Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex

Abstract

Purpose of Review

Surgery of the petrous apex lesions is considered a surgical challenge. We report our experience and review the literature highlighting current indications and limits in the management of benign and malignant lesions with special focus on the endoscopic approaches.

Recent Findings

Over the last years, indications and limits of the extended endonasal approaches range from inflammatory disease of the paranasal sinuses to the management of various diseases involving the skull base such as CSF leak, pituitary tumors, ethmoid tumors, petrous apex lesions, and purely intracranial lesions thanks to the development of dedicated surgical instrumentation, the improvement of skull base reconstruction techniques, and a better knowledge of the anatomy.

Summary

Extended endonasal approach to petrous apex lesions is a safe and effective procedure for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. Nowadays, referral centers equipped by surgical teams with expertise to both endoscopic and lateral skull base routes represent the most safe and effective way of treatment of those diseases.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X2tqAn

Society for Neuroscience in Anesthesiology & Critical Care (SNACC) Neuroanesthesiology Education Milestones for Resident Education

Background: The Accreditation Council for Graduate Medical Education (ACGME) has introduced competency-based assessments (milestones) for resident education. However, the existing milestones for Anesthesiology are not specific to Neuroanesthesiology. The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) commissioned a task force to adapt the ACGME anesthesiology milestones for use in Neuroanesthesiology training, and to provide recommendations for implementing milestones. Methods: A 7-member expert task force supported by an advisory committee developed the initial milestones by consensus. Written permission was given by the ACGME. The milestones were refined following 3-month pilot use in 14 departments across the United States and inputs from SNACC members. Final milestones were approved by the SNACC Board of Directors. Results: Twelve Neuroanesthesiology-specific milestones in 5 major ACGME domains are recommended; these were identified as most pertinent to this subspecialty rotation. These pertain to patient care (7 milestones), medical knowledge (2 milestones), practice-based learning and improvement (1 milestone), and interpersonal and communication skills (2 milestones). Each milestone was described in detail, with clear outline of expectations at various levels of training. Conclusions: The SNACC Neuroanesthesiology milestones provide a framework for reviewing resident performance and are expected to facilitate improved use of ACGME milestones during Neuroanesthesiology subspecialty training. The task force recommends that the target should be to accomplish level 4 or higher milestones by the end of residency training. Individual programs should decide the implications of a resident not meeting the expected milestones. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Deepak Sharma, MD, DM, Departments of Anesthesiology & Pain Medicine and Neurological Surgery, Division of Neuroanesthesiology & Perioperative Neurosciences, University of Washington, Seattle, WA, P.O. Box #359724, 325, 9th Ave., Seattle, WA 98104 (e-mail: dsharma@uw.edu). Received December 15, 2018 Accepted January 7, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GDSuIa

Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study

Background: In patients with subarachnoid hemorrhage (SAH), abnormalities in glucose and lactate metabolism have been described using cerebral microdialysis. Glucose and lactate concentrations in cerebrospinal fluid (CSF) are more easily accessible, but scarce data are available in this setting. The aim of this study is to assess the relationship of CSF glucose and lactate with blood concentrations and with unfavorable neurological outcome after SAH. Methods: A retrospective cohort study was conducted in 5 European University intensive care units. Patients aged 18 years and above who were admitted after a nontraumatic SAH over a 4-year period (2011 to 2014) were included if they had an external ventricular drain placed, daily analysis of CSF including glucose (±lactate) concentrations for 1 to 4 consecutive days, and concomitant analysis of glucose and lactate concentrations in the arterial blood. Results: A total of 144 patients were included in the final analysis (median age: 58 [49 to 66] y; male sex: 77/144). Median time from admission to external ventricular drain placement was 1 (0 to 3) day; median Glasgow Coma Scale on admission was 10 (7 to 13), and CT-scan Fisher scale was 4. A total of 81 (56%) patients had unfavorable neurological outcome at 3 months (Glasgow Outcome Scale ≤3). There was a weak correlation between blood and CSF glucose (r2=0.07, P=0.007), and between blood and CSF lactate levels (r2=0.58, P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tjbtjp

International Multicenter Survey of Perioperative Management of External Ventricular Drains: Results of the EVD Aware Study

Introduction: The perioperative management of patients with external ventricular drains (EVDs) is not well defined, and adherence to published management guidelines unknown. This study investigates practice, patterns, and variability in the perioperative management of patients with EVDs. Methods: A 31-question survey was sent to 1830 anesthesiologists from 27 institutions in North America, Europe, and Asia. A perioperative EVD Guideline Adherence Score was calculated for the preoperative, transport and intraoperative periods. Differences in management practices between neuroanesthesiologists and non-neuroanesthesiologists, and factors affecting EVD guideline adherence, were examined using bivariate significance tests and linear regression. Results: Among a sample of 599 anesthesiologists (survey response rate, 32.7%), compared with non-neuroanesthesiologists, neuroanesthesiologists were more likely to include baseline neurological examination (P=0.023), hourly cerebrospinal fluid output (P=0.006) and color (P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GGMtuk

Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury

Background: Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI. Methods: Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4. Results: Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R2=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R2=0.32, P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ti9nAi

Intubating Laryngeal Mask Airway-assisted Flexible Bronchoscopic Intubation is Associated With Reduced Cervical Spine Motion When Compared With C-MAC Video Laryngoscopy-guided Intubation: A Prospective Randomized Cross Over Trial

Background: In the evolving research into cervical spine mechanics during airway intervention, new devices are being constantly added to the armamentarium of anesthesiologists. In this study we compared cervical spine movement during orotracheal intubation using an intubating laryngeal mask airway (LMA Fastrach) assisted flexible bronchoscope or video laryngoscope. Materials and Methods: In total, 40 consenting patients without history of abnormalities of cervical spine and planned for elective neuroradiologic interventions in the angiography suite were enrolled in this randomized crossover trial. Every patient was subjected to LMA Fastrach-guided flexible bronchoscopic as well as video laryngoscopy guided intubation. Cervical spine motion at the occipital bone, C1-C5 vertebrae, the occiput-C1, C1-C2, C2-C3 and C4-C5 junctions was investigated using continuous fluoroscopy during intubation. The primary outcome of the study was combined craniocervical motion from occiput to C5 between the 2 intubation techniques. Results: There was less (62%) combined craniocervical movement from occiput to C5 during the LMA Fastrach-flexible bronchoscopy-guided technique as compared with video laryngoscopy-guided intubation (17.55±14.23 vs. 28.95±11.58 degrees, respectively; P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GDStUC

Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex

Abstract

Purpose of Review

Surgery of the petrous apex lesions is considered a surgical challenge. We report our experience and review the literature highlighting current indications and limits in the management of benign and malignant lesions with special focus on the endoscopic approaches.

Recent Findings

Over the last years, indications and limits of the extended endonasal approaches range from inflammatory disease of the paranasal sinuses to the management of various diseases involving the skull base such as CSF leak, pituitary tumors, ethmoid tumors, petrous apex lesions, and purely intracranial lesions thanks to the development of dedicated surgical instrumentation, the improvement of skull base reconstruction techniques, and a better knowledge of the anatomy.

