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1.
Robert T. Swanson Jane R. Schubart Michele M. Carr 《American journal of otolaryngology》2018,39(5):618-622
Objective
Evaluate post-tonsillectomy outcomes in children discharged with ibuprofen versus those without.Methods
This was a retrospective review of children who underwent tonsillectomy?±?adenoidectomy from 2012 to 2016 at a tertiary care children's hospital. Main outcome measures included bleed rates, ER visits, and nurse phone calls.Results
Seven hundred and seventy-three patients were included; 504 had ibuprofen at discharge (ID) and 269 did not (NID). There were significant differences in mean age, 6.7?years in the ID group years versus 8.6 for the NID group (P?<?0.001). Indication for surgery was sleep apnea in 70.5% of ID patients and 44.0% of NID patients (P?<?0.001). Post-tonsillectomy bleeds occurred in 8.7% in the ID group and 5.9% of the NID group (P?=?0.168). Other outcome measures revealed no significant differences between the two groups. There was no significant difference in the outcome measures between patients with sleep apnea or recurrent tonsillitis. Age was important; 12.1% of children 9–18?years versus 4.8% in children 3.1–6?years (P?=?0.006) had post-tonsillectomy bleeding. For children 9–18?years old, 16.7% in the ID group bled versus 7.5% in the NID group (P?=?0.039). Logistical regression revealed that age contributed to post-op bleeding, and ibuprofen contributed to number of ER visits.Conclusion
Ibuprofen is associated with significantly elevated post-tonsillectomy bleeding in older children, further research is needed and other analgesics should be considered. 相似文献2.
Objective
The use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF.Design and participants
This was a retrospective cohort study of 95 TMPs who were observed for at least 6?months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses.Interventions
Each traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time.Results
A total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6?months, and the mean closure time was 10.5?±?4.8?days. The closure rate was not significantly different according to the duration of perforation ≤3?days and >3?days (P?=?0.816). However, the mean closure time was significantly different according to the duration of perforation (P?<?0.001). The perforation size did not affect the closure rate (P?=?0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P?=?0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P?=?0.001). Multivariate logistic regression analyses showed that the duration of perforation (P?=?0.011), size of perforation (P?<?0.001), and involvement of the malleus in perforation (P?=?0.005) were factors independently correlated with closure time.Conclusions
Daily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time. 相似文献3.
Objectives
This study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI.Method
Eighty-one patients treated for non-odontogenic DNI over 5?years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed.Results
Sixty-two male and 19 female patients with a median age of 46.22?years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n?=?60, 74.07%), DNIs with infrahyoid space involvement (n?=?21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P?=?0.000), mediastinitis (38.10%, P?=?0.000), tracheostomy (28.57%, P?=?0.008), surgery using a transcervical approach (66.67%, P?=?0.000), and intensive care unit therapy (19.05%, P?=?0.004), as well as longer hospital stays (16?days, P?=?0.000) and higher costs ($2872, P?=?0.000).Conclusion
Infrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement. 相似文献4.
Objective
Eagle syndrome, a spectrum of disease resulting from an elongated styloid process and/or calcified stylohyoid ligament, lacks standardized recommendations regarding indications for surgical intervention and approach.Study design
Retrospective cohort study.Setting
Single tertiary care institution.Subjects
Patients treated surgically for Eagle syndrome between January 2011 and June 2017.Methods
Patients were diagnosed with Eagle syndrome based on thorough clinical workup and assessment. The primary outcome was improvement in pain severity following surgery, with complete resolution of pain being considered clinically meaningful. Wilcoxon rank-sum tests and Fisher's exact were used to compare numerical and categorical variables, respectively.Results
Twenty-one patients were diagnosed with Eagle syndrome and underwent surgical resection of the styloid process. Patients most often complained of neck pain (81%), throat pain (62%), and ear pain (48%). Among these patients, 57% of procedures featured a transcervical approach, while the remaining 43% were transoral. The vast majority (90%) of patients experienced improvement in pain severity from a median of 6.0 before surgery to 0.0 afterwards (p?<?0.01) as 62% experienced complete resolution. Using multivariable linear regression to model changes in pain severity, neck pain (β?=??1.69, p?<?0.01) and jaw pain (β?=??0.93, p?=?0.03) predicted greater relief, while headache (β?=?0.82, p?=?0.04) predicted an inferior response. Adverse events were uncommon and typically resolved within three months, with 24% experiencing first bite syndrome and 19% reporting numbness.Conclusions
Transcervical and transoral styloidectomy are effective treatments for Eagle syndrome with minimal adverse effects. Patients with classic symptoms of neck or jaw pain benefit most from surgery. 相似文献5.
