The use of dehydrated amniotic membrane allograft for augmentation of dural repair in transsphenoidal endoscopic endonasal resection of pituitary adenomas.

BACKGROUND: In transsphenoidal endoscopic endonasal surgery (TEES), watertight separation of the sinonasal cavity and intracranial compartment is the primary goal of closure. However, even when meticulous closure technique is implemented, cerebrospinal fluid (CSF) leaks, dural scarring, and meningitis may result. Particularly when intraoperative CSF leak occurs, materials that facilitate the creation of a watertight seal that inhibits disease transition and minimizes inflammatory response after durotomy are sought. Dehydrated amniotic membrane (DAM) allograft appears to confer these attributes as studies have shown it augments epithelialization, facilitates wound healing, and minimizes and impedes bacterial growth. We detail the use of DAM allograft to augment sellar closures after TEES. METHODS: We conducted a feasibility study, retrospectively reviewing our institution's database of TEES for resection of pituitary adenomas in which DAM was utilized to supplement sellar closure. RESULTS: One hundred twenty transsphenoidal surgery cases with DAM were used during sellar closure, with a 49.2% intraoperative CSF leak rate. Of this cohort, two patients experienced postoperative CSF leak (1.7%), and no patients developed meningitis. CSF leak rate for TEES-naïve patients was 0.9%. CONCLUSIONS: This feasibility study demonstrates that dehydrated amniotic membrane allograft can be safely utilized as an adjunct during sellar closures for TEES for pituitary adenoma resection with very low rates of CSF leak and meningitis.

Transsphenoidal Approach for Pituitary Adenomas in Elderly Patients.

INTRODUCTION: With a rapidly expanding elderly population in the United States, the incidence of pituitary adenomas in elderly will continue to rise. In this study, we aim to evaluate the safety and efficacy of transsphenoidal endoscopic endonasal resection for pituitary adenomas in the elderly population. METHODS: A retrospective review of 131 consecutive patients who underwent transsphenoidal endoscopic endonasal resection for pituitary adenomas at the University of Miami Hospital between 2012 and 2016 was performed. Preoperative, intraoperative, and surgical outcomes were analyzed in elderly (>70 years) versus nonelderly (<70 years) patients. RESULTS: Of the 131 patients, 23 of them were >70 years (18%), of which 14 were septuagenarians and 9 were octogenarians. Elderly patients were more likely to present with vision loss (80.8% vs. 56.6%; P = 0.013) and larger tumors on imaging (2.7 ± 1.0 cm vs. 2.4 ± 1.3 cm; P = 0.042). Overall surgical and endocrinologic outcomes between the 2 groups were similar. However, patients <70 years old were more likely to have a gross total resection (86.7% vs. 65.4%; P = 0.011), as well as transient diabetes insipidus (54.3% vs. 26.9% P = 0.012) and intraoperative cerebrospinal fluid leak (83.5% vs. 58.5%; P = 0.013). However, permanent postoperative complication rates were similar including rate of permanent diabetes insipidus (4.3% elderly vs. 12.1% adult), cerebrospinal fluid leak (8.7% elderly vs. 8.4% adult), and meningitis (4.3% elderly vs. 2.8% adult). There were no medical complications or deaths in our cohort. CONCLUSION: The transsphenoidal endoscopic endonasal approach can be a safe and effective technique for resection of pituitary adenomas in patients >70 years old with appropriate patient selection.

Significant orbital and intracranial complications from balloon sinus dilation as a stand-alone and powered dissector-assisted procedure.

Chronic rhinosinusitis is one of the most common chronic conditions affecting millions of people in the United States every year. Balloon sinus dilation is a minimally invasive intervention that was introduced as a possible alternative to endoscopic sinus surgery (ESS). In select patients, balloon dilation has been advocated as a relatively safe procedure with comparable efficacy to traditional ESS. Over the past 12 months, significant intracranial and intraorbital complications have been observed on five patients who underwent balloon sinus dilation as a stand-alone procedure, as well as what could be termed a power dissector-assisted balloon dilation procedure, obviating the need for a wide sinusotomy or any significant ethmoid surgery, which are typically performed to establish anatomical landmarks before the introduction of power instruments into dependent sinus cavities. Laryngoscope, 2455-2459, 2018.

Effect of renal failure on voice.

