Search

To determine if perioperative administration of dexmedetomidine affects postoperative fluid intake in tonsillectomy patients. A retrospective chart review was performed at University Medical Center, Texas Tech Health Science Center, Lubbock, Texas. The study identified 534 patients within the last five years who met the criteria. Common indications for the surgeries included recurrent tonsillitis, obstructive sleep apnea, and sleep disordered breathing. Patients with concurrent peritonsillar abscess drainage, microlaryngoscopy, bronchoscopy, supraglottoplasty, and other procedures that may impact fluid intake were excluded. The relationship between dexmedetomidine and fluid intake was evaluated using bivariate analysis as well as multivariable regression to account for possible confounders such as age, concurrent medication, surgery type, and method of surgery using STATA statistical software, version 17.0 (StataCorp LLC, College Station, TX). Administration of dexmedetomidine did not significantly impact the amount of fluid intake, fluid intake per kilogram per hour, or average postoperative pain levels in patients who underwent tonsillectomy or adenotonsillectomy in the bivariate analysis (p = 0.217, 0.489, 0.512 respectively) and multiple regression model (p = 0.156, 0.802, 0.795) Dexmedetomidine does not negatively influence postoperative fluid intake levels in patients and should continue to be utilized in appropriately selected patients experiencing anxiety or agitation prior to surgery. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Socioeconomics and demographics have been shown to be determinates of healthcare in specialty clinics, in which thorough research is lacking in the setting of the United States clinical sphere. We set out to determine the impact of socioeconomic and demographic factors on patient preparedness in an otolaryngologic clinic as to highlight the need for awareness in this aspect of disparate and delayed clinical care. Study Design: Retrospective chart review. Methods: A chart review was conducted of 482 patients who visited our otolaryngology clinic between June 1, 2020 and June 1, 2023. Demographic data including marital status, gender, age, zip code, and race was collected. Results: Our study found several interesting points of significance. Marital status was a significant determinant of whether patients had missing labs and/or imaging (p =.001). Age was a significant determinant of patients having their imaging (p <.0001). Patients were more likely to have all their labs and imaging at a follow‐up appointment compared to an initial appointment (p <.0001). Finally, a patient's zip code was found to be a significant determinant of whether a patient no‐showed an appointment or arrived with all their needed imaging and labs (p =.004). Conclusions: Having the needed labs and imaging for a clinical visit is vital to providing timely and well‐informed care for all patients. This study highlighted several potential determinates of missing labs and imaging. Elderly patients were less likely to have imaging, which may be attributed to transportation issues and a weaker support system. Individuals who were married were more likely to have their imaging. Married individuals may have a stronger support system, where their spouses can provide transportation and reminders for appointments. Finally, the significance of zip code highlights the role transportation distance and living in an underserved area may have on patients being able to go to their appointments or obtain their needed imaging. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Intrathyroidal parathyroid carcinoma (PC) is a rare malignancy that is usually difficult to diagnose. We present a case of a 31-year-old male with a history of hyperparathyroidism who was found to have intrathyroidal PC upon review of immunostains along with a review of the current literature. A systematic review of the literature utilizing the PubMed database identified 24 relevant, full-text articles. 25 cases were analyzed, including our own report. The case of a 31-year-old man with a history of hyperparathyroidism managed with subtotal thyroidectomy and subtotal parathyroidectomy who had persistent hypercalcemia and elevated parathyroid hormone. Abnormal radiotracer uptake was noted in the left thyroid gland. Neck exploration with left parathyroidectomy and revision thyroidectomy was performed. A candidate left inferior parathyroid was found within the left thyroid lobe remnant and identified as parathyroid carcinoma. Immunostains determined an intrathyroidal parathyroid carcinoma. The literature review shows the average presenting age was 50.9 years. 54.17% (CI, 43–82%) of affected patients are female. Right-sided thyroid involvement is seen in 54.17% (CI, 34–74%) of cases. The inferior aspect of the thyroid is involved in 66.67% of cases (CI, 53–89%). Intrathyroidal parathyroid carcinoma is a rare and challenging diagnosis due to similarities with other more common endocrine abnormalities. This review found that the inferior parathyroid is more likely to be located within the thyroid gland. Surgeons may consider aberrant anatomical locations, including intrathyroidal locations, for the inferior parathyroid glands. [ABSTRACT FROM AUTHOR]

