Thursday, February 4, 2021

Killian-Jaimeson Diverticulum

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Incidentally Found Killian-Jaimeson Diverticulum During Thyroidectomy: A Case Report.

Ear Nose Throat J. 2021 Feb 02;:145561321989433

Authors: Yücel L, Isayev N, Beton S, Gökcan MK, Küçük TB

Abstract
The aim of this case study is to demonstrate the very rare coincidental existence and management of a Killian-Jamieson diverticulum (KJD) during thyroid surgery. A 57-year-old woman was referred to our clinic with a malignant thyroid nodule and the complaint of a sore throat. There were no suspicions concerning a diverticulum on examining her with flexible laryngoscopy or ultrasound imaging. During the right central neck dissection, we noticed a 3 × 3 cm KJD and resected it while preserving the recurrent laryngeal nerve. After the successful operation, we questioned the patient and learned that for 1 year she had an occasional complaint of dysphagia. Postoperatively, there was no vocal cord palsy or hypocalcemia, and there was no pharyngoesophageal leak after oral alimentation. There was no recurrence or complaint for KJD or papillary carcinoma for 8 years follow-up. Nonspecific symptoms like a sore throat should be investigated, and patients should be questioned for all aer odigestive symptoms. If necessary, further investigation should be undertaken for a differential diagnosis.

PMID: 33530743 [PubMed - as supplied by publisher]

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Improvement of Pulmonary Function in Cystic Fibrosis Patients following Endoscopic Sinus Surgery

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Objective/Hypothesis

To compare pre‐and post‐operative pulmonary function relative to disease severity in cystic fibrosis (CF) patients following endoscopic sinus surgery (ESS).

Study Design

Retrospective chart review.

Methods

Patients with CF who underwent ESS between January 1996 and July 2018 were identified, with subsequent study exclusions based upon surgical indications or incomplete records. CF disease severity was based upon percentage predicted of forced expiratory volume in 1 second (%FEV1) with <40% considered severe disease, 40% to 70% as moderate disease, and >70% as mild disease. The changes in %FEV1 before and after ESS were examined using multivariable mixed‐effects models controlling for age, gender, genotype, medications, nutritional status, diabetes status, microbiology results, extent of surgery, and number of surgeries.

Results

A total of 427 surgeries were performed in 188 patients during the study period. Mean age at first ESS was 12.7 years (SD 6.0 years, range 4–38) and 54.8% were females. The effect of ESS varied by severity of lung disease. After surgery, %FEV1 increased by 8.1% (95% CI: 2.3, 13.9%) among patients with severe lung disease and by 3.0% (95% CI: 0.7, 5.2%) among patients with moderate disease. %FEV1 also increased by 7.3% (95% CI: 4.2, 10.5%) among patients with mild disease whose %FEV1 value was 70% to 80% at baseline. No improvement was observed in patients with a baseline %FEV1 >80%.

Conclusions

When controlling for important confounding factors, lung function improved following ESS among CF patients with severe and moderate disease and in select patients with mild disease. This improvement was sustained at 12 months following surgery.

Level of evidence

4 Laryngoscope, 2021

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CDP-choline and galantamine, a personalized α7 nicotinic acetylcholine receptor targeted treatment for the modulation of speech MMN indexed deviance detection in healthy volunteers: a pilot study.

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CDP-choline and galantamine, a personalized α7 nicotinic acetylcholine receptor targeted treatment for the modulation of speech MMN indexed deviance detection in healthy volunteers: a pilot study.