The objective of this case-control study was to assess the impact of dysphonia on quality of life and to report the perceptual and acoustic findings in patients with chronic renal failure. A total of 22 patients with chronic renal failure and 18 healthy controls were recruited. Patients were asked to complete the Voice Handicap Index (VHI)-10 to assess the impact of dysphonia on quality of life. Perceptual evaluation of patients' voice recordings using the GRBAS classification was performed. Acoustic analysis was also conducted. Fundamental frequency, habitual pitch, shimmer, relative average perturbation, harmonic-to-noise ratio, voice turbulence index, and the maximum phonation time were reported. The mean scores of the VHI-10 were within normative values, with no significant difference between groups. There was also no significant difference in any of the acoustic parameters or in the mean score of any of the perceptual parameters between patients and controls. We conclude that patients with renal failure do not have dysphonia with a significant impact on quality of life, as evident by the normative values of the VHI-10. There were neither perceptual nor acoustic differences between patients and controls.

Association Between Facial Length and Width and Fundamental Frequency.

OBJECTIVE: This study aimed to evaluate the association between facial width and length and fundamental frequency (F0) and habitual frequency. STUDY DESIGN: Prospective cross-sectional study. SUBJECTS: A total of 50 subjects (35 females;15 males) were included in this study. METHODS: Lateral and posteroanterior cephalometric measurements included: facial height (N-Me); widths of the maxilla (J-J), mandible (AG-AG), and face (Zyg-Zyg); ratios J-J to AG-AG, N-Me to Zyg-Zyg, and lower face to total face heights. All subjects underwent acoustic analysis using Visi-Pitch IV. Sample was stratified according to age and gender. RESULTS: In the total group (mean age: 14.19±6.49 years; range 6-35 years), a significantly moderate negative correlation existed between Zyg-Zyg, J-J, and AG-AG, and F0 and habitual pitch. Similarly, N-Me moderately correlated with habitual pitch. In males, there was a significant moderate negative correlation between Zyg-Zyg and J-J, and habitual pitch, and between J-J and F0 (-0.571;p=0.026). In females, a significant moderate correlation existed between Zyg-Zyg and AG-AG, and habitual pitch, and between AG-AG and F0 (-0.347;p=0.041). In the prepubertal group (n=25), a negative moderate correlation occurred between J-J and AG-AG, N-Me and habitual frequency, and between J-J and F0 (-0.407;p=0.043). In the postpubertal group, there was a significant moderate correlation only between AG-AG and F0 (-0.403;p=0.046). CONCLUSION: Facial length correlates significantly with habitual frequency, and facial width correlates significantly with both F0 and habitual pitch. A larger sample of adult subjects is needed to substantiate this conclusion.

Reliability assessment of the endoscopic examination in patients with allergic rhinitis.

OBJECTIVE: To study if nasal endoscope can be a reliable tool in assessing patients with allergic rhinitis. MATERIALS AND METHODS: A prospective study. Patients who were diagnosed with allergic rhinitis underwent a nasal endoscopic examination performed by two physicians blinded to the scoring of each other. A correlation was made among symptom severity, endoscopic findings, and interrater variability. RESULTS: Ninety patients were included in the study: 34 patients had mild disease and 56 had moderate-to-severe allergic rhinitis according to the Allergic Rhinitis and its Impact on Asthma guidelines. Increases in mucosal edema and bluish discoloration were predictive of the severity of allergic rhinitis disease (p < 0.05). The presence of nasal secretions was not predictive of allergic rhinitis. Interrater reliability was fair for mucosal edema, moderate-to-almost perfect for the rest of the endoscopic findings. CONCLUSION: Nasal endoscopy may reveal signs that are predictive of the severity of allergic rhinitis. A detailed checklist is needed for the nasal endoscopic examination to decrease interrater variability.

Preventing thalassemia in Lebanon: successes and challenges in a developing country.

Thalassemia continues to be a major health burden. The chronicity of the disease and the high cost of life-long treatment make prevention strategies crucial in the management of this disease. In this article, we revisit different successful prevention strategies, and underline the Lebanese model. The Chronic Care Center (CCC), Beirut, is the only specialized center in Lebanon for the treatment and prevention of thalassemia. The current number of patients registered up to August 2013 was 724, representing cases from all over Lebanon. In 1994, the center launched a national prevention program following the World Health Organization (WHO) recommendations. The major activities of the program include awareness campaigns, screening for thalassemia carriers in the general population and high risk groups, registry of new cases and follow-up on the mandatory premarital law (established at the same time). Screening programs showed a carrier rate of around 2.3% in the general population, and 4.0-41.0% in high risk groups. The major pitfall in the law is that only persons with a mean corpuscular volume (MCV) of >70.0 fL are asked to perform further hemoglobin (Hb) testing. A significant decrease in the number of new cases of thalassemia patients in Lebanon reflects the efforts deployed in the prevention of the disease. However, some limitations are faced in reaching a complete eradication of the disease, mainly due to the fact that abortion is illegal and due to pitfalls and incorrect implementation of the premarital law.