- Does a tow-bar increase the risk of neck injury in rear-end collisions? [Journal Article]
- JSJ Safety Res 2018; 65:59-65
- CONCLUSIONS: The present study may serve as valuable input for a meta-analysis on the effect of a tow-bar because negative results are necessary in order to avoid publication bias.
- Rates and causes of 30-day readmission and emergency room utilization following head and neck surgery. [Journal Article]
- JOJ Otolaryngol Head Neck Surg 2018 May 18; 47(1):36
- CONCLUSIONS: Rate of 30-day IP readmission and ED utilization was 3.20 and 8.43%, respectively. Pain and infection were common causes for returns to hospital. Discharge planning may be improved to target common causes for post-surgical hospital visits in order to decrease readmission rates.
- Shoulder Lesion in a 69 Year Old Woman. [Journal Article]
- JLJ Long Term Eff Med Implants 2018; 28(1):47-53
- Milwaukee Shoulder Syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. Th...
Milwaukee Shoulder Syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. These enzymes are destructive to periarticular tissue, including the synovium, articular cartilage, rotator cuff muscles, and the intrasynovial cortical bone. MSS predominantly occurring in women (90%) over the age of 70 years of age with a clinical history marked by recurrent joint effusions and pain, which classically worsens at night. Our patient is a 69-year-old woman who presented with progressive shoulder pain, most prominent at night, with limited range of motion and swelling; intermittent discharge; and intermittent neck pain that radiated to her right upper extremity. Her medical history was notable for invasive carcinoma of the right breast treated with mastectomy and radiation. She was also treated with radiation therapy for right shoulder pain and a lucent right shoulder lesion presumed to be metastatic breast cancer. The remainder of her medical history consists of hypertension, diabetes mellitus, hyperlipidemia, and uneventful bilateral total knee arthroplasties. At presentation, she denied constitutional symptoms. Based on the patient's history and physical exam the differential diagnosis included primary and metastatic malignancy, radiation induced sarcoma and necrosis, infection, Charcot disease, and crystal arthropathies. Physical exam, laboratory findings, and imaging studies led us to the diagnosis of MSS.
- Factors Predictive of Postoperative Acute Respiratory Failure Following Inpatient Sinus Surgery. [Journal Article]
- AOAnn Otol Rhinol Laryngol 2018 May 01; :3489418775129
- CONCLUSIONS: To our knowledge, this represents the first study to evaluate potential risk factors of acute respiratory failure following inpatient sinus surgery. Knowledge of these risk factors may be used for risk stratification.
- Numb chin syndrome: an ominous sign of mandibular metastasis. [Journal Article]
- BCBMJ Case Rep 2018 May 14; 2018
- A 51-year-old woman a known case of stage 2 breast carcinoma in 2006 and underwent left mastectomy performed in the same year presented with bilateral lower limb pain suggestive of spinal pathology, ...
A 51-year-old woman a known case of stage 2 breast carcinoma in 2006 and underwent left mastectomy performed in the same year presented with bilateral lower limb pain suggestive of spinal pathology, and left chin numbness, both of 2 weeks' duration. Examination revealed left mandibular hypoesthesia without any other sign or symptoms. Orthopantomogram was unremarkable apart from mild alveolar bone expansion at tooth 36 area, which was extracted 3 months earlier. Subsequently, a full-body positron emission tomography contrast enhanced computer tomography revealed hypermetabolic lesions of her axial (excluding skull) and appendicular skeleton. In the head and neck region, left mandibular foramen and oropharynx bilaterally showed increased metabolism suggestive of tumour metastasis. The diagnosis was numb chin syndrome secondary to mandibular metastasis. Apart from supportive treatment, she was started on palliative chemotherapy and radiotherapy. At the time of discharge, there were no active complaints other than the aforementioned hypoesthesia.
- A stepped approach for the management of symptomatic internal derangement of the temporomandibular joint. [Journal Article]
- JOJ Otolaryngol Head Neck Surg 2018 May 15; 47(1):33
- CONCLUSIONS: The stepped approach for the management of symptomatic internal derangement with or without osteoarthritis is a successful treatment strategy with favourable therapeutic outcomes.
- Opioid prescribing practices in patients undergoing surgery for oral cavity cancer. [Journal Article]
- LLaryngoscope 2018 May 14
- CONCLUSIONS: The majority of patients received greater than the recommended 200 mg total OME. Advanced stage and higher inpatient pain scores were associated with receiving more opioids for discharge. Consensus-driven analgesic plans are needed to reduce excess opioids after discharge following head and neck surgery.
