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1.
Ear Nose Throat J ; 102(7): 425-427, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33915054

RESUMO

Intraosseous hemangiomas, also referred to as bony hemangiomas, arising within the nasal cavity are exceedingly rare with only 2 cases arising in the ethmoid region. Despite their rarity, they are important to consider in a patient presenting with long-standing nasal congestion. While characteristic findings on computed tomography imaging may be observed, biopsy is diagnostic. En bloc resection using a transnasal endoscopic approach with or without preoperative embolization is the treatment of choice for intranasal intraosseous hemangiomas.


Assuntos
Seio Etmoidal , Hemangioma , Humanos , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/patologia , Cavidade Nasal/patologia , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Hemangioma/patologia , Crânio
3.
Ear Nose Throat J ; : 1455613221106208, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35638547

RESUMO

Parathyroid cyst is a rare entity that can closely mimic thyroid and brachial cleft cysts, particularly when located within the thyroid gland. Most commonly, the cysts are non-functional but can produce compressive symptoms. The cyst contains watery content with elevated PTH levels, specifying parathyroid origin1. Parathyroid cysts should be considered in the differential in patients with a neck mass. This study describes a rare case of a middle-aged woman with a history of a symptomatic intrathyroidal parathyroid cyst discovered intraoperatively.

4.
Dermatol Surg ; 44(6): 785-795, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29360657

RESUMO

BACKGROUND: The paramedian forehead flap (PMFF) is the repair of choice for large nasal defects involving multiple cosmetic subunits. However, the PMFF may not be optimal for all patients. The combination of a melolabial interpolation flap (MLIF) and a nasal sidewall flap may serve as an alternative. OBJECTIVE: To present the surgical technique and aesthetic outcomes of the alternative reconstruction for surgical defects of the lower nose. MATERIALS AND METHODS: Fourteen patients with multisubunit nasal Mohs defects reconstructed alternatively were identified from 2 academic centers in this retrospective case series. Illustrations and photographs were used to demonstrate surgical technique and outcomes. Final aesthetic results were analyzed using the Patient and Observer Scar Assessment Scale. RESULTS: The physician observer rated the scar outcome a mean score of 10.9 ± 3.3. Patients rated their results as a mean of 9.1 ± 4.7. The mean "Patient" Overall Opinion score was 2.3 ± 2.6 and the mean "Observer" Overall Opinion score was 1.9 ± 0.9. No patients reported problems with nasal airflow or obstruction, and cosmetic complications such as pincushioning or alar buckling were not observed. CONCLUSION: The combined MLIF and nasal sidewall flap is an alternative repair for complex distal nasal defects.


Assuntos
Carcinoma Basocelular/cirurgia , Bochecha/cirurgia , Cirurgia de Mohs , Neoplasias Nasais/cirurgia , Rinoplastia , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Testa/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Cartilagens Nasais/cirurgia , Estudos Retrospectivos , Rinoplastia/métodos , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos
5.
J Cyst Fibros ; 17(3): 383-390, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29289454

RESUMO

BACKGROUND: The purpose of this study was to evaluate hearing impairment in pediatric patients with cystic fibrosis (CF). METHODS: This is a retrospective analysis of the AudGen database generated by Children's Hospital of Philadelphia. Audiograms were analyzed for type of hearing loss (HL), pure-tone-average (PTA), laterality, and change in hearing over time. Medical charts were reviewed to identify factors that influence development and progression of hearing loss. RESULTS: 217 patients with CF were included in this study. 69 (31.8%) had hearing loss on initial audiogram. Chronic otitis media (OR: 2.4, 95% CI: 1.3-4.5, p<0.01), Eustachian tube dysfunction (OR: 2.4, 95% CI: 1.4-5.4, p<0.01), and otorrhea (OR: 6.3, 95% CI: 1.6-24.7, p<0.01) were positive predictors of HL. Children with a diagnosis of diabetes had more decline in hearing over time than those without diabetes (12.4±17.2dB worsening vs. -5.7±9.8dB improvement in PTA, p=0.014). CONCLUSION: This is the largest comprehensive analysis of all types of hearing loss in pediatric patients with CF. Our data suggest that children with more severe sinus disease may be at lower risk for inflammatory middle ear disease and subsequent hearing loss. Patients who develop complications of CF such as diabetes should be monitored frequently, and the use of ototoxic drugs should be limited if possible.