Yunqin Wu Chengyao Gu Weiwei Han Xiaoxiong Lu Caijing Chen Zhenyi Fan 《American journal of otolaryngology》2018,39(1):31-33
Objective
This study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD).Methods
BMD was measured in 78 native Chinese female de novo idiopathic BPPV patients and 126 healthy controls using dual-energy X-ray absorptiometry. We compared the mean T-scores and abnormal BMD prevalence between the two groups.Results
The mean T-scores were significantly lower in idiopathic BPPV patients than in healthy controls. The prevalence of osteopenia and osteoporosis were significantly higher in idiopathic BPPV patients than in healthy controls (65.4% vs 48.4%, p = 0.013).Conclusion
BMD reduction may be associated with idiopathic BPPV occurrence. 相似文献6.
Daniel C. O&#x;Brien Yuti Desai Robert T. Swanson Uma Parekh Jane Schubart Michele M. Carr 《American journal of otolaryngology》2018,39(5):623-627
Objectives
To investigate the relationships between preoperative sleep study findings of children undergoing adenotonsillectomy anesthesia emergence time, recovery room time, and length of stay.Study design
Retrospective case series with chart review.Setting
Tertiary care children's hospital.Subjects and methods
All children aged 1–17?years who had undergone adenotonsillectomy between 2013 and 2016 were included. Apnea-hypopnea index (AHI), central apnea index (CAI), oxygen saturation nadir, and end-tidal carbon dioxide were compared with the in-operating room times, recovery room time, and length of stay.Results
Three hundred and fourteen patients with a mean age of 6.67 (95% CI 6.25–7.09) years were included. Mean AHI was 9.14 (95% CI 7.33–10.95), mean CI was 0.88 (95% CI 0.50–1.26), mean oxygen saturation nadir was 82.9% (95% CI 81.41–84.32), mean end-tidal carbon dioxide was 50.3 (95% CI 49.39–51.15). Mean emergence time was 16?min (95% CI 15:11–17:13?min), recovery room time was 66?min (95% CI 1:00–1:11?h), and length of stay was 25.7?h (95% CI 21:43–30:00?h).When controlled for age, gender and BMI, linear regression showed that children with a higher AHI had a significantly longer operating room and operative times (p?<?0.001), emergence time (p?<?0.001) and length of stay (p?=?0.01). CAI was related to shorter total operating room times (p?=?0.03). AHI, oxygen saturation nadir, CAI and end-tidal carbon dioxide were not associated with recovery room time.Conclusion
Preoperative sleep study indices are associated with longer in-operating room times and length of stay, and can be useful in planning operating room and hospital flow. 相似文献7.
Khoi Anh Nguyen Truong Xuan Bui Hue Van Nguyen Richard O. Wein 《American journal of otolaryngology》2018,39(3):317-320
Objective
The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery.Design
Case series with intervention.Participants
Thirty consecutive patients, from 2011 to 2015, with carcinoma of the tongue undergoing surgical resection and reconstruction with a radial forearm free flap.Main measures
The Speech Intelligibility Test (SIT) is used for objective evaluation of speech function. The 7-point ordinal scale Functional Oral Intake Score (FOIS) was used to estimate the swallowing function.Results
The patients included were 25 men and 5 women with a mean age of 50.4?years (range – 27–65). All tumors were squamous cell carcinomas and all patients underwent a hemiglossectomy. There were two complete flap failures, with a resultant flap success rate of 93.3%. The initial mean speech intelligibility scores at 1-month increased from 72.3?±?0.2 to 77.7?±?8.9 at 6-months after surgery (p?=?0.05). Similarly, the mean score of swallowing function improved from 6.1 at 1-month to 6.8 at 6-months after surgery (p?=?0.05).Conclusion
Reconstruction of hemiglossectomy defects with a radial forearm free flap offers functional benefits in speech and deglutition that demonstrate progressive improvement when 1- and 6-month post-surgical assessments are compared. 相似文献8.
