bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision of the genus Carybdea (Cnidaria: Cubozoa: Carybdeidae): clarifying the identity of its type species Carybdea marsupialis
Authors: ACEVEDO MELISSA J. , STRAEHLER-POHL ILKA , MORANDINI ANDRÉ C. , STAMPAR SERGIO N. , BENTLAGE BASTIAN , MATSUMOTO GEORGE I. , YANAGIHARA ANGEL , TOSHINO SHO , BORDEHORE CÉSAR , FUENTES VERÓNICA L.
Published: January 2019

While records of Carybdea marsupialis in the literature suggest a worldwide distribution of this species, the validity of some of these records has been questioned recently, as has the validity of some nominal Carybdea species. We inspected material of all known species of Carybdea from multiple locations (i.e. Spain, Algeria, Tunisia, Puerto Rico, California, Hawaii, Australia, South Africa, and Japan) using morphological and genetic tools to differentiate Carybdea species as well as understand their evolutionary relationships. We observed morphological differences between adult medusae of Mediterranean and Caribbean C. marsupialis; the most obvious differences were the structure of the phacellae, the structure of the pedalial canal knee bend, and the number and structure of the velarial canals. The characters of the adult Mediterranean specimens agree with the description provided by Claus (1878) for individuals of C. marsupialis from the Adriatic Sea (Italy); specimens from the Caribbean (Puerto Rico) agreed with the description of C. xaymacana by Conant (1897). Significant differences between both species were also observed in the newly released medusa stage. Further, we resolved a discord about the undefined polyp culture originating from Puerto Rico that was long considered Carybdea marsupialis but should be referred to as C. xaymacana. Although C. marsupialis is currently considered the only species of Cubozoa to occur in the Mediterranean, specimens collected in Algeria and Tunisia suggest that species of Alatinidae may also be present in the Mediterranean. Our investigations indicate that Carybdea spp. are more restricted in their geographical distribution than has been recognized historically. These findings confirm that Carybdea arborifera Maas, 1897 from Hawaii, Carybdea branchi, Gershwin & Gibbons, 2009 from South Africa, Carybdea brevipedalia Kishinouye, 1891 from Japan, Carybdea confusa Straehler-Pohl, Matsumoto & Acevedo, 2017 from California, Carybdea marsupialis Linnaeus, 1758 from the European Mediterranean Sea, Carybdea rastonii Haacke, 1886 from South Australia, and Carybdea xaymacana, Conant, 1897 from the Caribbean Sea are valid names representing distinct species, rather than synonyms. A taxonomic key for all valid species is provided, and a neotype for C. marsupialis is designated.
An Examination of Higher Education Policy Problems Using Narrative Policy Analysis
Authors: Martinez Magdalena
Published: January 2019

Policy actors and coalitions use narratives to frame higher education policy problems and solutions. In this article, I illustrate how I employed narrative policy analysis (NPA) in practice to demonstrate how state policy actors and coalitions created policy storylines that offered social orientation, reassurance, or guidance for a stubborn higher education policy problem in one state. I begin the article with a review of NPA, followed by a discussion of the methods and tools that guided my analysis and scholars interested in NPA can employ. Next, I provide a brief overview of the policy problem context followed by a detailed description and examples of analysis for policy artifacts and the construction of policy storylines.
Teaching Psychotherapy to Psychoanalytic Candidates
Authors: Cherry Sabrina , Rosenberg Michele , Caligor Eve
Published: January 2019

Psychoanalytic institutes have developed a variety of approaches to address the reality that psychoanalytically trained clinicians generally practice more psychodynamic psychotherapy than they do formal psychoanalysis. At the Columbia University Center for Psychoanalytic Training and Research we developed a course for advanced candidates challenging them to integrate what they have learned about doing psychoanalysis during training with their ongoing fund of knowledge about psychotherapy practice. We encourage them to consider how they select treatments and to reflect on similarities and differences between the two modalities with regard to listening, selecting a focus, intervening, and managing the relationship. We also discuss how they approach terminations and how they transition between psychoanalysis and psychotherapy. We selectively use the psychotherapy research literature grounded in the common factors approach in order to update candidates about current knowledge in the field.
Workplace mental health: Current practice and support needs of Ontario occupational therapists
Authors: Moll Sandra E. , Heino Caitlin M. , LeBlanc Alison H. , Beck Lydia B. , Kalef Laura M.
Published: January 2019

Background.

Workplace mental health (WMH) is an important and expanding practice area for occupational therapists.

Purpose.

This cross-sectional study explores the current practices and support needs of Ontario-based occupational therapists in WMH.

Method.

