Oded Cohen

Feeling without seeing? engagement of ventral, but not dorsal, amygdala during unaware exposure to emotional faces

The ability to selectively perceive items in the environment may be modulated by the emotional content of those items. The neural mechanism that underlies the privileged processing of emotionally salient content is poorly understood. Here, using fMRI, we investigated this issue via a binocular rivalry procedure when face stimuli depicting fearful or neutral expressions competed for awareness with a house. Results revealed an interesting dissociation in the amygdala during rivalry condition: Whereas its dorsal component exhibited dominant activation to aware fearful faces, a ventral component was more active during the suppression of fearful faces. Moreover, during rivalry, the dorsal and ventral components of the amygdala were coupled with segregated cortical activations in the brainstem and medial PFC, respectively. In summary, this study points to a differential involvement of two clusters within the amygdala and their connected networks in naturally occurring perceptual biases of emotional content in faces.

Surgical treatment of gastroesophageal reflux with esophageal stricture in infancy and childhood

During the past 5 years, 26 infants and children with gastroesophageal reflux were operated on. The results have been highly satisfactory and unattended by serious complications or mortality. Barium fluoroscopy was the most reliable diagnostic method. The indications for operation were persistent vomiting with failure to thrive, recurrent aspiration pneumonia, gastrointestinal bleeding and peptic stricture of the esophagus, not relieved by medical treatment. The high incidence of peptic stricture of the esophagus (50 percent) may reflect delay in diagnosis and medical treatment, which is successful in 60 to 87 percent of the infants with gastroesophageal reflux. Surgical treatment consisted of Nissen fundoplication combined with gastrostomy in cases of esophageal stenosis where dilatations were indicated. Complications related to the operation were minimal. In a follow-up period of 9 months to 5 years, all patients had obtained relief of symptoms of reflux and had excellent nutritional status and normal growth.

Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients.

Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach.

Volumetric analysis of the maxillary, sphenoid and frontal sinuses: A comparative computerized tomography based study☆

OBJECTIVE To study volume characteristics of the maxillary, sphenoid and frontal sinuses among healthy Caucasians adults, using computed tomography (CT) scans. METHODS A retrospective, case series study in a single academic center, CT scans of 201 consecutive adult subjects, performed between January and September 2014, were reviewed for the volume and dimensions of the paranasal sinuses. Patients with documented sinus pathology or lack of pneumatization were excluded. The study population was subdivided by gender and age (50 men age 25-64; 51 men age ≥65; 50 women age 25-64, and 50 women age ≥65). RESULTS The mean volume of maxillary, sphenoid and frontal sinuses in the four groups were 12.75±4.38 cc; 4.00±1.99 cc and 2.92±2.57 cc, respectively. In both genders, older patients demonstrated a significantly lower volume of the maxillary and sphenoid sinuses (14.81±3.96 cc vs. 11.82±4.28 cc and 4.84±1.97 vs. 3.84±1.89 cc respectively; p<0.001). No age related difference was found in the frontal sinus. Males had significantly larger sinus volumes than females (p<0.001): maxillary 14.38±(4.64) vs. 12.23±(3.82) cc, sphenoid 4.74±(2.06) vs. 3.55±(1.73) cc, frontal 3.74±(2.97) vs. 3.21±(2.79) cc. No synergistic effect of age and gender was found. CONCLUSION Volumes of the paranasal sinuses correlates with age and gender. Age related volume degeneration is expected in the maxillary and sphenoid sinuses. This volume reduction may influence future surgical and therapeutic approaches in the geriatric population.

Spontaneous Neck Hematoma in a Patient with Fibromuscular Dysplasia: A Case Report and a Review of the Literature

Background. Fibromuscular dysplasia (FMD) is a vascular disease that may present as aneurysms in the cervical arteries. Spontaneous neck hematoma is a rare life threatening medical condition. This is the first report of neck hematoma in a patient with FMD. Methods and Results. We present a case of a 69-year-old woman, with diagnosed cervical FMD and a 3-day history of sore throat and neck pain, who presented with enlarging neck hematoma. No active bleeding was noticed on CT angiography, airway was not compromised, and patient was managed conservatively. Next day, invasive angiography was performed, and no bleeding vessel was demonstrated. Patient has improved and was discharged after 5 days of hospitalization. We have discussed the different etiology of this condition, focusing on systemic vascular diseases. Conclusion. Complaint of neck pain in a patient with a FMD should raise suspicion for possible neck hematoma. Conversely, spontaneous neck hematoma without clear etiology should raise suspicion for a systemic vascular disease.

