Pub Date : 2016-09-01DOI: 10.1177/014556131609500905
John M. Lee, Michael Au
Onodi cell mucoceles are rare entities that can cause devastating ocular complications if not treated promptly. Delays in the diagnosis are possible because of the wide range of differential diagnoses of unilateral retrobulbar optic neuropathy. We describe a new case of Onodi cell mucocele in a 39-year-old woman, and we present a comprehensive review of the literature on this entity. To the best of our knowledge, no review of Onodi cell mucoceles has been previously published. Our review found that 69% of patients with an Onodi cell mucocele experienced an improvement in vision after surgical decompression. The vast majority of these patients underwent endoscopic decompression; the timing of surgical decompression did not appear to affect outcomes in terms of vision. Onodi cell mucocele requires a high degree of clinical suspicion for diagnosis and a multidisciplinary approach to management that involves primary care physicians, ophthalmologists, and otolaryngologists. Early surgical treatment via an endoscopic approach is recommended for most patients, regardless of the duration of their ophthalmologic signs and symptoms.
{"title":"Onodi Cell Mucocele: Case Report and Review of the Literature","authors":"John M. Lee, Michael Au","doi":"10.1177/014556131609500905","DOIUrl":"https://doi.org/10.1177/014556131609500905","url":null,"abstract":"Onodi cell mucoceles are rare entities that can cause devastating ocular complications if not treated promptly. Delays in the diagnosis are possible because of the wide range of differential diagnoses of unilateral retrobulbar optic neuropathy. We describe a new case of Onodi cell mucocele in a 39-year-old woman, and we present a comprehensive review of the literature on this entity. To the best of our knowledge, no review of Onodi cell mucoceles has been previously published. Our review found that 69% of patients with an Onodi cell mucocele experienced an improvement in vision after surgical decompression. The vast majority of these patients underwent endoscopic decompression; the timing of surgical decompression did not appear to affect outcomes in terms of vision. Onodi cell mucocele requires a high degree of clinical suspicion for diagnosis and a multidisciplinary approach to management that involves primary care physicians, ophthalmologists, and otolaryngologists. Early surgical treatment via an endoscopic approach is recommended for most patients, regardless of the duration of their ophthalmologic signs and symptoms.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"43 1","pages":"E4 - E8"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73411804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/014556131609500903
Jason P. Lockette
{"title":"The Power of Healthcare IT: An EHR Case Report","authors":"Jason P. Lockette","doi":"10.1177/014556131609500903","DOIUrl":"https://doi.org/10.1177/014556131609500903","url":null,"abstract":"","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"39 6","pages":"408 - 408"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91507728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-01DOI: 10.1177/014556131609500904
A. Richter, K. Gallagher
We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae. Cultures demonstrated Burkholderia cepacia, diphtheroid organisms, and Enterococcus and Serratia spp. The patient was administered an intravenous antibiotic and antifungal for several months, but interval imaging found no significant improvement in bone healing although the stability of her palate had improved on clinical examination. Chronic rhinosinusitis has been found to be a complication of soft-tissue, orbital, and intracranial infections but, to the best of our knowledge, a pathologic facial fracture secondary to chronic invasive fungal and bacterial rhinosinusitis has not been previously reported in the literature.