Tamer M. Attia 《American journal of otolaryngology》2018,39(5):476-480
Objective
To compare the effect of Paracetamol/Prednisolone versus Paracetamol/Ibuprofen on post-operative recovery after adult tonsillectomy.Background
Various analgesic protocols have been proposed for the control of post-tonsillectomy morbidity with need for better control in adult population for having higher severity of post-operative pain and risk of secondary post-tonsillectomy bleeding.Methods
This is a prospective cohort study conducted on 248 patients with age of 12?years or older distributed as two equal groups; the first one receiving Paracetamol/Prednisolone and the second one receiving Paracetamol/Ibuprofen. Both groups were compared at 7?days post-operative regarding pain at rest, tiredness of speech, dietary intake, and decrease in sleep duration. Both groups were compared regarding incidence of nausea and vomiting at 2?days post-operative. The incidence and severity of secondary post-tonsillectomy hemorrhage was compared between the two groups.Results
Pain at rest (no swallowing - no talking) was less in group I but not reaching statistical significance (p?=?0.36). In addition, dietary intake was better in group I but not reaching statistical significance (P?=?0.17). However, talking ability was better with statistically significant difference (P?=?0.03) in group I. Impairment of sleep was less with group II but not reaching statistical significance (p?=?0.31). The incidence of vomiting at second post-operative day was less in group I with statistical significance (p?=?0.049). The incidence of secondary post-tonsillectomy bleeding was significantly higher in group II with statistical significance (p?=?0.046). The severity of bleeding episodes was also significantly higher in group II (p?=?0.045).Conclusion
Both ibuprofen and prednisolone were effective as a part of post-operative medication regimen after adult tonsillectomy. However, prednisolone was superior to ibuprofen regarding improvement of pain at rest, dietary intake, tiredness of speech and post-operative nausea and vomiting. However, ibuprofen had a better impact on sleep. The incidence and severity of secondary post-tonsillectomy hemorrhage were significantly higher with ibuprofen favoring the selection of prednisolone to be combined with paracetamol in the post-operative medication protocol following tonsillectomy. 相似文献9.
Alexander L. Luryi David Wright Juliana Lawrence Seilesh Babu Michael LaRouere Dennis I. Bojrab Eric W. Sargent John Zappia Christopher A. Schutt 《American journal of otolaryngology》2018,39(3):313-316
Purpose
Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool.Methods
Retrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair.Results
A total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, p?<?0.0005) and Meniere's disease (12.1% vs. 5.9%, p?=?0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, p?=?0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, p?=?0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV.Conclusions
Comparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo. 相似文献10.
Domenico Ciavarella Michele Tepedino Claudio Chimenti Giuseppe Troiano Manuela Mazzotta Maria Pia Foschino Barbaro Lorenzo Lo Muzio Michele Cassano 《American journal of otolaryngology》2018,39(4):388-391
Purpose
To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA).Materials and methods
Seventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p?<?0.025.Results
No correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r2?=?0.424; p?<?0.001) was found between the BMI index and the Nadir SaO2.Conclusions
Higher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA. 相似文献11.
Mustafa Sitki Gozeler Muhammed Sedat Sakat Korhan Kilic Ozgur Ozmen Abdullah Can Ilker Ince 《American journal of otolaryngology》2018,39(6):726-730
Purpose
Septorhinoplasty is a surgical procedure widely employed by otolaryngologists and plastic surgeons. The purpose of this study was to investigate the effects of a single pre-emptive dose of iv ibuprofen on postoperative pain and opioid consumption in patients undergoing septorhinoplasty.Material and methods
50 patients scheduled for septorhinoplasty were included in this prospective, randomized, double-blinded study. Control group (n?=?25) was administered 100?mL iv saline solution 30?min preoperatively, while Ibuprofen group (n?=?26) received 800?mg ibuprofen iv. in 100?mL saline solution. Intravenous fentanyl was administered with a Patient Controlled Analgesia device after surgery for postoperative pain management. Postoperative pain was evaluated using a Visual Analogue Scale (VAS) with 0 representing no pain and 10 the worst pain possible.Results
VAS scores at 10, 20, and 30?min and at 1, 2, 4, 8, 12 and 24?h were lower in the ibuprofen group than in the control group (p?<?0.05). Total fentanyl consumption was lower in the ibuprofen group compared to the placebo group (148.8?±?86.4?mcq vs 338.00?±?81.00?mcq), respectively.Conclusion
We suggest that the pre-emptive use of iv ibuprofen at a dosage of 800?mg 30?min before septorhinoplasty will be beneficial in reducing opioid consumption and pain scores. 相似文献12.