Psychopharmacology (Berl). 2020 Dec;237(12):3665-3687

Authors: Choueiry J, Blais CM, Shah D, Smith D, Fisher D, Illivitsky V, Knott V

Abstract
RATIONALE: The combination of CDP-choline, an α7 nicotinic acetylcholine receptor (α7 nAChR) agonist, with galantamine, a positive allosteric modulator of nAChRs, is believed to counter the fast desensitization rate of the α7 nAChRs and may be of interest for schizophrenia (SCZ) patients. Beyond the positive and negative clinical symptoms, deficits in early auditory prediction-error processes are also observed in SCZ. Regularity violations activate these mechanisms that are indexed by electroencephalography-derived mismatch negativity (MMN) event-related potentials (ERPs) in response to auditory deviance.
OBJECTIVES/METHODS: This pilot study in thirty-three healthy humans assessed the effects of an optimized α7 nAChR strategy combining CDP-choline (500 mg) with galantamine (16 mg) on speech-elicited MMN amplitude and latency measures. The randomized, double-blinded, placebo-controlled, and counterbalanced design with a baseline stratification method allowed for assessment of individual response differences.
RESULTS: Increases in MMN generation mediated by the acute CDP-choline/galantamine treatment in individuals with low baseline MMN amplitude for frequency, intensity, duration, and vowel deviants were revealed.
CONCLUSIONS: These results, observed primarily at temporal recording sites overlying the auditory cortex, implicate α7 nAChRs in the enhancement of speech deviance detection and warrant further examination with respect to dysfunctional auditory deviance processing in individuals with SCZ.

PMID: 32851421 [PubMed - indexed for MEDLINE]

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Oncoplastic volume replacement using local perforator flaps.

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Six-year experience of oncoplastic volume replacement using local perforator flaps.

J Plast Reconstr Aesthet Surg. 2021 Jan 09;:

Authors: Quinn EM, Burrah R, O'Ceallaigh S, Highton L, Murphy J

Abstract
Local perforator flaps may be utilised to correct volume defects after breast-conserving surgery (BCS), improving the cosmetic outcome and avoiding the need for contralateral symmetrising surgery. The aims of this study were to assess longer term oncological outcomes following local perforator flap reconstruction, and to demonstrate the learning curve associated with incorporating such techniques within routine clinical practice. We report a consecutive case series of 116 local perforator flaps performed between January 2014 and May 2020. Data collected included patient demographics, tumour characteristics, surgical procedure data, complications and follow-up outcomes. All breast cancer patients are followed with annual mammographic surveillance for a minimum of five years. Of 116 procedures, 101 were performed as immediate partial breast reconstruction and 15 as delayed reconstructive procedures for patients who had prior breast surgery. The overall complication rate was 15% ; the majority were minor surgical site infections, 1.7% required haematoma evacuation. At a median follow-up of 37 months, there were no local cancer recurrences. Three patients who underwent delayed reconstruction required revision procedures, and one required a contralateral symmetrisation procedure. One patient in the immediate reconstruction group required additional lipofilling. Over time, the mean lesion size selected for immediate local flap reconstruction increased, operative times decreased and the proportion of day case procedures increased. Our data confirm that local perforator flaps are associated with low morbidity, excellent oncological outcomes and long-term durability. The use of local flaps can increase the range of indications for BCS, reducing mastectomy rates and the associated revision and symmetrising procedures associated with them.

PMID: 33531208 [PubMed - as supplied by publisher]

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Treatment of deep-seated palatal vascular malformations by bleomycin sclerotherapy.

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Treatment of deep-seated palatal vascular malformations by bleomycin sclerotherapy.

J Plast Reconstr Aesthet Surg. 2021 Jan 10;:

Authors: Agarwal R, Agarwal M, Agarwal D, Chandra R, Prasad R

Abstract
BACKGROUND: Vascular malformations of the head and neck are common. The management of these lesions is complex and challenging due to the high complication rate and recurrence following treatment. Palatal vascular malformations (PVMs) are infrequent and present as slow growing lesions in the palate with recurrent bleeding and pain. These lesions are best managed by sclerotherapy due to their posterior location and risk of bleeding if surgery is attempted. Many sclerosants have been used for treating PVMs but the use of intralesional bleomycin for these lesions has not been reported at length. This paper describes the use of intralesional bleomycin injections for the treatment of deep-seated palatal vascular malformations.
METHODS: Intralesional bleomycin injections were given directly into the lesion with the patients under short general anaesthesia. The total dose of bleomycin ranged between 8 and 15 IU, which depends upon the body weight and was repeated every four weeks till the resolution of lesion was observed.
RESULTS: All the lesions in 12 patients regressed significantly with serial bleomycin injections. Clinically, the involved palatal mucosa became normal and magnetic resonance imaging demonstrated the significant regression of the lesion in all the cases. No complications were encountered with the use of intralesional bleomycin.
CONCLUSIONS: Intralesional bleomycin injections have proved to be an emerging modality in the management of remotely situated palatal vascular malformations. Their rapid regressive effect on the lesion coupled with a high safety margin makes bleomycin sclerotherapy the first choice of treatment for palatal vascular malformations.

