bluuebunny/crossref_metadata_2025 huggingface dataset:
Schneiderian Papillomas and Carcinomas: A Retrospective Study with Special Reference to p53 and p16 tumor suppressor gene expression and association with HPV
Authors: Cheung Florence M.F. , Lau Tina W.S. , Cheung Leslie K.N. , Li Albert S.M. , Chow Shun Kit , Lo Anthony W.I.
Published: January 2019

Schneiderian papillomas are uncommon benign tumors of the sinonasal area. They are prone to local aggressiveness and recurrence, and some undergo malignant progression. We analyzed specimens obtainedfrom 67 Chinese patients who had presented to the ENT department of a regional hospital with biopsy-proven schneiderian papilloma. Seven of these patients had either synchronous or metachronous carcinoma, 1 of whom had pure carcinoma in situ. For each case, we documentedthe morphology, immunohistochemical expression of tumor suppressor genes p53 and p16, and any association with human papillomavirus (HPV) infection as detected by either polymerase chain reaction or in situ hybridization techniques. We found that severe dysplasia andp53positivity were strongly associated with malignantprogression. Association with HPV was demonstrated in 22 of the 67patients (33%); the association was strongest among patients with exophytic papillomas and carcinomas. The effect of HPV in papilloma oncogenesis probably begins duringthe early phase, while other factors are responsible for progression to carcinoma. We conclude thatp53-positive, dysplastic schneiderian papillomas warrant aggressive surgical treatment.
Otolaryngologic Uses for Spinal Drains
Authors: Maguire Raymond C. , Gull John , Weaver Michael , Sataloff Robert T.
Published: January 2019

Cerebrospinal fluid (CSF) fistulae have been encountered by otolaryngologists often since the advent of modern endoscopic sinus surgery, otologic surgery, and skull base surgery. Treatment of CSF leaks may include bed rest, head-of-bed elevation, stool softeners, external spinal fluid drainage, and surgery. External CSF drainage is accomplished via a lumbar spinal drain. Placement of spinal drains is often performed by neurosurgeons and anesthetists. A few otolaryngologists have been trained in the placement and management of lumbar drains, but at most otolaryngology training institutions, education in lumbar drains is not provided. However, in some circumstances, it may fall to an otolaryngologist to accomplish the task. We believe that every otolaryngologist, from the generalist in private practice to the academic neuro-otologic surgeon, should understand the proper technique for the insertion and management of a lumbar drain. Otolaryngologists should be familiar with the physiologic properties of CSF, the methods used to diagnose fistulae, and the techniques used to repair leaks. External spinal drainage is an important element in the management of CSF fistulae, and it has been used in treating perilymphatic fistulae and “gushers.” Much controversy surrounds its routine use. Otolaryngologists need to understand the risks, benefits, and outcomes of spinal drain use in order to decide which patients may benefit from this procedure.
Otolaryngologic Community-Acquired MRSA Infections in a Suburban Private Practice
Authors: Shaw Gary Y. , Montandon Shari V. , Driks Michael R.
Published: January 2019

A retrospective review was conducted of all cases of head and neck community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections seen in the senior author's suburban private practice during a 12-month period. An office and hospital chart review was performed for all patients identified with culture-positive CA-MRSA infections. Several parameters were evaluated, including site of infection, prior therapy, imaging, comorbid disease, culture and sensitivities, surgical and medical management, and long-term results. Of the 10 patients identified, 3 had infections of nasal soft tissues, 3 had infections of the lips, 2 had infections of the paranasal sinus, 1 had an infection of the chin, and 1 had a diffuse, hemifacial infection. All patients were managed successfully with a combination of surgical drainage, wound care, and antibiotics. CA-MRSA is a burgeoning problem in otolaryngology. Appropriate management–including early recognition, appropriate empirical therapy, prompt and thorough surgical drainage with culture and sensitivities, correct antibiotic choice, and meticulous postoperative care—appears to offer excellent results.
An Unusual Recurrent Intrathoracic Goiter: Case Report
Authors: Telusca Natacha , Le Kenneth , Palacios Enrique , Friedlander Paul A.
Published: January 2019

Most intrathoracic goiters are located in the anterior mediastinum, frontal to the recurrent laryngeal nerve and anterolateral to the trachea. Posterior mediastinal goiters account for only 10 to 15% of all intrathoracic goiters and arise from the posterolateral portion of the thyroid gland. We present a case involving a 59-year-old man with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. He had undergone bilateral thyroid lobectomy for a cervical goiter 10 years previously, with no subsequent complications. Contrast-enhanced computed tomography demonstrated a large, well-circumscribed mass extending paratracheally from the thoracic inlet to the posterior mediastinum. The mass was removed via a transcervical and transthoracic approach.
An Aberrant Internal Carotid Artery Discovered during Evaluation of Obstructive Sleep Apnea: A Report of 2 Cases with Consideration of a Possible Association
Authors: Picel Andrew C. , Davidson Terence M.
Published: January 2019

