Τρίτη 27 Ιουλίου 2021

A Large Intraoral Lipoma: Case Report

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Abstract

Lipomas of the oral cavity are uncommon. Here we report a case of 85 year old female presenting with a progressively increasing large growth in the oropharynx which was diagnosed as lipoma on histopathology. The clinicoradiological and histopathological findings are discussed. To the best of our knowledge; this is one of the largest intraoral lipoma reported in India till date. The present case highlights the need to be aware of intraoral lipomas which can present as large growths at this unusual site so as to avoid any unwarranted aggressive surgery.

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Nasopharyngeal Tuberculosis mimicking Nasopharyngeal Carcinoma: A Case Series

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Abstract

Tuberculosis is a highly contagious granulomatous disease which is endemic in South East Asia. Most common presentation is pulmonary tuberculosis which is spread by droplets inhalation of mycobacterium tuberculosis bacterium. Nasopharyngeal tuberculosis is a rare entity which poses a diagnostic difficulty as its presentation is greatly similar to that of nasopharyngeal carcinoma. Herein, we describe two cases of nasopharyngeal tuberculosis which mimics nasopharyngeal malignancy leading to diagnostic difficulties.

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Negative pressure wound therapy in cases of spinal surgery and exposed dura: a case-based review

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Childs Nerv Syst. 2021 Jul 26. doi: 10.1007/s00381-021-05302-9. Online ahead of print.

ABSTRACT

PURPOSE: Study of negative pressure wound therapy (NPWT) safety for patients with intraoperative exposure of the dura.

METHODS: We analyzed the literature on the NPWT usage after spinal surgery in patients with exposure of the dura. We also described our experience of NPWT in 3 pediatric patients with spinal dysraphism. Due to the peculiarities of the anatomy (spina bifida), all of these patients had dural sac exposure during spinal surgery.

RESULTS: The reasons for NPWT in all three cases were different. In the first patient with segmental spinal dysgenesis, surgery was complicated by extensive postoperative wound necrosis and the formation of soft tissue deficiency. The second patient with post-myelomeningocele kyphosis had a deficiency of soft tissues during spinal surgery due to a large bedsore at the apex of the deformity. And in t he third patient also with post-myelomeningocele kyphosis, NPWT was applied with surgical site infection. In all three cases, NPWT was used when the dura was exposed, without complications and with satisfactory results. The observation period for the patients was 3 years, 2.5 years, and 2 years, respectively.

CONCLUSIONS: The usage of NPWT in cases of wound complications in the spinal surgery may be a useful option, which allows saving implants. NPWT is not contraindicated in cases of intraoperative dural exposure if there are no signs of cerebrospinal fluid (CSF) leak.

PMID:34312707 | DOI:10.1007/s00381-021-053 02-9

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Immunohistochemical study of inflammatory responses in septa arising from type I intestinal atresia

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Histol Histopathol. 2021 Jul 27:18364. doi: 10.14670/HH-18-364. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate defensive functional cells in intestinal septa during recanalization in the embryonic period, and to access immune responses in septa arising from type I intestinal atresia and normal intestinal walls. Tissue samples were of septa located in the intestinal wall at a distance <15cm from the ligament of Treitz, and normal intestine walls obtained from seven neonates who underwent surgery. Following serial tissue sectioning, the samples were subjected to hematoxylin and eosin (HE), periodic acid-Schiff (PAS) and immunohistochemical staining to determine the morphological features and markers of functional cells and immune responses in the septa and normal intestinal walls. Quantitative analysis was conducted to compare differences between them. Compared with normal intestinal wall, the mucosal layer of septa arising from type I intestinal atresia had fewer misaligned villi and no classic epithelial crypts. Immunohistochemical staining showed that the mucosal layer of septa arising from type I intestinal atresia had fewer Paneth cells and goblet cells and lower amounts of lysozyme and MUC2, than normal intestinal walls. The concentration of pro-inflammatory cytokines, including interlukin (IL)-6 and tumor necrosis factor (TNF) -α, as well as macrophage inflammatory protein 3α (MIP-3α) and its receptor, CCR6, were higher in the mucosal layer of septa arising from type I intestinal atresia than in normal intestinal walls. Moreover, the numbers of mature dendritic cells and CD4+ T lymphocytes were higher in the mucosal layer of septa than in normal intestinal walls. The defensive activity of septa arising from type I intestinal atresia is weaker than that of normal intestinal walls. This weaker activity may correlate with increases in mature dendritic cells and CD4+ T lymphocyte s, as well overexpression of proinflammatory cytokines.

PMID:34312829 | DOI:10.14670/HH-18-364

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The COVID-19 pandemic and its effects on otorhinolaryngology, head and neck surgery

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HNO. 2021 Aug;69(8):609-610. doi: 10.1007/s00106-021-01091-4. Epub 2021 Jul 27.

