Late recurrence of post-dural puncture headache

xlomafota13 shared this article with you from Inoreader Late recurrence of post-dural puncture headache Via leak of cerebrospinal fluid Agri. 2021 Oct;33(4):261-264. doi: 10.14744/agri.2019.44711. ABSTRACT The term post-dural puncture headache (PDPH) refers to a common complication that occurs after accidental dural puncture. One of the diagnostic symptoms of PDPH is a postural headache, which worsens dramatically while sitting or standing and is relieved mostly by lying down. This symptom is caused by a cerebrospinal fluid (CSF) leak, leading to decreased CSF pressure or low CSF volume, which provokes a shift of intracranial contents and traction on pain-sensitive structures in the upright position. PDPH is commonly a self-limited condition and remits spontaneously within 2 weeks, or becomes less severe after surgical intervention to seal the leak with autologous epidural blood patch (EBP). Although recurrence of spontaneous intracranial hypotension following an EBP is not rare, spontaneously late recurrence of PDPH has been rarely reported. The purpose of this paper is to d iscuss this case with late recurrence of PDPH after 10 months following EBP. PMID:34671953 | DOI:10.14744/agri.2019.44711 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Posterior fossa decompression for children with Chiari I malformation and hydrocephalus

xlomafota13 shared this article with you from Inoreader Posterior fossa decompression for children with Chiari I malformation and hydrocephalus Via leak of cerebrospinal fluid Childs Nerv Syst. 2021 Oct 20. doi: 10.1007/s00381-021-05377-4. Online ahead of print. ABSTRACT INTRODUCTION: Chiari I malformation (CMI) and hydrocephalus often coexist, with no clear understanding of the cause-and-effect relationship. In the absence of other associated etiologies, the traditional teaching has been to treat the hydrocephalus first, partly to minimize the risk of cerebrospinal fluid (CSF) leak from CMI decompression in the setting of elevated ICP. We describe a series of consecutive pediatric patients with CMI and hydrocephalus, the majority of whom were managed with posterior fossa decompression. METHODS: A retrospective review was conducted on consecutive children who presented to the senior author with both hydrocephalus and CMI, with emphasis on rationale for and outcomes of surgical intervention, including the need for additional surgery. RESULTS: There were 14 patients aged 2 weeks to 16 years (median 2 year s) who presented with Chiari I and hydrocephalus. Four of these underwent posterior fossa decompression without duraplasty (PFD) as first-line therapy (one of whom eventually required duraplasty), 7 had PFD with duraplasty (PFDD), 1 received a ventriculoperitoneal shunt (VPS), and two had endoscopic third ventriculostomy (ETV). Of the 11 who had PFD/D, 9 (90%) had significant symptom improvement/resolution, 7 (55%) showed decrease in ventricle size, and 1 (10%) required VPS placement for persistent hydrocephalus. Both ETV patients improved clinically, and 1 showed decrease in ventricle size. There were no pseudomeningoceles, infections, or neurological deficits. One CSF leak occurred after an ETV and was successfully treated with wound revision. CONCLUSION: In patients with both CMI and hydrocephalus, treating the CMI first in an effort to avoid a shunt can be safe and effective. In this series, PFDD in the setting of hydrocephalus did not result in CSF leak or pseudomeningoce le. While limited by a small sample size, these data support a causative relationship between CMI and hydrocephalus. PMID:34671850 | DOI:10.1007/s00381-021-05377-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Granulomatous Disease of the Upper Airway

xlomafota13 shared this article with you from Inoreader Chronic Granulomatous Disease of the Upper Airway Via ear nose throat Ear Nose Throat J. 2021 Oct 21:1455613211054635. doi: 10.1177/01455613211054635. Online ahead of print. NO ABSTRACT PMID:34670444 | DOI:10.1177/01455613211054635 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Iatrogenic Cervical Epidermoid Cyst Following Tracheostomy

xlomafota13 shared this article with you from Inoreader Iatrogenic Cervical Epidermoid Cyst Following Tracheostomy Via ear nose throat Ear Nose Throat J. 2021 Oct 20:1455613211053423. doi: 10.1177/01455613211053423. Online ahead of print. ABSTRACT Epidermoid cysts are generally benign lesions surrounded by squamous epithelium with cystic contents. The lining of the cysts produce keratin, which resemble a cheese-like material. They typically occur in the skin and mucous membranes and are congenital in origin; iatrogenic epidermoid cysts are rare. Epidermoid cysts are usually painless and asymptomatic, and the ir diagnosis is based on histological examination. This paper aims to present the case report of a 23-year-old patient with an iatrogenic epidermoid cyst that occurred following tracheostomy. The importance of preoperative radiological imaging in the diagnosis of epidermoid cysts is also highlighted. PMID:34670428 | DOI:10.1177/01455613211053423 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The efficacy of peritonsillar injection of bupivacaine vs intravenous acetaminophen on post-tonsillectomy pain in children'

xlomafota13 shared this article with you from Inoreader The efficacy of peritonsillar injection of bupivacaine vs intravenous acetaminophen on post-tonsillectomy pain in children" Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 20. doi: 10.1007/s00405-021-07146-0. Online ahead of print. NO ABSTRACT PMID:34671857 | DOI:10.1007/s00405-021-07146-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