Registrants from the provincial association who provide mental health and/or work-related services were invited to participate. Ninety-three therapists completed an online survey; 10 participated in follow-up focus groups. Analysis involved descriptive statistics of the survey data and content analysis of the focus group data.

Findings.

Return to work, reactivation, and functional cognitive assessment were the most commonly reported services. Key challenges were limited funding and training and lack of awareness of the occupational therapy role. Therapists emphasized the importance of raising the competence, credibility, and profile of occupational therapy in WMH.

Implications.

Defining the role of occupational therapy, developing training and resources, and advocacy are needed to advance occupational therapy practice within this rapidly changing field.
Characterization and performance analysis of a shear thickening fluid damper
Authors: Wei Minghai , Lin Kun , Guo Qian , Sun Hong
Published: January 2019

Shear thickening fluid is a smart material with rheological properties that can be rapidly varied by excitation changes. To fully explore the advantages of using shear thickening fluid in various devices, a phenomenological model for simulating complex viscosity characteristics of the shear thickening fluid has been developed, and an analytical model has been presented to predict the mechanical characteristics and performance of a damper filled with shear thickening fluid. Based on the analytical model, the force displacement curves are first analyzed for different excitation amplitudes and frequencies. Second, an investigation of the time history of the damping force at various excitation amplitudes is conducted. Finally, the effects of key design parameters on the force displacement and force velocity curves are discussed. The results show that the shear thickening fluid damper exhibits significant velocity correlation, and the damping force increased as the shear rate of shear thickening fluid increased until the threshold value. For the vibration with high frequency, or fast velocity, or large amplitude, the shear thickening fluid is easy to have high shear rate, which results in a great vibration control capability for the shear thickening fluid damper.
Coupling dynamic modelling and parameter identification of a flexible manipulator system with harmonic drive
Authors: Wang Bin , Lou Junqiang
Published: January 2019

This paper formulates a coupling dynamic model for a flexible manipulator system with harmonic drive using experimental identification method. Parameters of the driven model of the harmonic joint and parameters of coupling vibration model of the flexible manipulator are identified. Accordingly, coupling dynamic models of the proposed system are obtained. Coulomb friction of the joint is identified by step current excitation and uniform rotation experiments at a low speed. Then, the transfer function model of the harmonic joint is established and identified by a pseudorandom binary sequence excitation. And predicted outputs of the obtained model are in good agreement with the experimental setup. Relationships between strain of the flexible manipulator and coupling torque are presented by theoretical derivation. Based on the theoretical model, transfer function from the angular displacement of the servo motor to the coupling torque is identified. Experimental results show this identified model match well with the proposed structure, both in the time and frequency domain. As a result, coupling dynamic modelling of the flexible manipulator system with harmonic drive is accomplished.
Congestion management using thyristor controlled series compensator employing Improved Grey Wolf Optimization technique
Authors: Behera Saswati K , Mohanty Nalin K
Published: January 2019

For reliable and secure operation of deregulated power systems, congestion management is a big task for system operators to control the line flows in the specified limits. Congestion may occur due to an increase in load demand or as a consequence of unexpected contingencies. Generator rescheduling and use of Flexible AC Transmission System devices are some of the approaches to lessen the flows in heavily loaded lines. This paper proposes to use an Improved Grey Wolf Optimization (IGWO) technique to solve congestion management problems. The improvement in Grey Wolf Optimization technique is made by a scheme which keeps an appropriate balance among the exploitation and exploration phases of the technique and a modified formula to determine the Grey Wolves’ positions throughout the course of iterations. The suggested IGWO technique is initially estimated by means of some typical test functions and comparative results are presented with original Grey Wolf Optimization, sine cosine algorithm, gravitational search algorithm, differential evolution and particle swarm optimization techniques to validate its advantage. The suggested IGWO algorithm is employed to control line power flows within limit in an overloaded modified IEEE 14 bus power system installed with a FACTS device by optimizing the generator real power settings, voltage settings, transformer tap settings, reactive power compensation setting and FACTS reactance settings.
The Trend toward Co-operation
Authors: Wilds Elmer H.
Published: January 2019

“Intrenched interests sponsoring these contests for commercial and recruiting purposes must be educated to see the undesirable effects of their policies …. Gradual substitution of co-operative inter-school activities for inter-school contests is undoubtedly feasible.”
Take Time to be Human
Authors: Case Roscoe David
Published: January 2019

Students and even instructors approach with trembling knees the office doors of certain administrators.
Glimpses of European Schools
Authors: Pitman J. Asbury
Published: January 2019

Beginning a series of reports by an American educator who had unusual opportunities for first-hand observation.
An Adventure in Health Teaching
Authors: Babson Ella Bailey
Published: January 2019

