Πέμπτη 18 Μαρτίου 2021

VEGF-A/VEGF-B/VEGF-C expressions in non-hereditary, non-metastatic phaeochromocytoma

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Histol Histopathol. 2021 Mar 18:18329. doi: 10.14670/HH-18-329. Online ahead of print.

ABSTRACT

Vascular endothelial growth factor (VEGF) is important in pathogenesis of different cancers. The aim of this study is to investigate the relationships between different VEGFs and clinicopathological factors in patients with phaeochromocytomas. Twenty patients (10 men; 10 women) with non-hereditary, non-metastatic phaeochromocytomas were examined for VEGF mRNA expressions by polymerase chain reaction. The expressions were correlated with the clinical and pathological factors of the patients. In addition, mouse double minute 2 (MDM2) expression in these tumours were studied by immunohistochemistry. High expressions of VEGF-A, VEGF-B, and VEGF-C mRNA were detected in 11 (55%), 9 (45%), and 9 (45%) of the tumours respectively. High expression of VEGF-A in phaeochromocytomas was significantly correlated with the tumour size (p=0.025) but did not correlate with patients' age, gender, and tumour laterality. Besides, there was a trend of VEGF-A expression correlated with MDM2 expression (p = 0.064). On the other hand, expressions of VEGF-B and VEGF-C were not significantly correlated with tumour size, patients' age, gender, tumour laterality, and MDM2 expression. In addition, high expressions of VEGF-B and VEGF-A were associated with increase of tumour size (p = 0.042). Co-expression of different VEGFs did not correlate with MDM2 expression. To conclude, there is a role for VEGF-A/VEGF-B/VEGF-C in the pathogenesis of non-hereditary, non-metastatic phaeochromocytomas.

PMID:33734425 | DOI:10.14670/HH-18-329

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Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea

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Ear Nose Throat J. 2021 Mar 18:1455613211001132. doi: 10.1177/01455613211001132. Online ahead of print.

ABSTRACT

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 (P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

PMID:33734881 | DOI:10.1177/01455613211001132

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Pathology Clinic: Nodular Fasciitis Involving the External Ear

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Ear Nose Throat J. 2021 Mar 18:1455613211001958. doi: 10.1177/01455613211001958. Online ahead of print.

ABSTRACT

Nodular fasciitis is a rare, benign lesion characterized by the pseudosarcomatous proliferation of fibroblasts and myofibroblasts. Accurate diagnosis presents a unique challenge for otolaryngologists, as nodular fasciitis frequently mimics malignancy clinically; however, it can be distinguished from malignancy by subtle findings on pathology. A diagnosis of nodula r fasciitis should be considered for any irregular or rapidly growing lesion of the head and neck area, as accurate diagnosis is particularly important to avoid overtreatment in cosmetically sensitive regions.

PMID:33734879 | DOI:10.1177/01455613211001958

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Use of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy

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Ear Nose Throat J. 2021 Mar 18:1455613211000599. doi: 10.1177/01455613211000599. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical students for manipulation of a nasal endoscope on a cadaveric model.

MATERIAL AND METHOD: We randomly selected 39 medical students who had never handled a nasal endoscope and subjected them to the MRT. Ge neral information including experience in manual, technical, or surgical activities and testing of anatomical knowledge were collected to exclude possible confounding factors. They were then asked to perform series of cadaveric model exercises using a nasal endoscope. Their cadaver performance was evaluated by 2 blinded observers, using a standardized scale.

RESULTS: We found that medical students with higher mental rotation skills had significantly increased endoscopic sinus performance (P = .0002 using multivariate regression adjusted for specialty choice, previous surgical exposure, and anatomy knowledge). Higher anatomy knowledge was also associated with better endoscopic sinus performance (P = .0141). Other parameters had no impact on endoscopic sinus performance measured by the endoscopic scale (P > .05).

CONCLUSION: The score obtained on the MRT was correlated with the practical performance of manipulating the nasal endoscope in cadaver. It could therefore be a useful spatial ability tool for directing targeted training in rhinology.

PMID:33734883 | DOI:10.1177/01455613211000599

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A Case Report of Spontaneous Nasal Septal Abscess in a Child

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Ear Nose Throat J. 2021 Mar 18:1455613211000613. doi: 10.1177/01455613211000613. Online ahead of print.

