Clival Meningioma Removal through a Suboccipital Retrosigmoid Approach: Operative Video and Technical Nuances

xlomafota13 shared this article with you from Inoreader Clival Meningioma Removal through a Suboccipital Retrosigmoid Approach: Operative Video and Technical Nuances Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1705163 Background Clival meningiomas are challenging lesions that need to be managed according to the displacement of the adjacent structures. Lateral skull base approaches are needed to achieve their radical removal; however, they are associated with significant morbidity, especially when the tumor involves the basilar artery, its perforators, brainstem, and lower cranial nerves. Design This is a case of a 79-year-old female patient, diagnosed with a large lower clival meningioma after suffering from headaches. It was offered a conservative treatment but on serial MRI, an increase in the meningioma's size was observed, so it was decided to remove the meningioma using a left suboccipital retrosigmoid approach. Settings On a left three-quarter prone position, with facial nerve, auditory brainstem response, lower cranial nerves, and motor-evoked potentials and somatosensory-evoked potentials neurophysiologic monitoring, a right suboccipital retrosigmoid craniotomy with opening of the foramen magnum was performed, giving enough lateral visualization of the tumor. Broad base tumor pushing backward and aside the vertebral and basilar arteries, cranial nerves (7th–12th), and the brainstem was exposed and removed. Results Near total resection of the meningioma was achieved, leaving a microscopic residual in the entry points of the low cranial nerves without complications. There was no neurological deficit after the surgery. Postoperative MRI revealed no signs of residual tumor. Conclusion: In this case, the regular retrosigmoid approach, extended into the foramen magnum was enough for the removal of this pure clival meningioma.The link to the video can be found at: https://youtu.be/3d6Uj4gjmDU. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IBCC chapter & cast – Ventilator Associated Pneumonia (VAP)

xloma.fota.13 shared this article with you from Inoreader IBCC chapter & cast – Ventilator Associated Pneumonia (VAP) Via EMCrit Blog - Emergency Department Critical Care VAP is a perennial riddle in the intensive care unit.  There are numerous murky diagnostic tests, but no single gold-standard diagnostic test.  Consequently, we are usually left wondering whether or not the patient truly has a VAP.  This makes VAP an unsatisfying diagnosis, as we are continually walking a blurred line between undertreatment and overtreatment. […] EMCrit Project by Josh Farkas. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Oral mucosal calcified nodule requiring palatoplasty.

xloma.fota.13 shared this article with you from Inoreader Oral mucosal calcified nodule requiring palatoplasty. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Oral mucosal calcified nodule requiring palatoplasty. Int J Pediatr Otorhinolaryngol. 2020 Oct 28;139:110476 Authors: Panico E, Robinette K, Kelly D, Wiatrak B Abstract Calcinosis cutis describes a condition of pathologic calcium deposition in the dermis. Several subtypes exist, including the subepidermal calcified nodule. The oral mucosal calcified nodule (OMCN) was posited in 1992 as a specific term for a subepidermal calcified nodule occurring in the oral cavity, and since that time only six such lesions have been described in the literature. This report explores a case of OMCN on the palate of a 3-month-old infant with the goal of supplementing extant literature, providing a consideration of the differentials of palatal lesions in the pediatric population, and describing a unique instance in which OMCN resulted in a full-thickness defect requiring palatoplasty for repair. PMID: 33166754 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review.

