Hermann Simo

Meniere's disease: importance of socioeconomic and environmental factors

STUDY OBJECTIVES 1. Describe the prevalence of Menieres disease in the United States. 2. Recognize important patient and environmental factors in Menieres disease. METHODS • Discharge data from the Nationwide Inpatient Sample, the largest US all-payer inpatient care database was analyzed for Menieres disease between 2008 and 2010 in patients > 10 years old. Patient characteristics including prevalence, age, sex, race, household income, and geographic location were studied to determine any correlation with disease prevalence. • T-test, Chi-square and logistic regression testing was used to compare the differences between groups for continuous and categorical data. RESULTS • The lower limit of Menieres prevalence in the United States population was 73 per 100,000, females 84 per 100,000 compared to 56 per 100,000 among males (OR = 1.51, 95% CI 1.48-1.54, P < 0.01). • Prevalence was highest in Caucasians 91 per 100,000, and was significantly higher than other ethnic groups (P < 0.05). • Prevalence increased as age with the highest prevalence found in 81-90 year age group. • Midwest prevalence (94 per 100,000) was significantly higher than other regions (P < 0.001). • Menieres is more common in less populated locations and the prevalence decreased as population increased. • Menieres prevalence increased with household income. The highest prevalence was found among the 76th-100th quartile with rates of 86 per 100,000 for MD. CONCLUSIONS Environmental factors, race and ethnicity, gender and age appear to be important factors in the prevalence of Menieres disease.

Volumes of cochlear nucleus regions in rodents.

The cochlear nucleus receives all the coded information about sound from the cochlea and is the source of auditory information for the rest of the central auditory system. As such, it is a critical auditory nucleus. The sizes of the cochlear nucleus as a whole and its three major subdivisions - anteroventral cochlear nucleus (AVCN), posteroventral cochlear nucleus (PVCN), and dorsal cochlear nucleus (DCN) - have been measured in a large number of mammals, but measurements of its subregions at a more detailed level for a variety of species have not previously been made. Size measurements are reported here for the summed granular regions, DCN layers, AVCN, PVCN, and interstitial nucleus in 15 different rodent species, as well as a lagomorph, carnivore, and small primate. This further refinement of measurements is important because the granular regions and superficial layers of the DCN appear to have some different functions than the other cochlear nucleus regions. Except for DCN layers in the mountain beaver, all regions were clearly identifiable in all the animals studied. Relative regional size differences among most of the rodents, and even the 3 non-rodents, were not large and did not show a consistent relation to their wide range of lifestyles and hearing parameters. However, the mountain beaver, and to a lesser extent the pocket gopher, two rodents that live in tunnel systems, had relative sizes of summed granular regions and DCN molecular layer distinctly larger than those of the other mammals. Among all the mammals studied, there was a high correlation between the size per body weight of summed granular regions and that of the DCN molecular layer, consistent with other evidence for a close relationship between granule cells and superficial DCN neurons.

ERCP-Related Duodenal Perforation Presenting as Pneumoscrotum

Duodenal perforation is a rare but life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). Duodenal perforation can cause air leak into the extraperitoneal space. In rare instances, the air in the extraperitoneal space could dissect along the fascial planes of the abdomen to reach scrotum, leading to pneumoscrotum. We present the case of a 35-year-old male patient who developed scrotal pain and swelling following ERCP. He was found to have extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with retroperitoneal duodenal perforation. He was managed conservatively with close monitoring and supportive care.

Endotracheal Tube Sizes and the Development of Ventilation-Associated Events: Does Gender Play a Role?

Hermann Simo* Aahd Kubbara William Barnett Kevin Qin Wail Alamoudi Madiha Fida Nawaf Almashal Asif Iqbal Amala Ambati Ajit Ramadugu Christopher Marino Faisal Khateeb Fadi Safi and Ragheb Assaly University of Toledo Medical Center, Toledo, OH IO N , R E S E A R C H , A N D Q U A L IT Y IM P R O V E M E N T PURPOSE: Ventilator-associated events (VAEs) are surveillance paradigms established by the CDC. They denote three categories of increasing progression in mechanically ventilated patients from a ventilator-associated condition (VAC), to an infection-related ventilator-associated complication (IVAC), and finally to a ventilator-associated pneumonia (VAP). In a recent study, Gacouin et al., incidentally found that risk of late-onset VAP was higher in patients with a tube size greater than or equal to 7.5 mm. While there has been association found between ventilator associated pneumonia and endotracheal tube (ETT) size, there has not been a study done looking at CDC defined Ventilator Associated Events occurence and ETT size. We wanted to determine if there is an association between endotracheal tube size and the development of VAEs and whether that association is gender base.