- An Unusual Presentation of Kikuchi-Fujimoto Disease with Recurrent Subdural Effusion. [Journal Article]
- CCureus 2018 Mar 10; 10(3):e2302
- A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical ex...
A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical exam was unrevealing except for right cranial nerve (CN) VI palsy, right parotid enlargement, and cervical adenopathy. Laboratory findings were significant for mild leukopenia at 3300 cells/uL. The computed tomography (CT) scan obtained showed a chronic left subdural effusion with a 4 mm midline shift and confirmed right parotid enlargement and cervical lymphadenopathy. Surgical burr hole evacuation was done and the fluid was sent for wound culture analysis. The infectious diseases service recommended initiating antibiotics, which were later stopped due to cerebrospinal fluid (CSF) cultures with no growth of any organisms. His CN VI palsy resolved during admission. The patient was discharged with follow-up for biopsy. The patient was lost to follow-up. The patient presented to the emergency department (ED) three months later, with a left-sided frontal headache. A repeat CT scan showed a new, right-sided fluid collection outside the brain parenchyma. Burr hole evacuation was done again and purulent fluid was drained. Antibiotics were held this time, but anti-tuberculous therapy was initiated empirically. The otolaryngology service was consulted and a lymph node biopsy was performed. The pathology showed histiocytic necrotizing lymphadenitis. A dural biopsy was done as well and was consistent with histiocytic necrotizing lymphadenitis involving the dura. Cultures from the subdural fluid did not grow any organism. The patient remained neurologically intact. He improved after surgery was done to drain the fluid and was managed by analgesics. The cultures from the extra-parenchymal fluid collection remained negative for pathogens and tuberculous mycobacteria. The patient was discharged with rheumatology clinic follow-up. He saw the rheumatologist six weeks after the discharge. During his clinic visit, the patient reported no recurrence of headaches, fevers, rash, or joint pain. Our patient had a rare presentation of Kikuchi-Fujimoto disease, in which he had a subdural fluid collection resulting in neurological complications that required surgical intervention.
- Risk of Gynecologic Cancer According to the Type of Endometriosis. [Journal Article]
- OGObstet Gynecol 2018 May 07
- CONCLUSIONS: The excess risk of ovarian cancer among women with ovarian endometriosis translates into two excess cases per 1,000 patients followed for 10 years. Acknowledging these risks is important when planning long-term management of women with endometriosis.
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- Prevalence of Potential Adult Chronic Rhinosinusitis Symptoms in the United States. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018 May 01; :194599818774006
- Objective To determine the prevalence of chronic rhinosinusitis-related symptoms in the United States. Study Design Cross-sectional analysis of a national database. Setting Representative sampling of...
Objective To determine the prevalence of chronic rhinosinusitis-related symptoms in the United States. Study Design Cross-sectional analysis of a national database. Setting Representative sampling of the US adult population. Subjects and Methods The National Health and Nutrition Examination Survey data set, taste and smell supplement 2013-2014 was analyzed for sinonasal question responses regarding discolored nasal mucus, nasal blockage, sinus pain, and dysosmia. The individual prevalences as well as the prevalence of 2 or more of these symptoms (which would be compatible with a diagnosis of chronic rhinosinusitis) were determined for the US population. Results After excluding adults with an intercurrent head cold, 113.5 million adults (mean age 58.2 years; 52.6% female) were analyzed. Individual symptom prevalences were dysosmia (9.17 million, 8.1%), nasal blockage (6.9 million, 6.0%), sinus pain (2.37 million, 2.1%), and discolored mucous (1.28 million, 1.1%). Overall, 14.8 million (13.0%) adults had exactly 1 sinonasal symptom, and 2.37 million adults (2.1%) responded with 2 or more cardinal symptoms for chronic rhinosinusitis. With respect to sex, 1.9% of males reported 2 or more symptoms compatible with chronic rhinosinusitis vs 2.2% of females ( P = .690), which is not statistically significant. Conclusion Of US adults, 2.1% meet symptom criteria for the potential diagnosis of chronic rhinosinusitis at any given time. Further objective corroboration with a physical exam and determination of duration of symptoms would be required to determine the true prevalence of chronic rhinosinusitis, but this point prevalence represents the potential population at risk for chronic rhinosinusitis in the United States.