bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Report: A Branchial Cleft Anomaly Presenting as an Oropharyngeal Mass
Authors: Mullin David , Merz Meredith
Published: January 2019

Branchial anomalies are common cervical pathologic entities encountered in the field of otolaryngology and are typical in the pediatric and young adult populations. In most cases, these anomalies present as a cyst, sinus, or fistula in a rather stereotypical fashion. When a branchial anomaly deviates from the classic presentation, an improper diagnosis and inadequate management are more likely to occur, leading to an increased recurrence rate. We present a case of a 6-year-old girl with an incidental finding of a right posterior oropharyngeal wall mass, distinctly separate from the tonsillar fossa, which was found on pathologic analysis to be a branchial cleft anomaly. The theories regarding the pathogenesis of branchial anomalies are presented, along with other cases of atypical branchial anomalies.
Glossal Abscess as a Complication of Tongue-Base Suspension Surgery
Authors: Tajudeen Bobby A. , Lanson Biana G. , Roehm Pamela C.
Published: January 2019

Approximately 60 cases of tongue abscess have been reported in the English-language literature over the past 30 years. We report what we believe is the first case of a glossal abscess that arose as a complication of tongue-base suspension surgery. The patient was a 31-year-old man who presented with a several-day history of odynophagia, tongue swelling, voice changes, and increased snoring. Two years earlier, he had undergone a tongue-base suspension procedure for the treatment of obstructive sleep apnea. Computed tomography (CT) revealed a tongue abscess. During peroral incision and drainage, a knotted 0 Prolene suture was discovered within the abscess cavity. The suture was removed, the area was thoroughly irrigated, the drain was placed in the abscess cavity, and the incision was loosely closed. On postoperative day 5, repeat CT revealed resolution of the abscess, and the patient was discharged on oral antibiotics. Although glossal abscess is very rare, physicians should consider it in the differential diagnosis of any patient who presents with lingual swelling following tongue-base suspension surgery.
Recurrent Myxoid Liposarcoma of the Buccal Mucosa in a Young Boy: A Case Report and Review of the Literature
Authors: Nichols Elizabeth M. , Mirmiran Ali , Garofalo Michael C. , Sun Chen-Chih J. , Hatten Kyle , Wolf Jeffrey
Published: January 2019

Liposarcomas are uncommon in the pediatric population. We present the case of a boy who had experienced multiple recurrences of liposarcoma in the buccal space before he reached the age of 13 years. We also provide a review of the literature and a discussion of adjuvant therapy, which are important to understanding the nature of this disease.
Endoscopic Orbital Decompression of an Isolated Medial Orbital Wall Fracture: A Case Report
Authors: Gultekin Erdogan , Ciftci Zafer , Develioglu Omer N. , Celik Oner , Yener Murat , Kulekci Mehmet
Published: January 2019

Motor vehicle and bicycle accidents are the most common causes of blunt head trauma. Other common etiologies are falls, physical violence, and sports accidents. Blunt trauma toward the superior orbital rim, lateral orbital rim, frontal region, and cranium may lead to intraorbital hematoma. A fracture following the blunt head trauma may form a one-way valve, which leads to orbital emphysema and a more pronounced increase in orbital pressure. Increased tissue pressure in an enclosed space will eventually lead to an inevitable decrease in tissue perfusion. It is important to treat the patient within the first 48 hours following the trauma, which is accepted as the “critical period.” In this report we present a case involving a 42-year-old man who was admitted to our clinic with left periorbital pain, edema, proptosis, and blurred vision after experiencing physical violence. The medical history and physical examination findings, along with imaging studies and a description of the endoscopic orbital decompression procedure within the first 24 hours, are reported.
Orofaciodigital Syndrome
Authors: Naiboglu Baris , Oysu Cagatay , Gokceer Tanju
Published: January 2019

Orofaciodigital syndrome is a very rare entity with X-linked dominant inheritance characterized by oral, facial, and digital anomalies. Thirteen different types have been described in the literature to date. Of these, orofaciodigital syndrome type I has the highest incidence. Renal and central nervous system malformations may accompany the oral, facial, and digital anomalies. We report a case of orofaciodigital syndrome type I in a 9-year-old girl. The patient was admitted with a complaint unrelated to the syndrome. The coexistence of an oral anomaly with a digital anomaly in this patient led us to search for other possible anomalies. Ultrasonography revealed a diagnosis of polycystic kidneys. Physicians must be mindful of the external appearance of patients with this syndrome and be aware of life-threatening anomalies possibly associated with it.
Report of a Sphenoid Sinus Lipoma
Authors: Davis Greg Eldon , Kernochan Lauren Elaine , True Lawrence D.
Published: January 2019

Sphenoid sinus opacification on computed tomography can represent a multitude of etiologies. Such a finding can signify an infectious, inflammatory, congenital, neuronal, vascular, or neoplastic mass. In this article, we describe a case of a lipoma of the sphenoid sinus, and we discuss the differential diagnosis and management of this finding.
Sphenopalatine Artery Pseudoaneurysm after Endoscopic Sinus Surgery: A Case Report and Literature Review
Authors: Campbell Raewyn G.
Published: January 2019

Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after transsphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.
Idiopathic Bilateral Auricular Petrification
Authors: Alsey Karl J. , Freeman Simon R. , Nigam Ajay
Published: January 2019

Auricular petrification is a rare diagnosis and presents an interesting therapeutic challenge. Fewer than 160 cases have been reported in the literature since the first description by Bochdalek in 1866. The most common etiology is ectopic calcification. It may also result from injurious processes including frostbite, physical trauma, inflammatory conditions, and various endocrinopathies. We report an incidental finding of idiopathic bilateral auricular petrification in a 40-year-old man presenting with idiopathic unilateral sensorineural deafness.
Extraorbital pseudotumor of the Petrous Apex: Biopsy via a Transnasal Endoscopic Approach
Authors: Nelson Jeffrey J. , Goyal Parul
Published: January 2019

Extraorbital idiopathic pseudotumors of the skull base are very uncommon. We report the case of a 50-year-old woman who presented with left ophthalmoplegia and vision loss. Imaging studies revealed an enhancing lesion involving the left petrous apex and cavernous sinus. A transnasal endoscopic approach was used to obtain a biopsy of the left petrous apex. Pathology identified the lesion as an idiopathic pseudotumor. The patient was treated with high-dose steroids and steroid-sparing immunomodulators, and she experienced a significant improvement. To the best of our knowledge, this is the first reported case of a transnasal endoscopic approach to a biopsy of a pseudotumor involving the petrous apex. We discuss the features of this case, and we review the literature on this condition.
Poorly Differentiated Small-Cell Neuroendocrine carcinoma of the Submandibular Gland: A Case Report
Authors: Scaduto Mary , Matrka Laura , Shah Manisha , Wakely Paul , Ozer Enver
Published: January 2019

Neuroendocrine carcinoma (NEC) is uncommon in the head and neck and rare in the salivary glands. In the latter location, it may manifest as pain or a palpable mass. These tumors can be quite aggressive, with a tendency toward recurrence and regional and distant metastasis. Because of the limited number of reported cases in the literature, no reliable treatment has been established. We describe the case of a 79-year-old man who presented with a persistent submandibular mass that was suspicious for a malignancy on imaging. Following surgical resection and histopathologic analysis, a diagnosis of poorly differentiated small-cell NEC was made. The patient was further treated with postoperative chemotherapy, and he exhibited no evidence of recurrence or metastasis on follow-up.
Renal Cell Carcinoma Metastatic to the Sinonasal Region: Three Case Reports with a review of the Literature
Authors: Parida Pradipta Kumar
Published: January 2019

The paranasal sinuses are a rare location for metastases. The most frequent infraclavicular primary tumor to metastasize to the nose and paranasal sinuses is renal cell carcinoma. Three cases of bilateral renal cell carcinoma with metastases to the paranasal sinuses and with destruction of the skull base are reported. These patients had a primary renal cell carcinoma on the left side for which they had undergone a left nephrectomy many years previously. Right-sided renal cell carcinoma was diagnosed only after the patients had developed symptoms secondary to their metastases. These patients presented with the unusual manifestations of frontal swelling, proptosis, and epistaxis. They were offered palliative treatment in the form of radiotherapy and interferon therapy.
Carcinoma Ex Pleomorphic adenoma of the Maxillary Sinus: A Case Report
Authors: Sreedharan Suja , Prasad Kishore Chandra , Hegde Mahesh Chandra , Sahoo Kausalya , Alva Arathi
Published: January 2019

A 52-year-old woman presented to the ENT clinic with a huge swelling on the right side of her face that had originated 6 years earlier. The mass was ultimately diagnosed as a carcinoma ex pleomorphic adenoma of the maxillary sinus. Carcinoma ex pleomorphic adenoma itself is uncommon, and its origin in the maxillary sinus is very rare. We discuss the presentation, histopathologic picture, and management of this case.
Behçet Disease as a Cause of Hearing Loss: A Prospective, Placebo-Controlled Study of 29 Patients
Authors: Kemal Ozgur , Anadolu Yucel , Boyvat Ayse , Tatarağasi Ahmet
Published: January 2019