Obstructive sleep apnea (OSA) is often associated with reduced pharyngeal muscle tone and an anatomically narrowed pharyngeal airspace. We describe 2 cases of aberrant internal carotid arteries that were diagnosed during evaluations of patients with suspected OSA. It is possible that these anatomic anomalies contributed to airspace narrowing in these patients. These 2 cases represent an interesting presentation of sleep apnea, and they provide a reminder of the importance of clinically recognizing carotid artery aberrations in order to avoid arterial damage during routine oropharyngeal procedures.
Traumatic Ocular Hypotonia Encountered during Reduction of Multiple Facial Fractures
Authors: Vipond Gregory J. , Hamilton Grant S.
Published: January 2019

There are many different potential causes of globe hypotonia after ocular surgery. To the best of our knowledge, this is the first report of traumatic intraoperative hypotonia during orbital floor exploration and repair. We present a case involving a patient with a history of cataract surgery who developed intraoperative hypotonia when undergoing ocular manipulation during the exploration of multiple facial fractures.
Characteristics of Osteoma of the Temporal Bone in Young Adolescents
Authors: Viswanatha Borlingegowda
Published: January 2019

The author conducted a retrospective review of the clinical presentation, management, and complications of temporal bone osteoma in young adolescents. The study population was made up of 9 patients—5 girls and 4 boys, aged 12 to 15 years at presentation (mean: 13.7)—who had been seen for radiologically and histopathologically proven temporal bone osteoma at the author's institution over a 9-year period. Of this group, 5 patients had extracanalicular osteoma (3 in the mastoid portion of the temporal bone, 1 in the squamous portion, and 1 in the mastoid antrum) and 4 patients had osteoma of the external auditory canal. Six of the 9 patients underwent surgical treatment; of the remainder, 1 refused surgery and 2 were managed conservatively with ongoing observation. All patients were followed for a minimum of 1 year, and no recurrences and no complications were observed during that time.
Dystonias of the Head and Neck: An Overview
Authors: Charous Steven J. , Cornelia Cynthia
Published: January 2019

Dystonias are a group of disorders characterized by muscle contractions that can produce twisting and repetitive movements or abnormal postures. Dystonias of the head and neck region, except for spasmodic dysphonia, are rarely described in the otolaryngology literature. Ironically, it is the otolaryngologic surgeon's knowledge of anatomy and physiology of the head and neck that can be of greatest benefit for patients suffering from these disorders. Medical and surgical treatment options are available in treating this disorder. This article is intended to serve as an introduction and overview of dystonias for the otolaryngologist-head and neck surgeon.
Malacoplakia of the Vallecula Masquerading as a Malignancy
Authors: Mannan A.A.S. Rifat , Sharma Mehar Chand , Bahadur Sudhir
Published: January 2019

Malacoplakia is an unusual chronic granulomatous inflammation that commonly occurs in the urinary tract. It is rarely encountered in the head and neck region, and only a handful of such cases have been described. We report a case of malacoplakia in a 50-year-old woman who presented with a mass in the vallecula that was clinically suspected of being malignant. This case illustrates the importance of recognizing this unusual benign lesion, which closely mimics a malignancy on clinical examination.
Pathologic Evaluation of Primary Laryngeal Anterior Commissure Carcinoma Both in Patients who have Undergone Open Surgery as Initial Treatment and in those who have Undergone Salvage Surgery after Irradiation Failure
Authors: Ahmed Wael A. , Suzuki Kenji , Horibe Yoshimune , Kato Ichiro , Fujisawa Toshiyuki , Nishimura Yoichi
Published: January 2019