A four-fold investigation by boys of a junior high school awakened a lively interest and yielded results beyond anticipation.
Who is Cultured?
Authors: Champlin Carroll D.
Published: January 2019

“The unscholarly are not necessarily vulgar people, and the philosophers, mathematicians, historians and linguists are by no means ex-officio persons of superior culture.”
When We Really Teach English
Authors: Eginton Daniel P.
Published: January 2019

Twenty Suggestions for Stimulating and Guiding Language Activities—and twenty more to come
Teaching as a Women's Occupation: A Feminist Critique
Authors: Mitrano Barbara S.
Published: January 2019

This article analyzes teaching as a women's occupation. It begins with undergraduate teacher-preparation programs and the ways in which women are influenced to view teaching as a desirable occupation for them while it is held to be not so desirable for men. It then examines those features of the occupation that have been criticized as helping to keep teaching from becoming a true “profession.” These include: a) ease of entry into preparation programs, b) the quality of these programs, c) the comparison of these preparation programs with those of law and medicine, through the concept of the “ordeal,” d) the ways in which undergraduate education in general perpetuates sexism, e) teaching as an unstaged, mobility-blocked occupation, f) role conflicts that women teachers experience, g) the moral quality attached to teaching, and h) the psychic rewards of teaching. For each of these issues, an analysis is made which demonstrates that these institutional constraints help perpetuate sexism in the occupation, while at the same time the constraints themselves are seen as caused by the women who are their victims.
An Account of Georgia's Mandated English Testing Program
Authors: Naugle Helen H.
Published: January 2019

“An Account of Georgia's Mandated English Testing Program” reveals reactions — pro and con — of Georgia teachers to the Regents' English Examination, a test mandated by the Board of Regents for all Georgia state-supported colleges as a requirement for graduation. The test has two parts, an objective section and a 45-minute essay. Testimonials reveal both strengths and weaknesses in the examination, which has made an impact on areas of instruction, staffing, and teaching techniques.
Nasal Cavity Ossifying Fibrosarcoma: An Unusual Fibro-Osseous Neoplasm
Authors: Alameda Yadiel A. , Perez-Mitchell Carlos , Busquets José M.
Published: January 2019

We describe the case of a 65-year-old woman who presented with left nasal obstruction. Clinical and radiographic examinations revealed the presence of a soft-tissue mass that had obliterated the left nasal cavity. The mass was completely excised via an endoscopic approach. Histopathologic examination identified the tumor as an ossifying fibrosarcoma. The patient recovered uneventfully and remained free of disease at the 2-year postoperative follow-up. To the best of our knowledge, no case of an ossifying fibrosarcoma of the nasal cavity has been previously reported in the English-language literature. We discuss the features of this case and the clinical presentation, diagnosis, and management of fibrosarcomas of the nasal cavity and paranasal sinuses.
Inadequate Health Insurance Coverage: A Major Factor in Premature Discontinuation of Subcutaneous Immunotherapy for Allergic Rhinitis
Authors: Vaswani Ravi , Liu Yi-Chun Carol , Parikh Leena , Vaswani Surender
Published: January 2019

We conducted a study of 155 patients with allergic rhinitis who prematurely discontinued subcutaneous allergen immunotherapy to determine the reasons for their discontinuation. The most commonly cited factor, which was cited by 62 patients (40.0%), was the issue of cost—specifically, inadequate or nonexistent insurance coverage. Studies have shown that subcutaneous allergen immunotherapy is more cost-effective than pharmacologic treatment for patients with allergic rhinitis. Therefore, improved insurance coverage for this treatment of proven efficacy would not only improve quality of life, it would also be economically beneficial to the health care system in general.
Timing of Removal of Neck Drains following Head and Neck Surgery
Authors: Harris Tashneem , Doolarkhan Zubair , Fagan Johannes J.
Published: January 2019

Studies of the volume of drainage over a 24-hour period that is sufficient to allow for the removal of a neck drain after head and neck surgery have not been reported, and thus the timing of drain removal varies among surgeons and institutions. We conducted a prospective study of 47 patients who had undergone major head and neck surgery to determine the safety and cost-effectiveness of removing a neck drain when the amount of drainage over a 24-hour period fell to 50 ml or less. When the volume reached that point in any given patient, the drain was clamped, and if no fluid collection was observed the following day, the drain was removed. We found that drain removal according to this protocol was successful in 91% of cases, as only 4 patients (9%) developed a seroma following removal. No other complications were observed. In a separate analysis, we retrospectively reviewed the cases of 22 other patients who had undergone surgery at a different institution. Their drains were not removed until the drainage volume fell to 25 ml over 24 hours. It took a median of 1.3 days (range: 1 to 3) for drainage to fall from 50 ml to less than 25 ml over 24 hours. We conclude that drains can be removed safely when the volume falls to 50 ml or less over a 24-hour period. This would result in less morbidity, shorter hospital stays, and significant cost savings.
Identification of Bacteria Isolated from Nasal Polyps and their Ability to Produce Superantigens and Biofilms in Lebanese Patients
Authors: Chakhtoura Marita , Hadi Usamah , Rameh Charbel , Nassar Jihad , Abdelnoor Alexander M.
Published: January 2019