xloma.fota.13 shared this article with you from Inoreader Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: A systematic review. Int J Pediatr Otorhinolaryngol. 2020 Nov 04;139:110482 Authors: Saniasiaya J, Kulasegarah J Abstract INTRODUCTION: Paediatrics obstructive sleep apnoea have been discussed to a great degree over the recent years and remains a conundrum till date. The advent of instrumentation has aided upper airway evaluation in determining the site and degree of upper airway collapse for targeted and effective surgical planning. The literature was reviewed to determine the outcome of Drug Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnoea. MATERIAL AND METHODS: A literature search was conducted for the period from January 2000 to December 2019 by using a number of medical literature data bases including Scopus, PubMed and Embase. The following search words were used either individually or in combination: drug-induced sleep endoscopy, sleep endoscopy directed surgery, paediatrics sleep apnoea. The search was conducted over a month period (December 2019). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible. RESULTS: Seven clinical research articles were selected based on our objective and selection criteria. Seven studies were of level III evidence: retrospective, case-control and prospective series. Altogether, there were 996 patients with male predominance; 61%. Over 10% of patients (133 patients) were found to have comorbidities or were syndromic. The mean age of patient was 6 years and majority (87.6%) of our patients were found to be surgically naïve, that is, no previous surgical procedures were performed for OSA. Surgical decision was changed in 295 patients (30%) following DISE. Post intervention outcomes were objectively revealed in 4 studies. Most of our patients underwent a multilevel surgery based on DISE (86%). Complications were documented in 3 studies. CONCLUSIONS: Analysis of the results indicated that DISE directed surgery was an effective, safe therapeutic approach to treating paediatrics obstructive sleep apnoea. DISE directed surgery has shown to have changed surgical management in most studies. PMID: 33166755 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A new dimension of success in the management of airway disease in children with neurological deficit.

xloma.fota.13 shared this article with you from Inoreader A new dimension of success in the management of airway disease in children with neurological deficit. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles A new dimension of success in the management of airway disease in children with neurological deficit. Int J Pediatr Otorhinolaryngol. 2020 Nov 04;139:110483 Authors: Kokje VBC, Mermod M, Bertinazzi M, Sandu K Abstract OBJECTIVES: Anomalies of the larynx and trachea can cause respiratory distress in infants and older children. Depending on its nature, degree and extent of the disease invasive open surgery is indicated. Non-airway-related co-morbidities increase the challenges in its treatment. Neurological deficit poses a great challenge as it is associated with hypotonia and causes diminished laryngeal coordination. The definition of success in treatment of laryngotracheal disease has always focused on the post-operative functional outcomes: breathing, voice swallowing. The aim of this study is to describe a new dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit, where the expected functional gain is less than in otherwise healthy children. METHODS: This retrospective observational study includes all patients who have undergone open reconstructive airway surgery between 2012 and 2017. Control patients without neurological deficit and cases with moderate neurological deficit were included. Functional outcome data was obtained from clinical records and two questionnaires were filled in by the parents of the children: one the pediatric voice-handicap index (pVHI) and a quality of life questionnaire. RESULTS: Thirty-two children were included of which ten had moderate neurological deficit. Both groups revealed post-operatively an improvement in the functional outcomes: breathing, voice and swallowing, however, as expected, a trend was observed towards less functional improvement in children with neurological deficit. Both groups reveal a remarkable gain in quality of life (QoL). CONCLUSION: Indicating the QoL to be an unidentified, dimension of success in the management of laryngotracheal disease in children with moderate neurological deficit. PMID: 33166756 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis

xloma.fota.13 shared this article with you from Inoreader Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016). Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016). Int J Pediatr Otorhinolaryngol. 2020 Nov 05;:110485 Authors: Sapir A, Ziv O, Leibovitz E, Kordeluk S, Rinott E, El-Saied S, Greenberg D, Kaplan DM Abstract OBJECTIVES: To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction. METHODS: Medical records of all AM patients <15 years of age diagnosed during 2005-2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005-2008), interim (2009-2011) and post-PCV13 vaccination (2012-2016). RESULTS: 238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 se rotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes. CONCLUSIONS: The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period. PMID: 33168224 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Understanding child anxiety before otoplasty: A qualitative study.