Assuntos
Audiometria/métodos , Fibrose Cística , Perda Auditiva , Adolescente , Criança , Pré-Escolar , Fibrose Cística/complicações , Fibrose Cística/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Sinusite/epidemiologia , Estados Unidos/epidemiologia
6.
J Pediatr ; 193: 27-33.e2, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29174076

RESUMO

OBJECTIVES: To evaluate hearing impairment in children with Down syndrome, and to describe the factors that influence the severity of hearing loss or changes in hearing over time. STUDY DESIGN: Using the Audiological and Genetic Database (AudGenDB), audiograms of children with Down syndrome were analyzed retrospectively for type, severity, and laterality of hearing loss, as well as changes over time. Medical charts and imaging results were reviewed to identify factors influencing hearing loss. RESULTS: Among the 1088 patients with Down syndrome included in the study, 921 had hearing loss in at least 1 ear, 91.1% had bilateral hearing loss, and 8.9% had unilateral hearing loss (1760 total ears with hearing loss). Of the ears with hearing loss, 18.8% (n = 180) had moderate or worse hearing loss. "Undefined" hearing loss and pure conductive hearing loss (CHL) were the most common types, followed by mixed hearing loss and sensorineural hearing loss (SNHL). Three-quarters (75.4%) of the children had experienced chronic otitis media or more than 2 episodes of acute otitis media. Patients with bilateral, mixed hearing loss or a history of seizures were at risk for more severe hearing loss. CHL, absence of cholesteatoma, and placement of first ear tubes before age 2 years were associated with greater improvement in hearing over time, whereas SNHL and mixed hearing loss were associated with progressive decline. CONCLUSION: Children with Down syndrome who have bilateral, mixed hearing loss or a history of seizures are at risk for more severe hearing loss. SNHL and mixed hearing loss should not be overlooked in patients with CHL. All patients with Down syndrome will benefit from serial audiograms, especially those children with SNHL or mixed hearing loss, which is likely to worsen over time.


Assuntos
Síndrome de Down/complicações , Perda Auditiva/etiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Progressão da Doença , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Testes Auditivos/métodos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
7.
JAMA Facial Plast Surg ; 19(2): 147-154, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-27768177

RESUMO

IMPORTANCE: Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. OBJECTIVE: To present the newest and best evidence to close common practice gaps in cutaneous surgery. EVIDENCE REVIEW: We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others. Bibliographies from these references, as well as meta-analyses, were also reviewed. FINDINGS: A total of 73 peer-reviewed studies, including randomized clinical trials, were selected to support the conclusions of the article. Levels of evidence were analyzed for selected studies using recommendations from the American Association of Plastic Surgeons based on guidelines from the Oxford Centre for Evidence-Based Medicine. Large cutaneous surgical resections can be done effectively and safely, taking steps to assure patient comfort under local anesthesia. Medically necessary anticoagulant and antiplatelet medication should be continued during cutaneous surgery. In preparation for surgery, patient anxiety and pain must be addressed. Music and anxiolytics limit anxiety, prevent cardiovascular compromise, and improve patient satisfaction. Cutaneous surgeons and support staff should carefully consider the dose and injection angle of local anesthetic. Postoperative opioids and topical antibiotics might cause harm to patients and should be avoided. Acetaminophen and ibuprofen provide adequate pain control with fewer adverse effects than opioid medications. CONCLUSIONS AND RELEVANCE: Clinicians performing cutaneous surgery should understand the importance of patient safety and comfort, as guided by recent evidence.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/tendências , Dermatopatias/diagnóstico , Dermatopatias/cirurgia , Tomada de Decisões , Medicina Baseada em Evidências , Humanos , Cuidados Pós-Operatórios/tendências
8.
Laryngoscope ; 127(10): 2337-2339, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-27861948

RESUMO

The microbiology of skull base osteomyelitis (SBO) is evolving. We present here the first case of SBO caused by Propionibacterium acnes leading to the development of a pseudoaneurysm of the internal carotid artery. Otolaryngologists should recognize this pathogen as a potential cause of invasive temporal bone infection to optimize prompt diagnosis and treatment. Laryngoscope, 127:2337-2339, 2017.


Assuntos
Falso Aneurisma/etiologia , Artéria Carótida Interna , Infecções por Bactérias Gram-Positivas/complicações , Osteomielite/complicações , Propionibacterium/isolamento & purificação , Idoso , Falso Aneurisma/diagnóstico , Angiografia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imageamento Tridimensional , Masculino , Osteomielite/diagnóstico , Osteomielite/microbiologia , Base do Crânio , Tomografia Computadorizada por Raios X
9.
J Am Acad Dermatol ; 75(6): 1205-1209, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27542587

RESUMO

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which the exact etiology is unknown. Case reports exist of DFSP appearing and growing rapidly during pregnancy, suggesting a hormonal role. OBJECTIVE: Our goal was to determine the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in patients with DFSP. METHODS: Archived formalin-fixed, paraffin-embedded tissue from patients with DFSP in the past 20 years at a single institution were analyzed for ER and PR using immunohistochemistry. A semiquantitative scoring method was used to evaluate the expression as positive or negative. Analysis was used to determine whether there was an association between receptor positivity and tumor site, age at diagnosis, sex, race, or disease recurrence. RESULTS: Forty-four patients with DFSP were included in the study. Tumors were 22.7% ER+/PR+, 34.1% ER+/PR-, 9.1% ER-/PR+, and 34.1% ER-/PR-. There was no significant association between expression of ER and PR and sex, age at diagnosis, race, or tumor location. Loss of receptor expression was observed in all recurrent tumors. LIMITATIONS: This study is limited by a lack of follow-up and a new scoring system. CONCLUSIONS: The data presented warrant additional study to determine hormone receptor function and the potential efficacy of antihormone therapies for the treatment of patients with DFSP.


