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Αλέξανδρος Γ. Σφακιανάκης

Monday, October 4, 2021

Falx Cerebelli Meningioma: Case Report of a Rarely Occurring Tumor, Management Nuances, and Literature Review

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J Neurol Surg Rep. 2021 Sep 29;82(3):e32-e35. doi: 10.1055/s-0041-1735905. eCollection 2021 Jul.

ABSTRACT

The falx cerebelli is a small crescent fold of dura mater that is attached to the internal occipital crest and projects forward into the posterior cerebellar notch between the cerebellar hemispheres. We report a rare case of a 61-year-old female who presented with a 1-month history of headache and gait instability. Imaging findings were suggestive of a meningioma arising from the falx cerebelli. Complete surgical resection was achieved with a standard posterior fossa midline approach. Duraplasty was performed using animal allograft dura (Duraguard) and additional layers of oxidized cellulose preparation (Surgicel), fibrin sealant, and nonsuturable collagen matrix (Duragen) were utilized to reduce the risk of a cerebrospinal fluid leak. Pathology confirmed a World Health Organization (WHO) grade-I meningioma. Postoperatively, patient with asymptomatic thrombosis of the left transverse/sigmoid sinuses and later with a pseudomeningocele managed with a lumbar drain. To our knowledge, this is the second documented case in the literature. We discuss intraoperative nuances and unique aspects in the postoperative care and management of these patients.

PMID:34603931 | PMC:PMC8481004 | DOI:10.1055/s-0041-17359 05

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“Penetrating Neck Injuries: A Comprehensive Study”

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Abstract

Penetrating neck injuries are defined as injury to the neck associated with breach in the platysmal muscle layer. All penetrating neck injuries are potentially dangerous and require emergency intervention due to its proximity to airway, important blood vessels, nerves and other organs in the neck. A complete evaluation, rapid airway intervention and proper surgical repair are highly essential to prevent complications. Clinical evaluation and management of penetrating neck injuries at a tertiary care hospital. In this study, 66 cases of penetrating neck injuries who presented to the emergency department from October 2018 to September 2020 were included. The particulars of the insult like type of instrument causing injury and zone of injury were compared. An analysis of the management of penetrating neck injury with respect to exploration and wound repair and the need for tracheostomy, vascular repair, esophageal repair, laryngeal framework repair and pharyngeal re pair was made. The maximum incidence was observed for the age group between 21 and 30 years. The object causing the maximum number of neck injuries was knife, in 36 cases. The distribution of cases according to zone of injury revealed that the zone II was most commonly affected in 43 cases. The structures injured in the study indicated that platysma was involved in all the cases, followed by thyroid cartilage in 33 cases. Wound exploration and repair was done in all cases and tracheostomy was done in 44 cases. Complications were vocal cord palsy in 19 patients, 15 had tracheal stenosis, 13 had hoarseness of voice, 7 developed pharyngocutaneous fistula and 1 developed pharyngeal stenosis. There were 2 deaths. 16 patients who attempted suicide had depression. All penetrating neck injuries are potentially dangerous and require emergency treatment because of the presence of important vessels, nerves andorgans in the neck. Thorough knowledge of the anatomy of neck, clinical assessme nt and diagnostic and therapeutic interventions are necessary for appropriate management.

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Correlation of the Neutrophil-to-Lymphocyte Ratio with the Middle Ear Risk Index in Patients with Chronic Otitis Media

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Abstract

This study aimed to investigate the neutrophil-to-lymphocyte ratio (NLR) and severity of the chronic otitis media according to middle ear risk index (MERI) scores. The NLR and middle ear risk index were calculated for 210 chronic otitis media (COM) patients retrospectively. NLR compared between COM patients and 159 participants in control group. Pearson correlation analysis was performed for NLR and MERI. In addition, The cut-off value, sensitivity, and specificity for NLR were determined in COM according to the severity of the disease with ROC analysis. The average of NLR in all patients was 1.94 ± 0.89. NLR was calculated as 2.05 ± 1.03 in the patients with COM and 1.79 ± 0.64 in the control group (p = 0.006, 95% CI 0.07–0.44, t test). According to the ROC analysis, the cut-off point was determined as 1.95 for moderate and severe disease in MERI. For the cut of a NLR = 1.95, sensitivity was calculated as 48.5% and the specifici ty 57.1% for moderate and severe COM. MERI score was found significantly higher in patients with postoperative graft perforation (p < 0.001, 95% CI 0.7–1.8). NLR has not related significantly with the MERI score according to linear regression analysis (p = 0.927). NLR was found to be significantly higher in chronic otitis media patients compared to the control group. But NLR was not related to the severity of the disease classified with MERI. The cut-off value, sensitivity and sensitivity rates of NLR obtained was not available for clinically use.