Summary

Extended endonasal approach to petrous apex lesions is a safe and effective procedure for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. Nowadays, referral centers equipped by surgical teams with expertise to both endoscopic and lateral skull base routes represent the most safe and effective way of treatment of those diseases.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X2tqAn

Society for Neuroscience in Anesthesiology & Critical Care (SNACC) Neuroanesthesiology Education Milestones for Resident Education

Background: The Accreditation Council for Graduate Medical Education (ACGME) has introduced competency-based assessments (milestones) for resident education. However, the existing milestones for Anesthesiology are not specific to Neuroanesthesiology. The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) commissioned a task force to adapt the ACGME anesthesiology milestones for use in Neuroanesthesiology training, and to provide recommendations for implementing milestones. Methods: A 7-member expert task force supported by an advisory committee developed the initial milestones by consensus. Written permission was given by the ACGME. The milestones were refined following 3-month pilot use in 14 departments across the United States and inputs from SNACC members. Final milestones were approved by the SNACC Board of Directors. Results: Twelve Neuroanesthesiology-specific milestones in 5 major ACGME domains are recommended; these were identified as most pertinent to this subspecialty rotation. These pertain to patient care (7 milestones), medical knowledge (2 milestones), practice-based learning and improvement (1 milestone), and interpersonal and communication skills (2 milestones). Each milestone was described in detail, with clear outline of expectations at various levels of training. Conclusions: The SNACC Neuroanesthesiology milestones provide a framework for reviewing resident performance and are expected to facilitate improved use of ACGME milestones during Neuroanesthesiology subspecialty training. The task force recommends that the target should be to accomplish level 4 or higher milestones by the end of residency training. Individual programs should decide the implications of a resident not meeting the expected milestones. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Deepak Sharma, MD, DM, Departments of Anesthesiology & Pain Medicine and Neurological Surgery, Division of Neuroanesthesiology & Perioperative Neurosciences, University of Washington, Seattle, WA, P.O. Box #359724, 325, 9th Ave., Seattle, WA 98104 (e-mail: dsharma@uw.edu). Received December 15, 2018 Accepted January 7, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GDSuIa

Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study

Background: In patients with subarachnoid hemorrhage (SAH), abnormalities in glucose and lactate metabolism have been described using cerebral microdialysis. Glucose and lactate concentrations in cerebrospinal fluid (CSF) are more easily accessible, but scarce data are available in this setting. The aim of this study is to assess the relationship of CSF glucose and lactate with blood concentrations and with unfavorable neurological outcome after SAH. Methods: A retrospective cohort study was conducted in 5 European University intensive care units. Patients aged 18 years and above who were admitted after a nontraumatic SAH over a 4-year period (2011 to 2014) were included if they had an external ventricular drain placed, daily analysis of CSF including glucose (±lactate) concentrations for 1 to 4 consecutive days, and concomitant analysis of glucose and lactate concentrations in the arterial blood. Results: A total of 144 patients were included in the final analysis (median age: 58 [49 to 66] y; male sex: 77/144). Median time from admission to external ventricular drain placement was 1 (0 to 3) day; median Glasgow Coma Scale on admission was 10 (7 to 13), and CT-scan Fisher scale was 4. A total of 81 (56%) patients had unfavorable neurological outcome at 3 months (Glasgow Outcome Scale ≤3). There was a weak correlation between blood and CSF glucose (r2=0.07, P=0.007), and between blood and CSF lactate levels (r2=0.58, P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tjbtjp

International Multicenter Survey of Perioperative Management of External Ventricular Drains: Results of the EVD Aware Study

Introduction: The perioperative management of patients with external ventricular drains (EVDs) is not well defined, and adherence to published management guidelines unknown. This study investigates practice, patterns, and variability in the perioperative management of patients with EVDs. Methods: A 31-question survey was sent to 1830 anesthesiologists from 27 institutions in North America, Europe, and Asia. A perioperative EVD Guideline Adherence Score was calculated for the preoperative, transport and intraoperative periods. Differences in management practices between neuroanesthesiologists and non-neuroanesthesiologists, and factors affecting EVD guideline adherence, were examined using bivariate significance tests and linear regression. Results: Among a sample of 599 anesthesiologists (survey response rate, 32.7%), compared with non-neuroanesthesiologists, neuroanesthesiologists were more likely to include baseline neurological examination (P=0.023), hourly cerebrospinal fluid output (P=0.006) and color (P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GGMtuk

Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury

Background: Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI. Methods: Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4. Results: Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R2=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R2=0.32, P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ti9nAi

Intubating Laryngeal Mask Airway-assisted Flexible Bronchoscopic Intubation is Associated With Reduced Cervical Spine Motion When Compared With C-MAC Video Laryngoscopy-guided Intubation: A Prospective Randomized Cross Over Trial

Background: In the evolving research into cervical spine mechanics during airway intervention, new devices are being constantly added to the armamentarium of anesthesiologists. In this study we compared cervical spine movement during orotracheal intubation using an intubating laryngeal mask airway (LMA Fastrach) assisted flexible bronchoscope or video laryngoscope. Materials and Methods: In total, 40 consenting patients without history of abnormalities of cervical spine and planned for elective neuroradiologic interventions in the angiography suite were enrolled in this randomized crossover trial. Every patient was subjected to LMA Fastrach-guided flexible bronchoscopic as well as video laryngoscopy guided intubation. Cervical spine motion at the occipital bone, C1-C5 vertebrae, the occiput-C1, C1-C2, C2-C3 and C4-C5 junctions was investigated using continuous fluoroscopy during intubation. The primary outcome of the study was combined craniocervical motion from occiput to C5 between the 2 intubation techniques. Results: There was less (62%) combined craniocervical movement from occiput to C5 during the LMA Fastrach-flexible bronchoscopy-guided technique as compared with video laryngoscopy-guided intubation (17.55±14.23 vs. 28.95±11.58 degrees, respectively; P

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GDStUC

Ultrasound Screening and Surveillance in Hepatocellular Carcinoma

Abstract

Purpose

To review the current state of the use of ultrasound in hepatocellular carcinoma (HCC) surveillance.

Findings

Despite limitations in the evidence supporting the use of ultrasound in HCC surveillance, it has been formally recommended by a number of guidelines based on the best available evidence showing that it improves survival and is cost effective. However, ultrasound surveillance is inconsistently adopted and is prone to a number of practical and technical challenges. The recent introduction of ultrasound LI-RADS aims to standardize performance and reporting of these surveillance studies.

Summary

Despite remaining a controversial topic, semi-annual ultrasound screening for HCC is still supported by multiple hepatology societies. Ongoing evaluation of its performance and cost-effectiveness is required as new standards such as US LI-RADS, as well as evolving therapies and technologies emerge.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BwetNB

Ultrasound Screening and Surveillance in Hepatocellular Carcinoma

Abstract

Purpose

To review the current state of the use of ultrasound in hepatocellular carcinoma (HCC) surveillance.

Findings

Despite limitations in the evidence supporting the use of ultrasound in HCC surveillance, it has been formally recommended by a number of guidelines based on the best available evidence showing that it improves survival and is cost effective. However, ultrasound surveillance is inconsistently adopted and is prone to a number of practical and technical challenges. The recent introduction of ultrasound LI-RADS aims to standardize performance and reporting of these surveillance studies.

Summary

Despite remaining a controversial topic, semi-annual ultrasound screening for HCC is still supported by multiple hepatology societies. Ongoing evaluation of its performance and cost-effectiveness is required as new standards such as US LI-RADS, as well as evolving therapies and technologies emerge.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BwetNB

The impact of cricothyroid involvement on adductor recovery in unilateral vocal fold paralysis

Objectives/Hypothesis

Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid–lateral cricoarytenoid (TA‐LCA) muscle complex at multiple times postinjury.

Study Design

Prospective cohort study in a medical center.

Methods

Eighty‐one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36‐Item Short Form Survey quality‐of‐life questionnaire at 3 to 6 months after UVFP onset and a follow‐up assessment at 12 months after UVFP onset.

Results

The initial and follow‐up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA‐LCA muscle complex on the lesion side was improved at the follow‐up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA‐LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy‐one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement.

Conclusions

Acute UVFP with combined TA‐LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA‐LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement.

Level of Evidence

2 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DCKTq1

Validating peritonsillar abscess drainage rates using the Pediatric hospital information system data

Objectives

To evaluate the accuracy of the Children's Hospital Association's Pediatric Health Information System (PHIS) registry data in determining surgical drainage rates as compared to a chart review on the same cohort of children with diagnosis of peritonsillar abscess.

Study Design

Retrospective analysis.

