Bobak A. Ghaheri

Perioperative parathyroid hormone levels in thyroid surgery

Objective: Perioperative hypocalcemia from temporary parathyroid gland dysfunction is common after thyroid surgery. No reliable cutoff values for parathyroid hormone (PTH) and the subsequent possibility of developing hypocalcemia exist. The purpose of this study is to determine a criterion for predicting hypocalcemia based on different PTH levels as cutoff values.

Preoperative ultrasound is worthwhile for reoperative parathyroid surgery

Objectives/Hypothesis: High‐resolution ultrasound and sestamibi scanning are regarded as the first‐line methods for preoperative localization of parathyroid adenomas. The utility of ultrasound in reoperative cases has been questioned because of concern that scarring will obscure normal tissue planes and vascularity that are critical to identification of an adenoma using this imaging modality. The purposes of the study were to evaluate the ability of high‐resolution ultrasound to accurately localize parathyroid adenomas in the reoperative exploration and to identify any factors that influence its accuracy

Cochlear cytokine gene expression in murine acute otitis media.

Objective: Recurrent acute otitis media (AOM) causes sensorineural hearing loss by unknown mechanisms. It is widely accepted that inflammatory cytokines diffuse across the round window membrane to exert cytotoxic effects. This study addresses whether inner ear cells are capable of expressing genes for inflammatory cytokines.

The utility of bipolar electrocautery in hereditary hemorrhagic telangiectasia.

OBJECTIVE: The surgical treatment of epistaxis associated with hereditary hemorrhagic telangiectasia (HHT) is varied. Laser therapy is often inadequate for larger complex lesions. This study sought to determine if bipolar cautery can be effectively and safely used in treating HHT-associated epistaxis. STUDY DESIGN AND SETTING: Records from all patients with HHT treated surgically over 8 years were reviewed retrospectively. Outcomes or complications were noted in the clinic on follow-up evaluation. RESULTS: Twenty-seven patients with HHT who underwent surgical treatment of epistaxis were evaluated; 18 were treated with bipolar cautery. Forty-two separate bipolar treatments were performed. No new septal perforations or synechiae were noted. Twenty-two of 42 treatments were coupled with ancillary laser treatments. The bipolar was also used as the sole technique in 20 procedures. CONCLUSION: Bipolar electrocautery is a safe and effective tool for the intraoperative control of HHT-related epistaxis. SIGNIFICANCE: Bipolar electrocautery may be used as an adjunct to laser techniques or as a stand-alone technique.

Cochlear cytokine gene expression in murine chronic otitis media.

OBJECTIVE: To investigate chronic otitis media (COM) induction of cochlear cytokine genes. STUDY DESIGN: RNA from cochleas of five C3H/HeJ mice with and without COM was isolated for cytokine expression in gene arrays. Immunohistochemistry was performed for the protein products of up-regulated genes to confirm their expression in cochlear tissues. RESULTS: Cochleas from COM mice showed increased expression of 29 genes (>2X normal) and decreased expression of 19 genes (<0.5X normal). Cytokines expressed were largely those related to inflammation and tissue remodeling. Cochlear immuno-histochemistry confirmed the presence of numerous cytokines, as well as NF-kB, a major inflammatory transcription factor that drives cytokine expression. CONCLUSION: COM causes elevated levels of cochlear cytokine mRNA, which demonstrates that inner ear tissues are capable of NF-kB activation and cytokine production. This may be another mechanism of otitis media-induced cochlear cytotoxicity in addition to that caused by migration of inflammatory cytokines from the middle ear. SIGNIFICANCE: Cochlear tissues are capable of mounting an immunological response to middle ear inflammatory stimuli.

Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study

Numerous symptoms may arise that prevent mother‐infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue‐tie/lip‐tie release on breastfeeding impairment.

Second Osteocutaneous Fibular Free Flaps for Head and Neck Defects

Objective: To analyze the morbidity of a second fibular free tissue transfer when necessary in rare instances when the initial fibular flap fails.