Laryngeal anterior commissure (AC) cancer has been the subject of much controversy. Our study was aimed at pathologically evaluating the tendency of AC cancer to invade the thyroid cartilage and analyzing the role of thyroid cartilage invasion by tumor cells at the AC as an anatomic cause for irradiation failure. Our study included 36 patients with glottic cancer involving AC. Patients with recurrent or persistent disease after radiotherapy underwent salvage surgery. Surgical specimens from 22 patients who had open surgery, either as primary or salvage surgery, were available for pathologic examination to identify the presence of cartilage invasion. We found microscopic invasion of the thyroid cartilage in 40.9% of the studied tumors. Only 21.4% of patients who had open salvage surgery showed evidence of cartilage invasion at the AC. We concluded that laryngeal AC cancers are more likely to invade the cartilage, and that anatomic risk factors are not the main cause of irradiation failure.
Aggressive Fibromatosis of the Neck Treated with a Combination of Chemotherapy and Indomethacin
Authors: Longhi Alessandra , Errani Costantino , Battaglia Milva , Alberghini Marco , Ferrari Stefano , Mercuri Mario , Molinari Massimo
Published: January 2019

Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes de-bulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.
Self-Induced Subcutaneous Facial Emphysema in a Prisoner: Report of a Case
Authors: Goudarzi Mahmoud , Navabi Jafar
Published: January 2019

Subcutaneous cervicofacial emphysema is a rare condition that results from various causes. Initially it might be misdiagnosed and managed as other clinical entities, such as angioedema. We report a case of self-induced subcutaneous facial emphysema in a prisoner who sought better living conditions by simulating an emergency.
Tapia Syndrome Caused by a Vertebral Artery Dissection
Authors: Al-Sihan Mutlaq , Schumacher Martin , Löhle Erwin
Published: January 2019

A 63-year-old man presented to our otorhinolaryngology department with hoarseness and neck pain of 3 weeks’ duration. After a thorough workup, we established a diagnosis of Tapia syndrome secondary to a vertebral artery dissection. We review the literature and discuss the clinical presentation of this rare syndrome.
Management of Lateral Cervical Metastases in Papillary Thyroid Cancer: Patterns of Lymph Node Distribution
Authors: King J. Michael , Corbitt Christian , Miller Frank R.
Published: January 2019

In this article we discuss the management of lateral cervical lymph node metastases in papillary thyroid cancer (PTC). We conducted a retrospective analysis of cases of PTC at our tertiary academic medical center involving 32 patients who underwent 39 neck dissections for the management of lateral cervical metastases from 2000 to 2007. Of these patients, 18 underwent primary neck dissections at the time of thyroidectomy after fine-needle aspiration biopsy confirmed the PTC. Secondary neck dissections for delayed metastases were performed in 14 patients who had previously undergone thyroidectomy for confirmed PTC. All 32 patients had positive nodes in at least one level. Our results highlight the high incidence of multilevel cervical metastasis associated with PTC and suggest the importance of including level ITB (submuscular recess) when performing a neck dissection; the upper posterior triangle (level V-A) is less likely to harbor occult tumor. Lateral neck metastasis from PTC is common and predictable; locoregional control is improved with a formal, comprehensive neck dissection at the time of thyroidectomy.
Arteriovenous Hemangioma Formation following Radiofrequency Ablation for Inferior Turbinate Reduction
Authors: Polat Senol , Tanyeri Hasan Murat , Bilgi Selcuk
Published: January 2019

Inferior turbinate reduction by radiofrequency ablation (RFA) has been recommended as an easy and safe option for the treatment of patients with inferior turbinate hypertrophy. Complications of this type of excision are generally acceptable. We describe a case of RFA turbinate reduction that resulted in an unusual complication: the formation of an arteriovenous hemangioma.
Bilateral multicystic parotid masses in primary Sjögren syndrome
Authors: Toh Alex S.L. , Broomfield Stephen J. , Teh Lee-Suan , Aslam Muhammad B. , Duncan Gavin , Morar Pradeep
Published: January 2019

We report the case of a 48-year-old woman who presented with bilateral parotid gland enlargement as the initial manifestation of primary Sjögren syndrome. Magnetic resonance imaging demonstrated multiple areas of low-intensity signal mixed with foci of high-intensity signal, a finding suggestive of Sjögren syndrome. Autoimmune blood tests for Sjögren syndrome were positive, and a sublabial biopsy confirmed the diagnosis. Investigations for other conditions, including human immunodeficiency virus infection, were negative. After 5 years of follow-up, the parotid swellings remained essentially unchanged. We discuss the etiology of multicystic parotid gland pathology, its involvement in Sjögren syndrome, and the risk of lymphoma.
Frontal Infundibular Cells: Pathway to the Frontal Sinus
Authors: Tuncyurek Ozum , Songu Murat , Adibelli Zehra Hilal , Onal Kazim
Published: January 2019

