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Ear, Nose, & Throat Journal Feb 2023Burns and injuries can lead to massive defects in the mastoid tissues, which increase the difficulty of ear reconstruction. It is crucial to choose an appropriate...
OBJECTIVE
Burns and injuries can lead to massive defects in the mastoid tissues, which increase the difficulty of ear reconstruction. It is crucial to choose an appropriate surgical method for these patients. Here, we introduce strategies for auricular reconstruction in patients without satisfactory mastoid tissues.
METHODS
From April 2020 to July 2021, 12 men and 4 women were admitted to our institution. Twelve patients were severely burned, 3 patients experienced car accidents, and 1 patient had a tumor on his ear. The temporoparietal fascia was used for ear reconstruction in 10 cases, and the upper arm flap was used in 6 cases. All of the ear frameworks were made of costal cartilage.
RESULTS
The location, size, and shape of both sides of the auricles were generally the same. Two patients needed further surgical repair because of cartilage exposure at the helix. All of the patients were satisfied with the outcome of the reconstructed ear.
CONCLUSION
For patients with ear deformity and poor skin coverage in the mastoid area, we can choose the temporoparietal fascia if the patient's available superficial temporal artery is longer than 10 cm. If not, we can choose the upper arm flap. The latter needs a five-stage operation, which is more time consuming and difficult than the former. Moreover, the expanded upper arm flap is thinner and has better elasticity than the temporoparietal fascia, so the shape of the reconstructed ear is better. We need to evaluate the condition of the affected tissue and choose the appropriate surgical method to achieve a good result.
PubMed: 36803207
DOI: 10.1177/01455613231158905 -
Medicina 2023A 33-year-old woman with a history of high blood pressure since she was 8 years old, hypothyroidism, polycystic ovary syndrome, metabolic syndrome, multiple nevi, and a...
A 33-year-old woman with a history of high blood pressure since she was 8 years old, hypothyroidism, polycystic ovary syndrome, metabolic syndrome, multiple nevi, and a maternal family history of death at age 50 due to malignant high blood pressure and heart failure. Cushing's syndrome secondary to a secretory pituitary microadenoma was diagnosed, being the cause of secondary arterial hypertension, and ruling out other causes such as renal stenosis and coarctation of the aorta. A transthoracic and transesophageal echocardiogram was performed, which detected a left atrial myxoma. Given the presence of an atrial myxoma, Cushing's syndrome and polycystic ovary syndrome, a diagnosis of Carney Complex was made due to the presence of positive Stratakis criteria. The cardiac tumor was resected, and pathology confirmed that it was an atrial myxoma. She evolved clinically stable in outpatient controls in a 6-month follow-up. Resection of the pituitary microadenoma is planned as a curative treatment for Cushing's syndrome and arterial hypertension.
Topics: Female; Humans; Middle Aged; Adult; Child; Carney Complex; Cushing Syndrome; Polycystic Ovary Syndrome; Atrial Fibrillation; Myxoma; Heart Neoplasms; Pituitary Neoplasms; Hypertension
PubMed: 36774606
DOI: No ID Found -
Frontiers in Physiology 2022SARS-CoV-2 is a highly contagious virus that was identified as the cause of COVID-19 disease in early 2020. The infection is clinically similar to interstitial...
SARS-CoV-2 is a highly contagious virus that was identified as the cause of COVID-19 disease in early 2020. The infection is clinically similar to interstitial pneumonia and acute respiratory distress syndrome (ARDS) and often shows cardiovascular damage. Patients with cardiovascular risk factors are more prone to COVID-19 disease and their sequelae. Due to the anti-inflammatory effect and the improvement in pulmonary function, auricular vagus nerve stimulation (aVNS) therapy might alleviate a COVID-19 infection. A high-risk patient with cardiovascular diseases and Implantable Cardioverter Defibrillator (ICD), type 2 diabetes and peripheral arterial disease IV, according to Rutherford`s classification, became infected with COVID-19. The patient underwent wound surgery because of an infected necrosis with a methicillin-resistant (MRSA) of his small toe and was already on aVNS therapy to relieve his leg pain and improve microcirculation. AVNS was performed with the AuriStim device (Multisana GmbH, Austria), which stimulates vagally innervated regions of the auricle by administering electrical stimulation percutaneous electrodes for 6 weeks. The multimorbid high-risk patient, who was expected to go through a severe course of the COVID-19 disease, showed hardly any symptoms during ongoing aVNS therapy, while other family members, being much younger and healthy suffered from a more serious course with headache, pneumonia and general weakness. The auricular vagus nerve stimulation is a clinically tested and safe procedure and might represent an alternative and effective way of treating COVID-19 disease. Nevertheless, due to several limitations of this case report, randomized controlled studies are needed to evaluate the efficacy of aVNS therapy on COVID-19 disease.
PubMed: 36714322
DOI: 10.3389/fphys.2022.1000194 -
Clinical Medicine (London, England) Jan 2023We present a case of an 82-year-old woman presenting with left-sided Horner's syndrome and stroke. She also had a 6-week history of intermittent dizziness, reduced...
We present a case of an 82-year-old woman presenting with left-sided Horner's syndrome and stroke. She also had a 6-week history of intermittent dizziness, reduced appetite, lethargy, muscle stiffness and weight loss. Examination revealed left temporal artery and left posterior auricular artery tenderness. Her ESR showed 62 mm/hr and imaging showed left vertebral artery dissection. Temporal artery biopsy was positive.The case highlights a rare presentation of giant cell arteritis with Horner's syndrome and left vertebral artery dissection. High clinical suspicion is required to prevent delay in diagnosis and treatment.
