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Surgical Neurology International 2024This type of pain syndrome occurs suddenly and briefly, beginning unilaterally from one side of the face. Modestly stimulating speech can provoke it, affecting the ear,...
Concurrent glossopharyngeal neuralgia and oromandibular dystonia resolved after microvascular decompression of the trigeminal and glossopharyngeal nerve: A rare presentation.
BACKGROUND
This type of pain syndrome occurs suddenly and briefly, beginning unilaterally from one side of the face. Modestly stimulating speech can provoke it, affecting the ear, tongue, throat, and jaw angle. Interestingly, it is the sensory distribution of the auricular and the pharyngeal branches of the cranial nerves IX and X. People have not had a confirmed case of glossopharyngeal neuralgia (GPN), along with oromandibular dystonia (OMD). Nevertheless, usually in the medical literature, this case report supplies information about a patient who has concurrent GPN and OMD.
CASE DESCRIPTION
A 36-year-old male patient presented with a history of sudden onset of increasing electric pains, which were centered in the middle of the forehead to the depth of the throat and accompanied by uncontrolled movements, repetitive tongue protrusions, jaw movements, and recurrent pervasive gagging reflexes. Magnetic resonance imaging showed that a vascular loop of the superior cerebellar and anterior inferior cerebellar artery on the left side had crossed over and compressed those nerves. Decompression surgery in the left glossopharyngeal and trigeminal nerves cured all the symptoms.
CONCLUSION
The simultaneous occurrence of GPN and OMD is rare, complex, and challenging from the clinician's viewpoint in the management of similar but different pathologies. A detailed history was taken, and a radiological investigation was called to devise a management plan in the context of understanding the pathology of both disorders.
PubMed: 38742011
DOI: 10.25259/SNI_642_2023 -
Asian Journal of Surgery Jun 2024Ex vivo liver resection and autotransplantation (ERAT) can be used to treat locally advanced tumors that are conventionally unresectable. Because the procedure is rare,...
PURPOSE
Ex vivo liver resection and autotransplantation (ERAT) can be used to treat locally advanced tumors that are conventionally unresectable. Because the procedure is rare, there are very few reports in the literature. Recently, we performed ERAT for two cases of cholangiocarcinoma invading caudate lobe, the retrohepatic vena cava and hepatic veins, and investigated technical variations of this procedure.
METHODS
One patient was a 57-year-old man with liver caudate lobe metastasis from cholangiocarcinoma after pancreaticoduodenal resection five years ago, and the other patient was a 68-year-old man with caudate lobe cholangiocarcinoma. Both cases were considered to be unresectable by conventional resection due to the critical invasion of the retrohepatic vena cava along with the three hepatic veins. Therefore, ERAT was indicated in these two cases.
RESULTS
The liver along with the retrohepatic vena cava was removed, which was replaced by GORE-TEX synthetic artificial vessel grafts with angioplasty to reconstruct the inferior vena cava (IVC), and the GORE-TEX synthetic artificial vessel anastomosed to the right auricular appendage or the IVC to build the continuity of the IVC. Ex vivo caudate lobe hepatectomy was performed, along with the retrohepatic vena cava and hepatic veins, and subsequently the reconstruction outflow of hepatic venous was established using cold-preserved allogeneic vessels and falciform ligament. Finally, remnant of the liver was implanted by Piggyback liver transplantation. The hepatic vein, portal vein, hepatic artery and bile duct were anastomosed, and autotransplantation of the liver was completed. The patients were followed-up for 18 months and showed good liver function, with no recurrence of cancer.
CONCLUSIONS
ERAT should be considered as a therapeutic option for selected patients with cholangiocarcinoma invading caudate lobe, the retrohepatic vena cava and hepatic veins. It is crucial to reconstruct the outflow of hepatic venous according to different situations.
Topics: Humans; Cholangiocarcinoma; Male; Bile Duct Neoplasms; Middle Aged; Aged; Transplantation, Autologous; Liver Transplantation; Hepatectomy; Vena Cava, Inferior; Hepatic Veins; Plastic Surgery Procedures; Liver Neoplasms
PubMed: 38555210
DOI: 10.1016/j.asjsur.2024.03.001 -
DWI scrolling artery sign for the diagnosis of giant cell arteritis: a pattern recognition approach.RMD Open Mar 2024To investigate the diagnostic accuracy of a pattern recognition approach for the evaluation of MRI scans of the head with diffusion-weighted imaging (DWI) in suspected...
OBJECTIVES
To investigate the diagnostic accuracy of a pattern recognition approach for the evaluation of MRI scans of the head with diffusion-weighted imaging (DWI) in suspected giant cell arteritis (GCA).