Danny B. Jandali Ashwin Ganti Samer Al-Khudari Bobby A. Tajudeen Peter C. Revenaugh 《American journal of otolaryngology》2019,40(1):110-114
Objectives
Malignant cutaneous adnexal tumors (MCAT) are rare and comprise a heterogeneous group of cancers. There have been several studies reviewing prognostic factors of these tumors, but no studies focusing on the head and neck. This study aimed to review a large population based database to evaluate prognostic factors that could impact survival.Methods
The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify patients with MCAT of the head and neck. Both overall and disease specific survival were the main outcome measures for the study. Univariate and multivariate analyses were performed to evaluate the association of suspected prognostic factors with survival.Results
The five-year OS and DSS were 72.6 and 95.5%, respectively. A favorable factor for OS was surgical resection ([HR] 0.324; P?=?0.001), while unfavorable factors for OS include older age (1.051; P?<?0.001), higher tumor grade (1.254; P?=?0.049), larger tumor size (1.293; P?=?0.003), and positive nodal involvement (3.323; P?=?0.002). A favorable factor for DSS was surgical resection (0.026; P?<?0.001). Unfavorable factors for DSS include older age (1.058; P?=?0.046), larger tumor size (2.528; 1.565–4.085; P?<?0.001), and positive nodal involvement (4.761; P?=?0.022).Conclusion
Review of the SEER database shows good 5-year OS and DSS rates, similar to those cited in other studies. We identified several prognostic factors associated with survival, while histologic sub-type does not seem to be associated with survival. Surgical resection is the mainstay of treatment. 相似文献13.
Tristan Tham Sushma Teegala Yonatan Bardash Saori Wendy Herman Peter Costantino 《American journal of otolaryngology》2018,39(6):764-770
Introduction
Human papillomavirus (HPV) is a known prognostic indicator in oropharyngeal cancer. Not much is known about the prognostic role of HPV in Nasopharyngeal cancer (NPC). Here, we performed a systematic review and meta-analysis of the literature to investigate if HPV status was a prognostic factor for NPC.Methods
PubMed (via the web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled Hazard Ratios (HR) for Overall Survival (OS).Results
A total of 7 studies from 2014 to 2018, reporting data on 2646 patients (range 43–1328) were included in this meta-analysis. The pooled data showed that HPV/p16 status was not associated with OS in NPC with HR of 0.77 (95% CI: 0.55–1.09, p?=?0.14). The test for heterogeneity showed little to no heterogeneity of results (I2?=?4%, p?=?0.38). Subgroup analysis showed that in large sample sizes, HPV was significantly associated with survival.Conclusion
Despite the finding in the pooled HR, we could not draw a definitive conclusion as to the prognostic significance of HPV in NPC. Recommendations for future research are given. 相似文献14.
Filip Matovinović Filip Bacan Elvira Kereković Alan Pegan Ivan Rašić Andro Košec 《American journal of otolaryngology》2018,39(5):515-517
Purpose
Tonsillectomy is one of the most common surgical procedures in otorhinolaryngology. Modern general anesthetic techniques have reduced surgical risks, but performing the procedure under local anesthesia may still offer significant benefit for both the patient and surgeon. This study analyzed the risks and benefits of performing tonsillectomies under local anesthesia.Methods
This is a retrospective longitudinal cohort study analyzing postoperative bleeding rates as a primary outcome measure. Secondary outcome measures were duration of surgery, consumption of analgesics and total surgery cost.Results
The study enrolled 1112 patients undergoing tonsillectomy, with 462 (41.5%) patients treated under general and 650 (58.5%) patients treated under local anesthesia. There were 12 postoperative bleeding incidents in in the local anesthesia group and 9 cases of postoperative bleeding in the general anesthesia group. No significant differences based on gender regarding quantity of intraoperative bleeding or patient age were observed between the patients undergoing local versus general anesthesia. However, significant differences were noted between the groups in analgesic consumption, (Mann-Whitney U test, p?=?0.001), duration of operating room stay (Mann-Whitney U test, p?=?0.001), duration of surgery (Mann-Whitney U test, p?=?0.001) and cost of surgery (Mann-Whitney U test, p?=?0.001).Conclusions
The incidence of postoperative bleeding is not dependent on type of anesthesia. The results suggest that tonsillectomy performed under local anesthesia is a safe alternative to tonsillectomy under general anesthesia, with significant reduction of cost and duration of surgery. 相似文献15.