我们描述的情况下，一个77岁的免疫功能正常的妇女与慢性鼻窦炎的历史，谁提出了病理性Le Fort I骨折后，一个强有力的喷嚏。影像学显示弥漫性鼻窦混浊和Le Fort I型复杂骨折累及上颌骨、翼状骨板、斜坡和右鼻梁。患者行内镜下鼻窦清创，发现粘膜开裂及其他正常的健康出血组织。解剖病理发现坏死骨伴侵袭性真菌菌丝。培养显示洋葱伯克氏菌、类白喉菌、肠球菌和沙雷氏菌。患者接受了几个月的静脉抗生素和抗真菌药物治疗，但间歇成像未发现骨愈合有明显改善，尽管临床检查显示她的腭稳定性有所改善。慢性鼻窦炎已被发现是软组织、眼眶和颅内感染的并发症，但据我们所知，慢性侵袭性真菌和细菌性鼻窦炎继发的病理性面部骨折在以前的文献中尚未报道。
{"title":"Chronic Invasive Fungal Sinusitis Causing a Pathologic Le Fort I Fracture in an Immunocompetent Patient","authors":"A. Richter, K. Gallagher","doi":"10.1177/014556131609500904","DOIUrl":"https://doi.org/10.1177/014556131609500904","url":null,"abstract":"We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae. Cultures demonstrated Burkholderia cepacia, diphtheroid organisms, and Enterococcus and Serratia spp. The patient was administered an intravenous antibiotic and antifungal for several months, but interval imaging found no significant improvement in bone healing although the stability of her palate had improved on clinical examination. Chronic rhinosinusitis has been found to be a complication of soft-tissue, orbital, and intracranial infections but, to the best of our knowledge, a pathologic facial fracture secondary to chronic invasive fungal and bacterial rhinosinusitis has not been previously reported in the literature.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"3 1","pages":"E1 - E3"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86670350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500609
J. Barr, P. Singh
We present a rare case of pediatric conductive hearing loss due to a high lateralized jugular bulb. An 8-year-old boy with a right-sided conductive hearing loss of 40 dB was found to have a pink bulge toward the inferior part of the right eardrum. Computed tomography showed a high, lateralized right jugular bulb that had a superolaterally pointing diverticulum that bulged into the lower mesotympanum and posterior external auditory meatus. It was explained to the child's parents that it is important never to put any sharp objects into the ears because of the risk of injury to the jugular vein. A high, lateralized jugular bulb with a diverticulum is a rare anatomic abnormality. Correct diagnosis of this abnormality is important so that inappropriate intervention does not occur.
{"title":"A Rare Cause of Conductive Hearing Loss: High Lateralized Jugular Bulb with Bony Dehiscence","authors":"J. Barr, P. Singh","doi":"10.1177/014556131609500609","DOIUrl":"https://doi.org/10.1177/014556131609500609","url":null,"abstract":"We present a rare case of pediatric conductive hearing loss due to a high lateralized jugular bulb. An 8-year-old boy with a right-sided conductive hearing loss of 40 dB was found to have a pink bulge toward the inferior part of the right eardrum. Computed tomography showed a high, lateralized right jugular bulb that had a superolaterally pointing diverticulum that bulged into the lower mesotympanum and posterior external auditory meatus. It was explained to the child's parents that it is important never to put any sharp objects into the ears because of the risk of injury to the jugular vein. A high, lateralized jugular bulb with a diverticulum is a rare anatomic abnormality. Correct diagnosis of this abnormality is important so that inappropriate intervention does not occur.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"60 1","pages":"227 - 229"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75632917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500610
Casey T. Kraft, R. Morrison, H. Arts
We describe the clinical presentation, management, and pathologic findings in a case of osteosarcoma of the petrous apex with an atypical metastasis to the lower abdominal wall. We retrospectively reviewed the record of a 49-year-old man who was diagnosed with a right petrous apex lesion, which biopsy identified as a high-grade osteoblastoma. After two attempts at en bloc resection were not curative, radiation and chemotherapy were recommended. The patient subsequently developed a cutaneous lower abdominal mass that was diagnosed as an osteosarcoma. Meanwhile, the petrous apex tumor continued to grow despite treatment until the patient died from the burden of disease. Temporal bone osteoblastomas and osteosarcomas are both extremely rare, and they can be difficult to differentiate histologically. Our case illustrates this difficulty and demonstrates the possibility of a high-grade osteoblastoma's malignant conversion to an osteosarcoma.
