Evaluation of tracheobronchial branching abnormalities in patients with microtia using chest computed tomography

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Chuan Li, Haiyue Jiang, Jingning Chen, Rongwei Wu, Ye Bi, Meirong Yang, Ye Zhang, Bo Pan
BackgroundThe objective of this study was to identify the characteristics and incidence of Tracheobronchial branching abnormalities in patients with microtia and to evaluate the risk of anesthesia.MethodsA total of 204 consecutive microtia patients and 465 nose cosmetic patients without microtia received a preoperative chest computed tomography. A retrospective study was performed with the clinical and imaging data from July 2016 to April 2017.ResultsWith the chest computed tomography images, a total of 7 cases were documented with Tracheobronchial branching abnormalities, including 6 cases among the microtia patients and 1 case among the cosmetic patients without microtia. The incidence of Tracheobronchial branching abnormalities was higher in microtia patients than the cosmetic patients without microtia (2.94% versus 0.22%, P < 0.01).ConclusionsThe incidence of Tracheobronchial branching abnormalities was high in patients with microtia. Preoperative diagnosis of tracheal bronchus can help anesthesiologists avoid complications. Microtia with Tracheobronchial branching abnormalities may involve a new syndrome previously undiscovered or just another extension with the very wide spectrum of microtia.



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Variations in electrode impedance during and after cochlear implantation: Round window versus extended round window insertions

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Jun Wang, Jiaqiang Sun, Jingwu Sun, Jianwen Chen
ObjectivesTo assess differences in intra- and postoperative electrode impedances following cochlear implantation between round window insertions (RWI) and extended round window insertions (ERWI).MethodsFifty patients with congenital hearing loss received unilateral hearing implants (Sonata Ti100, Med-El GmbH, Innsbruck, Austria) with standard electrode arrays. The patients were divided into two groups according to the surgical technique used. Thirty-five procedures were performed with RWI (group A) and 15 with ERWI (group B). Electrode impedance was measured and analysed during the operation, and one week and one month postoperatively.ResultsThere were no statistically significant differences (i.e., P > 0.05) in electrode impedance between groups A and B intraoperatively, or at one week or one month postoperatively. Electrode impedance at one month postoperatively was higher than the intraoperative and postoperative one week values in group A (P < 0.05), with similar results in group B.ConclusionThere was no significant difference between RWI and ERWI in operative duration or complications of cochlear implantation. Moreover, no significant differences in postoperative electrode impedance values were found between the two surgical routes.



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Rehabilitation bei Fazialisparese und Schwindel bei Patienten mit Vestibularisschwannom

Zusammenfassung

Hintergrund

Fazialisparese und Schwindel als Symptom eines Vestibularisschwannoms (VS) oder als Folge der Therapie beeinträchtigen die Lebensqualität der Patienten erheblich.

Fragestellung

Die Arbeit analysierte die aktuelle Literatur zum Thema und gibt darauf basierend Handlungsempfehlungen.

Material und Methode

Es handelt sich um eine PubMed-basierte Literaturrecherche der letzten 10 Jahre.

Ergebnisse

Zur Behandlung der akuten postoperativen Fazialisparese nach VS-Operation gibt es keine evidenzbasierte medikamentöse Therapie. Für die chirurgische Therapie gibt es etablierte Verfahren zur Nervenrekonstruktion, zum Muskeltransfer und zu statischen Maßnahmen. Eine physiotherapeutische Bewegungstherapie, am besten mit Biofeedback, verbessert möglicherweise die Fazialisfunktion bei Patienten mit Defektheilung. Botulinumtoxin ist Therapie der Wahl zur Behandlung von Synkinesien. Gegen akuten und chronischen Schwindel bei Patienten mit VS werden dieselben Antivertiginosa wie bei anderen Schwindelpatienten eingesetzt. Bei noch erhaltener Vestibularisfunktion ist die präoperative intratympanale Gentamycinausschaltung und ein Kompensationstraining eine vielversprechende Therapiestrategie, um postoperativen Schwindel zu verringern. Eine gute Vestibularisrehabilitation umfasst ein intensives und regelmäßiges Bewegungstraining, am besten mit Echtzeitfeedback und Therapiekontrolle.

