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Changes in antibiotic resistance in recurrent Pseudomonas aeruginosa infections of chronic suppurative otitis media

October 25, 2016  |  Jae-Jun Song, MD; Byung Don Lee, MD; Koen Hyeong Lee, MD; Jong Dae Lee, MD; Young Joo Park, MD; Moo Kyun Park, MD, PhD

Abstract

This study investigated the changes in antibiotic resistance in recurrent Pseudomonas aeruginosa infections in chronic suppurative otitis media (CSOM). Its aim was to provide a treatment strategy for P aeruginosa infections in CSOM for the prevention of multidrug resistance. A case-control study was conducted in tertiary teaching hospitals in Korea. The experimental group included patients with recurrent P aeruginosa infection who had relapsed within 2 months after the successful control of a previous P aeruginosa infection. The control group consisted of patients with a P aeruginosa infection who had no history of such an infection. An antibiotic sensitivity test was performed for each culture. The proportion of recurrent P aeruginosa infection was 22.69% (98 of 432 cases). Drug resistance to amikacin, tobramycin, netilmicin, ciprofloxacin, and levofloxacin was significantly changed after recurrent infection. The fluoroquinolone strains seen in recurrent P aeruginosa showed high cross-resistance to other drugs. Antibiotic resistance of P aeruginosa in CSOM changed with recurrent infection.

Evaluation of transiently evoked otoacoustic emissions and auditory brainstem responses in patients with multiple sclerosis

October 25, 2016  |  Emre Kaytancı, MD; O. Ilkay Ozdamar, MD; Gul Ozbilen Acar, MD; Muhammet Tekin, MD

Abstract

Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system. This prospective study was planned to evaluate these changes through brainstem evoked response audiometry (BERA) latency abnormalities and otoacoustic emissions (OAE). This study was performed between September 2009 and May 2010. A total of 160 recordings of BERA and OAE were examined, which were obtained from 80 ears of 40 participants. Twenty of these were MS patients and 20 were healthy volunteers in the control group. Mean ages of the MS group and the control group were 31.3 ± 4.73 and 30.95 ± 4.83 years, respectively. In patients' right ears in the MS group, the wave I, III, and V peak latencies and the I-V interpeak latencies were significantly prolonged compared to those in the control group. In patients' left ears in the MS group, the wave I, III, and V peak latencies and the I-III and I-V interpeak latencies also were significantly prolonged compared to those in the control group. There were no significant differences between the right and left ears for each group regarding wave latencies and intervals. In the MS group, the average of the interaural difference for I-V interpeak latency was significantly prolonged compared to that in the control group. The most reliable diagnostic method in MS is magnetic resonance imaging (MRI). However, sometimes plaques in the central nervous system may not be displayed. The pathologic process may exist and continue before these plaques become detectable on MRI, but electrophysiologic testing such as BERA can demonstrate these changes.

Features of oral, pharyngeal, and laryngeal lesions in bullous pemphigoid

October 25, 2016  |  Masafumi Ohki, MD; Shigeru Kikuchi, MD, PhD; Atsushi Ohata, MD, PhD; Yuka Baba, MD; Junichi Ishikawa, MD; Hirohito Sugimoto, MD

Abstract

Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare in affected patients. We conducted a study to investigate the characteristics of oral and pharyngolaryngeal lesions in bullous pemphigoid. Our study population was made up of 6 consecutively presenting outpatients-2 men and 4 women, aged 40 to 83 years (mean: 68.2)-who had been referred to our department over an 11-year period. Presenting symptoms included sore throat in all 6 patients and oral pain in 3. The sites of mucosal lesions included the soft palate, epiglottis, gingiva, hypopharynx, tongue, nasal cavity, and buccal mucosa. These lesions appeared as erosions, erosions with white coating, erythematous patches, and/or blisters. Mucosal lesions preceded skin lesions in 2 patients, appeared after skin lesions in 1 patient, and appeared simultaneously with skin lesions in 3 patients. We conclude that bullous pemphigoid sometimes involves the mucosa, such as that of the laryngopharynx and the oral cavity, and it can manifest as skin lesions. In the differential diagnosis of refractory pharyngolaryngeal lesions, bullous pemphigoid should be considered.