Assuntos
Dermatofibrossarcoma/química , Neoplasias de Cabeça e Pescoço/química , Recidiva Local de Neoplasia/química , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Neoplasias Cutâneas/química , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatofibrossarcoma/diagnóstico , Feminino , Humanos , Imuno-Histoquímica , Lactente , Recém-Nascido , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Neoplasias Cutâneas/diagnóstico , Tronco , Extremidade Superior , Adulto Jovem
10.
Int J Pediatr Otorhinolaryngol ; 81: 26-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26810284

RESUMO

Pediatric neck masses represent a variety of differential diagnoses. A common pathology in pediatric cystic neck tumors include ranulas, mucus retention cysts due to salivary gland obstruction. Epidermoid cysts are lesions infrequently encountered in the pediatric population and may appear similarly to ranulas on computed tomography imaging. MRI more easily differentiates these masses, and should therefore be the preferred imaging modality. Due to their distinct intraoperative management, ranulas and epidermoid cysts should be distinguished preoperatively through proper workup.


Assuntos
Cisto Epidérmico/diagnóstico , Rânula/diagnóstico , Doenças das Glândulas Salivares/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Dermatol Surg ; 42 Suppl 1: S24-31, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26730971

RESUMO

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which data on risk factors, incidence, and survival are limited. OBJECTIVE: The authors sought to establish a comprehensive report on the incidence of and survival from primary DFSP. METHODS: The authors used data from the 18 registries of the Surveillance, Epidemiology, and End Results Program from 2000 to 2010. RESULTS: Overall incidence was 4.1 per million person-years and steady over the decade. Trunk was the most common anatomic site except in older men. Incidence among women was 1.14 times higher than men (95% confidence interval [CI] of rate ratio: 1.07-1.22). Incidence among blacks was almost 2 times the rate among whites (95% CI of rate ratio: 1.8-2.1). Ten-year relative survival of DFSP was 99.1% (95% CI: 97.6-99.7). Increased age, male sex, black race, and anatomic location of the limbs and head as compared with the trunk were associated with higher all-cause mortality. CONCLUSION: This is the largest population-based study of DFSP derived from a cohort of almost 7,000 patients. The epidemiologic profile of DFSP differs from most skin cancers. Incidence is stable and highest among women and blacks. Worse survival is associated with increased age, male sex, black race, and anatomic location of the limbs and head.


Assuntos
Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/mortalidade , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , População Negra/estatística & dados numéricos , Dermatofibrossarcoma/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programa de SEER , Distribuição por Sexo , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Tronco/patologia , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto Jovem
12.
J Pediatr ; 166(6): 1505-13, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25866386

RESUMO

OBJECTIVE: To assess trends in the incidence of melanoma in children and adolescents in the US from 2000-2010. STUDY DESIGN: Using the Surveillance, Epidemiology, and End Results cancer registry data, we calculated age-adjusted incidence rates of melanoma in children and adolescents (age <20 years) from 2000-2010, as well as annual percent changes. We analyzed incidence trends using joinpoint regression models. We further stratified incidence rates and trends by age group, sex, race, and melanoma-specific characteristic (histology, anatomic site, Breslow depth, ulceration status, lymph node involvement, and presence of metastasis). RESULTS: We included 1185 pediatric patients (age <20 years) diagnosed with melanoma from 2000-2010. In patients age <20 years overall, we found a significant decreasing incidence (11.58% per year) from 2004-2010. Overall, significant decreasing incidence trends were also noted in males, melanoma located on the trunk, melanoma located on the upper extremities, superficial spreading melanoma, and melanoma with good prognostic indicators. When further subdividing the pediatric population by age group, these significant decreasing incidence trends were most notable in adolescents (age 15-19 years), decreasing 11.08% per year from 2003-2010. Furthermore, in 15- to 19-year-olds, decreasing trends were found to be significant in melanoma located on the trunk, superficial spreading melanoma, and melanoma with good prognostic indicators. CONCLUSIONS: Decreasing trends in melanoma incidence in the pediatric population from 2000-2010 stand in contrast to previous reports of increasing long-term incidence trends. Possible contributors to these decreasing trends include effective public health initiatives, decreased time spent outdoors, and increased sunscreen use.


Assuntos
Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Sistema de Registros , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
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