METHODS
Retrospectively, 156 patients with suspected GCA were included. The 'DWI-Scrolling-Artery-Sign' (DSAS) was defined as hyperintense DWI signals in the cranial subcutaneous tissue that gives the impression of a blood vessel when scrolling through a stack of images. The DSAS was rated by experts and a novice in four regions (frontotemporal and occipital, bilaterally). The temporal, occipital and posterior auricular arteries were assessed in the T1-weighted black-blood sequence (T1-BB). The diagnostic reference was the clinical diagnosis after ≥6 months of follow-up.
RESULTS
The population consisted of 87 patients with and 69 without GCA; median age was 71 years and 59% were women. The DSAS showed a sensitivity of 73.6% and specificity of 94.2% (experts) and 59.8% and 95.7% (novice), respectively. Agreement between DSAS and T1-BB was 80% for the region level (499/624; kappa(κ)=0.59) and 86.5% for the patient level (135/156; κ=0.73). Inter-reader agreement was 95% (19/20; κ=0.90) for DSAS on the patient level and 91.3% (73/80; κ=0.81) on the region level for experts. For expert versus novice, inter-reader agreement for DSAS was 87.8% on the patient level (137/156; κ=0.75) and 91.2% on the region level (569/624; κ=0.77).
CONCLUSIONS
The DSAS can be assessed in less than 1 min and has a good diagnostic accuracy and reliability for the diagnosis of GCA. The DSAS can be used immediately in clinical practice.
Topics: Humans; Female; Aged; Male; Giant Cell Arteritis; Temporal Arteries; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Arteries
PubMed: 38519109
DOI: 10.1136/rmdopen-2023-003652 -
Clinica E Investigacion En... 2024One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading...
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
Topics: Humans; Vascular Diseases; Spain; Atherosclerosis; Global Health; Risk Factors; Heart Disease Risk Factors; Cardiovascular Diseases; Societies, Medical
PubMed: 38490888
DOI: 10.1016/j.arteri.2024.02.001 -
Pilot and Feasibility Studies Feb 2024Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of...
Transcutaneous auricular vagus nerve stimulation for the treatment of myoarthropatic symptoms in patients with craniomandibular dysfunction - a protocol for a randomized and controlled pilot trial.
BACKGROUND
Temporomandibular disorders (TMD) are a collective term for pain and dysfunction of the masticatory muscles and the temporomandibular joints. The most common types of TMD are pain-related, which may impact the psychological behavior and quality of life. Currently, the most popular methods for the treatment of TMD patients are occlusal splint therapy, often in combination with physical- and/or pharmacotherapy. However, due to the complexity of etiology, the treatment of chronic TMD remains a challenge. Recently, CE-certified systems for non-invasive VNS (transcutaneous auricular vagus nerve stimulation, taVNS) have become available and show positive effects in the treatment of chronic pain conditions, like migraine or fibromyalgia, with which TMD shares similarities. Therefore, it is the main purpose of the study to evaluate the feasibility of daily taVNS against chronic TMD and to assess whether there is an improvement in pain severity, quality of life, and kinetic parameters.
METHODS
This study is designed as a single-blinded, double-arm randomized controlled trial (RCT) in a 1:1 allocation ratio. Twenty adult patients with chronical TMD symptoms will be enrolled and randomized to stimulation or sham group. In the stimulation group, taVNS is performed on the left tragus (25 Hz, pulse width 250 µs, 28 s on/32 s off, 4 h/day). The sham group will receive no stimulation via a non-functional identical-looking electrode. Validated questionnaire data and clinical parameters will be collected at the beginning of the study and after 4 and 8 weeks. The compliance of a daily taVNS of patients with chronical TMD will be evaluated via a smartphone app recording daily stimulation time and average intensity. Additionally, the treatment impact on pain severity and quality of life will be assessed with different questionnaires, and the effect on the mandibular mobility and muscle activity will be analyzed.
DISCUSSION
This is the first clinical trial to assess the feasibility of taVNS in patients with chronic TMD symptoms. If taVNS improves the symptoms of TMD, it will be a significant gain in quality of life for these chronic pain patients. The results of this pilot study will help to determine the feasibility of a large-scale RCT.
TRIAL REGISTRATION
This study has been registered in the DRKS database (DRKS00029724).
PubMed: 38331976
DOI: 10.1186/s40814-024-01447-x -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Jan 2024To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
OBJECTIVE
To create a novel chitosan antibacterial hemostatic sponge (NCAHS) and to evaluate its material and biological properties.