Methods

Our analysis included 200 children, ages 2 to 17 years, treated for a peritonsillar abscess from 2011 to 2016. The primary outcome was to determine the sensitivity, specificity, predictive values, receiver operating characteristics (ROC), and likelihood ratios of surgical drainage rates comparing the PHIS database to manual chart review of the same patients.

Results

One hundred and fifteen (58%) children underwent drainage by chart review, whereas 87 (44%) had a drainage procedure by PHIS data. Age was a significant predictor of abscess drainage by chart review (age coefficient = 0.10; standard error = 0.04; 2 = 5.8; P = 0.02; odds ratio = 1.1; 95% confidence interval [CI] = 1.01–1.19). When using the chart review as the reference value for surgical drainage, the PHIS data had a sensitivity of 76% and 100% specificity. The positive and negative predictive values were 100% and 75%, respectively. The ROC area was 0.88 (95% CI, 84 to 92). Cases that lacked a clear procedure note composed the false negative cases in the PHIS.

Conclusion

At our institution, the PHIS Administrative data was adequate at predicting surgical drainage of the peritonsillar abscess when compared to chart review.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SvvZMw

Regarding “patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation”

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBdzQm

In response to letter to the editor regarding: “Patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation”

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SzWy38

The impact of cricothyroid involvement on adductor recovery in unilateral vocal fold paralysis

Objectives/Hypothesis

Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid–lateral cricoarytenoid (TA‐LCA) muscle complex at multiple times postinjury.

Study Design

Prospective cohort study in a medical center.

Methods

Eighty‐one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36‐Item Short Form Survey quality‐of‐life questionnaire at 3 to 6 months after UVFP onset and a follow‐up assessment at 12 months after UVFP onset.

Results

The initial and follow‐up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA‐LCA muscle complex on the lesion side was improved at the follow‐up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA‐LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy‐one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement.

Conclusions

Acute UVFP with combined TA‐LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA‐LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement.

Level of Evidence

2 Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DCKTq1

Validating peritonsillar abscess drainage rates using the Pediatric hospital information system data

Objectives

To evaluate the accuracy of the Children's Hospital Association's Pediatric Health Information System (PHIS) registry data in determining surgical drainage rates as compared to a chart review on the same cohort of children with diagnosis of peritonsillar abscess.

Study Design

Retrospective analysis.

Methods

Our analysis included 200 children, ages 2 to 17 years, treated for a peritonsillar abscess from 2011 to 2016. The primary outcome was to determine the sensitivity, specificity, predictive values, receiver operating characteristics (ROC), and likelihood ratios of surgical drainage rates comparing the PHIS database to manual chart review of the same patients.

Results

One hundred and fifteen (58%) children underwent drainage by chart review, whereas 87 (44%) had a drainage procedure by PHIS data. Age was a significant predictor of abscess drainage by chart review (age coefficient = 0.10; standard error = 0.04; 2 = 5.8; P = 0.02; odds ratio = 1.1; 95% confidence interval [CI] = 1.01–1.19). When using the chart review as the reference value for surgical drainage, the PHIS data had a sensitivity of 76% and 100% specificity. The positive and negative predictive values were 100% and 75%, respectively. The ROC area was 0.88 (95% CI, 84 to 92). Cases that lacked a clear procedure note composed the false negative cases in the PHIS.

Conclusion

At our institution, the PHIS Administrative data was adequate at predicting surgical drainage of the peritonsillar abscess when compared to chart review.

Level of Evidence

4. Laryngoscope, 2019

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SvvZMw

Regarding “patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation”

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBdzQm

In response to letter to the editor regarding: “Patient‐reported versus physiologic swallowing outcomes in patients with head and neck cancer after chemoradiation”

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SzWy38

Autoregressive Moving Average Modeling for Hepatic Iron Quantification in the Presence of Fat

Background

Measuring hepatic R2* by fitting a monoexponential model to the signal decay of a multigradient‐echo (mGRE) sequence noninvasively determines hepatic iron content (HIC). Concurrent hepatic steatosis introduces signal oscillations and confounds R2* quantification with standard monoexponential models.

Purpose

To evaluate an autoregressive moving average (ARMA) model for accurate quantification of HIC in the presence of fat using biopsy as the reference.

Study Type

Phantom study and in vivo cohort.

Population

Twenty iron–fat phantoms covering clinically relevant R2* (30–800 s^‐1) and fat fraction (FF) ranges (0–40%), and 10 patients (four male, six female, mean age 18.8 years).

Field Strength/Sequence

2D mGRE acquisitions at 1.5 T and 3 T.

Assessment

Phantoms were scanned at both field strengths. In vivo data were analyzed using the ARMA model to determine R2* and FF values, and compared with biopsy results.

Statistical Tests

Linear regression analysis was used to compare ARMA R2* and FF results with those obtained using a conventional monoexponential model, complex‐domain nonlinear least squares (NLSQ) fat–water model, and biopsy.

Results

In phantoms and in vivo, all models produced R2* and FF values consistent with expected values in low iron and low/high fat conditions. For high iron and no fat phantoms, monoexponential and ARMA models performed excellently (slopes: 0.89–1.07), but NLSQ overestimated R2* (slopes: 1.14–1.36) and produced false FFs (12–17%) at 1.5 T; in high iron and fat phantoms, NLSQ (slopes: 1.02–1.16) outperformed monoexponential and ARMA models (slopes: 1.23–1.88). The results with NLSQ and ARMA improved in phantoms at 3 T (slopes: 0.96–1.04). In patients, mean R2*‐HIC estimates for monoexponential and ARMA models were close to biopsy‐HIC values (slopes: 0.90–0.95), whereas NLSQ substantially overestimated HIC (slope 1.4) and produced false FF values (4–28%) with very high SDs (15–222%) in patients with high iron overload and no steatosis.

Data Conclusion

ARMA is superior in quantifying R2* and FF under high iron and no fat conditions, whereas NLSQ is superior for high iron and concurrent fat at 1.5 T. Both models give improved R2* and FF results at 3 T.

Level of Evidence: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IbTpSv

Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2I7ZQ94

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GuZuIf

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRFHU

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GpXbpO

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRAnA

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GqDRZu

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IapcU0

Future Meetings

Thyroid, Volume 29, Issue 2, Page 307-308, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRv3g

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GpP38y

Autoregressive Moving Average Modeling for Hepatic Iron Quantification in the Presence of Fat

Background

Measuring hepatic R2* by fitting a monoexponential model to the signal decay of a multigradient‐echo (mGRE) sequence noninvasively determines hepatic iron content (HIC). Concurrent hepatic steatosis introduces signal oscillations and confounds R2* quantification with standard monoexponential models.

Purpose

To evaluate an autoregressive moving average (ARMA) model for accurate quantification of HIC in the presence of fat using biopsy as the reference.

Study Type

Phantom study and in vivo cohort.

Population

Twenty iron–fat phantoms covering clinically relevant R2* (30–800 s^‐1) and fat fraction (FF) ranges (0–40%), and 10 patients (four male, six female, mean age 18.8 years).

Field Strength/Sequence

2D mGRE acquisitions at 1.5 T and 3 T.

Assessment

Phantoms were scanned at both field strengths. In vivo data were analyzed using the ARMA model to determine R2* and FF values, and compared with biopsy results.

Statistical Tests

Linear regression analysis was used to compare ARMA R2* and FF results with those obtained using a conventional monoexponential model, complex‐domain nonlinear least squares (NLSQ) fat–water model, and biopsy.