We conducted a prospective, placebo-controlled study to determine the incidence and severity of inner ear involvement and hearing loss in patients with Behçet disease. Our study population was made up of 29 patients with Behçet disease and 28 healthy controls. Audiometric pure-tone thresholds and transient evoked otoacoustic emission (TEOAE) levels were determined in both groups. The main outcome measures were pure-tone audiometry (PTA) levels and TEOAE levels in the two groups. PTA detected a sensorineural hearing loss in 10 of the 29 patients (34.5%). The difference in audiometric findings between the two groups was statistically significant at 1, 2, 4, and 8 kHz ( p ≤ 0.0498). A comparison of TEOAE levels revealed that the difference in sound-to-noise ratio between the two groups was not significant at 1, 1.5, 2, and 3 kHz, but it was significant in 4 kHz (p = 0.02), and the difference in reproducibility between the two groups was significant at 2 and 4 kHz ( p ≤ 0.03). We conclude that all patients with Behçet disease should be screened for hearing impairment and subsequently treated if an impairment is discovered.
A False-Positive FDG Uptake in Teflon Granuloma: A Case Report
Authors: Bajin Münir Demir , Hoşal Ali Şefk
Published: January 2019

Positron emmision tomography (PET) is successfully used to monitor malignancies. Unfortunately it is not tumor specific. We present a case with history of rectum cancer and lentigo maligna who underwent PET-CT which revealed an increased uptake in the larynx. What was first considered as a third pirmary turned out to be a Teflon granuloma.
Facial Nerve Hemangioma: A Case Report
Authors: Wu Edward C. , Rothholtz Vanessa S. , Zardouz Shawn , Lee Alice D. , Djalilian Hamid R.
Published: January 2019

Although hemangiomas are relatively common in the head and neck, those that originate in the facial nerve are extremely rare. These benign tumors have the potential to compress or invade the adjacent facial nerve and thereby produce facial paralysis and other associated symptoms. We present a case of facial nerve hemangioma in a 15-year-old girl that initially manifested as unilateral facial weakness. We also discuss the diagnostic imaging and management options.
Methicillin-Resistant Staphylococcus Aureus as a Cause of Neonatal Suppurative Parotitis: A Report of two Cases and Review of the Literature
Authors: Donovan Sean T. , Rohman Grant T. , Selph John P. , Rajan Roy , Stocks Rosemary M. , Thompson Jerome W.
Published: January 2019

Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.
Kasabach-Merritt Syndrome in a Child with Upper Airway Compromise and Spontaneous Periorbital Bruising
Authors: Goswamy Jay , Aggarwal Rohini , Bruce Iain A. , Rothera Michael P.
Published: January 2019

A hemangioma that rapidly increases in size has the potential to trap platelets and cause a consumptive co-agulopathy. We describe the case of an 18-week-old boy who was brought to a local emergency department with ecchymosis on his nasal bridge and medial epicanthi, as well as a sub-conjunctival hemorrhage. He was noted to be anemic and thrombocytopenic. Packed red blood cells and platelets were transfused. However, despite hematologic correction, the ecchymosis and petechiae worsened, and a mass became evident in the right posterior triangle of the patient's neck. Computed tomography demonstrated a lobular soft-tissue-density mass in the right posterior triangle that extended to the level of the skull base. Histologic analysis of a biopsy specimen revealed that the lesion was a giant kaposiform hemangioma. The patient was diagnosed with Kasabach-Merritt syndrome, and prednisolone was commenced as a first-line treatment. However, the mass continued to grow, resulting in inspiratory stridor. Magnetic resonance imaging revealed encroachment into the thecal sac and compression of the spinal cord. The lesion was embolized, and vincristine therapy was commenced. Following a second embolization, the size of the lesion decreased and no further blood products were required. The hemangioma was deemed to be unresectable. The successful treatment in this case was dependent on the maintenance of hemostasis, the initial medical treatment with a corticosteroid, repeat embolization, and longer-term control with vincristine.
Laryngeal Plexiform Neurofibroma in a Child
Authors: Kasapoglu Fikret , Özdemircan Talip , Erisen Levent
Published: January 2019

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and “Lisch nodules.” Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.
Metastatic Choriocarcinoma: A Rare Presentation as a Neck Mass
Authors: Şenkal Hilmi Alper , Yilmaz Taner , Sözeri Ahmet Bülent
Published: January 2019

Testicular carcinoma metastatic to the neck is rare. Even more rare is a finding of choriocarcinoma as a neck mass without any sign of a primary testicular tumor, as only a few cases have been reported in the literature. We describe a new case that occurred in a 29-year-old man who presented with a neck mass. Fine-needle aspiration biopsy identified the tumor as a malignant epithelial neoplasm. Radiologic findings indicated the presence of a systemic metastasis of a tumor to the chest and abdomen, as well as the neck. Findings on an incisional biopsy of the neck mass were consistent with a choriocarcinoma. The testicles were normal on palpation and ultrasonography. The patient was diagnosed with metastatic choriocarcinoma with an unknown primary, and he was started on chemotherapy. On the second day of treatment, which was 25 days after his referral to our clinic, he died of respiratory insufficiency.
Aneurysmal Bone Cyst in the Middle Turbinate: A Case Report
Authors: Simsek Gokce , Saka Cem , Sonbay Didem N. , Akin Istemihan , Koybasioglu Fulya
Published: January 2019