Revision Lingual Frenotomy Improves Patient-Reported Breastfeeding Outcomes: A Prospective Cohort Study

Background: Lingual frenotomy improves patient-reported outcome measures, including infant reflux and maternal nipple pain, and prolongs the nursing relationship; however, many mother–infant dyads continue to experience breastfeeding difficulty despite having had a frenotomy. Research aim: The aim of this study was to determine how incomplete release of the tethered lingual frenulum may result in persistent breastfeeding difficulties. Methods: A one-group, observational, prospective cohort study was conducted. The sample consisted of breastfeeding mother–infant (0-9 months of age) dyads (N = 54) after the mothers self-elected completion lingual frenotomy and/or maxillary labial frenectomy following prior lingual frenotomy performed elsewhere. Participants completed surveys preoperatively, 1-week postoperatively, and 1-month postoperatively consisting of the Breastfeeding Self-Efficacy Scale–Short-Form (BSES-SF), Visual Analog Scale (VAS) for nipple pain severity, and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). Results: Significant postoperative improvements were reported between mean preoperative scores compared with 1-week and 1-month scores of the BSES-SF, F(2) = 41.2, p < .001; the I-GERQ-R, F(2) = 22.7, p < .001; and VAS pain scale, F(2) = 46.1, p < .001. Conclusion: We demonstrated that besides nipple pain, measures of infant reflux symptoms and maternal breastfeeding self-confidence can improve following full release of the lingual frenulum. Additionally, a patient population was identified that could benefit from increased scrutiny of infant tongue function when initial frenotomy fails to improve breastfeeding symptoms.

09:00 AM: Cytokine Gene Expression in Murine Chronic Otitis Media

(OME). METHODS: Ambulatory 24-hour dual-probe pH monitoring was performed in 31 children divided into two groups. Group I included 17 children who had undergone surgical interference for their OME, and group II included 14 children with OME who responded to the usual conservative lines of medical treatment. Middle ear effusions were collected from 17 children (Group I) during myringotomy and tympanostomy tube placement. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA using antipepsin antibody. RESULTS: Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant LPR. The concentrations of pepsin/pepsinogen in middle ear effusions ranged from 0.085 to 5.02 g/ml (mean 1.91;SD 1.65), while their serum concentrations in children ranged from 19.3 to 21.69 ng/ml (mean 21.24;SD 3.35). The concentrations of pepsin/pepsinogen in the effusions were up to 4.51-231.44 times higher than the serum levels. There was a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children (Group I) and the number of pharyngeal reflux episodes measured by pH monitoring whether using a threshold of pH 4 (r 0.584, p 0.014) or pH 5 (r 0.543, p 0.024). CONCLUSION: LPR may be an essential component in the successful diagnosis and management of OME in pediatric patients, and its control may lead to improved outcome of medical and surgical interventions. Analysis of pepsin/pepsinogen in effusions of middle ear, using ELISA, is indicated for assessment of reflux in children with OME. SIGNIFICANCE: Tests for evaluation of LPR as well as implementation of antireflux therapy should be considered when other usual methods yield no improvement of the middle ear condition or in those children showing frequent recurrence of middle ear problems.

Clamshell Approach for Cervical Mediastinal Esophageal Reconstruction

Objectives: The thoracic inlet is a complex anatomic structure. Many vital structures ranging from vessels to organ systems traverse through here on their way from the chest into the neck. Access to reconstruct these areas can be quite difficult. The esophagus is a structure that stretches from the cervical region through the thoracic inlet into the mediastinum. Diseases or defects in the esophagus have traditionally been repaired by end-to-end anastomosis when a distal anastomosis is possible. Lesions where the distal esophagus is not accessible through a cervical approach often necessitate a total esophagectomy with a stomach pull-up. One approach, the clamshell approach, involves a median sternotomy and right thoracotomy with rotation of the anterior and lateral bony confinements of the thoracic inlet laterally. This provides access to the anterior mediastinum. Mobilization of the upper lung provides access to the posterior mediastinum. Methods: We present an interesting case of a gentleman with Boerhaave’s syndrome who had a diverting esophagostomy at the cervical thoracic level. The distal esophagus was allowed to retract into the chest. After he survived his initial insult, reconstruction was undertaken. Results: The distal esophagus could not be connected to the proximal esophagus. Using a clamshell approach, distal and proximal esophageal segments were isolated and a free jejeunal tissue transfer was undertaken. Anastomosis to the internal mammary vessels allowed reconstruction of the esophageal conduit. Conclusion: This poster will demonstrate the interesting complexity of the thoracic inlet with a photographic demonstration of the technical approach.