Results

In phantoms and in vivo, all models produced R2* and FF values consistent with expected values in low iron and low/high fat conditions. For high iron and no fat phantoms, monoexponential and ARMA models performed excellently (slopes: 0.89–1.07), but NLSQ overestimated R2* (slopes: 1.14–1.36) and produced false FFs (12–17%) at 1.5 T; in high iron and fat phantoms, NLSQ (slopes: 1.02–1.16) outperformed monoexponential and ARMA models (slopes: 1.23–1.88). The results with NLSQ and ARMA improved in phantoms at 3 T (slopes: 0.96–1.04). In patients, mean R2*‐HIC estimates for monoexponential and ARMA models were close to biopsy‐HIC values (slopes: 0.90–0.95), whereas NLSQ substantially overestimated HIC (slope 1.4) and produced false FF values (4–28%) with very high SDs (15–222%) in patients with high iron overload and no steatosis.

Data Conclusion

ARMA is superior in quantifying R2* and FF under high iron and no fat conditions, whereas NLSQ is superior for high iron and concurrent fat at 1.5 T. Both models give improved R2* and FF results at 3 T.

Level of Evidence: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IbTpSv

Regulation of Foxe1 by Thyrotropin and Transforming Growth Factor Beta Depends on the Interplay Between Thyroid-Specific, CREB and SMAD Transcription Factors

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Gt7t8u

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GuZuIf

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRFHU

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GpXbpO

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRAnA

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GqDRZu

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IapcU0

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GmbQSE

Future Meetings

Thyroid, Volume 29, Issue 2, Page 307-308, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IfRv3g

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GpP38y

Long‐term functional and esthetic outcomes after fibula free flap reconstruction of the mandible

Abstract

Background

The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients.

Methods

Twenty‐five long‐term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient‐reported outcomes, using EORTC, QLQ‐C30, H&N35, and FACE‐Q questionnaires.

Results

Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ‐C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy.

Conclusion

To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UXO7LI

Long‐term functional and esthetic outcomes after fibula free flap reconstruction of the mandible

Abstract

Background

The goal of this study is to report functional and esthetic outcomes, after fibula free flap (FFF) reconstruction of the mandible for oral cancer, assessed by physicians, nonclinicians, and patients.

Methods

Twenty‐five long‐term survivors from oral cancer after FFF reconstruction were recalled for head and neck examination by surgeons, for photographs and patient‐reported outcomes, using EORTC, QLQ‐C30, H&N35, and FACE‐Q questionnaires.

Results

Physicians reported 64% restoration of functionality compared to normal. Patients reported high scores on QLQ‐C30 but lower scores on H&N35. Esthetic scores were reported higher by clinicians than nonclinicians. The decline in function and appearance was attributed to loss of lower dentition, trismus, malocclusion, xerostomia, and tissue atrophy.

Conclusion

To minimize the decline in function and appearance, immediate dental implants in FFF, better reconstruction of the temporomandibular joint, newer methods of radiotherapy to minimize xerostomia and oral exercises to prevent trismus should be considered.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UXO7LI

An Administrator —and Former SLP—Shares His Perspective on the LA Teachers’ Strike 

Editor's note: We are publishing this post after the conclusion of the LA teachers' strike in order to share insights for members about the continuing wave of strikes, such as the current one in Denver. As an administrator in the Speech and Language Program in the Los Angeles Unified School District (LAUSD), I belong to the Associated Administrators of Los Angeles, the union representing administrators. I'm not a member of the union on strike—United Teachers of Los Angeles—so my role during the strike was to provide instruction and supervisory support to those students who reported to school during this time. Schools remained open during the strike and students participated in instructional programs. Qualified LAUSD staff—including reassigned administrators like...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X2gNoX

Regulation of Foxe1 by Thyrotropin and Transforming Growth Factor Beta Depends on the Interplay Between Thyroid-Specific, CREB and SMAD Transcription Factors

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmJaAE

Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GIWKG7

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmJ9wA

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjuqj

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tnjpjs

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tu8Qvj

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjiHB

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIUBG

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIPOo

Regulation of Foxe1 by Thyrotropin and Transforming Growth Factor Beta Depends on the Interplay Between Thyroid-Specific, CREB and SMAD Transcription Factors

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmJaAE

Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GIWKG7

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmJ9wA

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjuqj

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tnjpjs

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GI3jJm

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tu8Qvj

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjiHB

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIUBG

Future Meetings

Thyroid, Volume 29, Issue 2, Page 307-308, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHj7vV

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIPOo

GLIS Rearrangement is a Genomic Hallmark of Hyalinizing Trabecular Tumor of the Thyroid Gland

Thyroid, Volume 29, Issue 2, Page 161-173, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjuqj

Increased Risk of Antithyroid Drug Agranulocytosis Associated with Amiodarone-Induced Thyrotoxicosis: A Population-Based Cohort Study

Thyroid, Volume 29, Issue 2, Page 193-201, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tnjpjs

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GI3jJm

Therapeutic Effects of Short Cyclic and Combined Epitope Peptides in a Long-Term Model of Graves' Disease and Orbitopathy

Thyroid, Volume 29, Issue 2, Page 258-267, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tu8Qvj

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjiHB

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIUBG

Primary Malignant Thyroid Teratoma: An Institutional Experience

Thyroid, Volume 29, Issue 2, Page 229-236, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIPOo

Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GIWKG7

Risk Haplotypes Uniquely Associated with Radioiodine-Refractory Thyroid Cancer Patients of High African Ancestry

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmJ9wA

Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism

Thyroid, Volume 29, Issue 2, Page 252-257, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GI3jJm

Thyroglobulin Is Markedly Elevated in 6- to 24-Month-Old Infants at Both Low and High Iodine Intakes and Suggests a Narrow Optimal Iodine Intake Range

Thyroid, Volume 29, Issue 2, Page 268-277, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GHjiHB

Correction to: Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor (TRAb) During Alemtuzumab Therapy: Evidence that TRAb May Precede Thyroid Dysfunction by Many Years by Muller I, Willis M, Healy S, Nasser T, Loveless S, Butterworth S, Zhang L, Draman MS, Taylor PN, Robertson N, Dayan CM, and Ludgate ME. Thyroid 2018;28:1682–1693. DOI: 10.1089/thy.2018.0232

Thyroid, Volume 29, Issue 2, Page 309-309, February 2019.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tmIUBG

Google ’s Live Transcribe and Sound Amplifier to Make Communications Easier for Deaf and Hard of Hearing

Deaf people and others who have trouble hearing are constantly finding themselves in situations in which communicating with other fellow humans is a challenge. Gesturing and writing things down on paper is simple, but slow and frustrating. Google, a part of Alphabet, is hoping to change that with a couple new tools that will be part of its Android operating system. Live Transcribe is, as the name implies, a real-time transcription app that convert's the voice of a person you're speaking to into text. It was developed with the help of Gallaudet University, a school for the deaf and hard of hearing. The app works in more seventy different languages, an impressive achievement, and it will certainly give Google a new way to be able to peek into the private lives of people around t...

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X0stsd

Digital Analysis of Nasal Airflow Facilitating Decision Support in Rhinosurgery

Facial plast Surg 2019; 35: 003-008
DOI: 10.1055/s-0039-1677720

Successful functional surgery on the nasal framework requires reliable and comprehensive diagnosis. In this regard, the authors introduce a new methodology: Digital Analysis of Nasal Airflow (diANA). It is based on computational fluid dynamics, a statistical shape model of the healthy nasal cavity and rhinologic expertise. diANA necessitates an anonymized tomographic dataset of the paranasal sinuses including the complete nasal cavity and, when available, clinical information. The principle of diANA is to compare the morphology and the respective airflow of an individual nose with those of a reference. This enables morphometric aberrations and consecutive flow field anomalies to localize and quantify within a patient's nasal cavity. Finally, an elaborated expert opinion with instructive visualizations is provided. Using diANA might support surgeons in decision-making, avoiding unnecessary surgery, gaining more precision, and target-orientation for indicated operations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N9hR5W