Aneurysmal bone cyst is a benign and locally destructive bone lesion usually seen in the younger population. Its etiology is unknown. Its yearly incidence rate has been reported to be 0.14/100,000, comprising 1% of all bone tumors. It may develop primarily or arise from primary bone tumors. Hemorrhagic fluid content with a septated appearance is the characteristic feature of aneurysmal bone cyst. It is most commonly seen in the metaphysis of the long bones. In rare cases, the cyst is located in the skull. Primary treatment is surgical excision, and the recurrence rate after treatment is 10 to 30%. Based on a review of the current literature, there have been no previous reports of aneurysmal bone cyst located in the middle turbinate. We report a case of aneurysmal bone cyst with an atypical location and discuss the treatment of the patient with endoscopic surgery in light of relevant literature.
Using a Capsule Flap for the Reconstruction of a Partial Auricular Defect
Authors: Keklik Bariş , Yazar Memet , Başaran Karaca , Güven Erdem , Kuvat Samet Vasfi
Published: January 2019

In this article we describe the capsular flap for covering the posterior surface of cartilaginous framework in ear reconstruction. This technique has not been previously described in the published literature.
Unusual Pseudomyiasis with Musca Domestica (Housefly) Larvae in a Tracheostomy Wound: A Case Report and Literature Review
Authors: Shakeel Mohammad , Khan Iram , Ahmad Imteyaz , Iqbal Zafar , Hasan Syed Abrar
Published: January 2019

We report a case of pseudomyiasis (accidental myiasis) in a 52-year-old man who had previously undergone surgery and placement of a tracheostomy tube for laryngeal cancer. The patient presented to our outpatient department with a foul-smelling, blood-stained discharge and frequent and severe episodic pain at the site of the tracheostomy. He also reported the discharge of many whitish larvae from the site. On clinical examination, 3 of these larvae were removed from the tracheostomy wound and later identified as Musca domestica (housefly) larvae. The patient underwent further mechanical removal twice daily for 3 days, during which time 23 more larvae, or maggots, were removed. His condition improved, and he returned for regular follow-up with no recurrence or complications. Myiasis is an infestation of humans and vertebrate animals by insect larvae that feed on both dead and living tissue. Myiasis is most common in hot and humid climates in tropical and subtropical regions, such as the underdeveloped areas of India, Africa, and Southeast Asia, which provide favorable breeding grounds for flies. Myiasis is classified as specific, semispecific, or accidental, depending on whether the fly larvae require a host in order to develop. We review the literature on myiasis and its entomologic aspects in general. We also discuss the need for the proper care of tracheostomy wound myiasis because the site of such an infestation is close to vital organs in the neck. To the best of our knowledge, only 3 cases of tracheostomy wound myiasis have been previously reported in the English-language literature; 2 of them involved infestation with Chrysomyia bezziana larvae and 1 with Lucilia caesar larvae. We believe our case is the first case of tracheostomy wound pseudomyiasis attributable to M domestica larvae.
Late-Onset Complications after Chemoradiation for Head and Neck Carcinomas
Authors: Surkin Marc I. , Schwartz Sandra A. , Markiewicz Deborah A.
Published: January 2019

Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.
Analysis of the Vertebrobasilar System in Patients with Obstructive Sleep Apnea
Authors: Taskin Umit , Yigit Ozgur , Sisman Ayse S. , Ogreden Sahin , Azizli Elad , Kantarci Fatih , Mihmanli Ismail
Published: January 2019

We conducted a prospective study to evaluate the vertebrobasilar system in adults with and without obstructive sleep apnea (OSA). Our study population was made up of 48 patients with OSA and 21 healthy volunteers who served as controls; the OSA patients were subdivided into one group with mild or moderate OSA (n = 22) and another with severe OSA (n = 26). Each participant underwent Doppler ultrasonography three times to mea-sure the diameter of the vertebral artery, the peak systolic velocity (PSV), the resistive index (RI), and the vertebral artery flow volume; the mean of the three measurements was calculated for each patient, for the OSA and control groups, and for various subgroups. No significant differences in vessel diameter, PSV, or RI were seen among any of the subgroups. Overall, the vertebral artery flow volume was slightly, but not significantly, higher in all patients with OSA (206 ml/min) than in the control group (177 ml/min); this difference might reflect the body's daytime response to the chronic apneic events experienced during sleep. The only statistically significant difference we found was in vertebral artery flow volume between the controls and the subgroup with mild or moderate OSA (p = 0.026); no difference was seen between the controls and the patients with severe OSA (p = 0.318). Likewise, no significant difference in any of the four parameters was seen when patients were subclassified by body mass index and arterial oxygen saturation level.
Non-Otogenic Lateral Sinus Thrombosis: A Complication of Acute Sphenoid Sinusitis
Authors: Somerville Jessica M. , Lyman Erik , Thompson Jerome W. , Stocks Rosemary
Published: January 2019

The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.
The Efficacy of Photodynamic Therapy in the Treatment of Oral Squamous Cell Carcinoma: A Meta-Analysis
Authors: Cerrati Eric W. , Nguyen Shaun A. , Farrar Joshua D. , Lentsch Eric J.
Published: January 2019

