Identification of the non-recurrent inferior laryngeal nerve using intraoperative neurostimulation

INTRODUCTION: The non-recurrent inferior laryngeal nerve occurs at a frequency of about 0.5% and usually on the right side. The identification of a non-recurrent laryngeal nerve may be difficult. We describe a new method for its identification using intraoperative neurostimulation. METHODS: We examined nine patients with a non-recurrent inferior laryngeal nerve and five patients with a normal inferior laryngeal nerve anatomy who were operated on trans-sternally. Neurostimulation of the vagal nerve producing electromyographic signal in the intrinsic laryngeal musculature was performed at different points proximally and distally. RESULTS:: Electromyographic signals were found proximally but not distally of the separation of the inferior laryngeal nerve from the vagus in 14 patients. In nine patients with a non-recurrent inferior laryngeal nerve, we performed neurostimulation of the vagus opposite the lower and the upper thyroid poles. In all patients we found no electromyographic signals at the distal stimulation point. In contrast, proximal neurostimulation of the vagus opposite the upper thyroid pole produced positive electromyographic signals. CONCLUSION: Neurostimulation of the vagal nerve distally of the separation of the inferior laryngeal nerve did not produce electromyographic signals in the intrinsic laryngeal musculature, perhaps due to the different modalities in the vagal fascicles. Negative electromyographic signals following neurostimulation of the distal vagal nerve opposite the lower thyroid pole should lead to proximal neurostimulation of the vagus opposite the upper thyroid pole. Positive electromyographic signals proximally and negative electromyographic signals distally predict the occurrence of a non-recurrent inferior laryngeal nerve which allows its diagnosis before surgical dissection of the thyroid gland and may prevent nerve palsy.     

Improved magnetization preparation for navigator steady-state free precession 3D coronary MR angiography.

The purpose of this work was to investigate a new magnetization preparation scheme for navigator steady-state free precession (SSFP) 3D coronary MR angiography (MRA) that executes the navigator and fat saturation pulses in steady state after the dummy RFs in order to minimize the delay between the magnetization preparation and the image echoes. Compared to the previous preparation scheme that executes the navigator and fat saturation pulses before the dummy RFs, the new scheme was found to provide more effective motion suppression, significantly improved blood-to-myocardium contrast-to-noise ratio (46%, P < 0.001) at slightly but insignificantly decreased blood signal-to-noise ratio (SNR) (2%, P = 0.73), significantly reduced fat SNR (32%, P < 0.001), and better overall image quality (P = 0.05; Wilcoxon paired sample signed rank test).     

Interferon-β downregulates interferon-γ-induced class II MHC molecule expression and morphological changes in primary cultures of human brain microvessel endothelial cells

Regulation of class II MHC (la) antigen expression by interferons β and γ was studied in an in vitro model of the blood-brain barrier. Primary cultures of human brain microvessel endothelial cells were incubated with IFN-β, γ or a combination of the two cytokines and surface expression of class II MHC molecules was investigated with the immunogold silver staining technique and enzyme-linked immunosorbent assay. Treatment of monolayers with IFN-β (100–6000 U/ml) failed to induce Class II MHC molecules. Co-incubation with IFN-γ (100 U/ml), with or without pretreatment with IFN-β, significantly inhibited the IFN-γ-induced de novo expression in a concentration-dependent manner. Downregulation was less significant when incubation with both cytokines was preceded by 2-day treatment with IFN-γ and was not observed in cultures incubated for an additional 4 days with IFN-γ. Endothelial cells treated with IFN-γ exhibited prominent morphological changes and frequent overlapping. These changes were not observed in the presence of either IFN-β or both cytokines in the media. IFN-β alone, or in combination with IFN-γ, significantly inhibited the growth of endothelial cells, while only slight inhibition was observed with IFN-y. The results of these studies suggest that IFN-β may function in modulating IFN-γ-mediated immune responses in the human central nervous system at the level of the blood-brain barrier and this negative regulatory mechanism may be, at least in part, responsible for the recently reported beneficial effect of IFN-β in relapsing-remitting multiple sclerosis.     

