Abdominal cerclage in a patient with a neocervix with planned cesarean hysterectomy at delivery.

Pregnancies complicated by congenital uterine anomalies (CUA) with a neocervix present a variety of challenges for the obstetrician. Abdominal cerclage can be utilized to help prevent preterm delivery in a patient with a neocervix. A 14-year-old female presented with right adnexal pain and was found to have a complex uterine anomaly resembling a noncommunicating unicornuate uterus with a cervix embedded in the rudimentary horn. A neocervix was created during surgical removal of the rudimentary horn. The patient became pregnant at age 24, and a transabdominal cerclage served an important role in the prevention of preterm delivery. Although limited data exists regarding the outcomes for the use of abdominal cerclage after the creation of a neocervix, term delivery is possible with said intervention.

Case series of vestibular schwannoma patients with no asymmetry in hearing.

OBJECTIVE: (1) Describe the presenting symptoms and tumor characteristics of patients who are diagnosed with a vestibular schwannoma (VS) with normal hearing or symmetric hearing loss, and (2) report the prospective growth and treatment of each tumor. METHODS: This is a retrospective cohort study of acoustic neuroma patients who were found to have a VS and normal or symmetric hearing loss at a single tertiary care academic center from 1999 to 2012. Medical records were reviewed collecting the following information: patient demographics, symptoms, MRI characteristics, and treatment modality. RESULTS: 15/195 (7.7%) patients met criteria for the study. Dizziness was the most common presenting symptom occurring in 9 subjects (60%), followed by headache in 6 (40%), vision changes in 5 (33%), tinnitus in 5 (33%), and unilateral hearing loss in 1 (7%). The average tumor size was 1.07 cm (range 0.3-2.2 cm). Eight (53%) patients presented with intracanalicular tumors. Growth was observed in 6 subjects (40%) with average growth rate in those who exhibited mean growth of 1.8 mm per year. Treatment consisted of surgical removal in 4 cases (27%), gamma knife therapy in 1 (7%), and observation or loss to follow-up in 10 (66%). CONCLUSIONS: The incidence of VS with normal hearing was 7.7% Patients with VSs who do not exhibit unilateral hearing loss present most commonly with dizziness. Most of our patients had small, intracanalicular tumors with the largest tumor measuring 2.2 cm in greatest dimension. Of those who were managed conservatively with repeat imaging and observation, most showed tumor growth.

Co-option of a motor-to-sensory histaminergic circuit correlates with insect flight biomechanics.

Nervous systems must adapt to shifts in behavioural ecology. One form of adaptation is neural exaptation, in which neural circuits are co-opted to perform additional novel functions. Here, we describe the co-option of a motor-to-somatosensory circuit into an olfactory network. Many moths beat their wings during odour-tracking, whether walking or flying, causing strong oscillations of airflow around the antennae, altering odour plume structure. This self-induced sensory stimulation could impose selective pressures that influence neural circuit evolution, specifically fostering the emergence of corollary discharge circuits. In Manduca sexta, a pair of mesothoracic to deutocerebral histaminergic neurons (MDHns), project from the mesothoracic neuromere to both antennal lobes (ALs), the first olfactory neuropil. Consistent with a hypothetical role in providing the olfactory system with a corollary discharge, we demonstrate that the MDHns innervate the ALs of advanced and basal moths, but not butterflies, which differ in wing beat and flight pattern. The MDHns probably arose in crustaceans and in many arthropods innervate mechanosensory areas, but not the olfactory system. The MDHns, therefore, represent an example of architectural exaptation, in which neurons that provide motor output information to mechanosensory regions have been co-opted to provide information to the olfactory system in moths.

Minimally invasive treatment of laryngoceles: a systematic review and pooled analysis.

Laryngoceles are best treated with surgery. The goal of this study is to compare patient outcomes and complications in patients undergoing removal of laryngoceles with either transoral endoscopic/microlaryngoscopic or robotic approaches. A systematic review of the published literature was conducted using Pubmed, Web of Science, and the Cochrane Clinical Trials databases. A pooled analysis of individual data was used to compare outcomes between robotic and endoscopic approaches. A total of 30 studies were included. Nine studies with 95 patients were included in the final analysis. Eighty-one (85.26%) were treated with microlaryngoscopic surgery and 14 (14.74%) were treated with robotic-assisted surgery. The rates of tracheostomy (RR = 1.44, 95% CI = 0.389-5.332), complications (RR = 0.329, 95% CI = 0.047-2.294) and recurrence (RR = 0.354, 95% CI = 0.021-5.897) were not statistically different between groups. Within the endoscopic subgroup, 66 laryngoceles (78.57%) were completely excised, while 18 (21.43%) laryngoceles were treated with marsupialization. Marsupialization was associated with an increased risk of recurrence (RR = 4.889, 95% CI = 1.202-19.891). In the robotic subgroup, there was an increased risk of nasogastric tube use (RR = 103.867, 95% CI = 6.379-1619.214) and a longer mean length of hospital stay (p = 0.0001). Transoral treatment of laryngoceles has complication and recurrence rates of 18.95% and 7.37%, respectively. Robotic approaches are associated with higher rates of NGT use and increased hospital stay, however much of this is due to one robotic surgeon's preference for routine NGT placement and higher rates of combined laryngocele removal via robotic approach. Complete excision of combined laryngoceles is possible with transoral approaches. Marsupialization, reported in traditional endoscopic approaches, is associated with a significantly higher rate of recurrence (22.22% vs. 4.76%).

Cryptococcal Anterior Glottic Web from Disseminated Infection Presenting as Confusion: A Case Report.

OBJECTIVES: To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient's disease burden. METHODS: An extensive review of the patient's clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications. RESULTS: Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient. CONCLUSION: Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.

Do Not Huff, Puff, or Vape That Stuff: Interstitial Airspace Disease in a Teenager.

A 17-year-old previously healthy male was admitted to the hospital for intractable and persistent vomiting, fever, cough, abdominal pain, and intermittent diarrhea and dehydration. He presented with severe chest pain and O2 desaturations up to 80% on room air. An infectious (including a nasopharyngeal swab), GI, and cardiac workup was completed and was negative except for elevated inflammatory markers with a C-reactive protein (CRP) level of 261 mg/L, erythrocyte sedimentation rate (ESR) of 53 mm/hr, and a D-dimer level of 0.93 mcg/ml. Chest X-ray showed diffuse multifocal infiltrates. The patient was treated with ceftriaxone and azithromycin initially for a suspected pneumonia. He was also started on 4L of nasal cannula O2 supplementation. Due to persistent hypoxic respiratory failure, worsening respiratory distress clinically, with tachypnea and retractions, and lab findings of elevated D-dimer, a chest CT was performed to rule out a pulmonary embolism (PE). Computed tomography (CT) findings were negative for PE but notable for diffuse airspace opacities, primarily within the lower lobes, with a ground-glass appearance concerning for ARDS. Upon further investigation of the social history, the patient admitted to vaping nicotine products for the past 4 years and tetrahydrocannabinol (THC) products within the last several months. He was immediately started on prednisone 30 mg BID for a diagnosis of e-cigarette or vaping product use-associated lung injury (EVALI) and started showing clinical improvement. The patient was able to be weaned off of supplemental oxygen to room air, and clinical symptoms of respiratory distress began to improve over the next 24 hours.