METHODS
Chitosan, a polysaccharide, was used as the sponge substrate and different proportions of sodium tripolyphosphate (STPP), glycerol, and phenol sulfonyl ethylamine were added to prepare the sponges through the freeze-drying method. The whole-blood coagulation index (BCI) was used as the screening criterion to determine the optimal concentrations of chitosan and the other additives and the hemostatic sponges were prepared accordingly. Zein/calcium carbonate (Zein/CaCO) composite microspheres loaded with ciprofloxacin hydrochloride were prepared and added to the hemostatic sponges to obtain NCAHS. Scanning electron microscope was used to observe the microscopic morphology and porosity of the NCAHS. The water absorption rate, antibacterial susceptibility rate against () and (), coagulation performance, and hemocompatibility of NCAHS were examined. The coagulation performance of NCAHS was evaluated by using rabbit liver injury and rabbit auricular artery hemorrhageear models and commercial hemostatic sponge (CHS) was used as a control. The biocompatibility, including such aspects as cytotoxicity, skin irritation in animals, and acute toxicity, of the NCAHS extracts was examined by using as a reference the national standards for biological evaluation of medical devices.
RESULTS
The NCAHS prepared with 1.5% chitosan (/), 0.01% STPP (/), 0% glycerol (/), 0.15% phenol-sulfonyl-ethylamine (/), Zein and CaCO at the mixing ratio of 5∶1 (/), Zein at the final mass concentration of 2.5 g/L, and ethanol at the final concentration of 17.5% (/) were fine and homogeneous, possessing a honeycomb-like porous structure with a pore size of about 200 μm. The NCAHS thus prepared had the lowest BCI value. The water absorption ([2362.16±201.15] % vs. [1102.56±91.79]%) and coagulation performance (31.338% vs. 1.591%) of NCAHS were significantly better than those of CHS (<0.01). Tests with the auricular artery hemorrhage model ([36.00±13.42] s vs. [80.00±17.32] s) and rabbit liver bleeding model ([30.00±0] s vs. [70.00±17.32] s) showed that the hemostasis time of NCAHS was significantly shorter than that of CHS (<0.01). NCAHS had significant inhibitory ability against and . In addition, NCAHS showed good and biocompatibility.
CONCLUSION
NCAHS is a composite sponge that shows excellent antimicrobial properties, hemostatic effect, and biocompatibility. Therefore, its extensive application in clinical settings is warranted.
Topics: Animals; Rabbits; Chitosan; Hemostatics; Escherichia coli; Glycerol; Staphylococcus aureus; Zein; Hemostasis; Anti-Bacterial Agents; Hemorrhage; Water; Ethylamines; Phenols
PubMed: 38322514
DOI: 10.12182/20240160403 -
Cureus Dec 2023Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was...
Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was brought to the emergency department with fever, low SpO, and effortful breathing. Arterial blood gas analysis showed that PaCO levels had accumulated to 120 mmHg. Although CT showed marked thickening of the bronchial wall from the central to the peripheral region, the cause was unknown. At the family's request, the patient was not placed on a ventilator, and treatment was started with steroids alone. After admission, the patient's condition improved with only intravenous steroids, and he was discharged to the facility with continued oral steroid medication. After a short treatment period, the possibility of relapsing polychondritis was considered and confirmed. The patient met Levine's diagnostic criteria, with findings of destruction of the bilateral auricular cartilage and the airway and a response to steroid administration. Although it is very difficult to diagnose relapsing polychondritis at the initial emergency department visit, early administration of steroids is worth trying in patients with asphyxia with extensive thickening of the airway on CT findings, as relapsing polychondritis may be considered, and early steroid administration may improve patient symptoms.
PubMed: 38274918
DOI: 10.7759/cureus.51101 -
BMC Nephrology Jan 2024Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is caused by mutations in the ubiquitin-activating enzyme1 (UBA1) gene and characterised by an...
Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome presenting as recurrent aseptic peritonitis in a patient receiving peritoneal dialysis: a case report.
BACKGROUND
Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is caused by mutations in the ubiquitin-activating enzyme1 (UBA1) gene and characterised by an overlap between autoinflammatory and haematologic disorders.