Alexandra C.G. Fonseca Margaret I. Engelhardt Zhen J. Huang Zi Yang Jiang Sancak Yuksel Soham Roy 《American journal of otolaryngology》2018,39(4):445-447
Purpose
To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management.Materials and methods
A retrospective review was performed of tonsillectomies conducted at a single institution between 1/1/2013 and 1/1/2017. The rates of PTH and subsequent intervention were calculated. These were categorized into patients having surgery pre- and post-July 1, 2015, the former group receiving narcotics and the latter ibuprofen with acetaminophen.Results
Of 1351 total tonsillectomies, 3.04% had PTH requiring return to the hospital. 0.74% required no further surgical intervention, whereas 2.30% required secondary surgical control. The bleed rate prior to July 2015 was 3.15%, with 1.05% non-surgical bleeds and 2.10% requiring surgery. Post-July 2015, the bleed rate was 2.92%, with 0.44% non-surgical bleeds and 2.49% requiring surgery. There were no statistically significant differences between the two groups with respect to overall, non-surgical, and surgical hemorrhage rates (p?>?0.05). Of the total bleeds, the need for secondary surgery in the narcotic group was 66.7% and 85% in the NSAID group (p?=?0.18). During the study period, 36 patients with PTH had their initial tonsillectomy performed at outside institutions; 53% required surgical intervention.Conclusions
Secondary hemorrhage remains a significant cause of morbidity in post-tonsillectomy patients, often requiring surgical intervention. This review found no increased bleeding risk associated with use of ibuprofen and acetaminophen as opposed to narcotic pain relief.Level of evidence
III 相似文献16.
Aleksander Grande Hansen Chi Zhang Jens Øyvind Loven Hanne Berdal-Sørensen Magnus TarAngen Rolf Haye 《BMC ear, nose, and throat disorders》2018,18(1):9
Background
Quality control after phonosurgery is important and may be time consuming. Often questionnaires focusing on quality of life are applied. We aimed at investigating the use of organ specific symptoms, such as hoarseness and voice failure with the use of self-reported visual analogue scales (VAS) and Likert-scales.Methods
A vocal surgical questionnaire using VAS and Likert-scales for hoarseness, voice failure and factors that could influence voice quality was given twice consecutively to a group of healthy volunteers (n?=?57, 45 female) and a group of voice patients (n?=?34, 21 females) for a test/re-test study. Secondly, a group of patients undergoing surgery (n?=?90, 61females) answered the questionnaire preoperatively and postoperatively. The difference between test/retest, healthy volunteers and patients, and between pre- and postoperative results were compared.Results
There was no significant difference in the test/retest results in healthy volunteers nor in the patient group. There was statistically significant difference between the healthy volunteers and patients, and between the preoperative and postoperative results after phonosurgery.Conclusion
This short and organ specific questionnaire clearly demonstrates the effect of phonosurgery, making it an easy and relevant tool in quality control and potentially reducing the need of postoperative controls in the outpatient clinic.17.