A frontal infundibular cell (FIC) is an uncommon anatomic variant of an anterior ethmoid pneumatization that originates from the frontal recess and typically extends into the lumen of the frontal sinus ostium. FICs may show several anatomic variants that impact the anatomy of the frontal recess. Familiarity with these variants is required for safe endoscopic sinus surgical procedures. We conducted a retrospective chart review, examining 1,040 frontal recesses in 520 adults with no frontal sinus disease, to explore the anatomy of the healthy frontal recess and to describe the prevalence of FICs in patients without a history of conditions that cause frontal pneumatization. Review of axial and coronal computed tomography data, which were reformatted for sagittal reconstruction, was performed at a computer workstation. Bent and Kuhn's classification was used to define types of FICs. We identified 167 patients (32.1%) as having unilateral or bilateral FICs. Type I infundibular cells were the most common type (found in 15.7% of the entire study population). Type II and type III FICs were found in 3.8% and 12.1%, respectively; type IV FICs were present in 0.4%. The FIC has not been emphasized as an important potential cause of frontal sinus obstruction in the radiology literature, but clinicians should specifically watch for it on all routine computed tomography of the frontal sinus. Fine-cut computed tomography scans aid in the identification of each individual cell and allow the surgeon to formulate a clear and precise surgical plan. A surgical plan with a thorough understanding of the anatomy enables confident dissection of this complex and difficult area.
Lymphangiomatous polyp of the Nasal Cavity: A Rare Presentation
Authors: Gupta Subhash C. , Jain Sachin , Singh Himanshu P. , Sachan Atul , Dey Soumit
Published: January 2019

Lymphangiomatous polyp of the nasal cavity is a very rare condition. We are reporting a case of a unilateral nasal mass presenting with noisy breathing during sleep, change of voice, watery nasal discharge, and anosmia in a 5-year-old boy. The mass was removed via a transnasal endoscopic approach, and a diagnosis of lymphangiomatous nasal polyp was established by histopathology.
Pilomatricoma of the Pinna
Authors: Rajeshwary Aroor , Somayaji Gangadhara , Manohar Sai
Published: January 2019

A 4-year-old boy presented with a painless swelling over the right pinna of 4 months’ duration. Histopathologic examination of the excised mass revealed features of pilomatricoma—a rare, benign skin neoplasm arising from hair follicle matrix cells. The unusual location of the lesion over the pinna, despite its frequent occurrence in the head and neck, prompted this article. We discuss the etiology, clinical presentation, and management of pilomatricoma of the auricular region
Complicated Coexisting Pyogenic and Tuberculous Otitis Media Affecting the Temporozygomatic, Infratemporal, and Parotid Areas: Report of a Rare Entity
Authors: Brar Tripti , Mrig Sumit , Passey J.C. , Agarwal A.K. , Jain Shayma
Published: January 2019

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.
Sinonasal Glomangiopericytoma: Is Anything New?
Authors: Asimakopoulos Panagiotis , Syed Mohammed Iqbal , Andrews Timothy , Syed Sheeba , Williams Alun
Published: January 2019

More than 100 cases of sinonasal hemangiopericytoma have been reported in the literature, but only a handful of cases of nasal glomangiopericytoma. In this article, we report a case of a nasal glomangiopericytoma that was treated with endonasal surgical excision. We also attempt to clarify the confusion that attends to the nomenclature surrounding the terms glomangiopericytoma and hemangiopericytoma, which are often used interchangeably. Although glomangiopericytomas are histologically similar to sinonasal hemangiopericytomas, they sometimes behave in a different clinical manner. To further enhance our understanding of nasal glomangiopericytomas, more cases need to be reported. This may improve our ability to establish specific treatment modalities for this type of neoplasm and to predict clinical outcomes.
Cavernous Hemangioma of the Submandibular Gland with Parapharyngeal Extension in an Adult: Case Report
Authors: Azadarmaki Roya , Then Matthew T. , Walia Rohit , Lango Miriam N.
Published: January 2019

Cavernous hemangiomas of the submandibular gland are rare. Signs and symptoms typically resemble those of sialolithiasis and chronic sialadenitis. If a lesion extends into the parapharyngeal space, otalgia and sore throat can result. Spontaneous regression is not a characteristic of cavernous hemangiomas. Surgical excision is a management option. We report the case of an adult with a submandibular gland cavernous hemangioma with parapharyngeal extension.
A Twin-Center Study of Nasal Tip Numbness following Septorhinoplasty or Rhinoplasty
Authors: Jaberoo Marie-Claire , De Zoysa Neil , Mehta Nishchay , Prasad Vyas , Heywood Rebecca , Saleh Hesham , Marais Joe
Published: January 2019