Current Practical Concepts for Using Rib in Secondary Rhinoplasty

Facial plast Surg 2019; 35: 031-046
DOI: 10.1055/s-0039-1677801

Rhinoplasty is universally considered as the most demanding procedure in facial plastic surgery. Secondary rhinoplasty is its crown jewel, even more complex, and likewise highly fascinating. The evolution of thought and practice in rhinoplasty in the last decades has been quick and steady, progressively acknowledging the importance of maintaining structure in primary rhinoplasty and rebuilding structure in secondary procedures. No longer is the paradigm to achieve a small, thin, and pointy nose, but rather a well-proportioned nose which looks natural, albeit elegant and breathing well. Rib is an essential tool in many secondary procedures, and thus some important concepts have to be well understood and some finesse points mastered. This will provide an elegant reconstruction, identical if possible, or at least not far apart, to what could be achieved by a well-executed primary rhinoplasty, while avoiding the feared luck of a bulky nose stuffed with grafts. These guiding concepts and specific nuances regarding harvesting rib and working with it are the scope and contents of this article.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQr1cL

The Healthy Nasal Cavity—Characteristics of Morphology and Related Airflow Based on a Statistical Shape Model Viewed from a Surgeon's Perspective

Facial plast Surg 2019; 35: 009-013
DOI: 10.1055/s-0039-1677721

Functional surgery on the nasal framework requires referential criteria to objectively assess nasal breathing for indication and follow-up. This motivated us to generate a mean geometry of the nasal cavity based on a statistical shape model. In this study, the authors could demonstrate that the introduced nasal cavity's mean geometry features characteristics of the inner shape and airflow, which are commonly observed in symptom-free subjects. Therefore, the mean geometry might serve as a reference-like model when one considers qualitative aspects. However, to facilitate quantitative considerations and statistical inference, further research is necessary. Additionally, the authors were able to obtain details about the importance of the isthmus nasi and the inferior turbinate for the intranasal airstream.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N3mEpg

Nasal Valve Lift in Nasal Valve Stenosis—A 2 Years Clinical Trial

Facial plast Surg 2019; 35: 014-022
DOI: 10.1055/s-0039-1677854

A clinical study was conducted to determine the effect of nasal valve lift treatment using absorbable, polylactic acid, self-retaining cone threads (Silhouette Soft) in patients with nasal valve stenosis. Sixty patients (n = 60) were included in this prospective study which was performed from January 2015 until December 2018, 19 patients dropped out due to noncompliance. Initially, participants were divided into two equal groups. One was treated by nasal valve lift only, the other additionally received turbinoplasty. A visual analog scale (VAS) was used to rate the sense of nasal ventilation. Patients' satisfaction was examined by a categorical scale, preoperatively, after 1 week, and after 1, 6, 12, 18, and 24 months. For statistical analysis, an univariant variance analysis was conducted to test the significance of differences in nasal breathing within one group at different points of postoperative controls, with the statistical significance set at p < 0.05. Moreover, the two groups were compared with each other regarding results of the categorical scale. After surgical treatment, an improvement is reported by all participants. Average VAS scores were significantly lower between preoperative and every postoperative rating. Although a decline in the effect of breathing improvement is recognizable as threads are dissolved, patients' satisfaction in improvement of nasal breathing is persistent in most cases, even at long-term observation. Overall, these results demonstrate that valve lift is an effective method to treat patients with nasal valve stenosis.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N76pYe

Outcomes in Rhinoplasty

Facial plast Surg 2019; 35: 047-052
DOI: 10.1055/s-0039-1677829

In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQqxDt

Bony Fixation of the Nasal Framework

Facial plast Surg 2019; 35: 023-030
DOI: 10.1055/s-0039-1677767

The importance of a straight and stable central framework is beyond dispute. Many authors allude to technical aspects how to achieve the above-mentioned requirements. Far less is said about the contact zones of the framework and how to achieve a long-lasting and solid fixation. In the authors' patient group, they found the need to work on the septum/the central framework in approximately 84% of the cases. In 61% of the patients, the authors had to operate on the fixation point. Of course, there is a great variety of anatomical findings. So the required techniques differ immensely. The surgeon must be prepared for all kinds of different situations. Especially the dorsal fixation and the anchoring on the maxilla without having a standard anterior nasal spine can be a great challenge. In their daily routine, suture techniques (e.g., the transcutaneous transosseous cerclage suture) have become the authors' working horse for these complex fixation situations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N76hIe

Minimally Invasive Rhinoplasty Technique Using a Hyaluronic Acid Filler and Polydioxanone Threads: An Effective Combination

Facial plast Surg 2019; 35: 109-110
DOI: 10.1055/s-0039-1677719

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQXj7w

Open Piezo Preservation Rhinoplasty: A Case Report of the New Rhinoplasty Approach

Facial plast Surg 2019; 35: 113-118
DOI: 10.1055/s-0039-1678578

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N62xXN

Replacement of the Nasal Dorsum with a Diced Cartilage Glue Graft

Facial plast Surg 2019; 35: 053-057
DOI: 10.1055/s-0039-1677802

The reconstruction of the nasal dorsum after a hump resection is challenging if narrowing of the nose is to be avoided, the nasal skin is very thin, and the nasal bones are short. This report describes the replacement of the bony and cartilaginous nasal dorsum after resection with an anatomically shaped dorsal replacement graft of diced cartilage in fibrin glue. The technique is illustrated with a clinical case and sonographic morphometry of the nasal dorsum and tip. A modification of the diced cartilage glue graft for thin-skinned patients is presented.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQrvQ7

Digital Analysis of Nasal Airflow Facilitating Decision Support in Rhinosurgery

Facial plast Surg 2019; 35: 003-008
DOI: 10.1055/s-0039-1677720

Successful functional surgery on the nasal framework requires reliable and comprehensive diagnosis. In this regard, the authors introduce a new methodology: Digital Analysis of Nasal Airflow (diANA). It is based on computational fluid dynamics, a statistical shape model of the healthy nasal cavity and rhinologic expertise. diANA necessitates an anonymized tomographic dataset of the paranasal sinuses including the complete nasal cavity and, when available, clinical information. The principle of diANA is to compare the morphology and the respective airflow of an individual nose with those of a reference. This enables morphometric aberrations and consecutive flow field anomalies to localize and quantify within a patient's nasal cavity. Finally, an elaborated expert opinion with instructive visualizations is provided. Using diANA might support surgeons in decision-making, avoiding unnecessary surgery, gaining more precision, and target-orientation for indicated operations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N9hR5W

Current Practical Concepts for Using Rib in Secondary Rhinoplasty

Facial plast Surg 2019; 35: 031-046
DOI: 10.1055/s-0039-1677801

Rhinoplasty is universally considered as the most demanding procedure in facial plastic surgery. Secondary rhinoplasty is its crown jewel, even more complex, and likewise highly fascinating. The evolution of thought and practice in rhinoplasty in the last decades has been quick and steady, progressively acknowledging the importance of maintaining structure in primary rhinoplasty and rebuilding structure in secondary procedures. No longer is the paradigm to achieve a small, thin, and pointy nose, but rather a well-proportioned nose which looks natural, albeit elegant and breathing well. Rib is an essential tool in many secondary procedures, and thus some important concepts have to be well understood and some finesse points mastered. This will provide an elegant reconstruction, identical if possible, or at least not far apart, to what could be achieved by a well-executed primary rhinoplasty, while avoiding the feared luck of a bulky nose stuffed with grafts. These guiding concepts and specific nuances regarding harvesting rib and working with it are the scope and contents of this article.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQr1cL

The Healthy Nasal Cavity—Characteristics of Morphology and Related Airflow Based on a Statistical Shape Model Viewed from a Surgeon's Perspective

Facial plast Surg 2019; 35: 009-013
DOI: 10.1055/s-0039-1677721

Functional surgery on the nasal framework requires referential criteria to objectively assess nasal breathing for indication and follow-up. This motivated us to generate a mean geometry of the nasal cavity based on a statistical shape model. In this study, the authors could demonstrate that the introduced nasal cavity's mean geometry features characteristics of the inner shape and airflow, which are commonly observed in symptom-free subjects. Therefore, the mean geometry might serve as a reference-like model when one considers qualitative aspects. However, to facilitate quantitative considerations and statistical inference, further research is necessary. Additionally, the authors were able to obtain details about the importance of the isthmus nasi and the inferior turbinate for the intranasal airstream.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N3mEpg