We performed an extensive review of the literature to compare the efficacy of photodynamic therapy (PDT) to surgical resection, the current standard of care, in the treatment of adults with early-stage (T1-2N0M0) squamous cell carcinoma (SCC) of the oral cavity. Since patients who receive PDT are chosen with a high degree of selectivity, particular care was taken when extracting data for comparison. For outcomes measures, PDT was assessed in terms of a complete response to therapy, and surgery was evaluated in terms of locoregional control. Recurrences were also analyzed. We found 24 studies—12 for each treatment—to compare for this meta-analysis. In comparing a complete response to PDT and locoregional control with surgery, we found no statistically significant difference (mean difference [MD]: 1.166; 95% confidence interval [CI]: 0.479 to 2.839). With respect to recurrences, again no statistically significant difference was observed (MD: 0.552; 95% CI: 0.206 to 1.477). We conclude that PDT is as effective as primary surgical resection for the treatment of early-stage SCC of the oral cavity and that it is a valid function-preserving approach to treatment.
Vestibular Dehiscence Syndrome Caused by a Labyrinthine Congenital Cholesteatoma
Authors: Fiorino Francesco , Pizzini Francesca B. , Mattellini Barbara , Barbieri Franco
Published: January 2019

A 40-year-old man presented with conductive hearing loss and pressure- and sound-related vestibular symptoms. Computed tomography and diffusion-weighted magnetic resonance imaging revealed the presence of a cholesteatoma involving the vestibular labyrinth. The patient underwent a canal-wall-up tympanoplasty, which revealed evidence of a disruption of the vestibular labyrinth and a wide dehiscence of the vestibule, which was immediately resurfaced. At the 2-month follow-up, the patient's pressure- and sound-related vestibular symptoms had disappeared. Pure-tone audiometry showed a reduction in the air-bone gap with a slight deterioration of bone conduction and an improvement in the air-conduction threshold. Fistulization of the otic capsule produces a “third window,” which can lead to a dehiscence syndrome. One possible cause is a cholesteatoma of the middle ear or petrous bone. When the vestibule is invaded by a cholesteatoma, hearing is almost invariably lost, either pre- or postoperatively. However, in our case, wide opening of the vestibule resulted in hearing preservation.
Primary Thyroid-Like Papillary Adenocarcinoma of the Nasal Septum: A Case Report
Authors: Ozturk Kerem , Midilli Rasit , Veral Ali , Ertan Yesim , Karci Bulent
Published: January 2019

Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
Intraductal Infusion of Steroids in Patients with Sjögren Syndrome to Treat Painful Salivary Swelling: Report of 2 Cases
Authors: Diggelmann Henry R. , Hoffman Henry T.
Published: January 2019

Painful salivary swelling in patients with Sjogren syndrome presents the clinician with a difficult-to-manage condition, and treatment options are limited. We report 2 cases that demonstrate the utility of a clinic-based intraductal corticosteroid infusion for the treatment of painful salivary swelling associated with Sjogren syndrome. Steroid infusion is a cost-effective, simple-to-perform, well-tolerated gland-sparing procedure that may yield good clinical results in selected patients.
Intraductal Infusion of Steroids in Patients with Sjögren Syndrome to Treat Painful Salivary Swelling: Report of 2 Cases
Authors: Diggelmann Henry R. , Hoffman Henry T.
Published: January 2019

Painful salivary swelling in patients with Sjögren syndrome presents the clinician with a difficult-to-manage condition, and treatment options are limited. We report 2 cases that demonstrate the utility of a clinic-based intraductal corticosteroid infusion for the treatment of painful salivary swelling associated with Sjögren syndrome. Steroid infusion is a cost-effective, simple-to-perform, well-tolerated gland-sparing procedure that may yield good clinical results in selected patients.
Internal Auditory Canal Osteoma: Case Report and Review of the Literature
Authors: Tamir Sharon Ovnat , Cyna-Gorse Francoise , Sterkers Olivier
Published: January 2019

We report a case of internal auditory canal osteoma and discuss this entity's etiology, natural history, and treatment options. The internal auditory canal osteoma is a rare entity with only a few reports published in the medical literature. Its diagnosis is based on two complementary imaging modalities: thin-slice computed tomography and magnetic resonance imaging. No consensus exists regarding the treatment of this entity, and treatment should be tailored to each patient depending on that patient's initial complaints, as well as his or her medical findings.
Anaplastic Large-Cell Lymphoma Presenting as a Nasopharyngeal Mass and Cervical Lymphadenopathy
Authors: Dion Gregory R. , Packer Mark D.
Published: January 2019