Nasal tip numbness is a recognized postoperative complication after septorhinoplasty and rhinoplasty. We performed a twin-center retrospective study to determine the incidence of short- and long-term (>6 mo) nasal tip numbness after these procedures, and we studied several variables that might have been associated with this complication. Our study group was made up of 65 patients—31 males and 34 females, aged 15 to 67 years (mean: 30.5). Septorhinoplasty had been performed in 52 patients and rhinoplasty in 13; all surgeries were performed by two different surgeons at two different centers. There were 50 closed (endonasal) surgeries and 15 open surgeries. Follow-up phone calls made 6 to 37 months postoperatively revealed that 17 patients had experienced postoperative nasal tip numbness (26.2%); there were 10 cases of short-term numbness (15.4%) and 7 cases of long-term numbness (10.8%). Numbness resolved within 2 weeks in 8 of the 10 short-term patients. Of the 7 cases of long-term numbness, 6 patients reported severe numbness beyond 8 months, and 1 had mild numbness for at least a year. We found no association between the incidence of numbness and the type of surgery, the particular surgeon, or the particular center where the surgery had been performed. We did find that there was an association between long-term numbness and the open procedure, but it was not statistically significant. We discuss the possible mechanisms that might cause numbness in cases when the external nasal nerve is not cut. We believe it is important to include a discussion of the risk of nasal tip numbness during preoperative consultations and when seeking informed consent.
External Auditory Canal Stenting with Nonlatex Glove and Gelfoam
Authors: Pan Judy C. , Harris Tucker M.
Published: January 2019

External auditory canal stenosis, although uncommon, is a condition that is sometimes encountered by otolaryngologists. This condition has been shown to result from inflammatory changes that may be incited by many different causes. Various methods of stenting the canal open postoperatively have been described. We describe a readily accessible and inexpensive method of stenting the canal open postoperatively. The technique presented has been used effectively in all age groups at our institution, in cases ranging from trauma to postmastoidectomy procedures.
Cervical Metastasis in Squamous Cell Carcinoma of the Hard Palate and Maxillary Alveolus
Authors: Koshkareva Yekaterina , Liu Jefrey C. , Lango Miriam , Galloway Tomas , Gaughan John P. , Ridge John A.
Published: January 2019

We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients—9 men and 11 women, aged 46 to 88 years (mean: 72.6)—who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients—4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs. <T4) was not significantly correlated with the risk of regional metastasis (p = 0.58). The rate of occult nodal metastasis in clinically and radiologically N0 necks was high. Clinical and radiologic understaging was common, and regional recurrences frequently resulted in death. We conclude that elective nodal evaluation and treatment of the neck warrants strong consideration for most patients with cancer of the hard palate and/or maxillary alveolus.
Therapeutic hypothermia as an adjunct to extracorporeal membrane oxygenation for acute respiratory distress and refractory hypoxemia
Authors: Luc Jessica G Y , Meyer Steven R , Murtha William J , Singh Gurmeet
Published: January 2019

Legionella community–acquired pneumonia necessitating veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome has been reported in adults. However, few options remain in cases of refractory hypoxemia on veno-venous extracorporeal membrane oxygenation. Herein, we describe adjunctive extended therapeutic hypothermia for refractory hypoxemia despite veno-venous extracorporeal membrane oxygenation for successful management of severe acute respiratory distress syndrome secondary to Legionella.
Compression therapy in lymphedema: Between past and recent scientific data
Authors: Mosti Giovanni , Cavezzi Attilio
Published: January 2019

Aim

To extrapolate and discuss the scientific data on compression in lymphedema treatment, so to review old and innovative concepts about pressure, stiffness and other interplaying factors related to its efficacy and comfort.

Material and methods

Narrative review based on search in Medline/Google Scholar through key-words related to compression in lymphedema.

Results

Currently available literature lacks relevant details about data on protocol, devices, techniques, interface pressure, stiffness, as well as biases are represented by the different descriptions to present the outcomes. More recent evidence from adjustable wrap devices and elastic garments question the need for high pressure (especially for the upper limb) and stiffness in lymphedema treatment.

Conclusions

At present time a very strong compression pressure exerted by material with high stiffness seem to be questionable in lymphedema treatment. A low pressure provides the best outcomes in arm lymphedema, while a pressure in the range of 40–60 mm Hg seems to provide higher efficacy in lower limb lymphedema, provided it is maintained overtime. A high stiffness seems to be unnecessary to treat chronic edema. Future clinical trials, including proper description of treatment methodology and adequate investigating instrumental tools, are awaited to possibly corroborate the conclusive outcomes of our review.
Percutaneous transhepatic biliary tract embolization using gelatin sponge
Authors: Augustin Anne Marie , Cao Victoria , Fluck Friederika , Kunz Julian , Bley Thorsten , Kickuth Ralph
Published: January 2019

Background

Percutaneous biliary drainage (PTBD) is a necessary procedure in several benign and malignant conditions. After PTBD removal biliocutaneous fistula is a rare but potential complication. Different embolization agents have been used for transhepatic catheter tract embolization in the past, while there is only little experience using gelatin sponge for this procedure.