NO ABSTRACT

PMID:34313793 | DOI: 10.1007/s00106-021-01091-4

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Subjective and objective evaluation of swallowing in lateral decubitus positions examined in healthy volunteers

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Eur Arch Otorhinolaryngol. 2021 Jul 27. doi: 10.1007/s00405-021-07001-2. Online ahead of print.

ABSTRACT

BACKGROUND: Dysphagia can result from shock, trauma, aging, head and neck neoplasms, and some cerebrovascular diseases or neuromotor degenerative disorders. Swallowing rehabilitation therapy combined with postural control of the neck, head, and body can be effective for patients with dysphagia. Though the lateral decubitus posture has been a favorable option for swallowing rehabilitation therapy, available clinical data pertaining to it are scarce.

METHODS: Twenty-seven healthy volunteers were enrolled in this study. The subjects underwent a repetitive saliva swallowing test, food swallowing test, and water swallowing test. The trials were performed in four different positions: upright sitting position, lateral decubitus position with the head raised to 60°, lateral decubitus position with the head raised to 30°, and complet e lateral decubitus position. After each trial, the subjects were asked to declare the swallowing difficulty utilizing a visual analogue scale. Swallowing time and swallowing sound level were recorded simultaneously, as objective evaluation in each trial. We analyzed the visual analogue scale scores, swallowing time, and swallowing sound levels for all the four positions.

RESULTS: The results of the visual analogue scale of the water swallowing test in the sitting position were significantly lower than those of the complete lateral decubitus position (p < 0.01). However, statistical significance was not detected in swallowing time or the swallowing sound level among the four different positions. Although subjective discomfort in swallowing was identified, difficulty of swallowing was not objectively evident in the trials, irrespective of the position.

CONCLUSIONS: A complete lateral decubitus position can be an effective and safe position in swallowing.

PMID:34313834 | DOI:10.1007/s00405-021-07001-2

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Mitochondrial encephalomyopathy involves ophthalmology otorhinolaryngology neurology and their clinical features

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Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jun;35(6):529-534. doi: 10.13201/j.issn.2096-7993.2021.06.010.

ABSTRACT

Objective:This study aimed to provide better understanding of the otolaryngologic features, combined with ophthalmologic and neurologic characteristics in mitochondrial encephalomyopathy(MEM), and to help ENT and auditory practitioner making correct diagnosis as well. Methods:Twenty-eight patients with MEM were enrolled between September 2001 and January 2020. Information about family histories and clinical symptoms was retrospectively analyzed. All patients underwent otorhinolaryngological, ophthalmological and neurological examinations, including: pure-tone audiometry, acoustic immittance(AI), distortion-product otoacoustic emissions(DPOAE), auditory brainstem response(ABR), cochlear micropotential(CM), speech discrimination score(SDS), electroneurography(ENoG), computed tomog raphy(CT) of the temporal bone and cranial magnetic resonance weighted imaging scan(MRI), muscle biopsy and mtDNA gene testing. Results:ENT subjective manifestations were present in 15 cases (53.6%) with sensorineural hearing loss(SNHL), 4(14.3%) with tinnitus, 4(14.3%) with facial weakness, 3(10.7%) with dysphagia, 1(3.6%) with auditory agnosia. Ophthalmological and neurological symptoms included ptosis in 16 cases (57.1%), exercise intolerance in 16(57.1%), optic atrophy in 15(53.6%), muscular atrophy in 6(21.4%), and stroke-like episodes in 5(17.9%). The results of objective examinations were as follows: DPOAE were not elicited in 18(64.3%) cases, ABR abnormalities in 18(64.3%) cases, hearing threshold shift in 15(53.6%) cases, AI normal and CM was not detected in all cases, SDS decreased in 6(21.4%) cases, facial ENoG abnormalities in 4(14.3%) cases, laryngeal ENoG abnormalities in 3(10.7%) cases, EMG abnormalities in 6(21.4%) cases, and ECG abnormalities in 8(28.6%) cases. Temporal CT were normal, but cranial MRI abnormalities were found in 19 cases(67.9%), including central nerve demyelination, white matter hyperintensities, generalized cerebellar and cerebral atrophy, multiple cortical/subcortical infarct-like lesions, basal ganglia calcification. Conclusion:Multisystemic syndromes in MEM can present as a variety of otolaryngological, ophthalmological and neurological abnormalities, such as ptosis, audio-visual disturbance, exercise intolerance and stroke-like episodes etc. SNHL, tinnitus, auditory agnosia, facial weakness and dysphagia were ENT specific manifestations. SNHL in MEM is bilateral symmetrical progressive or of sudden onset since teenage. mtDNA testing may be helpful for adolescent patient whose SNHL was associated with neuromuscular symptoms. Muscle biopsy should be considered when middle-aged patients developed facial weakness and dysphag ia. DPOAE and ABR are the optimal objective audiometric tests to monitor the progression of MEM associated with SNHL.

