Abnormalities of the muscles of the soft palate and their impact on auditory function in patients operated on for cleft palate: a case-control study

Patients with cleft palate have a high incidence of otitis media (OM), which, even after palatal repair, can persist and lead to auditory dysfunction. We aimed to identify what predisposes such patients to develop OM and correlate it with auditory function. We designed a prospective case-control study of adults who had had their cleft palates repaired in childhood. We examined the anatomy of the eustachian tube and the paratubal muscles of the soft palate with magnetic resonance imaging (MRI), assessed auditory function, and correlated the results to evaluate the impact of the pathological anatomy on the function of the middle ear. A total of 64 ears in 32 patients were evaluated (Group A, n = 16) (Group B, controls = 16). MRI showed a short eustachian tube with a shortened tensor attachment in Group A when compared with Group B. The pterygoid hamulus was found to be intact in both groups, but extensive perihamular fibrosis was seen in Group A. A total of 15 ears in Group A had loss of hearing (prevalence ratio (PR) 1.08), (13 mild loss, and 2 moderate loss), and impedance audiometry showed effusion of the middle ear in 12 ears in 16 patients, and dysfunction of the eustachian tube with high negative pressure in the middle ear in four ears in the 16 patients (PR 4.6). These could be positively correlated with the pathological anatomy using Pearson’s correlation coefficient. Otitis media is persistent and can lead to conductive hearing loss in adults who have been operated on for cleft palate. This can be attributed to abnormalities in the development of the eustachian tube and the paratubal musculature.     

The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia

Objective

Patient selection for open lower extremity revascularization in patients with chronic kidney disease (CKD) remains a clinical challenge. This study investigates the impact of CKD on early graft failure, postoperative complications, and mortality in patients undergoing lower extremity bypass for critical limb ischemia.

Incidence,Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting

1. Download : Download high-res image (147KB)
2. Download : Download full-size image

     

Subacute sclerosing panencephalitis resembling Rasmussen’s encephalitis on magnetic resonance imaging

Subacute sclerosing panencephalitis (SSPE) is a rare, slowly progressing but invariably fatal disease that is related to a prior measles virus infection and most commonly affects paediatric patients. Magnetic resonance (MR) imaging is the modality of choice for determining such changes in white matter. SSPE typically demonstrates bilateral but asymmetric periventricular and subcortical white matter involvement. We herein report a rare case of unilateral white matter involvement in a 13-year-old boy with SSPE that closely simulated Rasmussen’s encephalitis. To the best of our knowledge, this is the first report of an atypical presentation on MR imaging in which SSPE was a rare cause of unilateral brain parenchymal involvement in a patient with intractable seizures.