Cervical lymphadenopathy in adults has a broad differential diagnosis, including bacterial and viral infections, Kikuchi-Fujimoto disease, systemic lupus erythematosus, and various neoplasms. Many of its etiologies share similar symptomatology and presentations, which complicates the diagnosis. A thorough history and a comprehensive physical examination, to include nasopharyngoscopy and imaging as indicated by the specific case, are key to determining the origin of the lymphadenopathy and to avoid a missed or delayed diagnosis. Based on our review of the literature, we present the second reported case of anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma presenting in an adult with an obstructing adenoid/nasopharyngeal mass and lymphadenopathy. The mass, which occurred in a 19-year-old woman of Asian descent, caused nasal airway obstruction in the setting of cervical lymphadenopathy that was initially ascribed to mononucleosis.
Use of Fluoroscopic Guidance to Remove a Migrating Esophageal Foreign Body
Authors: Sinha Ramanuj , Jana Utpal , Ghatak Soumya , Biswas Gautam , Saha Jayanta , Sen Indranil
Published: January 2019

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.
Oncocytic Mucoepidermoid Carcinoma of the Parotid Gland: A Case Report and Review of the Literature
Authors: Jain Deepali , Nayak Nabeen C.
Published: January 2019

Oncocytic metaplasia rarely has been reported in mucoepidermoid carcinomas. Most salivary gland lesions with oncocytic change are benign; therefore, it is important to distinguish mucoepidermoid carcinoma from other entities that may show prominent oncocytic change. We report a rare case of oncocytic mucoepidermoid carcinoma in a 65-year-old woman.
Two Cases of Thyroid Rupture after Blunt Cervical Trauma
Authors: Shin Ji Hoon , Ji Yong Bae , Jeong Jin Hyeok , Lee Seung Hwan , Tae Kyung
Published: January 2019

The consequences of thyroid gland rupture following blunt cervical trauma can be quite grave. Almost all of these cases are associated with preexisting thyroid lesions; the traumatic rupture of a previously normal thyroid gland is very rare. Both surgical and nonsurgical management techniques have been advocated for thyroid injuries, but there is still no consensus on treatment. We report cases of thyroid gland rupture following blunt cervical trauma in 2 patients: a 24-year-old man with a previously normal thyroid and an 8-year-old boy with a preexisting thyroid nodule. The man was treated surgically and the boy was treated conservatively. Based on our experience with these cases and our review of the literature, we propose treatment guidelines for thyroid injuries.
Radiographic Findings of a Well-Differentiated Sinonasal Neuroendocrine Neoplasm: Case Report and Review of the Literature
Authors: Mao Cui Ping , Zhang Ming , Niu Chen , Li Min , Wang Yuan
Published: January 2019

Typical carcinoid is a rare tumor among other neuroendocrine neoplasms that occur in the nasal cavity. Only a few cases of typical carcinoids in the nasal cavity have been reported. We report a case of typical carcinoid of the nasal cavity in a 61-year-old man who had a history of persistent nasal obstruction and epistaxis for approximately 17 years. Computed tomography revealed a huge, lobulated mass in the nasal cavity with extension into the posterior sphenoid sinus. Extensive bone destruction could be seen in the neighboring sphenoid sinus. MR imaging suggested that the tumor was close to the dura. The final histologic evaluation of the excised biopsy specimen yielded a diagnosis of a well-differentiated neuroendocrine neoplasm (typical carcinoid). In this article, the relevant reports in the literature are reviewed, and the role of radiographic findings on tumor diagnosis and on the establishment of a surgery plan is emphasized.
Otic Capsule Dehiscence Syndrome: Superior Semicircular Canal Dehiscence Syndrome with no Radiographically Visible Dehiscence
Authors: Wackym P. Ashley , Wood Scott J. , Siker David A. , Carter Dale M.
Published: January 2019

We conducted a prospective longitudinal study of two cohorts of patients who had superior semicircular canal dehiscence syndrome (SSCDS); one group had radiographically confirmed superior canal dehiscence (SCD), and the other exhibited no identified otic capsule dehiscence on imaging (no-iOCD). We compiled data obtained from prospective structured symptomatology interviews; diagnostic studies; three-dimensional, high-resolution, temporal bone computed tomography; and a retrospective case review from our tertiary care referral center. Eleven adults and 1 child with SSCDS were identified, surgically managed, and followed. Six of these patients—1 man and 5 women, aged 29 to 54 years at first surgery (mean: 41.8)—had radiologically confirmed SCD. The other 6 patients—1 man, 4 women, and 1 girl, aged 1 to 51 years (mean: 32.2)—had no-iOCD. The 6 adults with SCD underwent surgery via a middle cranial fossa approach with plugging procedures. The 5 adults and 1 child with no-iOCD underwent round window reinforcement (RWR) surgery. One SCD patient developed no-iOCD 1.5 years after SCD surgery, and she subsequently underwent RWR surgery. Our main outcome measures were patient symptomatology (with video documentation) and the results of diagnostic studies. Other than the character of migraine headaches, there was no difference in preoperative symptomatology between the two groups. Postoperatively, resolution of SSCDS symptoms ultimately occurred in all patients. Both the SCD and the no-iOCD groups experienced a highly significant improvement in postural control following treatment (Wilcoxon signed rank test, p < 0.001). We conclude that the term otic capsule dehiscence syndrome more accurately reflects the clinical syndrome of SSCDS since it includes both superior semicircular canal dehiscence and no-iOCD, as well as posterior and lateral semicircular canal dehiscence, all of which can manifest as SSCDS. We have also included links to videos in which 4 of the SSCDS patients with no-iOCD in this study discussed their symptoms and the results of their surgery; these links are found in the “References” section in citations 12–15. Links to three other videos of interest are contained in citations 10, 11, and 24.
Impact of Nasal Septal Perforations of Varying Sizes and Locations on the Warming Function of the Nasal Cavity: A Computational Fluid-Dynamics Analysis of 5 Cases
Authors: Li Lifeng , Han Demin , Zhang Luo , Li Yunchuan , Zang Hongrui , Wang Tong , Liu Yingxi
Published: January 2019