{"title":"Malignant Transformation of a High-Grade Osteoblastoma of the Petrous Apex with Subcutaneous Metastasis","authors":"Casey T. Kraft, R. Morrison, H. Arts","doi":"10.1177/014556131609500610","DOIUrl":"https://doi.org/10.1177/014556131609500610","url":null,"abstract":"We describe the clinical presentation, management, and pathologic findings in a case of osteosarcoma of the petrous apex with an atypical metastasis to the lower abdominal wall. We retrospectively reviewed the record of a 49-year-old man who was diagnosed with a right petrous apex lesion, which biopsy identified as a high-grade osteoblastoma. After two attempts at en bloc resection were not curative, radiation and chemotherapy were recommended. The patient subsequently developed a cutaneous lower abdominal mass that was diagnosed as an osteosarcoma. Meanwhile, the petrous apex tumor continued to grow despite treatment until the patient died from the burden of disease. Temporal bone osteoblastomas and osteosarcomas are both extremely rare, and they can be difficult to differentiate histologically. Our case illustrates this difficulty and demonstrates the possibility of a high-grade osteoblastoma's malignant conversion to an osteosarcoma.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"1 1","pages":"230 - 233"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83419618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500608
G. S. Özler, E. Yengil
The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis (15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.
{"title":"Why do Geriatric Patients Visit Otorhinolaryngology?","authors":"G. S. Özler, E. Yengil","doi":"10.1177/014556131609500608","DOIUrl":"https://doi.org/10.1177/014556131609500608","url":null,"abstract":"The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis (15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"198 1","pages":"224 - 229"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75186689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500611
I. Foulon, O. Soetens, Leen Vleurinck, F. Gordts, A. Leus, A. Naessens
We present the case of a 6-year-old boy who received a cochlear implant for profound sensorineural hearing loss after being born with cytomegalovirus (CMV) infection. Even after 6 years, CMV DNA was still found in the perilymph of the cochlea. Our case shows that CMV DNA can be present in the cochlea years after congenital CMV infection, and it can explain why progressive and/or late-onset hearing loss occurs in these children.
{"title":"Detection of CMV DNA in the Perilymph of a 6-Year-Old Boy with Congenital Cytomegalovirus Infection","authors":"I. Foulon, O. Soetens, Leen Vleurinck, F. Gordts, A. Leus, A. Naessens","doi":"10.1177/014556131609500611","DOIUrl":"https://doi.org/10.1177/014556131609500611","url":null,"abstract":"We present the case of a 6-year-old boy who received a cochlear implant for profound sensorineural hearing loss after being born with cytomegalovirus (CMV) infection. Even after 6 years, CMV DNA was still found in the perilymph of the cochlea. Our case shows that CMV DNA can be present in the cochlea years after congenital CMV infection, and it can explain why progressive and/or late-onset hearing loss occurs in these children.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"22 1","pages":"234 - 239"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81002011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500607
Thad W. Vickery, R. Weterings, Cristina Cabrera-Muffly
We conducted a study to determine the demographic traits, training characteristics, and geographic distribution of otolaryngologists in the United States using publicly available data. We then correlated our findings with U.S. census data. Univariate analysis was performed to analyze results, with a p value of < 0.05 determined as significant. We used data from the American Board of Otolaryngology's list of 18,587 board-certified allopathic otolaryngologists through 2013 and the American Osteopathic Colleges of Ophthalmology & Otolaryngology–Head & Neck Surgery's list of 428 osteopathic otolaryngologists. From these two databases, 9,642 otolaryngologists met inclusion criteria, which included an active practice in the United States and an age of 70 years and younger. This group was made up of 8,185 men (84.9%) and 1,449 women (15.0%); we were not able to identify the sex of 8 otolaryngologists (0.1%). The median age of the women was significantly lower than that of the men (54 vs. 48 yr; p < 0.001). A total of 8,510 otolaryngologists (88.3%) graduated from a U.S. allopathic medical school, and 8,520 (88.4%) graduated from a U.S. allopathic residency program. We determined that 25.9% of otolaryngologists established their practice in the same metropolitan statistical area where they completed their residency training. Older practitioners (p < 0.001) and women (p < 0.001) were significantly more likely to stay in the same area than younger physicians and men. In terms of population, 61.8% of the otolaryngologists practiced in metropolitan areas with more than 1 million residents; by comparison, these areas represent only 55.3% of the total U.S. population, indicating that otolaryngologists are over-represented in larger U.S. cities.