Background: Although several surgical landmarks have been proposed to localize the recurrent laryngeal nerve (RLN), there is still no reliable landmark. Aims: To validate the reliability of a novel reference point at the intersection of the inferior border of the cricopharyngeal muscle and the inferior cornu of thyroid cartilage for locating the RLN. Study Design: Cadaver dissection study in the academic department of otolaryngology-head and neck surgery. Methods: Sixty-four RLNs in cadavers were assessed, and measurements of different surgical landmarks in conjunction with the proposed surgical landmark were obtained. Descriptive statistics, Pearson's chi-squared test, and Student's t-test were performed to analyze the data using GraphPad Prism (version 9.4.1; Dotmatics, Boston, Massachusetts, USA). Results: The average distance from the proposed landmark to the RLN was 2.3 ± 0.85 mm. The RLN was located just posterior to the reference point in 95.31% of the cadavers. The RLN passed under the inferior constrictor muscle in 90.63°% of the cadavers. There was no statistically significant difference between right- and left-sided RLNs in terms of their relation with the reference point. Conclusion: The proposed reference point can be used as a reliable landmark to locate the RLN. This reference point may help surgeons during difficult thyroidectomy surgeries by providing an additional anatomical landmark. [ABSTRACT FROM AUTHOR]

Evaluates in vivo desensitization and self-modeling for effectiveness in treating a 29-year-old female with an intense fear of children. Following 19 sessions over a six-month period the subject stopped avoiding situations involving children, heart rate and blood pressure decreased slightly, confidence increased, and multiple fears were reduced. (RJM)

Objectives: Humans receiving tissue-engineered tracheal grafts have experienced poor outcomes ultimately resulting in death or the need for graft explantation. We assessed the performance of the synthetic scaffolds used in humans with an ovine model of orthotopic tracheal replacement, applying standard postsurgical surveillance and interventions to define the factors that contributed to the complications seen at the bedside.Study Design: Large animal model.Setting: Pediatric academic research institute.Subjects and Methods: Human scaffolds were manufactured with an electrospun blend of polyethylene terephthalate and polyurethane reinforced with polycarbonate rings. They were seeded with autologous bone marrow-derived mononuclear cells and implanted in sheep. Animals were evaluated with routine bronchoscopy and fluoroscopy. Endoscopic dilation and stenting were performed to manage graft stenosis for up to a 4-month time point. Grafts and adjacent native airway were sectioned and evaluated with histology and immunohistochemistry.Results: All animals had signs of graft stenosis. Three of 5 animals (60%) designated for long-term surveillance survived until the 4-month time point. Graft dilation and stent placement resolved respiratory symptoms and prolonged survival. Necropsy demonstrated evidence of infection and graft encapsulation. Granulation tissue with signs of neovascularization was seen at the anastomoses, but epithelialization was never observed. Acute and chronic inflammation of the native airway epithelium was observed at all time points. Architectural changes of the scaffold included posterior wall infolding and scaffold delamination.Conclusions: In our ovine model, clinically applied synthetic tissue-engineered tracheas demonstrated infectious, inflammatory, and mechanical failures with a lack of epithelialization and neovascularization. [ABSTRACT FROM AUTHOR]

