• Complex Skull Base Reconstructions in Kadish D Esthesioneuroblastoma: Case Report

      Palejwala, Sheri; Sharma, Saurabh; Le, Christopher; Chang, Eugene; Erman, Audrey; Lemole, G.; Univ Arizona, Dept Surg, Div Neurosurg; Univ Arizona, Dept Otolaryngol; Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, United States; Department of Otolaryngology, University of Arizona, Tucson, Arizona, United States; et al. (GEORG THIEME VERLAG KG, 2017-05-04)
      Introduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and aggressive adjuvant therapy to obtain adequate disease-free control, which can lead to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma who underwent multiple surgeries for infectious, neurologic, and wound complications, highlighting potential preventative and salvage techniques. Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant chemotherapy. He then returned with breakdown of his skull base reconstruction and subsequent frontal infections and ultimately received 10 surgical procedures with surgeries for infection-related issues including craniectomy and abscess evacuation. He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized and free autologous grafts and flaps, synthetic tissues, and CSF diversion. Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation, and chemotherapy, which can lead to complications. Ultimately, there are several options available to surgeons, and although precautions should be taken whenever possible, risk of wound breakdown, leak, or infection should not preclude radical surgical resection and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.
    • Imaging of Acute Appendicitis in Children

      Ferguson, Mark R.; Wright, Jason N.; Ngo, Anh-Vu; Desoky, Sarah M.; Iyer, Ramesh S.; Univ Arizona, Coll Med, Dept Radiol (GEORG THIEME VERLAG KG, 2017-03)
      Acute appendicitis is a common cause of abdominal surgery in children, and is the result of appendiceal luminal obstruction and subsequent inflammation. The clinical presentation is often variable, allowing imaging to play a central role in disease identification and characterization. Ultrasound is often the modality of choice for diagnosis of appendicitis in children. Ready availability and lack of ionizing radiation are attractive features of sonography, though operator dependence is a potential barrier. Computed tomography (CT) was historically the preferred modality in children, as in adults, but recent awareness of the risks of radiation has reduced its usage. The purpose of this article is to detail the imaging findings of appendicitis in children. The discussion will focus on typical signs of appendicitis seen on ultrasound, CT, and magnetic resonance imaging. Considerations for percutaneous drainage by interventional radiology will also be presented. Finally, the evolution of imaging algorithms for appendicitis will be discussed.
    • Intravenous Immunoglobulin for Congenital Parvovirus Myocarditis

      Kurland, Yonatan; Kylat, Ranjit I.; Johnson, Drew C.; Barber, Brent J.; Bedrick, Alan D.; Bader, Mohammad Y.; Univ Arizona, Arizona Hlth Sci Ctr, Dept Pediat; Univ Arizona, Arizona Hlth Sci Ctr, Sect Neonatal Perinatal Med & Dev Biol; Univ Arizona, Arizona Hlth Sci Ctr, Sect Pediat Cardiol (GEORG THIEME VERLAG KG, 2018-01-18)
      Congenital parvovirus infection has a diverse presentation ranging from asymptomatic infants to intrauterine demise secondary to red cell aplasia or myocarditis. Treatment is aimed at correcting anemia with intrauterine and postnatal transfusions. We report a case of fetal hydrops with severe atrioventricular regurgitation and myocardial dysfunction secondary to parvovirus infection in a preterm infant. Myocarditis and myocardial dysfunction responded to immunoglobulin administration.
    • Neck Dissection Technique Commonality and Variance: A Survey on Neck Dissection Technique Preferences among Head and Neck Oncologic Surgeons in the American Head and Neck Society

      Hemmat, Shirin; Wang, Steven; Ryan, William; Univ Arizona, Dept Otolaryngol Head & Neck Surg (GEORG THIEME VERLAG KG, 2017-01)
      Introduction Neck dissection (ND) technique preferences are not well reported. Objective The objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32-77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year. ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context.
    • Obstructive Sleep Apnea in Elective Spine Surgery: National Prevalence and Inpatient Outcomes

      Chung, Andrew S; DiGiovanni, Ryan; Tseng, Steve; Hustedt, Joshua W; Chutkan, Norman; Univ Arizona, Coll Med (GEORG THIEME VERLAG KG, 2018-09-01)
      Patients with OSA were, on average 2.6 years older than those without OSA (P < .001) and had a higher comorbidity burden. The prevalence of OSA increased between 2008 and 2012 from 3.5% to 6.8%; P < .001. OSA was associated with a 3-fold increase in major complications (P < .001) and was confirmed as an independent risk factor for major complications based on multivariate analysis (odds ratio [OR] = 2.82; 95% CI = 2.59-2.79; P < .001). Rates of deep venous thrombosis were doubled in patients with OSA. OSA was determined to be an independent predictor of pulmonary complications (OR = 2.69; 95% CI = 2.59-2.79; P < .001). OSA did not increase the risk of postoperative mortality.