Auris Nasus Larynx最新文献

Objective

Methods

Results

Conclusion

Objectives

Methods

Results

Conclusion

Objective

Hyperactive delirium with agitation following head and neck surgeries with free tissue transfer reconstruction (HNS-FTTR) represents a critical and potentially life-threatening postoperative complication. Although preoperative risk assessment is important, no established risk screening tool has been developed to accurately predict its occurrence.

Methods

In this retrospective observational study, we examined 192 consecutive patients who underwent HNS-FTTR between August 2019 and January 2024. We assessed the effectiveness of the existing delirium risk screening system, the DELirium Team Approach program which includes factors such as age ≥ 70 years, presence of brain disorders, dementia, alcohol consumption habits, a history of delirium, and use of benzodiazepines. Additionally, we explored the association between each risk factor and the onset of delirium.

Results

Delirium occurred in 43 patients (22.4 %). The risk screening tool effectively predicted the occurrence of hyperactive delirium after HNS-FTTR (OR: 8.316; 95 % CI: 2.205–36.060; p = 0.004), with a sensitivity of 95.3 % and a specificity of 28.9 %. Multivariate analysis revealed age ≥ 70 years (OR: 2.179; 95 % CI: 1.058–4.662; p = 0.0383) and alcohol consumption habits (OR: 2.554; 95 % CI: 1.260–5.268; p = 0.0098) as significant independent risk factors.

Conclusion

Our findings suggest that the risk screening system evaluated in this study appears to be sensitive, simple, and effective for the preoperative prediction of hyperactive postoperative delirium following HNS-FTTR.

Objective

Approximately 30 % of thyroid nodules yield an indeterminate diagnosis through conventional diagnostic strategies. The aim of this study was to develop machine learning (ML) models capable of identifying papillary thyroid carcinomas using preoperative variables.

Methods

Patients with thyroid nodules undergoing thyroid surgery were enrolled in a retrospective monocentric study. Six 2-class supervised ML models were developed to predict papillary thyroid carcinoma, by sequentially incorporating clinical-immunological, ultrasonographic, cytological, and radiomic variables.

Results

Out of 186 patients, 92 nodules (49.5 %) were papillary thyroid carcinomas in the histological report. The Area Under the Curve (AUC) ranged from 0.41 to 0.61 using only clinical-immunological variables. All ML models exhibited an increased performance when ultrasound variables were included (AUC: 0.95–0.97). The addition of cytological (AUC: 0.86–0.97) and radiomic (AUC: 0.88–0.97) variables did not further improve ML models’ performance.

Conclusion

ML algorithms demonstrated low accuracy when trained with clinical-immunological data. However, the inclusion of radiological data significantly improved the models' performance, while cytopathological and radiomics data did not further improve the accuracy.

Level of evidence

Level 4.

Objective

To investigate the accurate volume changes in the paranasal sinus and nasal cavity with age development, using three-dimensional (3D) imaging software

Methods

Paranasal sinus and nasal cavity volumes from computed tomography (CT) images in patients aged 0–24 years were measured using a 3D model to examine age-related changes. Paranasal sinus and nasal cavity growth were compared between age groups. Additionally, the correlation between body height and paranasal sinus growth was examined.

Results

A total of 139 CT scans from 137 patients were analyzed. Volume growth of maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavity was observed until 18, 16, 20, 20, and 22 years, respectively. Maxillary sinus rapidly grew at 2–8 and 9–12 years, ethmoid sinus 2–8 and 13–16 years, sphenoid sinus 5–8 years, frontal sinus 2–10 years, and nasal cavity 7–12 years. The median volume after growth completion for maxillary, ethmoidal, sphenoid, frontal sinuses, and nasal cavities was 21,937 mm³, 4868 mm³, 5870 mm³, 3172 mm³, and 15,555 mm³, respectively. The left-right difference in the nasal cavity volume increased with age. Sinus and nasal cavity growth completion was delayed by 2–4 years compared to general height growth.