Objective: Significant morbidity and mortality are associated with clinical use of synthetic tissue‐engineered tracheal grafts (TETG). Our previous work focused on an electrospun polyethylene terephthalate and polyurethane (PET/PU) TETG that was tested in sheep using a long‐segment tracheal defect model. We reported that graft stenosis and limited epithelialization contributed to graft failure. The present study determined if the epithelialization defect could be attributed to: 1) postsurgical depletion of native airway basal stem/progenitor cells; 2) an inability of the PET/PU‐TETG to support epithelial migration; or 3) compromised basal stem/progenitor cell proliferation within the PET/PU environment. Study Design: Experimental. Methods: Basal stem/progenitor cell frequency in sheep that underwent TETG implantation was determined using the clone‐forming cell frequency (CFCF) method. A novel migration model that mimics epithelial migration toward an acellular scaffold was developed and used to compare epithelial migration toward a control polyester scaffold and the PET/PU scaffold. Basal stem/progenitor cell proliferation within the PET/PU scaffold was evaluated using the CFCF assay, doubling‐time analysis, and mitotic cell quantification. Results: We report that TETG implantation did not decrease basal stem/progenitor cell frequency. In contrast, we find that epithelial migration toward the PET/PU scaffold was significantly less extensive than migration toward a polyester scaffold and that the PET/PU scaffold did not support basal stem/progenitor cell proliferation. Conclusions: We conclude that epithelialization of a PET/PU scaffold is compromised by poor migration of native tissue‐derived epithelial cells and by a lack of basal stem/progenitor cell proliferation within the scaffold. Level of Evidence: NA [ABSTRACT FROM AUTHOR]

Aspiration of foreign bodies is common and among the leading causes of accidental death in children. When detected promptly, an experienced physician can successfully manage foreign bodies of the airway. However, uncommon objects and physical trauma can complicate their removal. Inhalation of organic and inorganic foreign bodies of all types is well documented, but glass in the airway is an unusual and difficult problem. Further, airway foreign bodies in conjunction with an unstable cervical spine are rare. Polytrauma tends to complicate any case. We present a case illustrating both circumstances: tempered automotive glass in the airway of a child with an unstable cervical spine fracture. [ABSTRACT FROM AUTHOR]

Concepts of simplicity and complexity in modeling have been explored in papers, editorials, and talks. The concept is not well understood because there are at least two flavors of simplicity. Modelers envision simplicity (i.e., elegant simplicity) as the sought-after goal in modeling, but naïve simplicity, which is the focus of this paper, is commonly unrecognized and dangerous. The problem is that naïve or simple ideas are often mistaken for settled science and come with the prospect of being more wrong than right. The concept of the so-called simplicity cycle, in relation to classical problems of carbon-14 age and salinity in closed-basin lakes, is used to illustrate these points. The emerging problems of water-mosquitoes-diseases show the value of mapping new problems to the simplicity cycle. Researchers can 'know what they do not know' and avoid the dangers of naïve simplicity. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of a graduated exposure procedure, combined with peer feedback, in the treatment of speech anxiety. Subjects were assigned to one of two conditions: (a) graduated exposure/shaping plus feedback or (b) no-treatment control. Results indicated that the graduated exposure/shaping plus feedback treatment group demonstrated significantly greater speech anxiety reduction than the no-treatment control group at post- and follow-up assessment. [ABSTRACT FROM AUTHOR]

Although widely utilized as a source of treatment for family members of alcoholics, the Al-Anon program has not been studied regarding its effectiveness. This study attempted to empirically assess presumed benefits reported by 77 members of Al-Anon programs in Southern Minnesota. To test hypotheses regarding levels of self-esteem and marital adjustment, correlational statistics were used to compare length of membership to results from the Tennessee Self-Concept Scale and Locke-Wallace Marital Adjustment Test. Although significant relationships were found between both self-esteem and marital adjustment regarding increased length of membership, confounds and methodological difficulties reduced the impact of these findings. [ABSTRACT FROM AUTHOR]

Tessier 7 clefts are a rare congenital anomaly, usually surgically repaired with Z-plasty or other reconstructive methods, although undesirable scars may result. We present a review of the literature and a case of unilateral Tessier 7 cleft repaired with a novel reconstruction technique using a combined Z-plasty and geometric broken line closure (GBLC) to camouflage and irregularize the otherwise linear scar. We present this case to expand the armamentarium of surgical options to address Tessier 7 clefts and to review techniques for repair. [ABSTRACT FROM AUTHOR]