Schlussfolgerungen

Es gibt eine Vielzahl durch Studien belegte konservative, chirurgische oder kombiniert konservativ-chirurgische Behandlungsoptionen zur individuellen Fazialisrehabilitation bei VS-Patienten. Bei akutem Schwindel ist eine Pharmakotherapie angezeigt. Sowohl bei akutem als auch bei belastendem chronischem Schwindel lindert eine intensive Bewegungstherapie die Beschwerden.

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Vestibularisschwannome – Teil 2

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Implantierbare Hörsysteme

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Validation of radial artery-based uncalibrated pulse contour method (PulsioFlex) in an unselected cohort of critically ill patients.

BACKGROUND: Because of their simplicity, uncalibrated pulse contour (UPC) methods have been introduced into clinical practice in critical care but are often validated with a femoral arterial waveform. OBJECTIVE: We aimed to test the accuracy of cardiac index (CI) measurements and trending ability from a radial artery with one UPC. SETTING: Tertiary care mixed-surgical ICU. Data were obtained from April 2015 to July 2016. PATIENTS: We studied 20 critically ill mechanically ventilated patients monitored by UPC (PulsioFlex; Pulsion Medical Systems SE, Munich, Germany). We used transpulmonary thermodilution (PiCCO2) as a reference. MAIN OUTCOME MEASURES: Bland-Altman-analyses with percentage errors were calculated to assess the accuracy of CI values from radial pulse contour analysis (CIRAD), autocalibration (CIAC) and femoral pulse contour analysis (CIFEM). All were compared with a reference (CITD) at 4-h intervals for 24 h. Trending ability was assessed by polar-plots and four-quadrant-plots. CI is given in l min-1 m-2. RESULTS: Bland-Altman-analyses: for CIRAD, the mean bias was -0.1 with limits of agreement (LOA) of -2.9 to 2.7 and a percentage error of 70%; for CIAC, the mean bias was 0 with LOA -2.8 to 2.7 and a percentage error of 70%; for CIFEM, the mean bias was 0 with LOA -1.2 to 1.2 and a percentage error of 30%, respectively. Polar plots for trending: for CIRAD, the angular bias was 12[degrees] with radial LOA of 39[degrees], a polar concordance rate of 73% and a concordance rate of 67% in the four-quadrant-plot; for CIAC, the angular bias was 4[degrees] with radial LOA of 41[degrees], polar concordance rate of 79% and a concordance rate of 74% in the four quadrant plot; for CIFEM, the angular bias was -2[degrees] with radial LOA of 50[degrees], polar concordance rate of 74% and a concordance rate of 81%. CONCLUSION: In critically ill patients, the PulsioFlex system connected to a radial arterial catheter is inaccurate for CI measurements and does not track changes in CI adequately. We therefore recommend using validated thermodilution techniques for monitoring in the critical care setting. (C) 2017 European Society of Anaesthesiology

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Multiple Myeloma Presenting as Massive Amyloid Deposition in a Parathyroid Gland Associated with Amyloid Goiter: A Medullary Thyroid Carcinoma Mimic on Intra-operative Frozen Section

Abstract

Clinical examples of amyloid deposition in parathyroid glands are exceedingly rare and usually present as an incidental finding in a patient with amyloid goiter. Here, we present the first histologically documented case of parathyroid amyloid deposition that presented as a mass. The patient did not have hyperparathyroidism. The parathyroid gland was submitted for intra-operative frozen section and concern for medullary thyroid carcinoma was raised. An important histologic clue arguing against medullary thyroid carcinoma was the evenly dispersed nature of the amyloid. Histologic perinuclear clearing and parathyroid hormone immunohistochemistry confirmed parathyroid origin on permanent sections. The patient was also found to have associated amyloid goiter. Mass spectrometry of the amyloid showed it to be composed of kappa light chains. On further work-up, the patient was diagnosed with multiple myeloma. Awareness of parathyroid amyloid deposition is important as it is a histologic mimic of medullary thyroid carcinoma, especially on frozen section. Amyloid typing with evaluation for multiple myeloma in any patient with kappa or lambda light chain restriction is also important.

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