Alveolar Soft Part Sarcoma with Unusual Cardiac Metastasis: A Case Report and Review of the Literature

Alveolar soft part sarcoma is a very uncommon soft tissue malignancy which accounts for <1% of soft tissue sarcoma. It is a malignant and highly vascular tumor arising most commonly in the musculature of the lower extremities, with metastasis primarily to the lungs, bones, and brain. Cardiac metastasis is very rare and only 5 cases have been reported in the literature so far. We report a case of a young woman with a history of surgically resected alveolar soft part sarcoma of left thigh who presented with persistent dry cough and was found to have a cardiac mass, which on biopsy proved to be alveolar soft part sarcoma.

Delayed Distant Metastasis of Tonsillar Squamous Cell Carcinoma Origin- A Case Report

Introduction: The incidence of distant metastases from head and neck Squamous Cell Carcinoma (SCC) is reportedly low; reports of distant metastases from tonsil carcinoma are rare. 85% of distant metastases of SCC in head and neck cancers usually become apparent within two years of primary diagnosis, but can take up to five years before diagnosis. Background: Metastases from tonsillar cancers are uncommon, with less than 1% reported to go to subcutaneous tissues. Metastases are reported to occur within 1-48 months after initial treatment. Methods and results: A case report is presented of a patient seen with an isolated temporal scalp Squamous Cell Carcinoma (SCC) lesion 8 years after treatment for a tonsillar SCC and negative annual PET scans thereafter. The comparative immunehistochemical study and in situ hybridization done between the scalp tumor and the previous tonsil tumor eight years earlier, showed similarities, thus suggesting a metastasis from the tonsil tumor. Conclusions: A tonsillar SCC metastasis presenting as a temporal scalp lesion 8 years after primary tumor treatment and locoregional control achievement is a uniquely rare event. The case highlights the need for a method to identify and track tumor cell lineage, and the need for better understanding of cancer stem cells role in head and neck SCC.

Prevalence of Ménière’s and the Importance of Socioeconomic Factors

Objectives: (1) Describe the prevalence of Ménière’s disease and migraine in the United States. (2) Recognize patient and environmental factors in Ménière’s disease. Methods: Discharge data from the Nationwide Inpatient Sample, the largest US all-payer inpatient care database, was analyzed for migraine or Ménière’s disease between 2008-2010 in patients >10 years old. Patient characteristics, including prevalence, age, sex, race, household income, and geographic location were studied to determine any correlation with disease prevalence. T test, chi-square, and linear regression testing were used to compare the differences between groups for continuous and categorical data. Results: Ménière’s prevalence was 73 per 100,000, females 84 per 100,000 compared with 56 per 100,000 among males (odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.48-1.54, P < .01). Among Ménière’s patients, migraine prevalence was 142 per 100,000 compared to 25 per 100,000 (relative risk [RR] = 5.7, 95% CI 4.7-6.9, P < .01) in those patients without Ménière’s. Ménière’s prevalence was highest in Caucasians, 91 per 100,000, and was significantly higher than other ethnic groups (P < .05). Ménière’s prevalence increased with age, with the highest prevalence found in 81-90 year age group. Midwest prevalence (94 per 100,000) was significantly higher than other regions (P < .001). Ménière’s disease is more common in less populated locations and the prevalence decreased as population increased. Ménière’s disease increased with household income. The highest prevalence was found amongst the 76th to 100th quartile with rates of 86 per 100,000 for Ménière’s disease. Conclusions: Environmental factors, race and ethnicity, sex, and age appear to be important factors in the prevalence of Ménière’s disease.