Comparison of Hemodynamics in Jet Ventilation vs. Intermittent Apnea for Airway Stenosis Surgery.

OBJECTIVE: The objective of this study is to assess the impact of two different ventilation techniques, jet ventilation and apneic anesthesia with intermittent ventilation (AAIV), on patient hemodynamics and operative time during endoscopic laryngotracheal stenosis surgery. METHODS: Retrospective chart review of patients who underwent airway dilation for laryngotracheal stenosis by a single surgeon at a single institution from October 1, 2000 through January 2, 2020. Logistic regression, Mann-Whitney U tests and chi square analysis were used to determine statistical significance. RESULTS: A total of 157 patients, 43 (27.4%) male and 114 (72.6%) female, and 605 total encounters were included for analysis. There were no significant differences in hemodynamic outcomes when comparing the AAIV and jet ventilation groups. Specifically, there was no significant difference in either peak end-tidal CO2 or nadir O2 saturation between the AAIV and jet ventilation groups (p = 0.4016) and (p = 0.1357), respectively. The patients in the AAIV group had a significantly higher median BMI 32.93 (27.40-39.40) compared with 28.80 (24.1-32.65) (p = 0.0001). Although not necessarily clinically significant, patients with higher BMI had lower median O2 nadirs (97.8%) than non-obese patients (99.2%) (p < 0.0001). The median total procedure time was equivalent when comparing the two ventilation techniques. CONCLUSION: AAIV is a safe method of ventilation for patients undergoing endoscopic laryngotracheal stenosis surgery with no significant differences in patient hemodynamics or procedure time when compared with jet ventilation. AAIV was the preferred method of ventilation for obese patients undergoing endoscopic laryngotracheal stenosis surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1343-1348, 2024.

Delayed Diagnoses in Patients With Dizziness in the US Commonwealth of Virginia and the Tidewater Region.

Objective: In a region of approximately 1.7 million people (Tidewater, coastal Virginia), identify secondary diagnoses in persons with dizziness. Methods: This cross-sectional study utilizing TriNetX included individuals in the region of interest diagnosed with dizziness between 2010 and 2020. Subsequent diagnoses of vestibular disease or medical conditions possibly associated with dizziness in the same subjects were catalogued. Results: During the study period, 31,670 subjects were identified with diagnoses of dizziness as a symptom; 18,390 subjects were subsequently given a dizziness-related nonvestibular diagnosis, and 930 were given a subsequent vestibular disease diagnosis. The proportion of subjects diagnosed with vestibular disease (3%) after the dizziness diagnosis is far below expected norms (25%-34%) in the general population. There were greater proportions of delayed diagnoses of labyrinth dysfunction (odds ratio [OR], 4.8; P < 0.0001), superior semicircular canal dehiscence (OR, 3.1; P = 0.0023), otolith disease (OR, 3.1; P = 0.0023), among others, and a decreased proportion of delayed diagnosis of benign paroxysmal positional vertigo (OR, 0.56; P < 0.0001). Conclusions: The discrepancy between expected and observed prevalence in our region indicates that vestibular disease is likely underdiagnosed.

Management of complicated acute sinusitis in the setting of concurrent COVID-19.

PURPOSE: Intraorbital and intracranial complications of acute bacterial rhinosinusitis require timely medical and surgical treatment to prevent the development of long-term neurologic sequelae. The era of Coronavirus Disease-2019 (COVID-19) has complicated the management of complicated acute rhinosinusitis, especially when patients have concurrent acute sinusitis and COVID-19 infection. This case series aims to highlight the clinical course of pediatric patients at a single tertiary pediatric hospital with concurrent complicated bacterial rhinosinusitis and COVID-19. MATERIALS AND METHODS: A search of pediatric patients treated for COVID-19 and complications from acute sinusitis was performed using billing records for the year 2020-2021 at a single pediatric tertiary hospital. Data regarding presentation, management, microbiology, and hospital course was collected for review. RESULTS: A total of 6 patients with complicated bacterial sinusitis in the setting of COVID-19 infection were included. All patients were initially managed with medical therapy, consisting of systemic antibiotics, but 3 of these patients ultimately required surgical intervention. Cultures from the cohort grew Staphylococcus aureus, streptococcus intermedius, streptococcus constellatus or Prevotella species. All patients experienced clinical improvements and were eventually discharged home with oral antibiotics. CONCLUSION: COVID-19 continues to be an unusual disease especially for the pediatric population. Concurrent complicated acute rhinosinusitis and COVID-19 appear to have higher rates of surgical requirement in the pediatric population. COVID-19 safety precautions have influenced management practices for patients with severe bacterial rhinologic infections. While there may be an association between complicated bacterial rhinosinusitis and COVID-19 infection, further research is necessary to determine a true correlation.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts.

BACKGROUND: Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. METHODS: This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. RESULTS: Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort (p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort (p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group (p = 0.077). DISCUSSION: Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

Luminescent liquid crystalline hybrid materials by embedding octahedral molybdenum cluster anions with soft organic shells derived from tribenzo[18]crown-6.

Crown ethers and their derivatives are versatile building blocks for the design of supramolecular materials. They can be functionalized at will and are well known for their abilities to complex with alkali cations. Here, we show that emissive lanthanide free hybrid materials can be generated by using such building blocks. The organic tribenzo[18]crown-6 central core was functionalized via six-fold Suzuki cross-coupling as a key reaction with three o-terphenyl units which could be converted into their corresponding triphenylenes by the Scholl reaction, leading to novel liquid-crystalline columnar materials. Selected tribenzo[18]crown-6 o-terphenyls could interact with emissive ternary metal cluster compound salts to generate hybrid materials combining the properties of both moieties. Due to synergistic effects and despite the anisometry of the cluster compounds, individual properties such as liquid-crystalline phase stability of the organic part and emission abilities of its inorganic counter-part are enhanced in the hybrid compounds.

Lord of The Crowns: A New Precious in the Kingdom of Clustomesogens.

Replacing pure inorganic materials by functional organic-inorganic hybrid ones to lower production costs has become a major challenge, in particular for the optoelectronic industry. Adding nanostructuration abilities meanwhile preserving homogeneity is even more challenging for this class of new materials. Here we show that red-NIR emissive ternary molybdenum cluster salts can be assembled to liquid crystalline 15C5 crown ethers. The resulting hybrids are homogeneous and stable up to high temperature despite the weakness of the supramolecular interactions binding both components. These are illustrated by 133 Cs MAS NMR. All hybrids show hexagonal columnar arrangements and strong red-NIR emission. Surprisingly, when chlorinated clusters are used instead of brominated ones, the mesophase stability is largely enhanced.