Staphylococcus aureus superantigens and bacterial biofilms have been implicated in the development of chronic rhinosinusitis and nasal polyps. We conducted a study of 32 Lebanese patients—21 males and 11 females, aged 15 to 71 years (mean: 39)—to identify bacteria isolated from nasal polyps and to determine if these bacteria produced superantigens and biofilms. Polyps were surgically removed, homogenized, and subjected to bacteriologic studies. The presence or absence of S aureus enterotoxin A, B, C, and D (superantigen) genes was determined in all isolates by polymerase chain reaction. Biofilm production by coagulase-negative staphylococci and Pseudomonas aeruginosa was assessed by tissue culture plate assay. A total of 34 bacterial species/groups were isolated from the nasal polyps. Of these, only 3 (8.8%) were S aureus, and only 1 possessed an enterotoxin-coding gene (enterotoxin B). Moreover, of the 21 coagulase-negative staphylococci isolates that were found, none possessed the investigated genes, and only 1 had a strong biofilm-formation property. Our results could not confirm that S aureus enterotoxins (superantigens) or biofilm-producing bacteria play a role in the development of nasal polyps in the Lebanese group studied.
A Study to Detect Helicobacter Pylori in Adenotonsillar Tissue
Authors: Toros Sema Zer , Toros Ahmet Burak , Kaya Kerem Sami , Deveci İldem , Özel Leyla , Naiboğlu Bariş , Habeşoğlu Tülay , Egeli Erol
Published: January 2019

We conducted a prospective study to investigate the possibility of Helicobacter pylori colonization on tonsillar and adenoid tissues. Our study group was made up of 84 consecutively presenting children aged 4 to 12 years who had undergone adenotonsillectomy or adenoidectomy with or without ventilation tube insertion. The excised specimens were analyzed by rapid urease testing and histopathologic examination to detect H pylori. Histologic sections were subjected to hematoxylin and eosin staining and Giemsa staining as performed in routine gastric biopsies. We found no H pylori colonization in any specimen. Therefore, we consider the possibility of H pylori colonization of adenotonsillar tissue unlikely, even though the authors of some recent studies have reported such a finding. Other means of detecting possible H pylori colonization in the upper aerodigestive tract rely on invasive biopsy procedures, which are difficult to use in clinical practice. Therefore, on the basis of our findings and our review of the literature, we conclude that looking for H pylori in the upper aerodigestive tract is not only clinically useless, but damaging, as well.
External Auditory Canal Cholesteatoma and Keratosis Obturans: The role of Imaging in Preventing Facial Nerve Injury
Authors: McCoul Edward D. , Hanson Matthew B.
Published: January 2019

We conducted a retrospective study to compare the clinical characteristics of external auditory canal cholesteatoma (EACC) with those of a similar entity, keratosis obturans (KO). We also sought to identify those aspects of each disease that may lead to complications. We identified 6 patients in each group. Imaging studies were reviewed for evidence of bony erosion and the proximity of disease to vital structures. All 6 patients in the EACC group had their diagnosis confirmed by computed tomography (CT), which demonstrated widening of the bony external auditory canal; 4 of these patients had critical erosion of bone adjacent to the facial nerve. Of the 6 patients with KO, only 2 had undergone CT, and neither exhibited any significant bony erosion or expansion; 1 of them developed osteomyelitis of the temporal bone and adjacent temporomandibular joint. Another patient manifested KO as part of a dermatophytid reaction. The essential component of treatment in all cases of EACC was microscopic debridement of the ear canal. We conclude that EACC may produce significant erosion of bone with exposure of vital structures, including the facial nerve. Because of the clinical similarity of EACC to KO, misdiagnosis is possible. Temporal bone imaging should be obtained prior to attempts at debridement of suspected EACC. Increased awareness of these uncommon conditions is warranted to prompt appropriate investigation and prevent iatrogenic complications such as facial nerve injury.
Bilateral Auricular Seromas: A Case Report and review of the Literature
Authors: Reitzen Shari D. , Rothstein Stephen , Shah Anil R.
Published: January 2019