Patients with a nasal septal perforation often exhibit symptoms associated with disturbed airflow, which can have an adverse effect on the warming function of the nasal cavity. The impact of this effect is not fully understood. The warming function is an important factor in the maintenance of nasal physiology. We conducted a study to investigate the impact of septal perforations of various sizes and locations on the warming function during inspiration in 5 patients—3 men and 2 women, aged 25 to 47 years. Three-dimensional computed tomography and computational fluid dynamics were used to model the flux of communication and temperature, and differences among patients were compared. All 5 patients exhibited an impairment of their nasal warming function. As the size of the perforation increased, the flux of communication increased and the warming function decreased. Perforations located in an anterior position were associated with greater damage to the warming function than those in a posterior position. In patients with a large or anteriorly located perforation, airflow temperature in the nasopharynx was decreased. Our findings suggest that septal perforations not only induce airflow disturbance, but they also impair the nasal warming function. Further analysis of warming function is necessary to better explore flow mechanisms in patients with structural abnormalities.
How Successful is the Fitting of Digital Hearing Aids? Implications for the Allocation of Resources within National Health Systems
Authors: Vlastarakos Petros V. , Cameron Alastair I. , Nikolopoulos Thomas P.
Published: January 2019

We conducted a retrospective study to determine the success rate of initial fittings in digital hearing aid (DHA) users. We also addressed the implications of national health systems’ continuing to provide access to these devices. We identified 1,597 consecutively presenting adults who had undergone a first fitting or a new fitting (i.e., an upgrade from an analogue hearing aid in the first or second ear) of a behind-the-ear DHA during the previous year. We further sought to identify all nominal reprogram appointments that had taken place within 6 months after the first or new fitting, we found 460 such appointments (28.8%). Of these, 419 appointments had been for typical reasons other than patient dissatisfaction with the fitting itself—for example, poor hearing, a further hearing loss, an uncomfortably loud hearing aid level, difficulty with speech in noise, an imbalance between bilateral hearing aids, and a faulty or lost hearing aid. Only 41 of the 1,597 first or new fittings (2.6%) were considered unsatisfactory by patients and necessitated a follow-up reprogramming appointment. Overall, DHA fittings were generally successful, as most patients (1,137/1,597 [71.2%]) did not require any follow-up appointment during the study period. Principles of cost-effectiveness demand the maximum practicable efficiency in the utilization of resources to ensure the continuous delivery of high-quality audiologic services through national health systems. This can be achieved by scheduling group appointments to reduce costs and to increase the time allocated to fitting and training patients.
A systematic review of the nutritional implications of military rations
Authors: Sotelo-Díaz Indira , Blanco-Lizarazo Carla María
Published: January 2019

Background:

The objective of this study was to assess military rations. Military rations must provide military personnel with suitable nutrition, as high-quality nutrition is crucial for promoting health.

Aim:

This systematic review provides information regarding the nutritional design of military rations according to energy and protein intake and supplements.

Methods:

A systematic search was conducted for articles published to date regarding the nutritional needs involved in a military diet for an active population of either gender, ranging from 18 to 60 years old, without excluding material by year, type of document, location, or author. The pertinent articles found were published from 1994 to 2017.

Results:

Physical activity and environmental factors directly affect calculating energy needs and carbohydrate intake when designing military rations. However, the results showed no influence on protein, fat and/or sodium intake. Furthermore, the search revealed that military populations have a high intake of dietary supplements; it is thus worth considering their incorporation into campaign rations.