Purpose

To evaluate the feasibility and safety of PTBD tract embolization with gelatin sponge.

Material and Methods

Between July 2008 and August 2017, 98 patients have been treated with PTBD access embolization using gelatin sponge. PTBD was performed in patients with malignant (67%) or benign (33%) bile duct obstruction. Outcome measures included technical success (complete cessation of bile flow out of the percutaneous access tract), clinical success (intermediate and long-term absence of biliocutaneous fistula, absence of right upper quadrant pain as typical symptom for bile leakage into the peritoneal cavity and absence of hemorrhage out of the catheter tract during follow-up inspections), and the rate of major and minor complications.

Results

Technical success with effective control of bile flow out of the percutaneous access tract was achieved in 97/98 patients (99.0%). Clinical success attributed to gelatin sponge embolization was documented in 96/98 procedures (98.0%). In one case, slight bleeding out of the percutaneous drainage tract occurred after drainage removal and embolization of the access tract. Bleeding was self-limiting; no blood transfusion or surgical intervention was necessary.

Conclusion

PTBD tract embolization with gelatin sponge is a feasible and safe method with a low rate of therapeutically relevant complications.
Recent Advances and Anaesthetic Considerations in Corneal Transplantation
Authors: Chua A. W. Y. , Chua M. J. , Kam P. C. A.
Published: January 2019

Significant surgical advances have been made recently in corneal transplantation. Penetrating keratoplasty was the dominant method from 1905, until selective lamellar keratoplasty emerged as the preferred technique over the last 20 years. Advanced techniques such as corneal limbal stem cell transplant and keratoprosthesis are also available. The major surgical complications of corneal transplantation are extrusion of ocular content and expulsive choroidal haemorrhage. It is essential for an ophthalmic anaesthetist to have a good understanding of these new surgical procedures so as to provide optimal surgical conditions. This article aims to inform anaesthetists about the recent surgical advances in corneal transplantation and explore the anaesthetic considerations of these new techniques. General anaesthesia remains suitable for a wide range of these procedures especially in repeat surgery, difficult, or prolonged procedures. Regional ophthalmic blocks are ideal for endothelial keratoplasty but can be used in penetrating keratoplasty based on individual risk–benefit assessment, and as a supplement to general anaesthesia. Topical anaesthesia provides an alternative when general anaesthesia and ophthalmic regional blocks are less desirable but overall its use is limited.
A Two Centre Observational Study of Simultaneous Pulse Oximetry and Arterial Oxygen Saturation Recordings in Intensive Care Unit Patients
Authors: Ebmeier S. J. , Barker M. , Bacon M. , Beasley R. C. , Bellomo R. , Chong C. Knee , Eastwood G. M. , Gilchrist J. , Kagaya H. , Pilcher J. , Reddy S. K. , Ridgeon E. , Sarma N. , Spragas S. , Tanaka A. , Tweedie M. , Weatherall M. , Young P. J.
Published: January 2019

The influence of variables that might affect the accuracy of pulse oximetry (SpO2) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO2/SaO2 (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO2 in detecting low SaO2 and PaO2. A paired SpO2/SaO2 measurement was obtained from 404 adults in ICU. Measurements were used to calculate bias, precision, and limits of agreement. Associations between bias and variables including vasopressor and inotrope use, capillary refill time, hand temperature, pulse pressure, body temperature, oximeter model, and skin colour were estimated. There was no overall statistically significant bias in paired SpO2/SaO2 measurements; observed limits of agreement were +/-4.4%. However, body temperature, oximeter model, and skin colour, were statistically significantly associated with the degree of bias. SpO2 <89% had a sensitivity of 3/7 (42.9%; 95% confidence intervals, CI, 9.9% to 81.6%) and a specificity of 344/384 (89.6%; 95% CI 86.1% to 92.5%) for detecting SaO2 <89%. The absence of statistically significant bias in paired SpO2/SaO2 in adult ICU patients provides support for the use of pulse oximetry to titrate oxygen therapy. However, SpO2 recordings alone should be used cautiously when SaO2 recordings of 4.4% higher or lower than the observed SpO2 would be of concern. A range of variables relevant to the critically ill had little or no effect on bias.
Governance of Rapid Response Teams in Australia and New Zealand
Authors: Sethi S. S. , Chalwin R.
Published: January 2019