Quality of life after stroke: a longitudinal analysis of a cluster randomized trial

Quality of Life Research - Health-related quality of life (QoL) is poor after stroke, but may be improved with comprehensive care plans. We aimed to determine the effects of an individualized...     

Validation of “patient-reported outcomes via online questionnaire” as a urinary continence assessment and quality improvement tool following radical prostatectomy

BackgroundSecuring reliable data on functional outcomes following radical prostatectomy (RP) is paramount to patient follow-up and management.ObjectiveTo validate an email-based patient-reported outcomes tracking system in assessing pad-free continence rates and time-to continence recovery following RP.Patients and Methods483 men undergoing RP by a single surgeon from November 2013 to March 2019 were prospectively assigned to 1 of 3 tracking systems: 1) a preaddressed paper packet containing a pad-free card and daily urinary pad log, (N = 249); 2) an automated email questionnaire, (N = 234) or 3) both (N = 51). Patients tracked electronically received electronic Research Electronic Data Capture surveys 30 days after catheter removal, with up to 3 reminders sent automatically if no response was received within 2 days. Response rates and continence rates were compared in group 1 vs. group 2 via student t-tests; time-to pad-free status was assessed for concordance among men in group 3 via linear regression.ResultsThirty-day response rates in group 1 (paper) vs. group 2 (electronic) were 80.7% (201/249) and 94.0% (220/234), (P < 0.0001); pad-free rates were 64.2% (129/201) and 64.1% (141/220), (P = 0.9847), respectively. Similarly, 1-year response rates in group 1 and 2 were 87.6% (218/249) vs. 94.0% (220/234), (P = 0.0146); pad-free rates were 91.7% (200/218) vs. 96.4% (212/220), (P = 0.0411), respectively.In group 3, time to pad-free continence recovery assessed via Patient Reported Outcomes via Online Questionnaire (PROVOQ) was highly concordant in 89.6% (43/48) of patients ± 5 days (Figure 1, R² = 0.9893). No significant bias was found for subsequent reporting in either group.ConclusionThe use of automated email survey questionnaires via PROVOQ for the assessment of patient-reported post-RP continence recovery facilitates increased response rates, timeliness of response, and accuracy. PROVOQ significantly reduce the labor of tracking continence outcomes, improve quality improvement efforts, and enables surgeons to more clearly differentiates risk of long-term incontinence.     

Plombage for Hemoptysis Control in Pulmonary Aspergilloma: Safety and Effectiveness of Forgettable Surgery in High-Risk Patients

Objectives: To evaluate plombage surgery for hemoptysis control in pulmonary aspergilloma in high-risk patients.Methods: This study was carried out on 75 pulmonary aspergilloma patients presenting with hemoptysis that underwent a plombage surgery for approximately 7 years (November 2011–September 2018) at Pham Ngoc Thach Hospital. They revisited the hospital 6 months after plombage surgery and considered plombage removal. The group whose plombage was removed was compared with that whose plombage was retained 6 and 24 months after surgery.Results: Hemoptysis reduced significantly after surgery. Hemoptysis ceased in 91.67% of the patients and diminished in 8.33% of the patients 6 months after surgery. Similarly, hemoptysis ceased in 87.32% of the patients and diminished in 12.68% of the patients 24 months after surgery. Body mass index (BMI) index, Karnofsky score, and forced expiratory volume in one second (FEV1) increased. Plombage surgery was performed with operative time of 129.5 ± 36.6 min, blood loss during operation of 250.7 ± 163.1 mL, and the number of table tennis balls of 4.22 ± 2.02. No deaths related to plombage surgery were recorded. Plombage was removed in 29 cases because of patients’ requirements (89.8%), infection (6.8%), and pain (3.4%). There were no patient developing complications after the treatment and there were no statistically significant differences between the two groups.Conclusions: Plombage surgery is safe and effective for hemoptysis control in pulmonary aspergilloma. To minimize the risk of long-term complications, surgeons should remove the plombage 6 months after the initial operation.