PMID: 33531209 [PubMed - as supplied by publisher]

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Prospective study to analyse the efficiency of Acoustic Doppler v/s Colour Duplex Ultrasound in locating perforators for antero-lateral thigh flap in reconstructive head and neck surgery.

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Prospective study to analyse the efficiency of Acoustic Doppler v/s Colour Duplex Ultrasound in locating perforators for antero-lateral thigh flap in reconstructive head and neck surgery.

J Plast Reconstr Aesthet Surg. 2021 Jan 10;:

Authors: Haribhakti VV, Thorat TS, Powle VR, Virarkar MK

Abstract
INTRODUCTION: The anterolateral thigh (ALT) flap has become the universal workhorse for Head and Neck reconstruction. Being a perforator-based flap, accurate planning by preoperative perforator localisation is clearly beneficial. Acoustic Doppler (AD) and Colour Duplex Ultrasound (CDU) are the most practicable methods of localisation available. We designed a prospective study to analyse the correlation between preoperative localisation (by AD and CDU) and intraoperative findings, factoring in the advantages of using a high frequency probe for CDU.
METHODS: Thirty-three consecutive patients were analysed in a prospective, observational study. AD was first used to mark the perforator point and its distance measured from two anatomical landmarks, the Anterior Superior Iliac Spine (ASIS) and the 'Reference line' (a line joining ASIS with the superior patellar border). CDU was then carried out to mark the perforator position with two probes (9 and 14 MHz), and the above distances measured for both points. At surgery, the actual point of perforator entry was separately marked and the same two distances were measured. A note was also made of perforator characteristics such as size and flow rate.
RESULTS: In 21/33 cases, there was a close concordance between pre- and intraoperative localisation (complete success). From the remaining 12 cases, the complete absence of perforator was found in one case, a small, unreliable perforator in 2 cases and a site disparity of > 2 cm between true and preop points in 9 cases.
CONCLUSION: No significant advantages were found with either a high frequency probe or indeed for CDU over AD. AD is sufficient for effective perforator localisation and should be routinely employed to accurately plan the anterior incision. CDU can be employed in cases where AD is unconvincing.

PMID: 33531210 [PubMed - as supplied by publisher]

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An Enlarging Parotid Mass in a 9-Year-Old Boy

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A 9-year-old boy presents with a left-sided neck mass that has been enlarging, mild intermittent pain, episodes of upper respiratory infection, and previous adenotonsillectomy and bilateral ear tubes placement. What is your diagnosis?
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Povidone Iodine to Reduce Viral Load in Patients With COVID-19

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This randomized clinical trial investigates the efficacy of na sopharyngeal povidone iodine solutions in reducing the viral load of patients with COVID-19.
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Diffuse Type 2 Dominant Rhinosinusitis and Corticosteroid Irrigation After Surgical Neosinus Cavity Formation

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This cohort study examines long-term treatment outcomes in pat ients with eosinophilic rhinosinusitis who have received corticosteroid irrigations after surgical creation of a neosinus cavity.
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New Age Mentoring and Disruptive Innovation

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This study examines how mentoring has evolved over time, what new challenges have recently emerged, and how to implement effective structural solutions in the field of otolaryngology–head and neck surgery.
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Risk and Clinical Factors of Late Lower Cranial Neuropathy in Oropharyngeal Squamous Cell Carcinoma

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This cohort study assesses the cumulative incidence of and cli nical factors associated with late lower cranial neuropathy among patients with long-term survival of oropharyngeal squamous cell carcinoma.
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