Rapid response systems (RRS) in hospitals in Australia and New Zealand (ANZ) have been present for more than 20 years but governance of the efferent limb—the rapid response team (RRT)—has not been previously reported in detail. The objectives of this study were to describe current governance arrangements for RRTs within ANZ and contrast those against expected implementation, using the Australian Commission for Safety and Quality in Health Care National Standard 9 (S9) as a benchmark. Assessment focused on S9 subclauses 9.1.1 (governance and oversight), 9.1.2 (RRT implementation), 9.2.3 (data collection and dissemination), 9.2.4 (quality improvement), 9.5.2 (call reviews), 9.6.1 and 9.6.2 (basic and advanced life support [ALS] skill set). We identified public and private hospitals across ANZ from government-maintained registers. Those reasonably expected to have an RRT were contacted and invited to participate. Responses were obtained via an online anonymised questionnaire. Three hundred and forty-two hospitals were contacted, of whom 284 (83.0%) responded. Two hundred and thirty-two hospitals submitted data, and the other 52 declined to participate or did not have an RRT. In hospitals with an intensive care unit (ICU), intensivist attendance at RRT calls occurred less often outside office hours (odds ratio, OR, 0.49, 95% confidence interval, CI, 0.32 to 0.75]). Where intensivists were not on the RRT, consultation with them about calls also occurred less often outside office hours (OR 0.39, 95% CI 0.22 to 0.66). Consultation with patients’ admitting specialists occurred more often during office hours versus out of hours RRT calls and in private versus public hospitals. The presence of ICU staff on the RRT decreased the likelihood of admitting specialists being consulted about RRT calls (OR 0.66, 95% CI 0.47 to 0.93). Most hospitals maintained databases of RRT calls and regularly audited RRT activity (92% and 90% respectively). However, most (63.7%) did not make that information available beyond their hospital or local network. We concluded that the majority of hospitals in the ANZ region had governance mechanisms for their RRT. However, there was a notable lack of consistency, especially around specialist involvement and audit processes. Although some findings from this study are reassuring, there is still potential for improvement. Further development of guidelines and the establishment of a regional RRS database may assist with achieving this.
The Incidence of Hyperthermia during Craniotomy
Authors: Malpas G. , Taylor J. A. , Cumin D. , Merry A. F. , Mitchell S. J.
Published: January 2019

There is evidence that even mild hyperthermia may exacerbate brain injury. There seem reasonable grounds for considering patients undergoing craniotomy as ‘at risk’ for brain injury. A retrospective observational study was undertaken to measure the incidence of mild hyperthermia in craniotomy cases in which the patient was initially normothermic. Auckland City Hospital's database of electronic anaesthetic records was searched for adult patients who were normothermic (≤37°C) prior to undergoing craniotomy procedures. For each case, demographic data, intraoperative naso- or oropharyngeal temperature measurements, and paracetamol use were extracted. We identified the proportion of patients whose temperature rose to exceed normal (>37°C) and further subdivided that group into the proportion in whom the temperature rose to ≥38°C. Two thousand, nine hundred and thirty-five craniotomy cases began their operations while normothermic and had adequate temperature data collected. There were 984 (33.5%) cases that had at least one temperature reading >37°C, for a mean (standard deviation [SD]) time of 66.0 (64.6) minutes, and 49 (1.7%) cases that had at least one reading ≥38°C for a mean (SD) time of 40.4 (38.1) minutes. The majority (77.8%) who became mildly hyperthermic remained so at the end of the procedure. New mild hyperthermia occurs commonly during craniotomy. In view of the compelling evidence of potential harm arising from mild hyperthermia in brain injury, these findings suggest an opportunity for practice improvement in the anaesthetic management of craniotomy patients. Reasonable steps should be taken by anaesthetists to avoid intraoperative hyperthermia of any degree.
A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria
Authors: Silvers A. , Licina A. , Jolevska L.
Published: January 2019

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.
Does A Catheter over Needle System Reduce Infusate Leak in Continuous Peripheral Nerve Blockade: A Randomised Controlled Trial
Authors: Edwards R. M. , Currigan D. A. , Bradbeer S. , Mitchell C.
Published: January 2019

Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. One hundred and ten patients scheduled for elective unilateral total knee arthroplasty were randomised to receive a perineural catheter with either a catheter over needle (CON) system (Pajunk® E-Cath) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany), or catheter through needle (CTN) system (Pajunk® SonoLong) (PAJUNK® GmbH, Medizintechnologie, Geisingen, Germany). There was no statistically significant difference in the rate of leaking catheters between groups (CON 1.8% versus CTN 3.7%; P=0.618), however, the overall leak rate was much lower than anticipated from pilot data. The CON system was on average faster to insert (CON 357 seconds versus CTN 482 seconds; P=0.004), but associated with poorer needle visibility under ultrasound (Likert scale 1–5, mean [SD], CON 3.31 [0.96] versus CTN 3.89 [0.84]; P=0.001). All seven instances of inadvertent catheter dislodgement occurred in the CTN group (P=0.006). There was no statistically significant difference between groups in the proportion of patients who had adequate analgesia on day one (CON 80% versus CTN 86.5%; P=0.294) and day two postoperatively (CON 85.5% versus CTN 91.8%; P=0.369). Our findings show the overall leak rate to be very low with both catheter systems; however, the CON system may have advantages in terms of speed of use and rate of inadvertent catheter dislodgement.
Attitudes and Self-Reported End-Of-Life Care of Australian and New Zealand Intensive Care Doctors in the Context of Organ Donation after Circulatory Death
Authors: Lee Y. Y. , Ranse K. , Silvester W. , Mehta A. , Van Haren F. M. P.
Published: January 2019

The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals’ attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors’ attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. Exploratory factor analysis was used to define various attributes of attitude to DCD. Results were subjected to comparative statistical analyses to examine the relation between demographic data and attitude to DCD. Multiple regression models were used to examine if attitude to DCD could predict intensive care doctors’ palliative prescription rationales at the end of life of DCD donors. One hundred and sixty-one intensive care doctors responded to the survey with 69.4% having worked in intensive care for ten years or more. Respondents responded positively to the support of and perceived importance of DCD in helping those who would benefit from the donations (constructive attributes) (mean composite factor score = 3.84, standard deviation [SD] 0.83), they positively perceived that conducive and facilitative orchestration of DCD helps families cope (mean composite factor score = 3.94, SD 0.72) and that they would manage a DCD donor similar to any patient at the end of their life (mean score = 3.94, SD 0.72). Respondents responded negatively to having concerns that the circulatory death of potential DCD donors does not occur within the specified time frame (mean score = 2.28, SD 1.02). There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors’ palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care.
Epinephrine (Adrenaline) Preventing Recovery from Intraoperative Anaphylactic Shock Complicated by Systolic Anterior Motion of the Mitral Valve with Left Ventricular Outflow Tract Obstruction on Transoesophageal Echocardiography
Authors: Sadleir P. H. M. , Clarke R. C. , Lim B. S. L. , Platt P. R.
Published: January 2019

We describe a case of severe left ventricular outflow tract obstruction (LVOTO) with severe mitral incompetence due to systolic anterior motion of the anterior mitral leaflet (SAM) that was recognised thanks to the immediate availability of transoesophageal echocardiography during the resuscitation of anaphylactic shock. The patient rapidly responded to cessation of the epinephrine (adrenaline) infusion and intravascular volume expansion with intravenous crystalloid. The absence of risk factors for developing SAM/LVOTO serve as a warning to clinicians to consider this diagnosis in all cases of epinephrine non-responsive anaphylactic shock.
Hyperinsulinaemic Euglycaemic Therapy Use in Neurogenic Stunned Myocardium following Subarachnoid Haemorrhage
Authors: Chandler B. T. , Pernu P.
Published: January 2019

We present a 62-year-old female who collapsed with a subarachnoid haemorrhage. This was complicated by profound shock secondary to neurogenic stunned myocardium. As the patient demonstrated life-threatening catecholamine-resistant shock that was unresponsive to conventional treatment measures, hyperinsulinaemic euglycaemic therapy was utilised as a rescue therapy. To our knowledge this has not previously been described in the literature. The patient proceeded to stabilise and made a good recovery.
Origin of the Word ‘Anesthesiology’: Mathias J. Seifert, MD
Authors: Haridas R. P.
Published: January 2019

The word ‘anesthesiology’ was coined in 1902 by Mathias J. Seifert, MD, of Chicago, Illinois. Seifert was an accomplished musician before he commenced his medical training. After graduation in 1901 he held academic positions in medicine and gynaecology before being appointed Professor of Physical Diagnosis and Anesthesiology at the College of Dentistry, University of Illinois. He was later appointed Professor of Surgery at the Chicago Hospital College of Medicine.