xloma.fota.13 shared this article with you from Inoreader Understanding child anxiety before otoplasty: A qualitative study. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Understanding child anxiety before otoplasty: A qualitative study. Int J Pediatr Otorhinolaryngol. 2020 Nov 07;139:110489 Authors: Prabhu N, MacNevin W, Wheelock M, Hong P, Bezuhly M Abstract BACKGROUND: Pre-operative anxiety in pediatric patients is a major concern in surgical care due to the future medical and behavioral consequences that can occur. The objective of this study was to understand the factors that lead to pre-operative anxiety before otoplasty. METHODS: Participants at a Canadian pediatric hospital were identified to discuss their experience with otoplasty and any anxiety they experienced using a semi-structured interview. Interviews were transcribed and analyzed using a qualitative semantic thematic approach. Major themes were identified and supporting quotes were extracted from the interviews. RESULTS: Ten participants were enrolled in the study. Three main themes (and seven subthemes) were identified: concern for post-operative well-being (perception by others, physical well-being, and negative experiences), fear of the unknown (surgical uncertainty, vulnerability), and support (family and friends, surgeon). CONCLUSIONS: Otoplasty was shown to be an emotional experience for participants with multiple sources of anxiety being identified. While most anxiety sources were similar to those for other pediatric surgeries, a number were specific to otoplasty and its post-operative care plan. This understanding of anxiety will allow physicians and care teams to better prepare patients and their families for otoplasty and enhance the patient's overall experience. PMID: 33186854 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IBCC chapter & cast – Toxic Shock Syndrome

xloma.fota.13 shared this article with you from Inoreader IBCC chapter & cast – Toxic Shock Syndrome Via EMCrit Blog - Emergency Department Critical Care Not all septic shock is created equal.  Toxic shock syndrome is one of the most fulminant and dangerous forms of septic shock.  It is one of the few infectious diseases capable of rapidly killing previously healthy young people.  Most importantly, toxic shock syndrome requires targeted therapy – it often fails to respond to conventional therapy […] EMCrit Project by Josh Farkas. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech.

xloma.fota.13 shared this article with you from Inoreader Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Nasal rustle: The retrospective and prospective investigation of effects of bubbling of secretions on speech. Int J Pediatr Otorhinolaryngol. 2020 Nov 01;:110480 Authors: Hosseinabad HH, Kummer AW, Boyce S Abstract OBJECTIVE: "Nasal rustle" is a type of nasal emission associated with a small velopharyngeal (VP) gap and distracting loud noise. Currently, the mechanisms behind noise generation are unclear. In this study, we use a combination of retrospective and prospective data to test the hypotheses that bubbling of secretions could be a source of audible noise. DESIGN: Retrospective: Nasopharyngoscopy records of 151 patients with nasal rustle were reviewed to determine if bubbling occurred during their nasopharyngoscopy examination. Prospective: Nine children with nasal rustle and bubbling of secretions were suctioned with the scope in place to assure removal of secretions. The Nasometer II was used to record the children's production of oral sentences prior to and post suctioning. All sentences were analyzed for the presence or absence of noise, nasalance scores, and Cepstral Peak Prominence (CPP). Intra-and inter-judge reliability of coding was high. RESULTS: Retrospective: 70% of the patients with nasal rustle had bubbling of secretions during nasopharyngoscopy. Prospective: Percentages of audible noise were reduced significantly post suctioning (Friedman's Test, Chi-square = 24.5, p = 0.001) with the greatest decrease in syllables with fricatives and bilabial stops (p < 0.05). The average CPP and nasalance scores pre-vs post-suctioning showed no significant differences (p = 0.91, 0.29). CONCLUSIONS: Retrospective: The high percentage of patients with nasal rustle had bubbling of secretions when producing speech in nasopharyngoscopy evaluations. Prospective: The incidence of audible noise was reduced as a result of suctioning. This suggests that the presence of secretions contributes to the production of nasal rustle. PMID: 33187722 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence and causes of visual impairment among hearing impaired students