PMID:34304513 | DOI:10.13201/j.issn.2096-7993.2021.06.010

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A preliminary study on the negative wave mismatch in patients with unilateral total sudden deafness

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Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 May;35(5):391-394. doi: 10.13201/j.issn.2096-7993.2021.05.002.

ABSTRACT

Objective:To observe the characteristics of different negativity negativity (MMN) in patients with unilateral sudden deafness, and compare them with normal MMN, in order to provide theoretical reference for discussing the pathogenesis of unilateral sudden deafness and their relationship with the auditory centers, and to provide theoretical basis for the treatment of sudden deafness in the future. Methods:Twenty-six cases of unilateral total sudden deafness were recruited as experimental group, 25 cases of normal healthy people as control group, the MMN inspections was performed respectively, the two groups using classical mode of oddball, standard and deviation stimulate with 1000 Hz and 2000 Hz short pure tone test MMN respectively, to observe the MMN latency and amplitude characteristics, and compare the latent period and amplitude difference between the two groups. Results:Among the 51 subjects, only 1 patient with unilateral total sudden deafness did not elicit MMN waveform, while the rest were all induced. The average incubation period of MMN in the experimental group was (162.03±38.64) ms, the average amplitude was (2.83±1.14)μV, and the mean age was (48.64±10.27) y. While the average incubation period of MMN in the control group was (197.52±27.43) ms, the average amplitude was (2.58±1.07)μV, and the mean age was (45.00±8.20) y. The MMN latency was significantly different between the two groups (P<0.01). There was no statistical difference in amplitude between the two groups (P>0.05). There was no statistical difference in age between the two groups (P>0.05). Conclusion:The latency period of MMN of unilateral total sudden deafness is shorter than that of the control group. It suggests th at the auditory center function of patients with acute sudden deafness has changed, and we speculate that the auditory center of patients with acute sudden deafness may have corresponding emergency changes, so as to make its function have adaptive changes, which will provide further reference for the discussion of the pathophysiological mechanism and treatment of sudden deafness in the future.We speculated that acute unilateral auditory deprivation caused by unilateral total deafness sudden deafness has an impact on cerebral cortical auditory function, which provides further reference for the discussion of pathophysiological mechanism and treatment plan of sudden deafness in the future.

PMID:34304460 | DOI:10.13201/j.issn.2096-7993.2021.05.002

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Anatomical implication of less occurrence of inferior oblique muscle entrapment in orbital floor trapdoor fracture

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Surg Radiol Anat. 2021 Jul 27. doi: 10.1007/s00276-021-02808-4. Online ahead of print.

ABSTRACT

PURPOSE: To examine the anatomy of the inferior oblique (IO) muscle and its surrounding structures to clarify why IO muscle entrapment develops less in orbital floor trapdoor fractures.

METHODS: Computed tomographic (CT) images on the unaffected sides were obtained from 64 patients with unilateral orbital fractures. On coronal planes, presence or absence of an infraorbital g roove below the IO muscle was confirmed. At the level of the medial margin of the infraorbital groove/canal, the distance from the orbital floor to the IO muscle (IO-floor distance), the thickness of the orbital floor, and the shortest distance from the inferior rectus (IR) muscle to the orbital floor (shortest IR-floor distance) were measured. On quasi-sagittal planes, the distances from the inferior orbital rim to the inferior margin of the IO muscle (IO-rim distance) and the most anterior point of the infraorbital groove (groove-rim distance) were measured.

RESULTS: The infraorbital groove was found below the IO muscle in eight patients (12.5%), and the IO-rim and IO-floor distances were significantly longer than the groove-rim and shortest IR-floor distances, respectively (p < 0.001). The orbital floor below the IO muscle was significantly thicker than that below the IR muscle (p < 0.001).

CONCLUSION: Although the medial margin of the infraorbital groove is the most common fracture site, the IO muscle was not located above the groove in most cases. A longer IO-floor distance and thicker orbital floor below the IO muscle may also contribute to less occurrence of IO muscle entrapment in orbital floor trapdoor fractures.

PMID:34313811 | DOI:10.1007/s00276-021-02808-4

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Radiosynthesis and in silico bioevaluation of 131 I-Sulfasalazine as a highly selective radiotracer for imaging of ulcerative colitis

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Chem Biol Drug Des. 2021 Jul 27. doi: 10.1111/cbdd.13929. Online ahead of print.