SMS classification of inner ear malformations: our experience with implantation in type II anomalies

xlomafota13 shared this article with you from Inoreader SMS classification of inner ear malformations: our experience with implantation in type II anomalies Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Oct 20. doi: 10.1007/s00405-021-07124-6. Online ahead of print. ABSTRACT PURPOSE: To study and analyse the radiological and surgical findings of 24 cochlear implantees with SMS type II cochleovestibular malformation and to compare their outcomes in terms of hearing and speech gains pre- and postoperatively. METHODS: Retrospective analysis of cochlear implanted candidates over a period of 8 year 6 months from 3 institutions was undertaken and 24 patients suffering from prelingual profound congenital sensori-neural hearing loss along with the presence of SMS type II cochleovestibular malformation were studied. Preoperative radiology, surgical difficulties and complication, and postoperative hearing and speech outcomes up to a period of 2 years, using IT-MAIS and SIR scores were noted. Statistical comparison pre- and postimplantation was done using Wilcoxon signed rank test and a p value of < 0.05 was considered statistically significant. RESULTS: In 24 cases, we encountered four cases of SMS type IIa malformation with a smaller modiolus, while the rest 20 were type SMS type IIb with partially defective modiolus. Intraoperatively, CSF leak was observed in 11 patients. Complete electrode insertion and good electrical response (NRT) was detected in all. No facial nerve anomaly was encountered. IT-MAIS and SIR scores increased from a preoperative mean of 5.6 and 1.16-34.56 and 3.88 after 2 years postsurgery, respectively and this difference was found to be statistically significant. CONCLUSION: Our experience with SMS Type II malformations show promising and motivating results with less chances of complications. Proper evaluation and surgical planning preoperatively can lead to an uneventful surgery with good outcomes. A simple and uniform classification system of these anomalies is a must for appropriate prognostication and right decision making. PMID:34671858 | DOI:10.1007/s00405-021-07124-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Jaw-retraction exercise increases anterior hyoid excursion during swallowing in older adults with mild dysphagia

xlomafota13 shared this article with you from Inoreader Jaw-retraction exercise increases anterior hyoid excursion during swallowing in older adults with mild dysphagia Via swallowing exercises Gerodontology. 2021 Oct 20. doi: 10.1111/ger.12595. Online ahead of print. ABSTRACT OBJECTIVES: The present study aimed to evaluate the effectiveness of a newly designed jaw-retraction exercise for strengthening the geniohyoid muscle and thus improving the anterior movement of the hyoid bone during swallowing. BACKGROUND: Although previous studies suggest a relationship between anterior hyoid excursion and upper esophageal sphincter (UES) opening, there are currently no repor ts of physical exercises without the use of special equipment that can effectively improve this movement of the hyoid bone during swallowing. MATERIALS AND METHODS: This before-after study included patients presenting to the authors' hospital with mild dysphagia (Level 5 on the Dysphagia Outcome and Severity Scale). The participants were instructed to perform a jaw-retraction exercise designed to strengthen the geniohyoid muscle. Each participant was instructed to perform two sets of the exercise daily for four weeks, with each set consisting of five repetitions. Before and after the four-week training period, videofluoroscopic swallowing studies were performed and later analysed. RESULTS: Twenty-five patients with a median age of 77 were included. The median peak anterior hyoid position before and after exercise were 129.82 and 132.74 (%C2-C4 length), respectively, and this increase was found to be significant (P = .007). The median extent of UES opening before and afte r exercise were 8.6 and 9.3 (mm), respectively, and this increase was also found to be significant (P = .040). CONCLUSION: Our findings demonstrate that the jaw-retraction exercise can effectively improve the anterior movement of the hyoid bone. This exercise may be effective in individuals with oral frailty when signs of swallowing disorders are observed. PMID:34672024 | DOI:10.1111/ger.12595 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study)