Lumisterol (L3) is a stereoisomer of 7-dehydrocholesterol and is produced through the photochemical transformation of 7-dehydrocholesteol induced by high doses of UVB. L3 is enzymatically hydroxylated by CYP11A1, producing 20(OH)L3, 22(OH)L3, 20,22(OH)2L3, and 24(OH)L3. Hydroxylumisterols function as reverse agonists of the retinoic acid-related orphan receptors α and γ (RORα/γ) and can interact with the non-genomic binding site of the vitamin D receptor (VDR). These intracellular receptors are mediators of photoprotection and anti-inflammatory activity. In this study, we show that L3-hydroxyderivatives significantly increase the expression of VDR at the mRNA and protein levels in keratinocytes, both non-irradiated and after UVB irradiation. L3-hydroxyderivatives also altered mRNA and protein levels for RORα/γ in non-irradiated cells, while the expression was significantly decreased in UVB-irradiated cells. In UVB-irradiated keratinocytes, L3-hydroxyderivatives inhibited nuclear translocation of NFκB p65 by enhancing levels of IκBα in the cytosol. This anti-inflammatory activity mediated by L3-hydroxyderivatives through suppression of NFκB signaling resulted in the inhibition of the expression of UVB-induced inflammatory cytokines, including IL-17, IFN-γ, and TNF-α. The L3-hydroxyderivatives promoted differentiation of UVB-irradiated keratinocytes as determined from upregulation of the expression at the mRNA of involucrin (IVL), filaggrine (FLG), and keratin 14 (KRT14), downregulation of transglutaminase 1 (TGM1), keratins including KRT1, and KRT10, and stimulation of ILV expression at the protein level. We conclude that CYP11A1-derived hydroxylumisterols are promising photoprotective agents capable of suppressing UVB-induced inflammatory responses and restoring epidermal function through targeting the VDR and RORs. [ABSTRACT FROM AUTHOR]

The posterior belly of the digastric muscle, referred to as the "resident's friend," serves as a valuable anatomical landmark because identification of its location during head and neck surgery helps to secure vital structures. A 53-year-old female was referred for an oral cavity mass with a biopsy confirmed squamous cell cancer. A physical exam revealed a 4 cm long and 2 cm wide right ulcerated oral tongue mass. Imaging findings demonstrated no evidence of pathological lymph nodes and distant metastasis. A surgical excision with elective neck dissection was planned along with submental island flap reconstruction. During the neck dissection, the external carotid artery (ECA) was noted to be passing over the posterior belly of the digastric muscle and then descending deeper than the stylohyoid muscle. No other vascular anomaly was identified. The surgery was completed without any complications, and the patient was discharged on post-operative day five. It is necessary to be attentive to a potential course variation of the neurovascular structures underneath that could affect the credibility of the posterior belly of the digastric muscle as a trusted friend. This case report emphasizes the significance of identifying the rare variation where the posterior belly of the digastric muscle exposes the ECA to its lateral side., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Texas Tech University Health Sciences Center School of Medicine issued approval Exempt. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, May et al.)

Intrathyroidal parathyroid carcinoma (PC) is a rare malignancy that is usually difficult to diagnose. We present a case of a 31-year-old male with a history of hyperparathyroidism who was found to have intrathyroidal PC upon review of immunostains along with a review of the current literature. A systematic review of the literature utilizing the PubMed database identified 24 relevant, full-text articles. 25 cases were analyzed, including our own report. The case of a 31-year-old man with a history of hyperparathyroidism managed with subtotal thyroidectomy and subtotal parathyroidectomy who had persistent hypercalcemia and elevated parathyroid hormone. Abnormal radiotracer uptake was noted in the left thyroid gland. Neck exploration with left parathyroidectomy and revision thyroidectomy was performed. A candidate left inferior parathyroid was found within the left thyroid lobe remnant and identified as parathyroid carcinoma. Immunostains determined an intrathyroidal parathyroid carcinoma. The literature review shows the average presenting age was 50.9 years. 54.17% (CI, 43-82%) of affected patients are female. Right-sided thyroid involvement is seen in 54.17% (CI, 34-74%) of cases. The inferior aspect of the thyroid is involved in 66.67% of cases (CI, 53-89%). Intrathyroidal parathyroid carcinoma is a rare and challenging diagnosis due to similarities with other more common endocrine abnormalities. This review found that the inferior parathyroid is more likely to be located within the thyroid gland. Surgeons may consider aberrant anatomical locations, including intrathyroidal locations, for the inferior parathyroid glands., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.