Conclusion:

Military personnel macro- and micro-nutrient needs depend on physical activity and nutrient intake measurement methodologies. The data regarding military personnel dietary supplement consumption indicated that this is a niche worth considering when designing military rations. Research on nutritional needs for military rations could concentrate on optimizing the amount of macro- and micro-nutrients and their biological value, according to physical activity, as well as maintaining their sensory quality, safety and shelf life using different processing technologies.
The Bones of Contention: The Secularization of Cemeteries and Funerals in the Spanish Second Republic
Authors: Kerry Matthew
Published: January 2019

The secularizing efforts of the Spanish Second Republic met fierce resistance from Catholics and the Church. Local authorities spearheaded secularization in an unclear legal context, yet they also attempted to mediate between different demands, while protecting Catholic sentiment and respecting property rights. Cemeteries and funeral processions were a key battleground in a ‘culture war’ which straddles the nineteenth-century preoccupation with the role of religion in the lives of Spanish citizens and the intensity of interwar conflict, the bitter struggles to occupy public space, and the mobilization of antagonistic conceptualizations of the ‘people’.
Seeking consensus amongst UK-based interventional radiologists on the imaging diagnosis of pelvic vein incompetence in women with chronic pelvic pain: A modified Delphi study
Authors: Riding David M , Pond Emma J , McCollum Charles , Caress Ann L
Published: January 2019

Objectives

This modified Delphi study of vascular interventional radiologists sought to achieve consensus statements on the optimal imaging strategy and definitions of important imaging diagnostic features in women with pelvic vein incompetence.

Method

The UK-based interventional radiologists with the experience of investigating and treating pelvic vein incompetence responded to up to three rounds of online questionnaires.

Results

Three consensus statements emerged from 27 responders: (1) catheter venography is the ‘gold standard’ investigation for the diagnosis of pelvic vein incompetence; (2) pelvic vein incompetence should be defined as ‘retrograde flow along the ovarian or internal iliac veins’; (3) pelvic varices should be defined as ‘tortuous, often dilated, vulval, adnexal, para-uterine veins arising from incompetent internal iliac or ovarian veins.’

Conclusion

This study achieved consensus statements on imaging diagnosis in women with suspected pelvic vein incompetence. These can be used to minimise heterogeneity of research protocols, and represent baseline positions which can, themselves, be tested.
The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physical therapy after stroke: a randomized controlled trial
Authors: Khan Fayaz , Rathore Chaturbhuj , Kate Mahesh , Joy Josy , Zachariah George , Vincent P C , Varma Ravi Prasad , Radhakrishnan Kurupath
Published: January 2019

Objective:

To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.

Design:

Single blind randomized controlled trial.

Setting:

Outpatient clinics and inpatient wards at tertiary care neurology center.

Subjects:

Adult patients with acute middle cerebral artery territory ischemic stroke.

Interventions:

60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.

Outcome measures:

Fugl Meyer Assessment upper limb score (FMA-UL) was primary outcome measure. Patients were evaluated at baseline and subsequently at one, three and six months and one year.

Results:

Compared to PT group, mean FMA-UL scores were higher in TBS and FES groups at all follow-ups ( P < 0.001). From baseline to one year, mean (SD) FMA-UL scores increased from 14.9(2.1) to 55.55(2.46) in TBS group, 15.5(1.99) to 55.85(2.46) in FES group, and 14.3(2.2) to 43.3(4.22) in PT group indicating an increase of 273%, 260%, and 203% respectively. There was no difference between FES and TBS groups.

Conclusion:

A four-week intervention with TBS or FES combined with PT produces better long-term arm functions as compared to PT alone in patients with acute stroke.
Oxidative stress-induced activation of Abl and Src kinases rapidly induces P-glycoprotein internalization via phosphorylation of caveolin-1 on tyrosine-14, decreasing cortisol efflux at the blood–brain barrier
Authors: Hoshi Yutaro , Uchida Yasuo , Tachikawa Masanori , Ohtsuki Sumio , Couraud Pierre-Olivier , Suzuki Takashi , Terasaki Tetsuya
Published: January 2019

Exposure of the brain to high levels of glucocorticoids during ischemia–reperfusion induces neuronal cell death. Oxidative stress alters blood–brain barrier (BBB) function during ischemia–reperfusion, and so we hypothesized that it might impair P-glycoprotein (P-gp)-mediated efflux transport of glucocorticoids at the BBB. Therefore, the purpose of this study was to clarify the molecular mechanism of this putative decrease of P-gp-mediated efflux function. First, we established that H2O2 treatment of a human in vitro BBB model (hCMEC/D3) reduced both P-gp efflux transport activity and protein expression on the plasma membrane within 20 min. These results suggested that the rapid decrease of efflux function might be due to internalization of P-gp. Furthermore, H2O2 treatment markedly increased tyrosine-14-phosphorylated caveolin-1, which is involved in P-gp internalization. A brain perfusion study in rats showed that cortisol efflux at the BBB was markedly decreased by H2O2 administration, and inhibitors of Abl kinase and Src kinase, which phosphorylate tyrosine-14 in caveolin-1, suppressed this decrease. Overall, these findings support the idea that oxidative stress-induced activation of Abl kinase and Src kinase induces internalization of P-gp via the phosphorylation of tyrosine-14 in caveolin-1, leading to a rapid decrease of P-gp-mediated cortisol efflux at the BBB.