xlomafota13 shared this article with you from Inoreader A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study) Via radioactive iodine BMC Endocr Disord. 2021 Oct 21;21(1):208. doi: 10.1186/s12902-021-00871-x. ABSTRACT BACKGROUND: To assess the gaps between the initial management of patients with differentiated thyroid cancer (DTC) in real clinical practice and the recommendations of the 2012 Chinese DTC guidelines. METHODS: This multicenter, prospective study was conducted at nine tertiary hospitals across China. Eligible patients were those having intermediate or high-risk DTC after first-time thyroidectom y. During 1 year of follow-up, comprehensive medical records were collected and summarized using descriptive statistics. RESULTS: Of 2013 patients, 1874 (93.1%) underwent standard surgery according to the guidelines (including total lobectomy plus isthmusectomy and total/near total thyroidectomy), and 1993 (99.0%) underwent lymph node dissection; only 56 (2.8%) had postoperative complications. Overall, 982/2013 patients (48.8%) received radioactive iodine (RAI) therapy after thyroidectomy. Of all enrolled patients, 61.4% achieved the target serum thyroid-stimulating hormone level, with a median time to target of 234.0 days (95% CI: 222.0-252.0). At 1 year of follow-up, proportions of patients with excellent response, incomplete structural response, biochemical incomplete response, and indeterminate response were 34.6, 11.2, 6.6, and 47.5%, respectively; recurrence or metastasis occurred in 27 patients (1.3%). During the overall study period, 209 patients (10.4%) had at least o ne adverse event: 65.1% of cases were mild, 24.9% moderate, and 10.1% severe. CONCLUSIONS: This was the first large-scale prospective study of how patients with DTC in China are treated in actual practice. Initial DTC management is generally safe and adheres to the 2012 Chinese guidelines but could be improved, and the level of guideline adherence did not produce the anticipated treatment response at 1 year of follow-up. PMID:34670546 | DOI:10.1186/s12902-021-00871-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

High FITM2 expression promotes cell migration ability of hepatocellular carcinoma by regulating the formation of caveolae and indicates poor patient survival

xlomafota13 shared this article with you from Inoreader High FITM2 expression promotes cell migration ability of hepatocellular carcinoma by regulating the formation of caveolae and indicates poor patient survival Via Cellular and Molecular Biology Histol Histopathol. 2021 Oct 21:18382. doi: 10.14670/HH-18-382. Online ahead of print. ABSTRACT BACKGROUND: Hepatocellular carcinoma (HCC) is among the most malignant tumors with high recurrence and low 5-year survival rate. Lipid metabolism is essential in tumor metastasis, although how altered lipid metabolism promotes HCC progression has not been well elucidated. Fat Storage Inducing Transmembrane Protein 2 (FITM2) is a gene involved in lipid homeostasis and cytoskeletal organization; however, its role in regulating tumor biological behavior has not been evaluated. METHODS: In this study, immunohistochemistry was performed to evaluate the expression of FITM2 in HCC. Univariate and multivariate analysis was performed to identify the prognostic factors. RNA interference wound healing and transwell experiments were performed to analyze the biological role of FITM2. Western blot analysis was performed to investigate the potential downstream signaling. RESULTS: The results revealed that FITM2 was highly expressed in the intratumoral tissues of HCC. Expression of intratumoral FITM2 was associated with microvascular invasion. FITM2 is an independent risk factor of HCC disease-free survival and overall survival. In vitro studies revealed that knockdown of FITM2 significantly inhibited the migration ability of HCC cells. FITM2 promotes HCC cell migration by regulating the expression of caveolin-1 and promoting the formation of caveolae. These results indicate that high intratumoral expression of FITM2 is associated with poor HCC prognosis, which may be applied to develop a new adjuvant therapy. PMID:34672358 | DOI:10.14670/HH-18-382 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Case 32-2021: A 14-Year-Old Girl with Swelling of the Jaw and Hypercalcemia

xlomafota13 shared this article with you from Inoreader Message: A 14-year-old girl presented with progressive swelling of the jaw. Six weeks before this admission, a nonpainful lump in the left lower jaw developed. The mass increased in size, and swelling of the left side of the face and neck developed. A biopsy specimen from the mass showed abundant giant cells. The calcium level was 11.8 mg per deciliter. Giant cell, also called Langhans giant cell, large cell characterized by an arc of nuclei toward the outer membrane. The cell is formed by the fusion of epithelioid cells, which are derived from immune cells called macrophages. Once fused, these cells share the same cytoplasm, and their nuclei become arranged in an arc near the outer edge of the cell. Langhans giant cells typically form at the centre of granulomas (aggregates of macrophages) and are found in the tubercle, or primary focus of infection, in tuberculosis, in lesions of syphilis, leprosy, and sarcoidosis, and in fungal infections. Large cells that form by fusion in reaction to the presence in the body of foreign substances differ from Langhans giant cells in that their many nuclei are scattered throughout the cell. In giant-cell tumours of bone and tendon the cells have many nuclei crowded together. The megakaryocytes, the normal bone-marrow cells thought to be the source of the blood platelets, are also called giant cells. Case 32-2021: A 14-Year-Old Girl with Swelling of the Jaw and Hypercalcemia Via The New England Journal of Medicine: Otolaryngology Presentation of Case. Dr. Austin Be (Surgery): A 14-year-old girl was admitted to this hospital because of swelling of the left jaw. The patient had been well until 6 weeks before this admission, when she noticed a lump in the left lower jaw; there was no pain, tenderness, or discomfort in the jaw.… View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.