Benjamin S. Oberman

Relationship between obesity, diabetes and the risk of thyroid cancer

PURPOSE Analyze the relationship between obesity and type-2 diabetes mellitus (DM) and the development of differentiated thyroid cancer (DTC). MATERIALS AND METHODS A randomized case-controlled retrospective chart review of outpatient clinic patients at an academic medical center between January 2005 and December 2012. DTC patients were compared to two control groups: primary hyperparathyroidism (PHPTH) patients with euthyroid state and Internal Medicine (IM) patients. Exposure variables included historical body-mass-index (BMI), most recent BMI within 6 months and DM. Multivariate logistic regressions adjusting for gender, age, and year of BMI assessed the adjusted Odds Ratio (OR) of DTC with both BMI and DM. RESULTS Comparison of means showed a statistically significant higher BMI in DTC (BMI=37.83) than PHPTH, IM, and pooled controls, BMI=30.36 p=<0.0001, BMI=28.96 p=<0.0001, BMI=29.53 p=<0.0001, respectively. When compared to PHPTH, DM was more frequent in DTC (29% vs. 16%) and prevalence trended towards significance (p=0.0829, 95% CI =0.902-5.407). BMI adjusted OR was significant when compared to PHPTH, IM and pooled controls: 1.125 (p=0.0001), 1.154 (p=<0.0001), and 1.113 (p=<0.0001), respectively. DM adjusted OR was significant when compared to PHPTH and pooled controls at 3.178 (95% 1.202,8.404, p=0.0198) and 2.237 (95% 1.033,4.844, p=0.0410), respectively. CONCLUSION Our results show that obesity and, to a lesser degree, DM are significantly associated with DTC. BMI in particular was a strong predictive variable for DTC (C=0.82 bivariate, C=0.84 multivariate).

Magnetic resonance imaging findings in Ménière's disease

OBJECTIVES To identify and evaluate cranial magnetic resonance imaging findings associated with Ménières disease. METHODS Seventy-eight patients with a documented diagnosis of Ménières disease and 35 controls underwent 1.5 T or 3 T magnetic resonance imaging of the brain. Patients also underwent otological, vestibular and audiometric examinations. RESULTS Lack of visualisation of the left and right vestibular aqueducts was identified as statistically significant amongst Ménières disease patients (left, p = 0.0001, odds ratio = 0.02; right, p = 0.0004, odds ratio = 0.03). Both vestibular aqueducts were of abnormal size in the Ménières disease group, albeit with left-sided significance (left, p = 0.008, odds ratio = 10.91; right, p = 0.49, odds ratio = 2.47). CONCLUSION Lack of vestibular aqueduct visualisation on magnetic resonance imaging was statistically significant in Ménières disease patients compared to the general population. The study findings suggest that magnetic resonance imaging can be useful to rule out retrocochlear pathology and provide radiological data to support the clinical diagnosis of Ménières disease.

Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism

To establish a time frame for postoperative improvements in neurocognitive function in patients who undergo parathyroidectomy for primary hyperparathyroidism by utilizing repeat neuropsychological assessment at multiple time points before and after surgery.

L’eziopatogenesi della sindrome di ménière: Stato dell’arte

SUMMARY Ménières disease, a condition first described in the 1800s, has been an advancing area of clinical interest and scientific research in recent decades. Guidelines published by the American Academy of Otolaryngology – Head and Neck Surgery remained nearly static for almost 20 years, although we have certainly expanded our knowledge of the aetiology of the disease since that time. This review of the literature highlights the breadth and detail of the current theories in understanding the pathophysiology of this enigmatic disease. Histopathological specimens providing evidence of many of the aetiologies are presented as well. We aim to provide a centralised and updated resource regarding current and emerging theories for Ménières disease.

Pharyngeal Presentation of Goltz Syndrome: A Case Report with Review of the Literature.

Focal dermal hypoplasia (Goltz syndrome; GS) is an X-linked dominant disorder caused by a mutation in the porcupine homolog (PORCN) gene and is typically embryonically lethal for males. The presence of disease in males is usually the result of post-zygotic mutation, but may also be due to mosaicism. The presentation of this disorder is highly variable, but generally is characterized by cutaneous, skeletal, ocular, oral, dental, and aural defects. Cutaneous manifestations include foci of hypoplastic skin, abnormal pigmentation, and papillomatous growths. We present both the first case of a patient with GS related laryngeal obstruction due to papillary lymphoid hyperplasia in an adult, and the first case in a male patient. Clinical, histologic, and genetic features of the disease are discussed. Operative technique for management of the patient with pharyngeal lesions is detailed, and intraoperative photos are showcased. The challenge in airway evaluation and management is also highlighted as manifestations of GS are rarely encountered in the airway and can cause laryngeal obstruction.

Effect of laryngotracheal topical anesthesia on recurrent laryngeal nerve monitoring during thyroid Surgery

STUDY OBJECTIVE Intraoperative neuromonitoring of the recurrent laryngeal nerve (RLN) is often used as an adjunct for RLN identification and preservation during thyroidectomies. Laryngotracheal anesthesia (LTA) with topical lidocaine reduces coughing upon emergence from anesthesia and in the immediate postoperative period; however, its use is prohibited with concerns that it could decrease the sensitivity of the intraoperative neuromonitoring. We hypothesize that there is no difference in measurements of nerve conduction made before and after LTA administration. DESIGN An observational study in which all patients were subjected to LTA administration was conducted. Recurrent laryngeal nerve threshold currents were measured before and after the intervention. SETTING Tertiary medical center operating room. PATIENTS Eighteen patients (total of 25 nerves at risk) with American Society of Anesthesiologists classes 1 to 3 undergoing thyroid surgery. INTERVENTIONS After the thyroid was removed and threshold currents at the RLN were obtained, LTA with endotracheal lidocaine was applied on the left and right side of the in situ endotracheal tube (2 cc of 4% lidocaine per side). Threshold currents were reassessed at 5 and 10 minutes after LTA administration. MEASUREMENTS Threshold currents (minimum stimulus current applied to the RLN required to generate a discernible electromyographic response at the vocal cords) were recorded along the RLN for a baseline at 5 and 10 mm from the insertion point of the RLN into the larynx. Threshold currents were reassessed at the same 2 positions on the RLN at 5 and 10 minutes after LTA administration. Differences in mean values, between threshold currents recorded at the 3 different times, at 2 positions on the RLN, were used to compare effects of LTA on nerve conduction. MAIN RESULTS There were no statistically significant differences when comparing threshold currents before and after LTA administration. CONCLUSIONS Laryngotracheal anesthesia had no significant effect on RLN nerve conduction in the period assessed.