Topics: Female; Humans; Aged, 80 and over; Horner Syndrome; Giant Cell Arteritis; Vertebral Artery Dissection
PubMed: 36697011
DOI: 10.7861/clinmed.2022-0479 -
Frontiers in Neuroscience 2022The objective of this pilot study was to identify frequency-dependent effects of respiratory-gated auricular vagus afferent nerve stimulation (RAVANS) on the regulation...
BACKGROUND
The objective of this pilot study was to identify frequency-dependent effects of respiratory-gated auricular vagus afferent nerve stimulation (RAVANS) on the regulation of blood pressure and heart rate variability in hypertensive subjects and examine potential differential effects by sex/gender or race.
METHODS
Twenty hypertensive subjects (54.55 ± 6.23 years of age; 12 females and 8 males) were included in a within-person experimental design and underwent five stimulation sessions where they received RAVANS at different frequencies (i.e., 2 Hz, 10 Hz, 25 Hz, 100 Hz, or sham stimulation) in a randomized order. EKG and continuous blood pressure signals were collected during a 10-min baseline, 30-min stimulation, and 10-min post-stimulation periods. Generalized estimating equations (GEE) adjusted for baseline measures were used to evaluate frequency-dependent effects of RAVANS on heart rate, high frequency power, and blood pressure measures, including analyses stratified by sex and race.
RESULTS
Administration of RAVANS at 100 Hz had significant overall effects on the reduction of heart rate (β = -2.03, = 0.002). It was also associated with a significant reduction of diastolic (β = -1.90, = 0.01) and mean arterial blood pressure (β = -2.23, = 0.002) in Black hypertensive participants and heart rate in female subjects (β = -2.83, = 0.01) during the post-stimulation period when compared to sham.
CONCLUSION
Respiratory-gated auricular vagus afferent nerve stimulation exhibits frequency-dependent rapid effects on the modulation of heart rate and blood pressure in hypertensive patients that may further differ by race and sex. Our findings highlight the need for the development of optimized stimulation protocols that achieve the greatest effects on the modulation of physiological and clinical outcomes in this population.
PubMed: 36570845
DOI: 10.3389/fnins.2022.1038339 -
Frontiers in Bioengineering and... 2022Transarterial embolization (TAE) is a personalized technology that offers precise delivery of chemotherapeutic drugs or selective internal radiation therapy for...
Transarterial embolization (TAE) is a personalized technology that offers precise delivery of chemotherapeutic drugs or selective internal radiation therapy for hepatocellular carcinoma (HCC). Beta-emitting radionuclide embolisms for TAE (β-based TARE) are commonly used in the clinic inducing biochemical lethality on tumor cells, while alpha-emitting radionuclides-based embolisms for TAE (α-based TARE) are still under study. The feeding artery plays a key role in tumor growth, metastasis, and recurrence. In this research, the auricular central arteries (ACAs) of rabbits were embolized with silk fibroin-based microspheres (SFMs) or SFMs integrated with α (Ra-223) or β (I-131) radionuclides to investigate the influence on vessels. TARE-induced tissue necrosis and the following neovascularization were measured by pathological analysis and Ga-DOTA-RGD PET/CT. The results showed that, compared to I-131, Ra-223 enhanced the growth inhibition of human hepatoma cells Huh-7 and induced more DNA double-strand breaks in vascular smooth muscle cells. Unlike β-based TARE, which mainly led to extensive necrosis of surrounding tissues, α-based TARE induced irreversible necrosis of a limited area adjacent to the embolized vessels. RGD PET revealed the inhibition on neovascularization in α-based TARE (SUV = 0.053 ± 0.004) when compared with normal group (SUV = 0.099 ± 0.036), the SFMs-lipiodol group (SUV = 0.240 ± 0.040), and β-based TARE (SUV = 0.141 ± 0.026), owing to the avoidance of the embolism-induced neovascularization. In conclusion, α-based TARE provided a promising strategy for HCC treatments destroying the embolized vessels and inhibiting neovascularization.
PubMed: 36277378
DOI: 10.3389/fbioe.2022.1021499 -
Laryngoscope Investigative... Oct 2022In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when...
BACKGROUND
In our previous cadaveric study, we highlighted the posterior auricular artery (PAA) as a potential landmark for early identification of facial nerve (FN) when performing parotidectomy. However, further clinical study is critically needed before this landmark could be applied in clinical practice.
METHODS
For 31 patients enrolled, we tried to identify the FN by the guide of the PAA during parotidectomy. Additionally, the FN function was evaluated during follow-up.
RESULTS
PAA could be exposed in 28 out of 31 (90.3%) patients during parotidectomy. Moreover, the FN trunk could be identified by the guide of the PAA in all these 28 patients with identifiable PAA. Furthermore, no iatrogenic FN damage happened in this study and the transient FN dysfunction rate was 5.7%.
CONCLUSION
The PAA is an ideal landmark for early identification of the FN trunk when performing parotidectomy.
PubMed: 36258872
DOI: 10.1002/lio2.894 -
Acta Otorhinolaryngologica Italica :... Aug 2022
Topics: Ear Auricle; Humans; Perforator Flap; Plastic Surgery Procedures
PubMed: 36254656
DOI: 10.14639/0392-100X-N2036