Profile Templates to Use during Surgery in Precision Rhinoplasty

Facial plast Surg 2019; 35: 111-112
DOI: 10.1055/s-0039-1677830

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SM7eLE

Nasal Valve Lift in Nasal Valve Stenosis—A 2 Years Clinical Trial

Facial plast Surg 2019; 35: 014-022
DOI: 10.1055/s-0039-1677854

A clinical study was conducted to determine the effect of nasal valve lift treatment using absorbable, polylactic acid, self-retaining cone threads (Silhouette Soft) in patients with nasal valve stenosis. Sixty patients (n = 60) were included in this prospective study which was performed from January 2015 until December 2018, 19 patients dropped out due to noncompliance. Initially, participants were divided into two equal groups. One was treated by nasal valve lift only, the other additionally received turbinoplasty. A visual analog scale (VAS) was used to rate the sense of nasal ventilation. Patients' satisfaction was examined by a categorical scale, preoperatively, after 1 week, and after 1, 6, 12, 18, and 24 months. For statistical analysis, an univariant variance analysis was conducted to test the significance of differences in nasal breathing within one group at different points of postoperative controls, with the statistical significance set at p < 0.05. Moreover, the two groups were compared with each other regarding results of the categorical scale. After surgical treatment, an improvement is reported by all participants. Average VAS scores were significantly lower between preoperative and every postoperative rating. Although a decline in the effect of breathing improvement is recognizable as threads are dissolved, patients' satisfaction in improvement of nasal breathing is persistent in most cases, even at long-term observation. Overall, these results demonstrate that valve lift is an effective method to treat patients with nasal valve stenosis.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N76pYe

Outcomes in Rhinoplasty

Facial plast Surg 2019; 35: 047-052
DOI: 10.1055/s-0039-1677829

In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is to measure the outcomes after surgery. Rhinoplasty is a unique operation because the surgeon affects three aspects: shape, function, and psychology of the patient. In an ideal world, the surgeon should have objective means of screening that cover these three aspects before and after surgery to measure outcomes. The goal of this article is to review these tools and compare them.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQqxDt

Bony Fixation of the Nasal Framework

Facial plast Surg 2019; 35: 023-030
DOI: 10.1055/s-0039-1677767

The importance of a straight and stable central framework is beyond dispute. Many authors allude to technical aspects how to achieve the above-mentioned requirements. Far less is said about the contact zones of the framework and how to achieve a long-lasting and solid fixation. In the authors' patient group, they found the need to work on the septum/the central framework in approximately 84% of the cases. In 61% of the patients, the authors had to operate on the fixation point. Of course, there is a great variety of anatomical findings. So the required techniques differ immensely. The surgeon must be prepared for all kinds of different situations. Especially the dorsal fixation and the anchoring on the maxilla without having a standard anterior nasal spine can be a great challenge. In their daily routine, suture techniques (e.g., the transcutaneous transosseous cerclage suture) have become the authors' working horse for these complex fixation situations.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N76hIe

Minimally Invasive Rhinoplasty Technique Using a Hyaluronic Acid Filler and Polydioxanone Threads: An Effective Combination

Facial plast Surg 2019; 35: 109-110
DOI: 10.1055/s-0039-1677719

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQXj7w

Open Piezo Preservation Rhinoplasty: A Case Report of the New Rhinoplasty Approach

Facial plast Surg 2019; 35: 113-118
DOI: 10.1055/s-0039-1678578

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N62xXN

New Tools and Proven Techniques in Rhinoplasty

Facial plast Surg 2019; 35: 001-002
DOI: 10.1055/s-0039-1677885

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SNL9Mr

An Administrator —and Former SLP—Shares His Perspective on the LA Teachers’ Strike 

Editor's note: We are publishing this post after the conclusion of the LA teachers' strike in order to share insights for members about the continuing wave of strikes, such as the current one in Denver. As an administrator in the Speech and Language Program in the Los Angeles Unified School District (LAUSD), I belong to the Associated Administrators of Los Angeles, the union representing administrators. I'm not a member of the union on strike—United Teachers of Los Angeles—so my role during the strike was to provide instruction and supervisory support to those students who reported to school during this time. Schools remained open during the strike and students participated in instructional programs. Qualified LAUSD staff—including reassigned administrators like...

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X2gNoX

An Administrator —and Former SLP—Shares His Perspective on the LA Teachers’ Strike 

Editor's note: We are publishing this post after the conclusion of the LA teachers' strike in order to share insights for members about the continuing wave of strikes, such as the current one in Denver. As an administrator in the Speech and Language Program in the Los Angeles Unified School District (LAUSD), I belong to the Associated Administrators of Los Angeles, the union representing administrators. I'm not a member of the union on strike—United Teachers of Los Angeles—so my role during the strike was to provide instruction and supervisory support to those students who reported to school during this time. Schools remained open during the strike and students participated in instructional programs. Qualified LAUSD staff—including reassigned administrators like...

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2X2gNoX

Identification of the recently described plasminogen gene mutation p.Lys330Glu in a family from Northern Germany with hereditary angioedema

Abstract

Hereditary angioedema (HAE) is a life-threatening disease characterized by recurrent episodes of subcutaneous and mucosal swellings and abdominal cramping. Corticosteroids and antihistamines, which are usually beneficial in histamine-induced acquired angioedema, are not effective in HAE. Therefore, diagnosing HAE correctly is crucial for affected patients. We report a family from Northern Germany with six individuals suffering from recurrent swellings, indicating HAE. Laboratory tests and genetic diagnostics of the genes SERPING1, encoding C1 esterase inhibitor (C1-INH), and F12, encoding coagulation factor XII, were unremarkable. In three affected and one yet unaffected member of the family, we were then able to identify the c.988A > G (also termed c.1100A > G) mutation in the plasminogen (PLG) gene, which has recently been described in several families with HAE. This mutation leads to a missense mutation with an amino acid exchange p.Lys330Glu in the kringle 3 domain of plasminogen. There was no direct relationship between the earlier described cases with this mutation and the family we report here. In all affected members of the family, the symptoms manifested in adulthood, with swellings of the face, tongue and larynx, including a fatal case of a 19 year-old female individual. The frequency of the attacks was variable, ranging between once per year to once a month. In one individual, we also found decreased serum levels of plasminogen as well as coagulation factor XII. As previously reported in patients with PLG defects, icatibant proved to be very effective in controlling acute attacks, indicating an involvement of bradykinin in the pathogenesis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IcjiSc

Identification of the recently described plasminogen gene mutation p.Lys330Glu in a family from Northern Germany with hereditary angioedema

Abstract

Hereditary angioedema (HAE) is a life-threatening disease characterized by recurrent episodes of subcutaneous and mucosal swellings and abdominal cramping. Corticosteroids and antihistamines, which are usually beneficial in histamine-induced acquired angioedema, are not effective in HAE. Therefore, diagnosing HAE correctly is crucial for affected patients. We report a family from Northern Germany with six individuals suffering from recurrent swellings, indicating HAE. Laboratory tests and genetic diagnostics of the genes SERPING1, encoding C1 esterase inhibitor (C1-INH), and F12, encoding coagulation factor XII, were unremarkable. In three affected and one yet unaffected member of the family, we were then able to identify the c.988A > G (also termed c.1100A > G) mutation in the plasminogen (PLG) gene, which has recently been described in several families with HAE. This mutation leads to a missense mutation with an amino acid exchange p.Lys330Glu in the kringle 3 domain of plasminogen. There was no direct relationship between the earlier described cases with this mutation and the family we report here. In all affected members of the family, the symptoms manifested in adulthood, with swellings of the face, tongue and larynx, including a fatal case of a 19 year-old female individual. The frequency of the attacks was variable, ranging between once per year to once a month. In one individual, we also found decreased serum levels of plasminogen as well as coagulation factor XII. As previously reported in patients with PLG defects, icatibant proved to be very effective in controlling acute attacks, indicating an involvement of bradykinin in the pathogenesis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2IcjiSc