Hematomas, pseudocysts, and seromas are all part of the differential diagnosis of auricular swellings. Seromas are benign collections of serous fluid that have a tendency to recur. The fluid accumulates in the space between the dermis and perichondrium of the ear. We describe what we believe is the first case of spontaneous bilateral auricular seromas to be reported in the literature. One of the seromas resolved in 4 weeks without treatment, and the other resolved with incision and drainage. It is important for physicians to be aware of auricular seromas when considering the differential diagnosis of an auricular swelling, and to understand the various treatment options.
Dilated Esophagus and Tracheal Compression Secondary to a Slipped Nissen Fundoplication: A Case Report
Authors: Rajan Roy , Thompson Jerome W.
Published: January 2019

We describe the case of a 20-month-old girl with a gastrostomy tube who presented with stridor, daily emesis, stertor, and mild neck retractions. Endoscopic and radiologic investigations revealed a dilated esophagus, an associated tracheal compression, and a paraesophageal hernia secondary to a slipped Nissen fundoplication. The patient underwent a revision fundoplication, and her stridor, stertor, and neck retractions subsided significantly. She tolerated tube feeding without emesis and was discharged home. We recommend a careful evaluation of fundoplication in patients who have undergone the procedure who present with stridor and frequent emesis. Esophageal dilation and associated tracheal compression should be considered in the differential diagnosis, and in such a case, revision of the gastric wrap should alleviate the problem.
Primary Extranodal T-Cell Non-Hodgkin lymphoma of the Tongue
Authors: Madana J. , Yolmo Deeke , Saxena Sunil Kumar , Gopalakrishnan S.
Published: January 2019

The most common sites of extranodal non-Hodgkin lymphoma (NHL) are the gastrointestinal tract and the head and neck region. Head and neck involvement accounts for 8 to 13% of all extranodal lymphomas. Primary NHLs of the oral cavity especially in the tongue, are extremely rare, which makes it difficult to understand their biologic behavior. Extranodal NHLs of the tongue usually present as a nodular lesion of the B-cell type. The T-cell variant of tongue NHL with an ulcerated exophytic presentation is extremely rare. We report such a case in a 37-year-old woman.
Giant chondroma of the Head and Neck Causing Gross Facial Deformity
Authors: Karaman Emin , Alimoğlu Yalçín , Öz Ferhan
Published: January 2019

Cartilaginous tumors in the head and neck region are rare. We report the case of a middle-aged man with a progressive swelling in the left cheek area who had been seen several times over the years at our otorhinolaryngology department. The progression of the swelling culminated in an extremely large tumor that grossly distorted the patient's face. Examination revealed that the mass had probably originated in the maxillary sinus; it eventually extended to the skull base, middle cranial fossa, and cavernous sinus. Several histologic examinations of biopsy specimens identified the mass as a chondroma. The unusual size and extension of the tumor indicated extensive surgery, but the patient refused. We discuss the natural history of this tumor, and we review the current literature on head and neck chondromas.
Suboccipital Malignant Solitary Fibrous Tumor: Report of a Case
Authors: Zuniga M. Geraldine , Orr Brent A. , Chang Steven S. , Tufano Ralph P.
Published: January 2019

Solitary fibrous tumors (SFTs) are rare soft-tissue sarcomas usually arising in the pleura of the thoracic cavity. Thirty percent of SFTs present in extrapleural locations, and infrequently in the head and neck region. While the majority of SFTs are benign, aggressive variants have been described. We report a case of a patient with a malignant SFT arising in the suboccipital soft tissues of the neck. We elucidate the diagnostic and therapeutic challenges in managing this tumor in this unusual location.
The effect of Asthma on Phonation: A Controlled study of 34 Patients
Authors: Asnaashari Amir M.H. , Rezaei Saman , Babaeian Mahasti , Taiarani Mohamad , Shakeri Mohamad Taghi , Fatemi Seiedeh Sedigheh , Darban Atefeh Amiri
Published: January 2019

The effect of upper respiratory tract diseases on phonation has been reviewed, but little is known about the influence of lower respiratory tract diseases. In particular, the effect of asthma as a reversible obstructive small-airway disease on phonatory variables is not yet clear. We conducted a cross-sectional controlled study to evaluate the quality of phonation in a group of 34 adults with untreated mild to severe persistent asthma who were seen at the Ghaem Hospital in Mashhad, Iran. Patients with sinusitis, gastroesophageal reflux disease, or primary laryngeal disease were ineligible for study participation. For comparison purposes, we identified a group of nonasthmatic, age- and sex-matched healthy controls. We evaluated eight voice parameters: basal voice frequency at the glottic level (F0), jitter, shimmer, breathiness, harshness, hoarseness, normalized noise energy (NNE), and S/Z ratio. These parameters were measured by a voice meter with Dr. Speech statistical software. We found that values for F0, jitter, and shimmer were very similar in the two groups, but there were statistically significant differences in values for harshness, hoarseness, NNE, S/Z ratio (all p 0.01), and breathiness (p = 0.015). Our findings suggest that lower airway diseases such as asthma can impair phonation, and we recommend future studies with larger populations to further explore this issue.
Recurrent Meningitis in An Adult Secondary to An Inner Ear Malformation: Imaging Demonstration
Authors: Wani Nisar Ahmad , Rawa Aijaz , Qureshi Umar , Robbani Irfan , Kosar Tasleem
Published: January 2019

