The incidence of early post-operative complications following uvulopalatopharyngoplasty: identification of predictive risk factors

OBJECTIVE: Characterize complications following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea. STUDY DESIGN: Retrospective chart review. SUBJECTS AND METHODS: Charts of patients undergoing UPPP at an academic teaching hospital from 1999 to 2005 were reviewed. RESULTS: 345 consecutive patients (248 inpatients; 97 outpatients) were studied. The most common post-operative complication in the entire study was oxyhemoglobin desaturation (12.8%). Three patients suffered major complications (airway obstruction, pulmonary edema, arrhythmia). Regarding complications limited to the post-anaesthetic care unit alone, only 8.2% of patients had oxyhemoglobin desaturation after discontinuation of oxygen supplementation. Inpatients requiring supplemental oxygen on the ward had significantly higher mean AHI (37.4 vs. 31.4; p=0.05) and BMI (32.3 kg/m(2) vs. 28.9 kg/m(2); p=0.004) than those who did not. Those inpatients who were obese (BMI > 30 kg/m(2)) with an AHI≥22 were associated with an increased risk of requiring oxygen on the ward (odds ratio = 3.48, 95% CI = 1.56 – 7.78). CONCLUSION: The incidence of post-UPPP complications is much lower than the literature has historically suggested. Selected patients should be able to safely undergo outpatient UPPP. Patients with higher AHI, higher BMI, or multiple comorbidities are at higher risk for postoperative complications and are most appropriate for overnight monitoring

An endonasal approach to the resection of a papillary seromucinous adenocarcinoma of the Eustacian tube

Abstract Objectives Papillary seromucinous adenocarcinoma of the sinonasal tract is exceedingly rare. The objectives of this case report are to describe a case of papillary seromucinous adenocarcinoma presenting in the nasopharynx and to review the literature pertaining to other similar cases. Methods A review of the patient's chart and a review of the English literature were conducted. Results We describe the case of a 64 year-old woman who presented with a 3-year history of epistaxis and right-sided otitis media with effusion. The patient had been followed for a known nasopharyngeal mass that had twice been biopsied and in both cases was considered a benign mass pathologically. A third biopsy was diagnosed as a low-grade papillary seromucinous adenocarcinoma. The patient was otherwise asymptomatic. The patient was referred to a multidisciplinary cancer clinic at which endoscopic resection was determined to be the preferred treatment modality. A literature review and approach to patients with nasopharyngeal masses will be presented. Conclusions Papillary seromucinous adenocarcinoma is a rare tumor that can present in the nasopharynx. We describe the endoscopic surgical management of one such patient that presented to our care. </jats:sec

Reducing otolaryngology surgical inefficiency via assessment of tray redundancy

BACKGROUND: Health care costs in Canada continue to rise. As a result of this relentless increase in healthcare spending, ways to increase efficiency and decrease cost are constantly being sought. Surgical treatment is the mainstay of therapy for many conditions in the field of Otolaryngology- Head and Neck Surgery. The evidence suggests that room exists to optimize tray efficiency as a novel means of improving operating room throughput. METHODS: We conducted a review of instruments on surgical trays for 5 commonly performed procedures between July 5th, 2013 and September 20th, 2013 at St Joseph’s Hospital. The Instrument Utilization Rate was calculated; we then designed new ‘optimized’ trays based on which instruments were used at least 20% of the time. We obtained tray building times from Central Processing Department, then calculated an overall mean time per instrument (to pack the freshly washed instruments). We then determined the time that could be saved by using our new optimized trays. RESULTS: In total, 226 instrument trays were observed (Table 1). The average Instrument Utilization Rate was 27.8% (+/− 13.1). Our optimized trays, on average, reduced tray size by 57%. The average time to pack one instrument was 17.7 seconds. CONCLUSIONS: By selectively reducing our trays, we plan to reduce tray content by an average of 57%. It is important to remember that this number looks at only 5 procedures in the Department of Otolaryngology- Head and Neck Surgery. If this was expanded city-wide to the rest of the departments, the improved efficiency could potentially be quite substantial