RELATIONSHIP OF INFILTRATING INTRAEPITHELIAL T-LYMPHOCYTES IN DIAGNOSIS OF ORAL LICHEN PLANUS VS EPITHELIAL DYSPLASIA: A PILOT STUDY

Identify the type and distribution of CD4+ and CD8+ T-lymphocytes in oral mucosa specimens to potentially distinguish underlying alterations or patterns between oral epithelial dysplasia and oral lichen planus.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TIRaay

Expression of Cornulin in Oral Premalignant Lesions

To evaluate expression of cornulin in oral mucosa as an adjunct to histopathologic grading of oral epithelial dysplasia (OED).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BApq0Z

T2 relaxation times of the retrodiscal tissue in patients with temporomandibular joint disorders and healthy volunteers: A comparative study

The aims of this study were to compare temporomandibular joint (TMJ) retrodiscal tissue T2 relaxation times between patients with temporomandibular disorders (TMDs) and asymptomatic volunteers and to assess their diagnostic potential.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNTBZr

RELATIONSHIP OF INFILTRATING INTRAEPITHELIAL T-LYMPHOCYTES IN DIAGNOSIS OF ORAL LICHEN PLANUS VS EPITHELIAL DYSPLASIA: A PILOT STUDY

Identify the type and distribution of CD4+ and CD8+ T-lymphocytes in oral mucosa specimens to potentially distinguish underlying alterations or patterns between oral epithelial dysplasia and oral lichen planus.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TIRaay

Expression of Cornulin in Oral Premalignant Lesions

To evaluate expression of cornulin in oral mucosa as an adjunct to histopathologic grading of oral epithelial dysplasia (OED).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BApq0Z

T2 relaxation times of the retrodiscal tissue in patients with temporomandibular joint disorders and healthy volunteers: A comparative study

The aims of this study were to compare temporomandibular joint (TMJ) retrodiscal tissue T2 relaxation times between patients with temporomandibular disorders (TMDs) and asymptomatic volunteers and to assess their diagnostic potential.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNTBZr

The value of MYB as a prognostic marker for adenoid cystic carcinoma: A meta‐analysis

Abstract

The aim of this meta‐analysis is to evaluate myeloblastosis (MYB) as a prognostic marker for patients with adenoid cystic carcinoma (ACC) with respect to MYB gene fusion, MYB protein expression, and tumor sites.

We comprehensively searched PubMed, Embase, Web of Science, and Cochrane libraries. Ten studies concerning the prognostic comparisons between MYB positivity and negativity were included.

The combined positive rates of MYB gene fusion and protein expression were 57.2% and 62.3%, respectively. Overall, no significant prognostic differences were observed between MYB‐positive and MYB‐negative ACCs. When further divided into MYB gene fusion and MYB protein expression subgroups, no significant differences were observed for any survival outcome (overall survival, disease‐free survival, and local control rate). Moreover, MYB also demonstrated no prognostic value in head and neck ACCs.

In conclusion, the current studies reveal that MYB is not a good prognostic marker for ACC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByoCJM

Fasting serum glucose, thyroid‐stimulating hormone, and thyroid hormones and risk of papillary thyroid cancer: A case‐control study

Abstract

Background

This study was to investigate the association of fasting serum glucose (FSG), thyroid‐stimulating hormone (TSH), and thyroid hormones with papillary thyroid cancer (PTC).

Methods

A total of 649 participants were included in this case‐control study. The associations of FSG, TSH, free triiodothyronine (FT3) and free thyroxine (FT4) with PTC were estimated using an unconditional logistic regression.

Results

Compared with the lowest quintile of TSH levels, odds ratios (ORs) and 95% confidence intervals (CIs) for association between PTC risk and highest quintile of TSH levels were 1.67 (95% CI, 0.99‐2.83). However, this risk correlation was more significant in PTC cases with ≤1.0 cm tumor size (adjusted OR, 1.95; 95% CI, 1.08‐3.54; adjusted P‐trend, 0.05). The PTC risk was also inversely associated with the serum FT3 level in all participants (adjusted P‐trend, 0.001), but positively associated with the serum FT4 (adjusted P‐trend, 0.001) and FSG (adjusted P‐trend, 0.01) levels. Among the participants without diabetes, the individuals with high FSG levels and abnormal TSH concentration had an increased PTC risk (adjusted OR, 3.38; 95% CI, 1.78‐6.42).

Conclusion

The current study provides evidence for the association of FSG, TSH, and thyroid hormones (FT3 and FT4) with PTC risk. However, larger relative studies are needed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNzx9H

Evaluating contemporary pain management practices in thyroid and parathyroid surgery: A national survey of head and neck endocrine surgeons

Abstract

Background

There is currently a lack of evidence‐based guidelines regarding postoperative opioids after thyroid and parathyroid surgery. This study aimed to objectively characterize contemporary postoperative pain management practices via a national survey of head and neck endocrine surgeons.

Methods

A standardized electronic survey was distributed to the membership of the American Head and Neck Society's Endocrine section.

Results

A total of 102 surgeons completed the survey representing a 34% response rate. In all, 65.7% of respondents utilize opioids with wide variations in the total morphine equivalents prescribed. Practice environment (χ² = 10.0; P = 0.04) and performing preoperative pain counseling (χ² = 9.7; P = 0.002) were significantly associated with a decreased likelihood of prescribing postoperative opioids. Utilization of non‐opioid pain management strategies was common and significantly associated with performing outpatient surgery (χ² = 6.2; P = 0.013) and preoperative pain counseling (χ² = 4.5; P = 0.034).

Conclusions

Pain management practice patterns vary significantly among head and neck endocrine surgeons which further emphasize the need for evidence‐based guidelines.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByoBFI

Unique mutation patterns in anaplastic thyroid cancer identified by comprehensive genomic profiling

Abstract

Introduction

Anaplastic thyroid cancer (ATC) is a highly aggressive thyroid cancer. Those ATC with genomic alterations (GAs) in TSC2, ALK, and BRAF may respond to targeted therapies.

Methods

Comprehensive genomic profiling on 90 ATC specimens identified base substitutions, short insertions and deletions, amplifications, copy number alterations, and genomic rearrangements in up to 315 cancer‐related genes and 28 genes commonly rearranged in cancer.

Results

Median patient age was 65 (range, 33‐86) years, 50 patients were male. There was a mean of 4.2 GA per case, range 1‐11. The most common GA were TP53 (66%), BRAF (34%), TERT (32%), CDKN2A (32%), and NRAS (26%). BRAF V600E and NRAS/HRAS/KRAS alteration were mutually exclusive. BRAF, CDKN2A, PIK3CA, and JAK2 were more frequent in patients >70 years of age; while myc, PTEN, and NRAS were more common in those ≤50 years.

Conclusion

ATC shows many GA with potential therapeutic significance and suggesting different molecular pathways can lead to ATC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNzsCV

Resected specimen size: A reliable predictor of severe Frey syndrome after parotidectomy

Abstract

Background

Frey syndrome is a common complication after parotidectomy. This study aimed to investigate the potential predictors for developing severe Frey syndrome after parotidectomy and to identify patients who may benefit from additional preventive maneuvers.

Methods

A total of 485 patients received parotidectomy because of parotid tumors at the Otolaryngology Department of the National Cheng Kung University Hospital, from July 2009 to November 2015. Only 115 of 485 patients were included in this study and to fill in a questionnaire to determine the occurrence and severity of Frey syndrome.