Conclusion

Growth of the ethmoid, maxillary, sphenoid, frontal sinus, and nasal cavity was completed in approximately 20 years. Compared to the results shown in reports based primarily on 2D measurements, the ethmoid and sphenoid sinuses and nasal cavity were found to continue to grow until older age than previously thought.

Objective

Airway stenosis impairs the quality of life of patients. However, the epidemiology and pathophysiology of airway stenosis remain underexplored owing to its rarity. Airway stenosis may go undetected for a long period without accurate diagnosis or treatment owing to the lack of established treatment guidelines. Thus, clinical information must be accumulated and analyzed to generate evidence-based treatment strategies for this rare entity.

Methods

A retrospective nationwide epidemiological survey was conducted targeting patients with pharyngeal, laryngeal, or tracheal stenosis in Japan. The initial survey was conducted across 1393 facilities between 2013 and 2017 to evaluate the treatment of airway stenosis. The clinical information of the patients was collected via a secondary survey.

Results

The primary survey revealed that airway stenosis was treated at only 43 % of the facilities over the 5-year period. The secondary survey revealed that 284 cases were registered across 57 facilities. The number of patients with acquired stenosis exceeded that of those with congenital stenosis. The larynx or cervical trachea was the most common site of stenosis, and intubation or tracheostomy was the most common cause of stenosis. Approximately 76 % of patients underwent surgical treatment, and tracheostomy was the most common procedure. Stenosis persisted in > 70 % of patients at the last visit.

Conclusions

This study clarified the clinical background of patients with pharyngeal, laryngeal, and tracheal stenosis in Japan and the surgical treatment received. The findings of this study confirmed the rarity of airway stenosis and the difficulty in treating this entity.

Endolymphatic hydrops, a pathological feature of Ménière's disease, has been experimentally and clinically confirmed to be influenced by the blood circulation of vasopressin (VP). VP is a well-known hormonal regulator of water homeostasis. In addition, VP is influenced by various environmental changes, dehydration, fluctuation of atmospheric pressure, pregnancy, and other factors. Furthermore, VP is a key regulator of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is a major neuroendocrine system that controls reactions to emotional and physical stresses, as well as the sleep/wake cycle (circadian rhythm). Therefore, VP is susceptible to change via the HPA axis.

This review considers possible mechanisms of the formation of endolymphatic hydrops from the perspective of the vasopressin-aquaporin 2 system.

Objective

To determine the predictive factors for residual disease occurring after surgical removal of congenital cholesteatomas and whether these predictive factors differ between microscopic ear surgery (MES) using data from the literature and transcanal endoscopic ear surgery (TEES) using data from our own institution.

Methods

Twenty-three patients with a congenital cholesteatoma who underwent surgical treatment at Yamagata University Hospital between December 2011 and December 2017 were retrospectively investigated. We divide TEES into three different approaches: non-powered TEES, powered TEES and dual MES/TEES. Main outcome measures were Potsic stage, closed or open congenital cholesteatoma type, TEES surgical approach, appearance of residual disease, tympanoplasty type and hearing outcome.

Results

A logistic regression analysis was conducted on the Potsic stage, closed or open type, TEES surgical approach and age to obtain the odds ratio for residual disease. The chance of residual disease significantly increased in the presence of an open-type congenital cholesteatoma (odds ratio: 30.82; 95 % confidence interval: 1.456–652.3; p = 0.0277), but not for any of the other factors including Potsic stage. The timing of the confirmation of residual disease after ossicular chain reconstruction was analyzed using a Kaplan-Meier analysis. The residual disease rate was significantly higher with an open-type congenital cholesteatoma (log-rank test, p < 0.05). In addition, all residual disease occurred within three years after surgery.

Conclusions

Our results showed that an open-type congenital cholesteatoma is the strongest predictive factor for residual disease when removing a congenital cholesteatoma by TEES.