ABSTRACT

We describe a case of spontaneous nasal septal abscess (NSA) in a 9-year-old child. We also reviewed the literatures in recent years and summarized the characteristics of NSA, such as gender, age, inducement, pathogenic bacteria, treatment, and prognosis. We found that this boy reported by us has the most extensive abscess. May be the delay of treatment was relate d to the recent fluctuation of COVID-19 epidemic in China. Fortunately, with the help of surgery and anti-infection treatment, the boy was discharged from the hospital without septal perforation or saddle nose.

PMID:33734887 | DOI:10.1177/01455613211000613

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The Function of Cochlear Implant After Cardioversion in a Patient With Atrial Flutter: A Case Report

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Ear Nose Throat J. 2021 Mar 18:1455613211001962. doi: 10.1177/01455613211001962. Online ahead of print.

ABSTRACT

Hearing loss in older people can cause communication impairments, decreased quality of life, social isolation, depression, and dementia. Cochlear implant surgery is an effective treatment for older patients with hearing loss who cannot achieve satisfactory audiologic outcomes with hearing aids. However, older people have an increased risk of heart disease and ofte n take medications that affect heart rhythm. Herein, we report a case of an 80-year-old woman who underwent cardioversion at 50J after cochlear implant surgery. Electrical impedance before and after cardioversion showed only minor changes without abnormality, and the cochlear implant functioned well. We believe that the electronic circuits of the cochlear implant may have been relatively tolerant to the electrical shock from the external defibrillator. Typically, cardioversion should be avoided in cochlear implant recipients because it may damage the implant. If cardioversion cannot be avoided, we strongly recommend starting cardioversion at the lowest energy level (50 J) and removing the sound processor of the implant during the procedure.

PMID:33734884 | DOI:10.1177/01455613211001962

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Facial Nerve Schwannoma Extending to Jugular Foramen: A Case Report

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Ear Nose Throat J. 2021 Mar 18:1455613211000292. doi: 10.1177/01455613211000292. Online ahead of print.

ABSTRACT

Facial nerve schwannoma (FNS) is a benign, slow-growing schwannoma that originates from Schwann cells. Facial nerve schwannoma is the most common tumor of the facial nerve but rare and only accounts for 0.15% to 0.8% of intracranial neurinomas. It may be manifested as asymmetric hearing loss, facial palsy, and hemifacial spasm. A 56-year-old woman was transferred to our department, because of pain behind the right ear and spasm of the right lateral muscle for more than 2 years and pulsatile tinnitus for half a year. Based on the preoperative medical history, physical signs, and auxiliary examination, it was diagnosed with jugular foramen (JF) space-occupying lesion. We removed the tumor through the infratemporal fossa type A approach and found that the tumor originated from the facial nerve. After the tumor resection, sural nerve transplantation was performed. The patient demonstrated postoperative facial palsy (House-Brackman grade VI) and was smoothly discharged after good recovery. Facial nerve schwannoma rarely invades the JF, and the most common tumor in the JF is the glomus jugular tumor, followed by the posterior cranial schwannoma. They have common symptoms, making it difficult to obtain a correct diagnosis. Clinical data, medical history, and auxiliary examinations should be carefully analyzed to avoid misdiagnosis or mistreatment. Infratemporal fossa type A approach is an effective method for treating FNS of JF.

PMID:33734878 | DOI:10.1177/01455613211000292

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A Rare Case of Hodgkin Lymphoma of the Maxillary Sinus

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Ear Nose Throat J. 2021 Mar 18:145561321993599. doi: 10.1177/0145561321993599. Online ahead of print.

ABSTRACT

Hodgkin lymphoma (HL) is an uncommon B-cell malignant disease. It usually presents with mediastinal and/or laterocervical lymph node localization, while primary extranodal HL is a rare entity giving rise to diagnostic and therapeutic challenges. It rarely presents as just extranodal localization, so its presence within the maxillary sinus without any lymphadenopathy is exceptional. Given the rarity of this localization, there is no standard treatment for maxillary sinus HL. We present a case of a patient with extranodal HL of the right maxillary sinus treated with primary surgery followed by adjuvant sequential chemoradiation therapy.

PMID:33734885 | DOI:10.1177/0145561321993599

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Percutaneous Tracheostomy With a Demistifier Canopy in the COVID-19 Era: A Safe Technique in the Intensive Care Unit

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Ear Nose Throat J. 2021 Mar 18:1455613211001595. doi: 10.1177/01455613211001595. Online ahead of print.