xloma.fota.13 shared this article with you from Inoreader Prevalence and causes of visual impairment among hearing impaired students in Lagos, Nigeria. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Prevalence and causes of visual impairment among hearing impaired students in Lagos, Nigeria. Int J Pediatr Otorhinolaryngol. 2020 Nov 07;139:110487 Authors: Abikoye TM, Aribaba OT, Musa KO, Idowu OO Abstract OBJECTIVES: To determine the prevalence and causes of visual impairment in hearing-impaired students in Lagos, Nigeria and to assess their level of ophthalmic care utilization. METHODS: Descriptive cross sectional study carried out in a primary school for hearing impaired students in Lagos, Nigeria. Socio-demographic characteristics, medical and ocular history were obtained. Ocular examination comprised of distance and near visual acuity assessment; cover tests; anterior segment examination and direct fundoscopy. Visually impaired students had cycloplegic refraction, dilated fundoscopy and subjective refraction. In-depth interviews were carried out for parents of students requiring referral for further eye care. RESULTS: One hundred and nine students participated in the study. The prevalence of visual impairment was 19%. The causes of visual impairment were refractive error (11%), amblyopia (6%), cataract (1%) and macular scarring (1%). A lower mean age (p = 0.020) and ocular misalignment (p = 0.037) were associated with visual impairment on multivariate analysis. The spectacle correction coverage was 11% and only 8% of the students had prior ophthalmic care utilization. Ignorance of ocular morbidity and perceived inaccessibility of eye care were cited by parents/guardians as reasons for poor utilization of eye-care services. CONCLUSION: A high prevalence of visual impairment was found among the hearing impaired students; uncorrected refractive error and refractive amblyopia were the most prevalent causes. The level of prior ophthalmic service utilization was found to be low. It was recommended that ophthalmic services especially refractive services should be made available in schools for the hearing impaired. PMID: 33190026 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hearing preservation with a slim modiolar cochlear implant in a pediatric cohort.

xloma.fota.13 shared this article with you from Inoreader Hearing preservation with a slim modiolar cochlear implant in a pediatric cohort. Via International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Related Articles Hearing preservation with a slim modiolar cochlear implant in a pediatric cohort. Int J Pediatr Otorhinolaryngol. 2020 Nov 01;:110479 Authors: Jimenez JE, Govil N, Shaffer AD, Ledonne JC, Chi DH Abstract OBJECTIVES: Recent cochlear implant (CI) electrodes are designed to be atraumatic to inner ear structures. Studies in adults have demonstrated improved hearing preservation rates with the CI532/632 electrode, but none have examined this in children. Our objective is to describe the hearing preservation rate with CI532/632 in pediatric patients and determine factors that influence hearing preservation. METHODS: We conducted a retrospective cohort study of children undergoing CI over a three-year period. Inclusion criteria were: CI with the 532/632 electrode, presence of pre-operative low frequency hearing defined by pure tone average (PTA) of ≤80 dB at 250 Hz or at the average of 250 and 500 Hz, and post-operative unaided audiometry. Other data collected included demographics, otologic history, imaging, and surgical details. RESULTS: A total of 13 patients and 15 ears were included. Hearing was preserved in 10/15 (66%) ears at an average follow-up of 6 months, similar to that reported in the adult literature. Patients with preserved hearing post-operatively were more likely to have a positive family history of hearing loss. There was a trend towards patients with anatomic inner ear abnormalities being more likely to lose hearing after CI, but this was not statistically significant. Pre-operative thresholds were not predictive of hearing preservation. Patients with preserved hearing had a significantly smaller shift in thresholds after cochlear implantation. Therefore, hearing preserved and non-preserved groups differed more by the magnitude of change in threshold, rather than their preoperative threshold. Other factors such as age, sex, surgeon, and surgery duration were not associated with hearing preservation. CONCLUSION: This study describes low frequency hearing preservation after pediatric CI532/632 implantation. The hearing preservation rate in our cohort was consistent with that reported in the adult literature. Our data suggest that preoperative thresholds do not solely determine which patients will go on to experience hearing preservation. We believe this will aid surgeons with patient-specific device selection and counseling potential pediatric CI recipients with preserved hearing. PMID: 33190921 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.