{"title":"Geographic Distribution of Otolaryngologists in the United States","authors":"Thad W. Vickery, R. Weterings, Cristina Cabrera-Muffly","doi":"10.1177/014556131609500607","DOIUrl":"https://doi.org/10.1177/014556131609500607","url":null,"abstract":"We conducted a study to determine the demographic traits, training characteristics, and geographic distribution of otolaryngologists in the United States using publicly available data. We then correlated our findings with U.S. census data. Univariate analysis was performed to analyze results, with a p value of < 0.05 determined as significant. We used data from the American Board of Otolaryngology's list of 18,587 board-certified allopathic otolaryngologists through 2013 and the American Osteopathic Colleges of Ophthalmology & Otolaryngology–Head & Neck Surgery's list of 428 osteopathic otolaryngologists. From these two databases, 9,642 otolaryngologists met inclusion criteria, which included an active practice in the United States and an age of 70 years and younger. This group was made up of 8,185 men (84.9%) and 1,449 women (15.0%); we were not able to identify the sex of 8 otolaryngologists (0.1%). The median age of the women was significantly lower than that of the men (54 vs. 48 yr; p < 0.001). A total of 8,510 otolaryngologists (88.3%) graduated from a U.S. allopathic medical school, and 8,520 (88.4%) graduated from a U.S. allopathic residency program. We determined that 25.9% of otolaryngologists established their practice in the same metropolitan statistical area where they completed their residency training. Older practitioners (p < 0.001) and women (p < 0.001) were significantly more likely to stay in the same area than younger physicians and men. In terms of population, 61.8% of the otolaryngologists practiced in metropolitan areas with more than 1 million residents; by comparison, these areas represent only 55.3% of the total U.S. population, indicating that otolaryngologists are over-represented in larger U.S. cities.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"1 1","pages":"218 - 223"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83021865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500612
Sunil D. Sharma, G. Kumar, Karen Guner, H. Kaddour
We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)—all women, aged 29 to 87 years (mean: 55.6; median: 50.5)—had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.
我们提出了一个回顾性的病例系列患者甲状腺机能亢进和甲状腺癌。我们的目标是观察他们的临床特征和结果，以确定哪些患者需要进一步调查。我们回顾了2006年1月至2013年10月在甲状腺癌中心接受治疗的所有甲状腺癌组织病理学诊断和甲状腺功能亢进生化证据患者的病例记录。在此期间，66名患者被诊断出患有甲状腺癌。其中，8例患者(12%)均为女性，年龄29 - 87岁(平均:55.6;中位数:50.5)-有甲状腺功能亢进的生化证据。8例患者中，4例为自主功能毒性结节(AFTN)， 3例为Graves病，1例为中毒性多结节性甲状腺肿。5例患者术前超声检查有可疑特征。8例患者均诊断为乳头状型甲状腺癌。4例AFTN患者的平均肿瘤大小明显大于Graves病患者(42.3±23.8 mm vs 3.8±1.6 mm;P = 0.04)。3例Graves病患者均偶然发现乳头状微癌。两组间，AFTN患者预后较差;其中2例出现囊外浸润及淋巴结转移，1例死亡。我们发现甲状腺癌患者甲状腺功能亢进的发生率相对较高(12%)。与先前文献报道的情况相反，AFTN患者似乎比Graves患者具有更强的侵袭性疾病和更差的预后。任何与甲亢相关的可疑结节都应仔细评估。
{"title":"Hyperthyroidism in Patients with Thyroid Cancer","authors":"Sunil D. Sharma, G. Kumar, Karen Guner, H. Kaddour","doi":"10.1177/014556131609500612","DOIUrl":"https://doi.org/10.1177/014556131609500612","url":null,"abstract":"We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)—all women, aged 29 to 87 years (mean: 55.6; median: 50.5)—had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"10 1","pages":"236 - 239"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85850236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1177/014556131609500605
Laura García-Rodríguez, Rahil M Dharia, Cameron Heilbronn, T. Ghanem