Congenital labyrinthine dysplasia with a translabyrinthine cerebrospinal fluid (CSF) fistula may be an anatomic cause for recurrent meningitis. This condition is usually seen in children aged 5 to 10 years who present with sensorineural hearing loss (SNHL) and CSF discharge through the nose or ear, with or without recurrent meningitis. Multidetector-row computed tomography (MDCT) and high-resolution T2-weighted magnetic resonance imaging (MRI) of the petrous portion of the temporal bone can help to diagnose this abnormality. We report a case of translabyrinthine CSF fistula in an adult—a 30-year-old man—who presented with recurrent pneumococcal meningitis, a long history of a clear nasal discharge, and evidence of SNHL. MDCT and MRI of the temporal bone demonstrated a cystic-appearing cochleovestibular malformation (an incomplete partition type I) in the right inner ear. Imaging also showed an absence of the basal turn of the cochlea and the cribriform membrane at the lateral end of the right internal auditory canal, which was shorter and narrower than normal. Evidence of fluid in the right middle ear suggested a CSF fistula.
Chromobacterium Violaceum Necrotizing Fasciitis: A Case Report and review of the Literature
Authors: Seigel Jonathan K. , Stadler Michael E. , Lombrano Jennifer L. , Almony Jeffrey S. , Couch Marion E. , Belhorn Thomas H.
Published: January 2019

Necrotizing fasciitis is a severe, rapidly progressive infection of the subcutaneous tissue that causes significant destruction. It is rarely encountered in the pediatric population. We describe the case of a 14-year-old boy who was diagnosed with Chromobacterium violaceum necrotizing fasciitis and subsequently found to have autosomal recessive chronic granulomatous disease.
Cervical Thoracic Duct Cyst: Importance of Preoperative Suspicion for Appropriate management of Left-Sided Neck Mass
Authors: Gill Matthew T. , Lian Timothy S. , Thibodeaux Joel D. , Cherie-Ann O. Nathan
Published: January 2019

Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.
Management of Pterygoid Venous Plexus Hemorrhage during Resection of a Large Juvenile Nasopharyngeal Angiofibroma: A Review of 27 Cases
Authors: Chang Lin , Zixiang Yi , Zheming Fang , Gongbiao Lin , Zhichun Li , Rong Zhang , Aidong Zhou , Shuzhan Lan
Published: January 2019

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.
Airway Management in an Infant with Alobar Holoprosencephaly and Cebocephaly Associated with Maternal Diabetes Mellitus
Authors: Petersson Rajanya S. , Carey William A. , Thompson Dana M.
Published: January 2019

We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents’ goal was to bring their child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers’ goals of care.
Extraosseous Ewing Sarcoma and Peripheral Primitive Neuroectodermal Tumor of the Thyroid Gland: Case Report and Review
Authors: Chirilă Magdalena , Muresan Mihaela , Ciuleanu Elisabeta , Cosgarea Marcel
Published: January 2019

Te Ewing family of tumors and peripheral primitive neuroectodermal tumor (pPNET) represent different manifestations of the same entity. Immunohistochemical and cytogenetic studies suggest that these tumors have a common origin. Ewing sarcoma is more common in bone, while pPNET is more common in soft tissues. Extraosseous Ewing sarcoma (EoES) is rare. We present the case of a 48-year-old man who presented with acute obstructive respiratory failure secondary to a large thyroid swelling. The patient was initially diagnosed with giant B-cell non-Hodgkin lymphoma and treated with chemotherapy. However, subsequent immunohistochemical staining of biopsy specimens revealed that the patient actually had EoES/pPNET of the thyroid gland. We performed a nearly complete surgical resection of the tumor plus a total laryngectomy and resection of five tracheal rings. However, the patient died of a cerebral metastasis 1 month later after he had completed one cycle of postoperative chemotherapy.
Glomangioma of the Nasal Septum: A Case Report and Review
Authors: Chirila Magdalena , Rogojan Liliana
Published: January 2019