Minsu Kwon Chaedong Yim Hye Jin Baek Jong Sil Lee Ji-Hyun Seo Jin Pyeong Kim Seung Hoon Woo Jung Je Park 《American journal of otolaryngology》2018,39(6):679-684
Purpose
This study was conducted to compare the diagnostic yields of Ultrasonography-guided core needle biopsy (USG-CNB) and open surgical biopsy (OSB) in head and neck (HN) lymphoma and to identify the factors that shape USG-CNB diagnostic yield.Materials and methods
All consecutive patients who were diagnosed with HN lymphoma in our hospital were analyzed. The frequencies with which these first-line procedures yielded a sample that permitted histological confirmation of lymphoma were determined. To identify the factors that shape the diagnostic yield of USG-CNB, the patients in whom USG-CNB was and was not sufficiently confirmatory were compared in terms of demographics, computed tomography (CT) and pathological findings.Results
In total, 83 patients underwent USG-CNB (n?=?26, 31.3%) or OSB (n?=?57, 68.7%) for confirming lymphoma. USG-CNB yielded a fully sufficient diagnosis in 18 (69.2%) patients. By contrast, OSB yielded a confirmative diagnosis in 56 (98.2%) patients. Maximal standardized uptake value (SUVmax) of targeted LN on positron emission tomography-CT (PET-CT) in confirmatively diagnosed subjects was much higher than deferred counterparts (22.9?±?13.4 vs. 10.1?±?5.2, p?=?0.017), however, there was no significant difference in other parameters associated with the first-line USG-CNB diagnostic success.Conclusions
First-line USG-CNB was less frequently successful than OSB for diagnosing HN lymphoma involving cervical LN. Mean SUVmax of LN on PET-CT in confirmatively diagnosed subjects was higher than deferred counterparts on USG-CNB. 相似文献18.
Nicholas B. Abt Rosh K. Sethi Sidharth V. Puram Mark A. Varvares 《American journal of otolaryngology》2018,39(3):261-265
Objectives
1) Describe normal/abnormal preoperative laboratory testing incidence in head and neck (H&N) composite resections and 2) determine complication, surgical site infection (SSI), and transfusion predictors by laboratory test.Methods
The 2006 to 2013 NSQIP databases were queried for H&N composite resections. Laboratory data was categorized within, under, or above the normal reference range according to NSQIP definitions. Overall complications and SSI were analyzed with multivariable logistic regression analysis.Results
From 2006 to 2013, there were 1193H&N composite resections, of which 1135 (95.1%) underwent ≥1 preoperative laboratory test. Complete blood counts were obtained in 92.3%, basic metabolic panels in 90.7%, coagulation studies in 56.2%, and liver function tests (LFTs) in 52.6%. Low sodium was found in 11.5%, increasing complication odds by 2.30 (p?=?0.005). High AST comprised 10.0% and increased complication odds (OR?=?2.93, p?=?0.012). Additionally, 9.2% had a high white blood cell (WBC) count and 3.5% had high platelets, increasing complications by 1.92 (p?=?0.030) and 3.13 (p?=?0.015), respectively. BUN, creatinine, total bilirubin, albumin, alkaline phosphatase, INR, PT, and aPTT abnormal values did not affect postoperative complications. Increased SSI odds were appreciated with low sodium (OR: 2.83, p?=?0.002), high AST (OR: 6.85, p?<?0.001), and high alkaline phosphatase (OR: 5.46, p?=?0.007). Importantly, INR had no effect on transfusion rates. High PT, aPTT, or low platelets did not change transfusion odds.Conclusion
Inflammatory markers are associated with complications but not SSI. High LFTs and low sodium are associated with complications and SSI. Coagulopathies did not increase transfusion rates. These findings identify laboratory studies to focus on during H&N resection preoperative assessments. 相似文献19.
Hongcun Sun Xiaowen Qiu Jiandao Hu Zhaoxin Ma 《American journal of otolaryngology》2018,39(5):531-535
Objective
This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy.Materials and methods
104 refractory high-frequency SSNHL patients were enrolled in our study. Among them, 31 received ITD alone (ITD group), 32 received HBO alone (HBO group) and 41 received no salvage therapies (control group). Hearing outcomes were determined by pure-tone average measured by audiometry. The total effective rates in the hearing recovery and improvement of tinnitus were calculated before and after salvage treatment.Results
There was no significant difference of the total effective rates in the hearing recovery between ITD and HBO group (p?=?0.368). However, ITD therapy showed much better improvements of tinnitus than HBO therapy (p?=?0.039). After ITD and HBO therapy, there were no significant differences in hearing gains at 2 and 4?KHz between ITD and HBO group (p?=?0.468 and 0.934, respectively). Nevertheless, ITD therapy showed significant improvements of hearing gains at 8?KHz (p?=?0.049) compared to that of HBO therapy.Conclusion
ITD therapy may have better improvements of tinnitus and hearing gains at 8 KHz than HBO therapy in patients with refractory high-frequency SSNHL. 相似文献20.
I. Seiwerth J. Jonen T. Rahne R. Schwesig A. Lauenroth T. E. Hullar S. K. Plontke 《HNO》2018,66(8):590-597