Transoral Endoscopic Approach to Repair Early Pharyngeal Perforations After Anterior Cervical Spine Surgery without Failure of Instrumentation: Our Experience and Review of Literature.

BACKGROUND: Pharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity. CASE DESCRIPTION: We describe the management strategies in patients with an early postoperative hypopharyngeal perforation that occurred after anterior cervical spine surgery without failure of instrumentation, and we present a case treated endoscopically at our institution. CONCLUSIONS: Appropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication.

Body habitus changes, metabolic abnormalities, osteopenia and cardiovascular risk in patients treated for human immunodeficiency virus infection.

The aim of this study was to evaluate the influence of three variables--protease inhibitors, stavudine, and the length of combined therapy--on body habitus changes, metabolic effects and bone mineral density in HIV patients treated with highly active antiretroviral therapy (HAART). The onset of possible cardiovascular involvement was considered. Forty HIV patients (29 men and 11 women, mean age 39.13 +/- 7.82 years, range 28-61 years) treated with HAART for 12-43 months were evaluated for fat, lean, bone tissues, immunohematological and cardiovascular alterations. The differences in fat/lean tissues and bone mineral density were evaluated at dual-energy X-ray absorptiometry (DEXA). Serum lipids and the CD4/CD8 T-cell counts were recorded. ECGs were taken every 6 months; color Doppler echocardiography and color Doppler ultrasounds of the carotid vessels were performed in close chronological sequence with the second DEXA. Statistical analyses included: Student's t-test, Wilcoxon test, and single-multiple regression analysis. Thirteen patients presented with fat loss, 7 fat accumulation, and 20 a combined form of both. The changes in the single body districts showed that the decrease in the limb fat is to be attributed to protease inhibitors, while none of the three variables was responsible for the decrease in the upper limb fat. The trunk weight increase was not significant. The decrease in the lean mass of the upper limbs is to be attributed to protease inhibitors, while none of the three variables was responsible for the increase in the lean mass of the upper and lower limbs. The decrease in bone mineral density was not significant. No treatment-related cardiovascular lesions were observed. In HIV patients treated with HAART for 12-43 months, the decrease in lower limb fat was due to protease inhibitors. Neither osteopenia nor cardiovascular diseases were observed during follow-up.

Intratympanic prednisolone therapy for sudden sensorineural hearing loss: A new protocol.

CONCLUSION: Intratympanic administration of prednisolone at a dose of 62.5 mg/ml performed every day for 3 consecutive days is more efficacious than the therapeutic approaches described so far in the literature. OBJECTIVES: The aim of the study was to evaluate the overall success rate, morbidity, and prognostic factors of a new protocol of intratympanic steroid administration as a means of primary therapy for idiopathic sensorineural hearing loss. METHODS: Overall, 34 patients presenting sudden unilateral sensorineural hearing loss of at least 30 dB over three frequencies that had developed within 72 h were treated once a day for 3 consecutive days with a single intratympanic injection of prednisone diluted in saline solution. RESULTS: Following intratympanic therapy with prednisone, 16 patients (47%) reported complete recovery of sudden sensorineural hearing loss, with a pure tone average that returned within 25 dB; 11 patients (32.3%) showed improvement in hearing of more than 30 dB; 4 patients presented improvement in pure-tone average between 10 and 30 dB. Only three patients failed to improve following intratympanic injection.

Indication for surgery in otosclerotic patients with unilateral hearing loss.

OBJECTIVE: The aim of this study is to evaluate postoperative spatial speech discrimination in noise in a group of otosclerotic patients with unilateral hearing loss in a 6-month follow-up. Moreover, an additional objective is to verify if our routine criteria (air-bone gap >30 dB at 250-2,000 Hz) for surgical indication in such patients can be acceptable. STUDY DESIGN: Prospective evaluation in 20 patients divided into 2 groups: unilateral otosclerosis and bilateral otosclerosis already successfully operated on 1 side and planned for stapedotomy on the contralateral ear. SETTING: Tertiary referral center, University clinic. PATIENTS: Otosclerotic patients with unilateral hearing loss. INTERVENTION: Evaluation of functional outcome. MAIN OUTCOME MEASURE: Spatial test based on speech discrimination in noise. RESULTS: All patients reach postoperative air-bone gap closure within 10 dB. Average postoperative gain in discrimination under noise was 11.5% for unilateral otosclerosis group and 19.3% for the second ear group. CONCLUSION: Free-field discrimination in noise closely reflects the usual listening conditions in everyday life. Improvement in postoperative free-field discrimination in noise can justify our routine criteria for surgical indication in the patients with unilateral otosclerosis and with bilateral otosclerosis already operated on 1 side. The surgical choice for each patient, apart from audiologic evaluation, is linked to a truly informed consent regarding possible advantages and risks mainly based on an analysis of the real auditory needs of the patient and individual results of the surgeon.