Notes

Range extension involving Myotis midastactus (Chiroptera, Vespertilionidae) to Paraguay.
Isolated malleus shaft fractures are rare cases. A commonly reported cause is a finger pulled out from a wet outer ear canal after a shower or bath. The objective was to investigate experimentally the mechanism and forces needed to establish an isolated malleus shaft fracture.

Ten fresh-frozen human temporal bones were adapted to allow visual inspection of the structures involved while negative pressure trauma was applied. Thirty malleus bones were broken and the required forces were measured. Measurements from 60 adult test subjects were used to create mathematical and physical models to calculate and measure the forces necessary for generating trauma. To calculate the maximum muscle force developed by the tensor tympani muscle, the muscle area and fiber type composition were determined.

The temporal bone experiments showed that applied negative pressure in a wet ear canal could not fracture the malleus shaft with only passive counterforce from supporting structures, although the forces exceeded what was required for a malleus shaft fracture. When adding calculated counteracting forces from the tensor tympani muscles, which consisted of 87% type II fibers, we estimate that a sufficient force is generated to cause a malleus fracture.

The combination of a negative pressure created by a finger pulling outward in a wet ear canal and a simultaneous counteracting reflexive force by the tensor tympani muscle were found to be sufficient to cause an isolated malleus fracture with an intact tympanic membrane.
The combination of a negative pressure created by a finger pulling outward in a wet ear canal and a simultaneous counteracting reflexive force by the tensor tympani muscle were found to be sufficient to cause an isolated malleus fracture with an intact tympanic membrane.
To evaluate the dilated Eustachian tube (ET) anatomy configuration using fresh human cadavers.

Fourteen ears from human cadavers were used to identify the ET configuration. The cadaver head was cut in the sagittal plane parallel to the nasal septum, dividing it into right and left sides. Silicone was then inserted into the ET through the nasopharyngeal orifice (NO). The volume and length of the impression were measured using 3D computed tomography imaging.

The ET lumen was found to narrow from the NO to the isthmus, and the ET surface was concave anteriorly and convex posteriorly. The lower portion of the ET lumen was the most dilated and displayed a narrow top. The average volume of the ET impression was 1.4 ± 0.5 ml. The total length of the posterior side was 30.5 ± 3.6 mm, and that of the anterior side was 26.3 ± 3.4 mm. The widest ET area of the NO was 10.1 ± 0.9 mm in height and 8.0 ± 1.5 mm in width. The preisthmus was 2.4 ± 0.4 mm in height and 1.3 ± 0.5 mm in width. BTK inhibitor in vivo The height and width were 8.37 and 5.33 mm at the 5 mm point from the NO, and 5.51 and 1.94 mm at the 20 mm point from the NO, respectively.

We evaluated the configuration of the cartilaginous ET lumen, which is the main target of balloon dilation, and our findings may give insights into this dilation process and assist with the further development of ET balloons and stents.
We evaluated the configuration of the cartilaginous ET lumen, which is the main target of balloon dilation, and our findings may give insights into this dilation process and assist with the further development of ET balloons and stents.
The Glasgow Benefit Inventory (GBI) is a health-related quality of life instrument used to detect changes in health status following otolaryngologic interventions. Despite its use in cochlear implant literature, assessment of utility, reliability, and validity of GBI in an adult cochlear implants (CI) patient population has yet to be performed.

Retrospective case series.

Academic, tertiary referral center.

Postlingually deafened, adult CI patients with at least 1 year of device use.

Five hundred fifty-two patients were administered GBI questionnaires at least 1 year following CI activation during follow-up visits.

GBI total and subscale scoring were compared to either the Hearing Handicap Inventory for Adults or Hearing Handicap Inventory for the Elderly. Moreover, a factor analysis and Cronbach's alpha were performed to determine GBI validity and internal reliability, respectively.

The average overall GBI score was 38.6 ± 21.7. This was weakly correlated to the reduction in Hearing Handicap Inventory for Adults/Hearing Handicap Inventory for the Elderly (τb = 0.282, p < 0.05). High factor loading with minimal cross-loading was noted on a three-factor solution, which emulated the original GBI development. Internal reliability was acceptable for the general benefit (α = 0.913) and social support subclasses (α = 0.706), whereas physical health's was low (α = 0.643).

Although GBI possesses adequate convergent and discriminant validity with acceptable reliability, its routine use to capture CI-specific health-related changes should not supersede validated CI-specific QoL instruments.
Although GBI possesses adequate convergent and discriminant validity with acceptable reliability, its routine use to capture CI-specific health-related changes should not supersede validated CI-specific QoL instruments.
To better counsel vestibular schwannoma patients, it is necessary to understand the tumor control rates of stereotactic radiosurgery (SRS).