ABSTRACT

BACKGROUND: Endoscopic percutaneous tracheostomy (PT) is a safe technique that is performed frequently by otolaryngologists and intensivists. New challenges have been identified in order to maintain the safety of this procedure during the COVID-19 pandemic. A novel approach, using a modified demistifier canopy, was developed during the first wave of the pandemic a nd implemented for 17 consecutive percutaneous tracheostomies in order to enhance procedural safety.

METHODS: A protocol was developed after performing a literature review of tracheostomy in COVID-19 patients. A multidisciplinary tracheostomy team was established, including the departments of otolaryngology, critical care, and respiratory therapy. Simulation was performed prior to each PT, and postoperative debriefings were done.

RESULTS: A protocol and technical description of PT using a modified demistifier canopy covering was written and video documented. Data were collected on 17 patients who underwent this procedure safely in our tertiary care hospital. There were no procedure-related complications, and no evidence of COVID-19 transmission to any member of the health care team during the study period.

CONCLUSION: As patients continue to recover from COVID-19, their need for tracheostomy will increase. The technique described provides a safe, multidisciplinary method of performing PT in COVID-19 patients.

PMID:33734882 | DOI:10.1177/01455613211001595

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Impact of Oral Steroids on Tonsillectomy Postoperative Complications and Pain

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Ear Nose Throat J. 2021 Mar 18:1455613211000832. doi: 10.1177/01455613211000832. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the impact of steroids on postoperative tonsillectomy recovery and implement findings for improvement in postoperative management.

METHODS: Institutional review board approved prospective study with retrospective analysis of private practice setting tonsillectomy patients (November 2015 to January 2017). A questionnaire was provided po stoperatively to patients undergoing tonsillectomy with or without adenoidectomy. The study population was separated into 2 groups: patients who received steroids (3 days of either dexamethasone or prednisolone), postoperative steroid (POS), versus patients who did not receive steroids (PONS).

RESULTS: The questionnaire had a return rate of 27.3% (254/931). Nine of the 254 responses were disqualified for lack of information; therefore, the total number of responses was 245. Of these, 115 were POS and 130 were PONS. The groups were similar in mean age (POS: 13.2 ± 10.4 years, PONS: 14.7 ± 12.1 years, P = .32) and sex (POS: Male 40.0%, PONS: Male 40.0%, P = .97). There was an overall decrease of pain and nausea/vomiting (N/V) in the steroid group (P = .0007). There was reduction in pain (P < .05) from postoperative day (POD) 2, 3, 4, and 6 in the POS group. Otherwise, there was no significant reduction in pain from POD 7 to 14, day-by-day rate of N/V, bleeding, or rate of emergency department (ED) or clinic visit (P > .05).

CONCLUSION: Postoperative steroid reduced overall pain and N/V, as well as daily pain on POD 2, 3, 4, and 6. Pain from POD 7 to 14, rate of ED or clinic visit, or daily N/V and bleeding rate were not significantly different between cohorts.

PMID:33734886 | DOI:10.1177/01455613211000832

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Sudden Sensorineural Hearing Loss in 6 Patients Following Dental Procedure

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Ear Nose Throat J. 2021 Mar 18:1455613211001597. doi: 10.1177/01455613211001597. Online ahead of print.

ABSTRACT

This study investigated the etiology and treatment outcome in sudden sensorineural hearing loss (SSHL) patients following dental procedure. During the past 2 decades, only 6 patients with SSHL following dental procedure were experienced including tooth extraction in 5 and endodontic treatment in 1. Three were males and 3 were females, with ages ranging from 10 to 75 years (median, 47 years). All patients underwent an inner ear test battery. Types of audiogram consisted of total deafness in 3 ears, flat-type loss in 2 ears, and high-tone loss in 1 ear. The pretreatment mean hearing level from 4 frequencies was 76 ± 37 dB for the lesion ears, significantly higher than 23 ± 15 dB for the opposite healthy ears. The treatment outcome is unsatisfactory. Five patients remained hearing unchanged 3 months after treatment. Only 1 (17%) patient had hearing improvement who was proved as having reactivation of the varicella-zoster virus. In conclusion, reactivation of the varicella-zoster virus may be one of the etiologies for SSHL patients following dental procedure. Serological assay coupled with MR imaging may help identify the etiology, determine the medication, and predict the outcome.

PMID:33734880 | DOI:10.1177/01455613211001597

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