ABSTRACT

This study demonstrated the tracking of ulcerative colitis, which is considered a stressful immune disease. Although there are many ways to test for this disease including dependence on gases, dyes, and painful anal endoscopy, these treatment modalities have many disadvantages. Hence, it is the utmost need of time to discover new methods to detect this chronic immune disease and to avoid the d efects of traditional methodologies. Sulfasalazine (SSD) was labeled with iodine-131 (Half-life: 8 days, Energy: 971 keV) under optimum reaction conditions including the amount of reducing agent, pH factor, Chloramine-T (Ch-T) amount, and incubation period. Characterization was performed using 1 H/ 13 C-NMR, ESI-MS, and HPLC (UV/ Radio) techniques. The biodistribution study was performed in normal and ulcerative mice models as well as in silico molecular docking study was performed to evaluate the possible mechanism of action to target peroxisome proliferator-activated receptor gamma (PPARγ). The high radiolabeling yield of [131 I]-sulfasalazine ([131 I]-SSD) was achieved ≥ 90% through the direct labeling method with radioactive iodine-131 in the presence of chloramine-T (100 μg). The radiotracer [131 I]-SSD was observed to be stable in normal saline and freshly eluted serum up to 12 h at ambient temperature (37°C ± 2°C). The radiotracer [131 I]-SSD showed the highest uptake in the targeted organ (i.e. ulcerative colon) which was observed to be ≥ 75% injected dose per gram (% ID/g) organ for 24 h post-injection (p.i). Furthermore, in silico data collected from molecular modeling analysis of SSD and [131 I]-SSD with antimicrobial protein (PDB code: 3KEG) and peroxisome proliferator-activated receptor-gamma (PPARγ) (PDB code: 4XTA) showed azoreductase activity and high binding potential for PPAR-γ site, respectively. The results of biological studies obtained in this study enlighten the usefulness of radiotracer [131 I]-SSD as a potential imaging agent for ulcerative colitis.

PMID:34314572 | DOI:10.1111/cbdd.13929

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Prevalence of Hashimoto Thyroiditis in Adults With Papillary Thyroid Cancer and Its Association With Cancer Recurrence and Outcomes

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JAMA Netw Open. 2021 Jul 1;4(7):e2118526. doi: 10.1001/jamanetworkopen.2021.18526.

ABSTRACT

IMPORTANCE: Hashimoto thyroiditis (HT) has been suggested to be associated with papillary thyroid cancer (PTC) development. However, its association with PTC progression remains unclear.

OBJECTIVE: To examine the association between HT and PTC presentation and outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a review of patients aged 18 to 75 years who had pathologically confirmed PTC treated at a single center in China from January 1, 2001, to December 31, 2014. Data analysis was performed from November 1 to December 31, 2020.

EXPOSURES: Coexistent HT was defined according to evaluation of postoperative paraffin sections.

MAIN OUTCOMES AND MEASURES: The primary outcome was the association of HT with PTC-related mortality, assessed using Cox proportional hazards regression models. The secondary outcome was the association of HT with aggressive characteristics and structural recurrence of PTC, assessed using logistic regression and Cox proportional hazards regression with and without adjustment for related factors.

RESULTS: Of 9210 patients with PTC (mean [SD] age, 43.6 [12.0] years; 6872 [75%] women) included in the analysis, 1751 (19%) had HT. In the logistic regression model, HT was negatively associated with frequencies of primary tumor size of 4 cm or greater (adjusted odds ratio [aOR], 0.20; 95% CI , 0.12-0.33; P < .001), gross extrathyroidal extension (aOR, 0.44; 95% CI, 0.36-0.54; P < .001), extranodal extension (aOR, 0.66; 95% CI, 0.55-0.80; P < .001), and distant metastasis (aOR, 0.17; 95% CI, 0.04-0.71; P = .02). After a median follow-up of 85 months (range, 12-144 months), 131 PTC-related deaths were identified in the cohort; 2 patients who died had HT. Patients with HT had significantly superior outcomes compared with patients without HT in terms of unadjusted 10-year disease-specific survival (99.9% vs 96.6%; log-rank P < .001) and recurrence-free survival (92.0% vs 87.6%; log-rank P = .001). After adjusting for sex, age, primary tumor size, extrathyroidal extension, lymph node metastasis, distant metastasis, extent of surgery, and radioactive iodine ablation, HT was associated with decreased PTC-related mortality (hazard ratio [HR], 0.19; 95% CI, 0.05-0.76; P = .02). Stratified analysis showed that HT was associated with less frequent structural recurrence in patients with extrathyroidal extension (HR, 0.52; 95% CI, 0.38-0.71; P < .001; P = .002 for interaction) or after total thyroidectomy (HR, 0.50; 95% CI, 0.35-0.69; P < .001; P = .009 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study, patients with coexistent HT had less aggressive characteristics at presentation and better outcomes of PTC than did patients without HT. The findings suggest that autoimmune thyroiditis has a protective role in association with thyroid cancer.

PMID:34313737 | DOI:10.1001/jamanetworkopen.2021.18526

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