Transnasal endoscopic removal of malformation of the odontoid process in a patient with type I Arnold-Chiari malformation: a case report

The endoscopic endonasal approach is emerging as a feasible alternative to the trans-oral route for the resection of the odontoid process, when the latter produces a compression of the brainstem and cervicomedullary junction. This type of approach has some advantages, such as excellent pre-vertebral exposure of the cranio-vertebral junction in patients with small oral cavities and the possibility to avoid the use of mouth retractors. A typical case of a 24-year-old male patient with a previous diagnosis of type I Arnold-Chiari Malformation, suffering from a posterior dislocation of the odontoid process causing severe anterior compression of the brainstem, is presented to stress the potential of this technique. Trans-nasal endoscopic removal of the odontoid process was performed and resolution of the ventral compression of the brainstem was achieved. This report demonstrates that in selected cases, an endoscopic endonasal approach should now be considered an excellent alternative to the traditional trans-oral approach

Aesthetic comparison between synthetic glue and subcuticular sutures in thyroid and parathyroid surgery: a single-blinded randomised clinical trial

The aim of our study was to compare, in terms of aesthetic results, the use of synthetic glue to intradermal absorbable sutures in postthyroidectomy and parathyroidectomy wound closure in a single blinded, randomised, per protocol equivalence study. From September 2008 to May 2010, patients undergoing thyroid or parathyroid surgery (with an external approach) at the Otolaryngology Department of the University Hospital of Modena were assessed for eligibility. In total, 42 patients who had had synthetic glue application on surgical incisions (A) and 47 patients who had subcuticular sutures on their surgical incisions (B) were enrolled. The mean of the endpoint (based on the Wound Registry Scale) of group A at 10 days was 1.4, while that in group B (based on the Stony Brook Scar Evaluation Scale) was 2.9. Statistically significant (p = 0.002) and clinically significant (difference of the means = 1.5) differences in the aesthetic results were found between groups A and B at 10 days, with better results in group B. On the other hand, at 3 months, the mean of the endpoint in group A was 3.1 while that in group B was 2.8; no statistically significant (p = 0.62) or clinically significant (difference in means = 0.3) differences were found between groups A and B. In conclusion, synthetic glue differs from subcuticular suture in post-thyroidectomy or post-parathyroidectomy incision for early aesthetic results, with better outcomes for subcuticular sutures. At 3 months, there were no differences in aesthetic outcomes between groups. Moreover, sex, incision length, age, cold/hot blade and correspondence of the incision with a wrinkle in the skin did not seem to influence aesthetic outcomes with this type of incision

Ultrasound-guided percutaneous laser ablation (LA) in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients

Background: Laser ablation may be useful in debulking of benign thyroid nodules. Methods: To evaluate retrospectively the effectiveness and safety of LA, 45 patients with benign solid thyroid nodules, with a fluid component 6420%, were included in our series between October 2009 and January 2011. All reported pressure and/or cosmetic complaints. Nd:YAG laser at 1064 nm was used, with a fix-power (3W), changing the application time. All patients were evaluated at baseline, 6 and 12 months. Complications were recorded. Results: mean nodule volume reduction decreased from 24.2 mL \ub119.4 to 4.5 \ub1 5.2 at 12 months (p<0.001). Mean nodule volume reduction was 84% \ub1 13. Cosmetic signs were completely resolved in 87%, reduced in 9%, unchanged in 2%; pressure symptoms were resolved in 88%. One patient experienced transient dysphonia. Conclusions: US-guided LA is an effective tool for treatment of symptomatic benign thyroid nodules in patients not eligible for surgery. This article is protected by copyright. All rights reserved

Health literacy and information literacy: a concept comparison

PurposeThe purpose of this paper is to compare health and information literacy with a focus on how the development of these concepts within two disciplines (nursing and library/information science) impacts librarian/nurse educator shared understanding.Design/methodology/approachThis paper uses a modified concept comparison method. The comparison, grounded in two seminal concept analysis articles, identifies common and unique antecedents, attributes and consequences of each concept.FindingsHealth and information literacy share common antecedents and attributes: literacy, health or information need, comprehension, decision-making and degree of technological competency. Unique to health literacy is an emphasis on interactive communication and unique to information literacy is a focus on discovery and search skills.Research limitations/implicationsThis concept comparison uses a snapshot approach rather than a full literature review. This work suggests further research into health literacy and information literacy as related concepts in the literature and how multidisciplinary concept comparison can be effectively framed.Practical implicationsLibrarians and nurse educators collaborating on complex concepts such as these should use available definitions, and evidence, to reach shared understanding. Librarians are encouraged to communicate with database developers to address questions and inconsistencies in subject headings.Originality/valueThis paper presents the first concept comparison of health and information literacy using the concept comparison method – an adaptation of concept analysis methods frequently used in nursing literature, developed by Walker and Avant, Rodgers and Knafl and others.</jats:sec

Pyramidal eminence and subpyramidal space: a dissection study

Objectives/Hypothesis: To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces. Study Design: This was an anatomical study on a prospective case series. Methods: The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections. Results: Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the sub-pyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence. Conclusions: Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed anatomical descriptions of hidden areas. Improvement in our knowledge of the anatomy may decrease the possibility of residual disease during cholesteatoma surgery

Imaging case of the month: facial nerve schwannoma.

Schwannomas are benign neoplasms arising from Schwann cells (1). In 25% of cases, Schwannomas develop in the head and neck region, representing 8 to 10% of primary intracranial tumors, whereas they constitute less than 1% of tumors with intratemporal localization (2). The most frequent cranial nerve neuromas typically arise from the VIIIth or Vth cranial nerve. The facial nerve is less frequently involved, and approximately 90% of facial nerve schwannomas arise from the internal auditory canal segment, generally from the geniculate ganglion (3). Its exclusive presence at the level of the tympanic or the mastoid segments of the nerve is rare. Computed tomography and magnetic resonance imaging (MRI) represent important diagnostic tools for this type of tumor

Pyramidal eminence and subpyramidal space: a dissection study

Objectives/Hypothesis: To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces. Study Design: This was an anatomical study on a prospective case series. Methods: The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections. Results: Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the sub-pyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence. Conclusions: Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed anatomical descriptions of hidden areas. Improvement in our knowledge of the anatomy may decrease the possibility of residual disease during cholesteatoma surgery

Subarcuate canal and artery: A case report

Variations in the course of the subarcuate artery (SAA) and of its related funnel are infrequent and asymptomatic. We present a case of a 15-year-old girl with a preverbal severe bilateral hearing loss and a subarcuate canal with an unusual course and atypical correlation with the adjacent anatomical structures, particularly with the lateral semicircular canal and the facial nerve. The variation proposed in this case, not previously reported in the literature consulted, can have important implications during middle ear surgical procedures, particularly for the retro-facial tympanoplasty approach: in fact otologic surgeons should consider any kind of variation of the SAA in surgical planning to avoid unexpected hemorrhages. The CT-scan, particularly HRCT, is a very useful tool for the study of intrapetrous vessels and their funnels, and should be considered mandatory in the case of a posterior approach to the tympanic cavity