Subcutaneous nasal angioleiomyoma: Case of a rare tumor and review of the literature

October 25, 2016  |  Robert Saadi, MD; Benjamin S. Oberman, MD; Henry Crist, MD; Jessyka Lighthall, MD

Abstract

We describe the case of a 46-year-old woman with a rare presentation of angioleiomyoma of the subcutaneous nasal tissue. The patient presented with pain and severe nasal obstruction. Her nasal deformity was sufficient to indicate an external rhinoplasty for both extirpation of the tumor and reconstruction of the defect with cartilage grafts. The procedure resulted in successful removal of the tumor and a satisfactory cosmetic outcome.

A novel approach to excision of distal tracheal granulation tissue in tracheostomy patients with difficult anatomy

October 25, 2016  |  Allison Rasband-Lindquist, MD; Keith Sale, MD

Abstract

Tracheostomy predisposes patients to various complications. The most common late complication is granuloma formation; others include tracheal stenosis, bleeding, infection, and fistula development. Small granulomas may not require treatment, but large ones necessitate removal to prevent bleeding, obstruction, respiratory distress and, in rare cases, death. Various treatment options have been described, but no single modality has proved to be superior. We describe a novel approach to treating substomal tracheal granulation by using trans-stomal Coblation for patients whose granulation is difficult to visualize. This procedure offers several advantages over other means, including better hemostasis, less risk of distal tissue loss, ease of use, and potentially less operative time.

Unusual case of dyspnea in a child

October 25, 2016  |  Stephanie Warrington, MD; Anita Jeyakumar, MD, FACS

Is the location of a septal deviation associated with the degree of postoperative pain after septoplasty?

October 25, 2016  |  Gül Soylu Özler, MD

Abstract

The author conducted a prospective study of patients who underwent septoplasty for nasal obstruction secondary to a septal deviation to determine if the location of the deviation had any association with the degree of postoperative pain. Patients with an anteroposterior deviation were not included in this study, nor were patients with vasomotor rhinitis, allergic rhinitis, nasal polyposis, turbinate pathologies, or a systemic disease; also excluded were patients who were taking any medication and those who had undergone any previous nasal surgery. The final study population included 140 patients, who were divided into two groups on the basis of the location of their deviation. A total of 64 patients (35 men and 29 women; mean age: 29.8 yr) had an anterior deviation, and 76 patients (35 men and 41 women; mean age: 30.3 yr) had a posterior deviation; there were no statistically significant differences between the two groups in terms of sex (p = 0.309) or age (p = 0.848). During the postoperative period, pain intensity in both groups was self-evaluated on a visual analog scale on days 1, 3, and 7 and again at 3 and 6 months. The mean postoperative pain scores on days 1, 3, and 7 were significantly higher in the posterior deviation group than in the anterior group; scores in the two groups were similar at 3 and 6 months.

Breast cancer metastasis to the thyroid gland

October 25, 2016  |  Michael Goldenberg, MA; Joshua Warrick, MD; Mariano Russo, BS; Darrin V. Bann, MD, PhD

It is important to distinguish between metastatic disease and a second primary thyroid malignancy, which is more common than thyroid gland metastasis.

Myeloid sarcomas of the head and neck in pediatric patients with myeloid leukemia

September 19, 2016  |  David W. Cuthbertson, MD; Jyotinder Nain Punia, MD; Vicki L. Owczarzak, MD

Abstract

Myeloid sarcoma is a rare extramedullary tumor composed of malignant myeloid cells that occur in the presence of myeloid leukemia. We report a case series of pediatric head and neck myeloid sarcomas representative of the epidemiology, symptomatology, laboratorial correlations, prognoses, and treatment of extramedullary leukemia. Presented are 3 cases involving patients ranging from 17 months to 11 years of age. Two patients were successfully treated with chemotherapy, and in the third patient, a large lytic lesion was treated palliatively with proton beam therapy. Knowledge and recognition of myeloid sarcomas is important as they can be locally invasive, and they may also be used as a diagnostic tool or a prognostic indicator for leukemia.

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