Liu Y, Wang L, Shen X, Han S, Wang W, Gao F, Liang W, Peng KA

Abstract
OBJECTIVE: To explore the characteristics of the electrically evoked auditory brainstem responses (EABR) in children with cochlear nerve canal stenosis (CNCs) following cochlear implantation (CI), and the EABR thresholds in children with stenotic versus normal cochlear nerve canals.
METHOD: Sixteen children with profound sensorineural hearing loss were included in this study: 8 with CNCs (CNCs group) and 8 with normal cochlear nerve canals (control group). All children underwent cochlear implantation with full insertion of all electrodes. EABR was performed 6 months postoperatively in both groups.
RESULTS: The EABR extraction rate was 100% in children with normal cochlear nerve canals and only 50% in children with CNCs. EABR thresholds were significantly higher in children with CNCs of electrodes No. 11and 22 than in children with normal cochlear nerve canals (P < 0.05 for both comparisons). There was no significant difference in EABR thresholds among electrode No. 1, 11 and 22 in CNCs group (P > 0.05 for all comparisons); while in the control group, the EABR threshold at electrode No 22 was lower than those at both electrodes No. 11 and 1 (P < 0.05 for both comparisons), and the EABR threshold at electrode No. 11 was also lower than that at electrode No. 1 (P < 0.05).
CONCLUSION: The EABR thresholds in children with normal cochlear nerve canals vary according to the different locations of electrodes in the cochlea; while in children with CNCs, there was no significant difference among different electrode locations. The EABR thresholds in CNCs children were higher than those of children with normal cochlear nerve canals at electrode 11 and 22.

PMID: 29287891 [PubMed - in process]

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Infection rates of MRSA in complicated pediatric rhinosinusitis: An up to date review.

Infection rates of MRSA in complicated pediatric rhinosinusitis: An up to date review.

Int J Pediatr Otorhinolaryngol. 2018 Jan;104:79-83

Authors: Hamill CS, Sykes KJ, Harrison CJ, Weatherly RA

Abstract
INTRODUCTION: Published studies have reported a rise in MRSA isolates in head and neck infections, but the microbiology of complicated pediatric rhinosinusitis is unclear. One study of such patients showed that MRSA isolates were seen only in the last three years of data collection, suggesting a possible recent increased prevalence. Given the public health concerns of increasing rates of antimicrobial resistance, the goal of this study was to investigate the microbiologic patterns and outcomes of complicated pediatric rhinosinusitis.
METHODS: Retrospective cohort of pediatric patients admitted to our children's hospital with complicated acute rhinosinusitis from 2004 to 2014.
RESULTS: The mean age of 250 hospitalized children with complicated rhinosinusitis was 7.6 ± 4.9 years; 109 of these (43%) underwent surgical procedures. Although MRSA prevalence was highest in 2014, no significant trend in overall MRSA prevalence occurred when considering the entire study period. No significant relationship was identified between MRSA and intra-orbital versus intra-cranial complications. Interestingly, 22.7% of patients with anaerobes detected by culture had persistent abnormal physical examination (PE) findings versus 6.1% of patients without anaerobes (p = 0.025). Furthermore, multivariate analysis also revealed that detection of anaerobes or MRSA was associated with persistent PE findings being 21.8 and 14.8 times more likely, respectively, when compared to other detected pathogens.
DISCUSSION: Our data indicate modest variability in the annual rates of MRSA associated pediatric rhinosinusitis, however there was no statistically significant pattern of change in MRSA prevalence during 2004-2014. Although detection of MRSA was not significantly associated with either intraorbital or intracranial complications of sinusitis, a significant association with a poorer outcome was observed by multivariate analysis for patients from whom MRSA or anaerobes were detected. These data raise the question as to whether clindamycin is adequate for MRSA and anaerobic coverage.

PMID: 29287887 [PubMed - in process]

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Effects of transient auditory deprivation during critical periods on the development of auditory temporal processing.

Effects of transient auditory deprivation during critical periods on the development of auditory temporal processing.

Int J Pediatr Otorhinolaryngol. 2018 Jan;104:66-71

Authors: Kim BJ, Kim J, Park IY, Jung JY, Suh MW, Oh SH

Abstract
OBJECTIVES: The central auditory pathway matures through sensory experiences and it is known that sensory experiences during periods called critical periods exert an important influence on brain development. The present study aimed to investigate whether temporary auditory deprivation during critical periods (CPs) could have a detrimental effect on the development of auditory temporal processing.
MATERIALS AND METHODS: Twelve neonatal rats were randomly assigned to control and study groups; Study group experienced temporary (18-20 days) auditory deprivation during CPs (Early deprivation study group). Outcome measures included changes in auditory brainstem response (ABR), gap prepulse inhibition of the acoustic startle reflex (GPIAS), and gap detection threshold (GDT). To further delineate the specific role of CPs in the outcome measures above, the same paradigm was applied in adult rats (Late deprivation group) and the findings were compared with those of the neonatal rats.
RESULTS: Soon after the restoration of hearing, early deprivation study animals showed a significantly lower GPIAS at intermediate gap durations and a larger GDT than early deprivation controls, but these differences became insignificant after subsequent auditory inputs. Additionally, the ABR results showed significantly delayed latencies of waves IV, V, and interpeak latencies of wave I-III and wave I-V in study group. Late deprivation group didn't exhibit any deterioration in temporal processing following sensory deprivation.
CONCLUSION: Taken together, the present results suggest that transient auditory deprivation during CPs might cause reversible disruptions in the development of temporal processing.

PMID: 29287884 [PubMed - in process]

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