Results

A total of 115 parotidectomies were identified. 84 (73%, 84/115) patients were aware of the discomfort and were thus considered symptomatic. 39 (34%, 39/115) patients considered the symptoms apparently affected their quality of life. MSI tests showed that 56 (49%, 56/115) patients had a positive MSI test. By combining the results from symptom questionnaire and MSI test, 23 patients (20%, 23/115) had a severe form of Frey syndrome. Among all clinicopathological variables, the resected specimen size was the only significant predictor of the severe Frey syndrome group (P = 0.04). Disease pathology, tumor size, and adjuvant radiotherapy did not correlate with the severe Frey syndrome. Using receiver operating curve analysis, the best cutoff value of the resected specimen size (in largest dimension) for predicting severe Frey syndrome was 40 mm(sensitivity: 71.7%, specificity: 42.0%; area under the curve = 0.6483). The odds ratio of severe Frey syndrome with every 10 mm increase in the largest diameter of resected specimen was 1.30 (95% confidence interval, 1.01‐1.68; P = 0.04).

Conclusions

Resected specimen size is the only significant predictor of developing severe Frey syndrome after parotidectomy. Preventive interventions may have to be considered in high‐risk patients whose resected specimen size (in largest dimension) is greater than 40 mm.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByTmuq

The value of MYB as a prognostic marker for adenoid cystic carcinoma: A meta‐analysis

Abstract

The aim of this meta‐analysis is to evaluate myeloblastosis (MYB) as a prognostic marker for patients with adenoid cystic carcinoma (ACC) with respect to MYB gene fusion, MYB protein expression, and tumor sites.

We comprehensively searched PubMed, Embase, Web of Science, and Cochrane libraries. Ten studies concerning the prognostic comparisons between MYB positivity and negativity were included.

The combined positive rates of MYB gene fusion and protein expression were 57.2% and 62.3%, respectively. Overall, no significant prognostic differences were observed between MYB‐positive and MYB‐negative ACCs. When further divided into MYB gene fusion and MYB protein expression subgroups, no significant differences were observed for any survival outcome (overall survival, disease‐free survival, and local control rate). Moreover, MYB also demonstrated no prognostic value in head and neck ACCs.

In conclusion, the current studies reveal that MYB is not a good prognostic marker for ACC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByoCJM

Fasting serum glucose, thyroid‐stimulating hormone, and thyroid hormones and risk of papillary thyroid cancer: A case‐control study

Abstract

Background

This study was to investigate the association of fasting serum glucose (FSG), thyroid‐stimulating hormone (TSH), and thyroid hormones with papillary thyroid cancer (PTC).

Methods

A total of 649 participants were included in this case‐control study. The associations of FSG, TSH, free triiodothyronine (FT3) and free thyroxine (FT4) with PTC were estimated using an unconditional logistic regression.

Results

Compared with the lowest quintile of TSH levels, odds ratios (ORs) and 95% confidence intervals (CIs) for association between PTC risk and highest quintile of TSH levels were 1.67 (95% CI, 0.99‐2.83). However, this risk correlation was more significant in PTC cases with ≤1.0 cm tumor size (adjusted OR, 1.95; 95% CI, 1.08‐3.54; adjusted P‐trend, 0.05). The PTC risk was also inversely associated with the serum FT3 level in all participants (adjusted P‐trend, 0.001), but positively associated with the serum FT4 (adjusted P‐trend, 0.001) and FSG (adjusted P‐trend, 0.01) levels. Among the participants without diabetes, the individuals with high FSG levels and abnormal TSH concentration had an increased PTC risk (adjusted OR, 3.38; 95% CI, 1.78‐6.42).

Conclusion

The current study provides evidence for the association of FSG, TSH, and thyroid hormones (FT3 and FT4) with PTC risk. However, larger relative studies are needed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNzx9H

Evaluating contemporary pain management practices in thyroid and parathyroid surgery: A national survey of head and neck endocrine surgeons

Abstract

Background

There is currently a lack of evidence‐based guidelines regarding postoperative opioids after thyroid and parathyroid surgery. This study aimed to objectively characterize contemporary postoperative pain management practices via a national survey of head and neck endocrine surgeons.

Methods

A standardized electronic survey was distributed to the membership of the American Head and Neck Society's Endocrine section.

Results

A total of 102 surgeons completed the survey representing a 34% response rate. In all, 65.7% of respondents utilize opioids with wide variations in the total morphine equivalents prescribed. Practice environment (χ² = 10.0; P = 0.04) and performing preoperative pain counseling (χ² = 9.7; P = 0.002) were significantly associated with a decreased likelihood of prescribing postoperative opioids. Utilization of non‐opioid pain management strategies was common and significantly associated with performing outpatient surgery (χ² = 6.2; P = 0.013) and preoperative pain counseling (χ² = 4.5; P = 0.034).

Conclusions

Pain management practice patterns vary significantly among head and neck endocrine surgeons which further emphasize the need for evidence‐based guidelines.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByoBFI

Unique mutation patterns in anaplastic thyroid cancer identified by comprehensive genomic profiling

Abstract

Introduction

Anaplastic thyroid cancer (ATC) is a highly aggressive thyroid cancer. Those ATC with genomic alterations (GAs) in TSC2, ALK, and BRAF may respond to targeted therapies.

Methods

Comprehensive genomic profiling on 90 ATC specimens identified base substitutions, short insertions and deletions, amplifications, copy number alterations, and genomic rearrangements in up to 315 cancer‐related genes and 28 genes commonly rearranged in cancer.

Results

Median patient age was 65 (range, 33‐86) years, 50 patients were male. There was a mean of 4.2 GA per case, range 1‐11. The most common GA were TP53 (66%), BRAF (34%), TERT (32%), CDKN2A (32%), and NRAS (26%). BRAF V600E and NRAS/HRAS/KRAS alteration were mutually exclusive. BRAF, CDKN2A, PIK3CA, and JAK2 were more frequent in patients >70 years of age; while myc, PTEN, and NRAS were more common in those ≤50 years.

Conclusion

ATC shows many GA with potential therapeutic significance and suggesting different molecular pathways can lead to ATC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TNzsCV

Resected specimen size: A reliable predictor of severe Frey syndrome after parotidectomy

Abstract

Background

Frey syndrome is a common complication after parotidectomy. This study aimed to investigate the potential predictors for developing severe Frey syndrome after parotidectomy and to identify patients who may benefit from additional preventive maneuvers.

Methods

A total of 485 patients received parotidectomy because of parotid tumors at the Otolaryngology Department of the National Cheng Kung University Hospital, from July 2009 to November 2015. Only 115 of 485 patients were included in this study and to fill in a questionnaire to determine the occurrence and severity of Frey syndrome.

Results

A total of 115 parotidectomies were identified. 84 (73%, 84/115) patients were aware of the discomfort and were thus considered symptomatic. 39 (34%, 39/115) patients considered the symptoms apparently affected their quality of life. MSI tests showed that 56 (49%, 56/115) patients had a positive MSI test. By combining the results from symptom questionnaire and MSI test, 23 patients (20%, 23/115) had a severe form of Frey syndrome. Among all clinicopathological variables, the resected specimen size was the only significant predictor of the severe Frey syndrome group (P = 0.04). Disease pathology, tumor size, and adjuvant radiotherapy did not correlate with the severe Frey syndrome. Using receiver operating curve analysis, the best cutoff value of the resected specimen size (in largest dimension) for predicting severe Frey syndrome was 40 mm(sensitivity: 71.7%, specificity: 42.0%; area under the curve = 0.6483). The odds ratio of severe Frey syndrome with every 10 mm increase in the largest diameter of resected specimen was 1.30 (95% confidence interval, 1.01‐1.68; P = 0.04).

Conclusions

Resected specimen size is the only significant predictor of developing severe Frey syndrome after parotidectomy. Preventive interventions may have to be considered in high‐risk patients whose resected specimen size (in largest dimension) is greater than 40 mm.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ByTmuq