Intravenous opioid drug abuse as an independent risk factor for supraglottic squamous cell carcinoma-A case-control study

Intravenous opioid drug abuse (IVDA) was previously correlated with laryngeal cancer. However, discrimination of this correlation by anatomical subsites has not yet been described. In this study, we aim to further establish the association between IVDA and laryngeal squamous cell carcinoma (SCC) and to indicate the laryngeal subsites that are predisposed for this correlation.

Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention

Acute supraglottitis is a potentially life‐threatening condition due to rapid onset upper airway obstruction. The study aimed to characterize adult acute supraglottitis patients and to recognize factors associated with an aggressive disease course.

Potential Causative Factors for Saccular Disorders: Association with Smoking and Other Laryngeal Pathologies

OBJECTIVE To describe risk factors, clinical presentation, and outcome of patients with saccular disorders. STUDY DESIGN Case control with chart review METHODS: A single center retrospective study. Case group included all adult patients, presenting with saccular disorders (saccular cyst or laryngocele), between the years 2010 and 2015. A matched group of patients with vocal fold cyst served as the control. RESULTS Twenty-nine patients met the inclusion criteria: 15 males and 14 females; the mean age was 60.5(±11.2). The median follow-up period was 10 months (range 2-48). Overall, 75.9% (22) had a positive smoking history; 55.2% (16) were active and 20.7% (6) were past smokers. The median pack- years of all smokers in the saccular disorder group was 40 (range 1-67). Saccular disorder patients demonstrated significantly higher prevalence of active smoking when compared to control patients (55.2% versus 17.9%, P = 0.014). Sixty-nine percent of the patients had some synchronous vocal fold comorbidity. The leading vocal fold comorbidity was Reinkes edema in 41% (12). Synchronous vocal fold comorbidities were significantly more prevalent in smokers compared with nonsmokers-82% (18 of 22) and 29% (2 of 7), respectively (P = 0.008). Surgical treatment was performed on 26 patients; all of whom underwent complete resection, either by endoscopic (92%), external (4%), or combined external and endoscopic (4%) approaches. There was a single case of recurrence (4%), 10 months following initial resection. CONCLUSION Saccular disorders are associated with smoking and synchronous vocal fold comorbidity. Complete resection is recommended as surgical outcome is excellent.

The Use of Surgeon Performed Ultrasound in the Assessment of Indeterminate Thyroid Nodules

ytopathology - BSRTC) hold a therapeutic dilemma. Our objective was to evaluate the clinical importance of surgeon performed ultrasound (SUS) in assessing thyroid lesions with BSRTC 3 and 4. Materials and methods: All data of all patients referred for a thyroid nodule work-up, including SUS and FNA,between July 2010 and December 2012 was recorded. All patients were treated according to accepted clinical guidelines. 105 patients were diagnosed with indeterminate cytology. 43 patients were referred to surgery, and 62 were referred to further follow up. In this retrospective chart review, all clinical, sonographical, cytopathological and histopathlogical data in this group was analyzed. Patients were subdivided according to follow up and outcome. Correlation between ultrasound features and final pathology was analyzed. Results: Malignancy rate was 35% (15/43) in the operated group, with 37% in BSRTC category 3 (10/27), and 31% of category 4 (5/16). Benign disease on histology or repeated cytology was found in 80% (40/50) of all BSRTC3, and 72% (17/22) of 4. The presence of two or more known sonographic features to be associated with malignancy were significantly higher in the malignant group (43% vs. 23%, p=0.035). Conclusions: SUS allows a better patient selection for non-surgical follow up, reducing unnecessary operations.

Pancreatic abscess: An unusual complication of pancreatitis in infancy

This is the report of the successful surgical treatment of a pancreatic abscess in a 15-month-old girl.