Wagnerkennedy3008

To identify areas of brain activity associated with involuntary muscle contractions in patients with blepharospasm using functional MRI.

15 patients with blepharospasm underwent 8-min resting state scans with spontaneous orbicularis oculi muscle contractions simultaneously recorded using MRI-compatible surface electromyography. Spasm severity and spasm onset/offset were modeled using the amplitude of the electromyography signal (EMG-Amp) and its first temporal derivative (EMG-Onset), respectively, and included in a multiple regression functional MRI analysis using SPM12. Primary outcome was within-group blood-oxygen-level dependent activations that co-varied with EMG-Amp and EMG-Onset following correction for multiple comparisons for an overall cluster corrected p<0.05. Secondary analyses included testing for correlations between imaging findings and symptom severity, as measured by clinical dystonia rating scales, using an uncorrected voxel-level threshold of p<0.001.

Imaging data from one subjecstonia and identifies specific areas of involvement consistent with known brain regions responsible for control of movement.

Determine the impact of ketorolac on post-tonsillectomy hemorrhage (PTH) and narcotic administration in children undergoing tonsillectomy.

Retrospective case series from 2013 to 2017. Patients younger than 18 years undergoing tonsillectomy were included. PTH was the primary outcome measured. selleck Secondary measures include percentage of patients requiring surgical intervention for PTH, average time to PTH, the number of post-operative opioid doses, and average post-operative opioid dose. Statistical methods include Chi-square, Wilcoxon rank sum, and binary logistic regression analyses.

During the study period, 669 patients received a single intraoperative dose of ketorolac (K+) and 653 patients did not receive ketorolac (K-). No differences were found in the rate of PTH (K- 6.5% vs. K+ 5.3%, RR=0.82, 95% CI=0.53 to 1.29, p=0.40), surgical control of PTH (K- 4.0% vs. K+ 3.5%, RR=0.87, CI=0.51 to 1.51, p=0.62), or average time [SD] to PTH (K- 6.0 [4.2] vs. K+ 5.2 [4.9] days; difference=0.8 days; 95% CI, -1.3 to 2.9; p=0.45). K+ patients had fewer post-operative opioid doses [SD] (K- 1.86 [1.14] vs. K+ 1.59 [1.23]; difference=-0.27; 95% CI, -0.053 to -0.49, Cohen d=0.23) and a lower average opioid dose [SD] (K- 0.041 [0.032] vs. K+ 0.035 [0.030] mg/kg; difference=-0.006mg/kg; 95% CI, -0.0003 to -0.012; Cohen d=0.19).

Ketorolac did not increase risk of hemorrhage following tonsillectomy and decreased narcotic use.

Ketorolac did not increase risk of hemorrhage following tonsillectomy and decreased narcotic use.

Since 2011, the American Academy of Otolaryngology - Head and Neck Surgery Clinical Practice Guidelines have recommended polysomnography (PSG) prior to tonsillectomy in children with Down syndrome (DS). The purpose of this study was to determine adherence to guidelines recommending polysomnography before tonsillectomy for children with DS and sleep-disordered breathing among pediatric otolaryngologists.

A one-year quality assurance retrospective review was conducted at four hospitals within one pediatric health system to identify children with a diagnosis of DS who underwent a tonsillectomy with or without adenoidectomy from January 1, 2018, to December 31, 2018. De-identified data related to age, sex, BMI, procedure type, and preoperative PSG were collected and examined.

The rate of PSG prior to tonsillectomy was 90.4% (66 of 73) among patients with DS. 51.6% of PSG studies were performed within 90 days before surgery, and 92.2% (59 of 64) of PSG studies were performed within one year before surgery. 33% of patients who did not undergo PSG also were obese or under age two years. The most common reason for not obtaining a PSG prior to tonsillectomy was that either the provider or parent felt the patient would not tolerate it. There was no variance from guidelines by age, sex, and procedure type.

Polysomnography for children with DS prior to tonsillectomy is achieved greater than 90% of the time in a multistate pediatric health system. Broader assessment across the nation and future studies regarding the timing of PSG before tonsillectomy are warranted.

Polysomnography for children with DS prior to tonsillectomy is achieved greater than 90% of the time in a multistate pediatric health system. Broader assessment across the nation and future studies regarding the timing of PSG before tonsillectomy are warranted.

Laryngomalacia is the dynamic collapse of supraglottic structures during inspiration, leading to a variable degree of airway obstruction. Clinical symptoms appear in the first months of life and are usually mild and resolve by the age of 12-18 months. In severe cases, surgical intervention may be considered. The goal of the study was to review the clinical outcome of pediatric patients who underwent supraglottoplasty for laryngomalacia.

Clinical and demographic data were retrieved from medical records of children diagnosed with laryngomalacia by laryngo-bronchoscopy between 2013 and 2019. Indications, outcome and long-term follow-up were collected from children undergoing surgery.

During the study period, 115 children were diagnosed with laryngomalacia. The median age at diagnosis was 3 months. Synchronous airway lesions were diagnosed in 20% of patients. Ten (8.7%) children underwent surgical treatment because of significant respiratory symptoms and/or failure to thrive. Three of them had comorbidities. All otherwise healthy children had significant respiratory and nutritional improvement after surgery while those with comorbidities had less successful outcomes.

We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.

We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.