Orocutaneous fistula (OCF) and pharyngocutaneous fistula (PCF) are known complications of head and neck surgeries, and they are the most common complications of total laryngectomy.' Patients with an OCF or PCF often complain of poor facial aesthetics, anxiety or depression, and discomfort secondary to fluid leakage.2,3 A nasal septal button has been used to manage a tracheoesophageal fistula after a laryngectomy.' We describe a novel use of a clear septal button as a temporary measure to control secretions from an OCF after total laryngectomy. The patient was a 55-year-old man with pT4N2cMx stage IV squamous cell cancer of the base of the tongue on the left side. He initially presented with dysphagia, odynophagia, occasional hemoptysis, and a 4.5-kg weight loss. His history included diabetes mellitus, hypertension, dyslipidemia, peripheral vascular occlusive disease, and morbid obesity. In September 2012, the patient had undergone a mandible split, total glossectomy, total laryngectomy, right modified radical neck dissection from levels I through V with sacrifice of the sternocleidomastoid muscle, and selective left-sided neck dissections from levels I through IV. A left radial forearm fasciocutaneous free flap was used to reconstruct the oropharynx and tongue. Pathology was positive for perineural invasion. The patient's condition was complicated by a dehiscence of the free flap at the left neopharynx with subsequent hemorrhage, which was controlled in the operating room on postoperative day 20. In November, he comFigure 1. TheOCF is seen at the top of the photo, and the laryngectomy stoma is toward the bottom.
{"title":"Unconventional Fix for an Orocutaneous Fistula","authors":"Laura García-Rodríguez, Rahil M Dharia, Cameron Heilbronn, T. Ghanem","doi":"10.1177/014556131609500605","DOIUrl":"https://doi.org/10.1177/014556131609500605","url":null,"abstract":"Orocutaneous fistula (OCF) and pharyngocutaneous fistula (PCF) are known complications of head and neck surgeries, and they are the most common complications of total laryngectomy.' Patients with an OCF or PCF often complain of poor facial aesthetics, anxiety or depression, and discomfort secondary to fluid leakage.2,3 A nasal septal button has been used to manage a tracheoesophageal fistula after a laryngectomy.' We describe a novel use of a clear septal button as a temporary measure to control secretions from an OCF after total laryngectomy. The patient was a 55-year-old man with pT4N2cMx stage IV squamous cell cancer of the base of the tongue on the left side. He initially presented with dysphagia, odynophagia, occasional hemoptysis, and a 4.5-kg weight loss. His history included diabetes mellitus, hypertension, dyslipidemia, peripheral vascular occlusive disease, and morbid obesity. In September 2012, the patient had undergone a mandible split, total glossectomy, total laryngectomy, right modified radical neck dissection from levels I through V with sacrifice of the sternocleidomastoid muscle, and selective left-sided neck dissections from levels I through IV. A left radial forearm fasciocutaneous free flap was used to reconstruct the oropharynx and tongue. Pathology was positive for perineural invasion. The patient's condition was complicated by a dehiscence of the free flap at the left neopharynx with subsequent hemorrhage, which was controlled in the operating room on postoperative day 20. In November, he comFigure 1. TheOCF is seen at the top of the photo, and the laryngectomy stoma is toward the bottom.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"44 1","pages":"212 - 215"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75678798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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