To determine tumor control rates, factors determining control and complication rates following SRS.

Tertiary hospital retrospective cohort.

579 tumors (576 patients) were treated with SRS. 477 tumors (474 patients, 82%) had ≥1 year follow up and 60% (344) ≥3 years follow up. 88% of tumors had primary SRS and 6.7% salvage SRS. Median follow up time was 4.6 years. At 3 years, the tumor control rate of primary SRS was 89% (258 of 290) in sporadic tumors compared to 43% in Neurofibromatosis type II (3 of 17) (p < 0.01). Our bivariable survival data analysis showed that Neurofibromatosis type II, documented pre-SRS growth, tumor measured by maximum dimension, SRS given as nonprimary treatment increased hazard of failure to control. There was one case of malignancy and another of rapid change following intra-tumoral hemorrhage. For tumors undergoing surgical salvage (25 of 59), 56% had a total or near-total resection, 16% had postoperative CSF leak, with 12% new facial paralysis (House-Brackmann grade VI) and worsening of facial nerve outcomes (House-Brackmann grade worse in 59% at 12 mo).

Control of vestibular schwannoma after primary SRS occurs in the large majority. Salvage surgical treatment was notable for higher rates of postoperative complications compared to primary surgery reported in the literature.
Control of vestibular schwannoma after primary SRS occurs in the large majority. Salvage surgical treatment was notable for higher rates of postoperative complications compared to primary surgery reported in the literature.The atlas (C1) is known to present congenital anomalies in its anterior and posterior arches. The reported incidence of C1 anomalies is varied among the ethnic groups. We sought to determine the prevalence and various existing variations of C1 arch congenital anomalies in Omani subjects. This study was carried out by reviewing the cervical spine computed tomography scans of all the patients who had been referred to the Radiology Department, Sultan Qaboos University Hospital. Descriptive statistics and chi-square test were employed to analyse the data. A total of 663 subjects aged ≥18 years were included in the present study. Overall prevalence of C1 arch anomalies was 4.37% with 4.07% of isolated posterior arch anomalies, 0.3% of combined anterior and posterior arch anomalies. Among isolated posterior arch anomalies, type A and type B posterior arch defects were found in 3.77% and 0.3% of cases, respectively. Atlanto-occipital assimilation was noted in one case of total study subjects. The prevalence rate of C1 arch anomalies is relatively high in Omani subjects. The baseline data of C1 arch anomalies reported in the present study has a great impact on clinical practice, due to the fact that studying and evaluating the types of congenital anomalies helps in their accurate diagnosis and early intervention.The temporalis muscle is usually described as a single layer originating at the temporal line, converging to a tendon, and inserting onto a narrow site of the coronoid process. However, recent studies have shown that the temporalis muscle can be divided into two or three separate segments and the distal attachment continues inferiorly beyond the coronoid process. Therefore, the aims of this study were to analyze the morphology of the temporalis muscle focusing on the tendinous attachment onto the coronoid process and to provide educational values. The temporalis muscle was carefully dissected in 26 cadavers and classified based on the muscle fascicle direction. Each divided part was sketched and measured based on bony landmarks to elucidate its tendinous insertion site onto the coronoid process, and the results obtained were reviewed through the literature. The temporalis muscle ends at two distinct terminal tendons with wider insertion sites than usually presented in textbooks and atlases and separates into two parts that combine to act as a single structural unit. The superficial part is a large fan-shaped muscle commonly recognized as the temporalis muscle. This converges infero-medially to form the superficial tendon and the lateral boundary of the retromolar triangle. Meanwhile, the deep part is a narrow vertically oriented rectangular muscle that converges postero-laterally to form the deep tendon and the medial boundary of the retromolar triangle. These results indicate that understanding the temporalis muscle's insertion site onto the coronoid process will be useful clinically with educational values during surgical procedures.Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.Robotic thymectomy has been adopted recently and has been shown to be safe and feasible in treating thymic tumors and myasthenia gravis. The surgical indications of robotic technology are expanding, with advantages including an excellent surgical view and sophisticated manipulation. Herein, we describe technical aspects, considerations, and outcomes of robotic thymectomy.In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4-5 cm horizontally at a single thumb's width down. Under two-lung ventilation, CO2 is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.
My Website: https://www.selleckchem.com/btk.html