Contribution of neuropsychiatric symptoms in Parkinson's disease to different domains of caregiver burden.

INTRODUCTION: Caregiver burden is high among caregivers of PD patients (CPD). Neuropsychiatric symptoms are leading contributors to CPD burden, but whether different symptoms differentially impact domains of caregiver burden is not known. Our objective was to examine which neuropsychiatric symptoms and demographic factors contribute to different domains of caregiver burden in PD. METHODS: This was a cross-sectional online survey study. Participants were recruited from the Fox Insight (FI) study and were eligible if they identified themselves as a CPD. The primary outcome was the Caregiver Burden Inventory (CBI) total score and its 5 sub-domain scores. The Neuropsychiatric Inventory Questionnaire (NPI-Q) assessed caregiver-reported neuropsychiatric symptoms in the care recipient. Multivariable linear regression models were used to characterize the associations between NPI-Q symptom severity scores and CBI scores. Covariates were caregiver age, sex, education, and caregiving duration. RESULTS: The sample consisted of 450 CPD, mean age 65.87 (SD 10.39) years, 74% females. After adjusting for covariates, CBI total score was predicted by NPI-Q total score (ß = 1.96, p < 0.001); model adjusted R2 = 39.2%. Anxiety severity had the largest effect size [standardized ß (sß) = 0.224] on the time-dependency domain, which was also associated with female sex (sß = - 0.133) and age (sß = 0.088). Severity of disinhibition (sß = 0.218), agitation (sß = 0.199), and female sex (sß = 0.104) were associated with greater emotional burden. CONCLUSION: Our findings indicate that demographic characteristics and specific neuropsychiatric symptoms contribute differentially to domains of caregiver burden. Tailored interventions to support CPD are needed.

Nasolacrimal duct obstruction and dacryocystocele associated with a concha bullosa mucocele.

PURPOSE: To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele. DESIGN: Case report. PARTICIPANT: Forty-two-year-old man with 6-month history of left medial canthal mass. INTERVENTION: Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed. RESULTS: The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele. CONCLUSIONS: Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.

Bezold's abscess with extension to the suprascapular space.

Since the advent of antibiotics, instances of untreated chronic otitis media have decreased considerably. The Bezold abscess seen occasionally with cases of acute otitis media has also become almost extinct. Its occurrence in association with chronic otitis media has always been even less frequent. This paper presents a case of Bezold's abscess associated with chronic otitis media, with the unusual clinical finding of extension to the suprascapular space.

Traumatic esophagopericardial fistula.

The pathological state of esophagopericardial fistula is a rare phenomenon. Its etiology may be either traumatic or disease induced. In either event, it is a most serious condition with a frequently fatal outcome. This case report concerns itself with an iatrogenic induced esophagopericardial fistula which was successfully treated by a thoracotomy and pericardotomy.

Transsternal radical neck dissection. Postoperative complications and management.

In 1962, Sisson et al reported the use of the transsternal radical neck dissection for carcinoma recurring in the peristomal area after laryngectomy. We have performed over 50 transsternal radical neck dissections in the past 14 years. A significant number of early cases succumbed to the postoperative problems of fistula, infection, and large vessel rupture. Our two cases illustrate intraoperative and postoperative complications. Management of these complications is discussed. Morbidity and mortality has decreased as we have gained experience in the management of these problems.