Glomangioma is a painful, blue-red tumor that appears as a solitary encapsulated nodular mass, almost always on the skin. The first case of nasal glomangioma was reported in 1965. Since then, only 31 other cases have been reported in the literature. We present a new case of glomangioma of the nasal septum in a 61-year-old woman. The tumor was removed via an intranasal endoscopic excision. No recurrence was found at 3 years of follow-up. Our challenge was to distinguish the glomangioma from a true hemangiopericytoma and a paraganglioma.
Unusual Hard Palate Foreign Body: A Case Report
Authors: Rasband-Lindquist Allison N. , Lusk Rodney
Published: January 2019

Foreign bodies embedded in the palate are exceedingly rare, and may imitate oral lesions. The majority of cases occur in infants and children. The following report discusses the unique presentation of a foreign body in the hard palate of an infant. This report emphasizes that foreign bodies must be considered in the differential of lesions found in the oral cavity of children.
Subcutaneous Emphysema and Pneumolabyrinth plus Pneumocephalus as Complications of Middle Ear Implant and Cochlear Implant Surgery
Authors: McKinnon Brian J. , Watts Tamara
Published: January 2019

We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.
Coexisting First and Bilateral Second Branchial Fistulas in a Child with Nonfamilial Branchio-Otic Syndrome
Authors: Lapeña Jose Florencio F. , Jimena Genilou Liv M.
Published: January 2019

We describe what we believe is only the third reported case of coexisting first and bilateral second branchial fistulas associated with nonfamilial branchio-otic syndrome. The patient was a 6-year-old girl who presented with bilaterally draining anterior neck puncta, a preauricular sinus, and moderately severe bilateral hearing loss. She had no family history of branchial anomalies. Compared with branchial cysts and sinuses, branchial fistulas are rare. Even more rare are bilateral second branchial fistulas coexisting with first branchial anomalies, as only 10 cases have been previously reported in the English-language literature. Of these 10 cases, 5 were associated with either branchio-otic syndrome or branchio-oto-renal syndrome; 2 patients had familial branchio-otic syndrome, 2 had nonfamilial branchio-otic syndrome, and 1 had nonfamilial branchio-oto-renal syndrome.
Wrong Egg in the Usual Nest: Thyroid Papillary Carcinoma within a Branchial Cleft Cyst
Authors: Sagit Mustafa , Gokler Ayhan , Akin Istemihan , Han Unsal
Published: January 2019

Branchial cleft cysts are the most common lesions to arise laterally in the neck. Ectopic thyroid tissue within a branchial cleft cyst is rare, and a papillary carcinoma arising from this tissue is extremely rare. We present a case of a lateral neck cyst representing a primary papillary carcinoma that arose in ectopic thyroid tissue within a branchial cleft cyst in a 41-year-old woman. After the mass was surgically excised, thyroid ultrasonography, thyroid scintigraphy, and whole-body F18-fuorodeoxyglucose–positron emission tomography/computed tomography detected no abnormality. The negative findings notwithstanding, surgery on the thyroid gland was planned, but the patient refused it. Therefore, she was followed up with ultrasonography and scintigraphy for 5 years, during which time she exhibited no evidence of recurrence. Total thyroidectomy is still the primary option in such cases, but when it cannot be performed for any reason, vigilant follow-up is essential.
Extensive Dentigerous Cyst Associated with a Mesiodens: CT Findings
Authors: Kim Kyung Soo , Mun Seog-Kyun
Published: January 2019

Te most common of the supernumerary teeth in humans are mesiodentes, which arise in the midline of the maxilla between the central incisors. The most common pathologic findings associated with a mesiodens are retention of the adjacent incisors, malposition, and diastema. The development of a dentigerous cyst in association with an impacted mesiodens is relatively uncommon. We report the case of a 35-year-old man with an extensive dentigerous cyst associated with a mesiodens who presented with a painful swelling in the left nasolabial area. We discuss the imaging findings in this case, particularly the contribution of computed tomography, and we review the literature on this interesting condition.
Peripheral Osteoma of the Hard Palate
Authors: Viswanatha Borlingegowda
Published: January 2019

Peripheral osteomas of the hard palate are relatively rare. Two cases of osteoma of the hard palate are reported, along with a review of the literature.
Fungal Otitis Externa as a Cause of Tympanic Membrane Perforation: A case series
Authors: Song James Eingun , Haberkamp Thomas J. , Patel Riddhi , Redleaf Miriam I.
Published: January 2019

We describe a series of 11 patients—8 men and 3 women, aged 18 to 70 years (mean: 46.0)—who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.
An Unusual Cause of Dyspnea in a Pregnant Woman: Supraglottic Hemangioma
Authors: Kurdoglu Zehra , Kurdoglu Mertihan , Cankaya Hakan
Published: January 2019