Tunable Electronic Structure in Gallium Chalcogenide van der Waals Compounds

Transition metal monochalcogenides comprise a class of two-dimensional materials with electronic band gaps that are highly sensitive to material thickness and chemical composition. Here, we explore the tunability of the electronic excitation spectrum in GaSe using angle-resolved photoemission spectroscopy. The electronic structure of the material is modified by $\textit{in-situ}$ potassium deposition as well as by forming GaS$_{x}$Se$_{1-x}$ alloy compounds. We find that potassium decouples the top-most tetra-layer of the GaSe unit cell, leading to a substantial change of the dispersion around the valence band maximum (VBM). The observed band dispersion of a single tetralayer is consistent with a transition from the direct gap character of the bulk to the indirect gap character expected for monolayer GaSe. Upon alloying with sulfur, we observe a phase transition from AB to $\text{AA}^{\prime}$ stacking. Alloying also results in a rigid energy shift of the VBM towards higher binding energies which correlates with a blue shift in the luminescence. The increase of the band gap upon sulfur alloying does not appear to change the dispersion or character of the VBM appreciably, implying that it is possible to engineer the gap of these materials while maintaining their salient electronic properties

A retrospective study of the clinical benefit from acetylsalicylic acid desensitization in patients with nasal polyposis and asthma

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). ASA challenge is the gold standard for diagnosing AERD (Curr Allergy Asthma 9:155-163, 2009). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011). METHODS: This retrospective study assessed 111 patients who underwent ASA desensitization in the Allergy and Immunology clinic at St. Joseph’s Healthcare (SJHC) in London, Ontario. The mean age was 50.7 years, and 52.5% (n = 58) were male. Sixty-one percent (n = 68) claimed prior, significant reactions to ASA, and all patients had features of AERD. RESULTS: Seventy-three percent (n = 81) claimed symptom improvement after achieving maintenance dosing on the desensitization protocol. Of this population, 21.6% (n = 24) improved in all 3 areas of interest (sense of taste or smell, upper respiratory symptoms and lower respiratory symptoms). Twenty-six percent (n = 29) had adverse effects, mostly in the way of gastrointestinal upset, but no severe adverse events were seen. CONCLUSIONS: ASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines

Good plasmons in a bad metal

Correlated materials may exhibit unusually high resistivity increasing linearly in temperature, breaking through the Mott-Ioffe-Regel bound, above which coherent quasiparticles are destroyed. The fate of collective charge excitations, or plasmons, in these systems is a subject of debate. Several studies suggest plasmons are overdamped while others detect unrenormalized plasmons. Here, we present direct optical images of low-loss hyperbolic plasmon polaritons (HPPs) in the correlated van der Waals metal MoOCl2. HPPs are plasmon-photon modes that waveguide through extremely anisotropic media and are remarkably long-lived in MoOCl2. Many-body theory supported by photoemission results reveals that MoOCl2 is in an orbital-selective and highly incoherent Peierls phase. Different orbitals acquire markedly different bonding-antibonding character, producing a highly-anisotropic, isolated Fermi surface. The Fermi surface is further reconstructed and made partly incoherent by electronic interactions, renormalizing the plasma frequency. HPPs remain long-lived in spite of this, allowing us to uncover previously unseen imprints of electronic correlations on plasmonic collective modes.Comment: 32 pages, 16 figure

Does nasal surgery improve multilevel surgical outcome in obstructive sleep apnea:A multicenter study on 735 patients

Objective Does nasal surgery affect multilevel surgical success outcome. Methods Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA (P = .008) and the severe OSA (P = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% (P = .002). Conclusion Combining nose surgery in multilevel surgery improves surgical success. Level of evidence IIC