CASE PRESENTATION
We reported a case of a 67-year-Japanese man receiving peritoneal dialysis (PD) who had recurrent aseptic peritonitis caused by the VEXAS syndrome. He presented with unexplained fevers, headache, abdominal pain, conjunctival hyperaemia, ocular pain, auricular pain, arthralgia, and inflammatory skin lesions. Laboratory investigations showed high serum C-reactive protein concentration and increased cell count in PD effluent. He was treated with antibiotics for PD-related peritonitis, but this was unsuccessful. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography images demonstrated intense FDG uptake in his left superficial temporal artery, nasal septum, and bilateral auricles. The working diagnosis was giant cell arteritis, and he was treated with oral prednisolone (PSL) 15 mg daily with good response. However, he was unable to taper the dose to less than 10 mg daily because his symptoms flared up. Since Tocilizumab was initiated, he could taper PSL dose to 2 mg daily. Sanger sequencing of his peripheral blood sample showed a mutation of the UBA1 gene (c.122 T > C; p.Met41Thr). We made a final diagnosis of VEXAS syndrome. He suffered from flare of VEXAS syndrome at PSL of 1 mg daily with his cloudy PD effluent. PSL dose of 11 mg daily relieved the symptom within a few days.
CONCLUSIONS
It is crucial to recognise aseptic peritonitis as one of the symptoms of VEXAS syndrome and pay attention to the systemic findings in the patients.
Topics: Humans; Male; Abdominal Pain; Fluorodeoxyglucose F18; Mutation; Myelodysplastic Syndromes; Patients; Skin Diseases, Genetic; Vacuoles; Aged
PubMed: 38212709
DOI: 10.1186/s12882-024-03454-9 -
Folia Morphologica Nov 2023The anatomy of the posterior auricular artery (PAA) is highly variable and relevant in various plastic and reconstructive procedures.
BACKGROUND
The anatomy of the posterior auricular artery (PAA) is highly variable and relevant in various plastic and reconstructive procedures.
MATERIALS AND METHODS
The results of 55 consecutive patients who underwent head and neck computed tomography angiography (CTA) were analyzed. A total of 78 hemifaces were evaluated. The analysis has been performed in 19 categories.
RESULTS
Median PAA length was found to be 47.59 mm (LQ = 32.75; HQ = 56.16). The median PAA diameter (at its origin) was established at 2.55 mm (LQ = 2.29; HQ = 2.90). Moreover, the median PAA cross-sectional area (at its origin) was set to be 3.22 mm (LQ = 2.49; HQ = 4.13). Sexual dimorphism regarding all of the measured parameters was also evaluated. Statistically significant differences (p ≤ 0.05) were found in 13 of the measured categories.
CONCLUSIONS
The present study demonstrated the complete anatomy of the PAA. The most frequent origin of the said artery was from the ECA, and its mean length was 45.07 mm; which did not differ between males and females significantly (p>0.05). Moreover, we have provided surgeons with tools to localize this artery pre- and intraoperatively using simple landmarks, namely the apex of the mastoid process and the center of the external acoustic meatus. The exact position of the origin of the PAA was also demonstrated by a heat map of the auricular region. Our findings have the potential to assist surgeons in developing a mental visualization of the arterial anatomy of the retroauricular region. This visualization can be instrumental in precisely identifying the location of the PAA during reconstructive surgeries, thereby minimizing complications and enhancing surgical outcomes.
PubMed: 37957932
DOI: 10.5603/fm.96993 -
BMC Cardiovascular Disorders Nov 2023The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart...
BACKGROUND
The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart contractility at the level of myocardial filaments harvested from left and right auricles during elective coronary artery bypass surgery.
METHODS
150 patients (132 male; 18 female) were enrolled. Preoperative testosterone and estradiol levels were measured with Immunoassay. Calcium induced force measurements were performed with left- and right auricular myofilaments in a skinned fiber model. Correlation analysis was used for comparison of force values and levels of sex hormones and their ratio.
RESULTS
Low testosterone was associated with higher top force values in right-sided myofilaments but not in left-sided myofilaments for both sexes (p = 0.000 in males, p = 0.001 in females). Low estradiol levels were associated with higher top force values in right-sided myofilaments (p 0.000) in females and only borderline significantly associated with higher top force values in males (p 0.056). In females, low estradiol levels correlated with higher top force values in left sided myofilaments (p 0.000). In males, higher Estradiol/Testosterone ratio (E/T ratio) was only associated with higher top force values from right auricular myofilaments (p 0.04) In contrast, in females higher E/T ratio was associated with lower right auricular myofilament top force values (p 0.03) and higher top force values in left-sided myofilaments (p 0.000).
CONCLUSIONS
This study shows that patients' comorbidities influence left and right sided contractility and may blur results concerning influence of sex hormones if not eliminated. A sex hormone dependent influence is obvious with different effects on the left and right ventricle. The E/T ratio and its impact on myofilament top force showed divergent results between genders, and may partially explain gender differences in patients with cardiovascular disease.
Topics: Humans; Male; Female; Myofibrils; Testosterone; Estradiol; Coronary Artery Bypass; Gonadal Steroid Hormones
PubMed: 37925416
DOI: 10.1186/s12872-023-03582-4