Dyspnea is a common complaint among pregnant women; upper airway obstruction is a rare cause of it. We report a case of supraglottic hemangioma in a 20-year-old pregnant woman who presented with increasing dyspnea and hoarseness at 40 weeks of gestation. She gave birth to a healthy 3,100-g girl by caesarean delivery under epidural anesthesia. She was able to breathe easily during the postpartum period. This case represents a rare instance of dyspnea caused by a supraglottic hemangioma in a pregnant woman.
Chronic Rhinosinusitis in Patients Requiring Surgical Repair of a Midface Fracture
Authors: Yelverton Joshua C. , Jackson Peter , Schmidt Robert S.
Published: January 2019

Midface fractures commonly occur following trauma to the face and may cause changes in the normal sinus outflow system. To the best of our knowledge, no study has examined the incidence of rhinosinusitis following midface fractures. We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in the control cohort of patients with rhinosinusitis. The highest mean scores for the individual components of the SNOT-20 were for “Wake up at night,” “Lack of a good night's sleep,” “Wake up tired,” and “Frustrated/restless/irritable.” The components that the most patients found bothersome were “Facial pain/pressure,” “Need to blow nose,” “Runny nose,” and “Lack of a good night's sleep.” We conclude that patients who experience a midface fracture have a much higher risk of developing chronic rhinosinusitis that negatively affects their long-term quality of life. These patients should be monitored with long-term follow-up and treated appropriately.
Pedunculated Cavernous Hemangioma Originating in the Olfactory Cleft
Authors: Su Kaiming , Zhang Weitian , Shi Haibo , Yin Shankai
Published: January 2019

Sinonasal cavernous hemangioma is a rare condition that usually affects the lateral wall of the nasal cavity. We report the case of a 77-year-old man who presented with severe epistaxis, nasal congestion, and olfactory dysfunction. Endoscopic examination of the nasal cavity revealed the presence of a red-blue tumor that had almost completely filled the nasopharynx. Preoperatively, it was difficult to distinguish this lesion from a juvenile nasopharyngeal angiofibroma. During endoscopic surgery, the tumor was found to originate in the left olfactory cleft, and it had a long peduncle that contained blood vessels. Postoperative histopathologic examination indicated that the mass was a cavernous hemangioma. To the best of our knowledge, this is the first case of an olfactory cleft cavernous hemangioma and the first case of olfactory cleft disease associated with a cavernous hemangioma to be reported in the English-language literature.
Cystic Chondromalacia of the Auricle Treated with Dual-Plane Excision with Intracartilaginous Dissection
Authors: Zoccali Giovanni , Pajand Reza , Vrentzos Nikolaos , Giuliani Maurizio
Published: January 2019

Cystic chondromalacia of the auricle is an uncommon condition in which a degenerative process occurs within the cartilage. The disorder affects young and middle-aged people. Clinically, it manifests as a painless, fluctuant swelling that frequently relapses despite various therapeutic approaches. In this article we report a typical case of cystic chondromalacia of the auricle that was successfully treated by surgery—specifically, dual-plane dissection—and we briefly review the literature.
Cerebrospinal Fluid Leaks following Septoplasty
Authors: Venkatesan Naren N. , Mattox Douglas E. , Del Gaudio John M.
Published: January 2019

We conducted a retrospective review to identify the characteristics of cerebrospinal fluid (CSF) leak in patients who had undergone septoplasty and in selected patients who had experienced a spontaneous CSF leak. CSF leak is a known but infrequently reported complication of septoplasty; to the best of our knowledge, only 4 cases have been previously published in the literature. A review of our institutions database revealed 3 cases of postseptoplasty CSF leak. We reviewed all the available data to look for any commonalities among these 7 cases. In addition, we reviewed 6 cases of spontaneous CSF leak selected from our database for the same purpose. For all patients, we noted the side of the cribriform plate defect, its size and, for the postseptoplasty cases, the interval between the septoplasty and the leak repair. Overall, we found that leaks were much more common on the right side than on the left. The sizes of the leaks in the 2 postseptoplasty groups were comparable (mean: 14.0 × 6.4 mm). The interval between septoplasty and leak repair ranged from 2.5 to 20 years in our cases and from 3 days to 22 weeks in the previously published cases. All 3 of the postseptoplasty patients in our database presented with clear rhinorrhea. Two of the 3 patients had meningitis; 1 of these 2 also had pneumocephalus. Of the 6 cases of spontaneous CSF leaks, 4 occurred on the right and 2 on the left; the average size of the defect was 5.8 mm in the greatest dimension. The finding that cribriform plate defects after septoplasty were typically right-sided likely reflects the prevalence of left-sided surgical approaches. Also, the fact that the defects were larger in the postseptoplasty cases than in the spontaneous cases is likely attributable to the torque effect toward the thin skull base that occurs when the perpendicular plate is twisted during septoplasty.