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Vocal Cord Hemangioma: A Common Tumor in an Unusual Localization. A Case Report with Short Review of Literature

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Abstract

Laryngeal adult-type hemangiomas are very rare lesions, more frequent in men, whose optimal treatment consists of microlaryngoscopical excision. We herein report a case of larynx cavernous hemangioma in a 64-year-old woman with hoarseness for about six months. Histologically, the tumor was composed of multiple vessels embedded in an edematous stroma.

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Hydatid Cyst in Left Sub-Mandibular Space, an Unusual Location

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Abstract

Hydatid cysts in the neck area are considered as very rare and few cases have been reported in endemic areas. In the present study, we reported a 38-year-old female that underwent surgical operation for extraction of simple cyst in the submandibular area and the diagnosis of hydatid cyst was established by laboratory examinations. The patient was later diagnosed with hepatic hydatid cyst and received systemic treatments. We recommend that physicians should pay more attention to the possibilities of hydatid cysts in unusual areas in endemic regions especially Middle East.

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COVID-19, Diabetes and Steroids: The Demonic Trident for Mucormycosis

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Abstract

Coronavirus disease 2019 (COVID-19) has been found to be associated with mucormycosis in few parts of the world, especially India. It is important to look for reasons for this upsurge of cases so that other countries may take proper steps to prevent it. A prospective clinico-demographic study was conducted in SMS Medical College, Jaipur, India from April to May 2021. All patients (235) with COVID associated mucormycosis (CAM) were studied in detail with reference to their diabetic status and steroid intake during treatment of COVID-19. Steroid usage was in 84.3% of patients with methylprednisolone being the most commonly used steroid (66.8%). Majority of the patients had taken steroids for 7–14 days. Diabetes was found in 204 patients and 42.1% of patients were newly diagnosed during/after COVID-19 treatment. The HbA1c levels of diabetic patients ranged from 6.0% to 16.3%. This is perhaps the biggest study in the world shows that the triad of COVID-19, dia betes and steroid usage is a major contributing factor towards mucormycosis. Proper steps should be taken to prevent CAM.

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Quantifying head acceleration exposure via instrumented mouthguards (iMG): a validity and feasibility study protocol to inform iMG suitability for the TaCKLE project

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BMJ Open Sport Exerc Med. 2021 Sep 12;7(3):e001125. doi: 10.1136/bmjsem-2021-001125. eCollection 2021.

ABSTRACT

Instrumented mouthguards (iMGs) have the potential to quantify head acceleration exposures in sport. The Rugby Football League is looking to deploy iMGs to quantify head acceleration exposures as part of the Tackle and Contact Kinematics, Loads and Exposure (TaCKLE) project. iMGs and associated software platforms are novel, thus limited validation studies exist. The aim o f this paper is to describe the methods that will determine the validity (ie, laboratory validation of kinematic measures and on-field validity) and feasibility (ie, player comfort and wearability and practitioner considerations) of available iMGs for quantifying head acceleration events in rugby league. Phase 1 will determine the reliability and validity of iMG kinematic measures (peak linear acceleration, peak rotational velocity, peak rotational acceleration), based on laboratory criterion standards. Players will have three-dimensional dental scans and be provided with available iMGs for phase 2 and phase 3. Phase 2 will determine the on-field validity of iMGs (ie, identifying true positive head acceleration events during a match). Phase 3 will evaluate player perceptions of fit (too loose, too tight, bulky, small/thin, held mouth open, held teeth apart, pain in jaw muscles, uneven bite), comfort (on lips, gum, tongue, teeth) and function (speech, swallowing, dry mouth). Phase 4 will evaluate the practical feasibility of iMGs, as determined by practitioners using the system usability scale (preparing iMG system and managing iMG data). The outcome will provide a systematic and robust assessment of a range of iMGs, which will help inform the suitability of each iMG system for the TaCKLE project.

PMID:34603742 | PMC:PMC8438841 | DOI:10.1136 /bmjsem-2021-001125

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