Head Area Research Articles

Exploring Head and Neck Fibromatosis: A Case Series and Literature Review.

This study aimed to retrospectively review the clinical data, management protocols, clinical outcomes, and literature review of patients diagnosed with head and neck fibromatoses. This case series aims to present and discuss seven cases of rare head and neck fibromatosis. The study design involves retrospective analysis of medical records, radiological imaging, and histopathological reports of the included cases. Ethical approval was obtained from the relevant Institutional Review Board. The results of the study reveal that individuals diagnosed with fibromatosis had a wide age range, starting from 6 to 58years, with the median age being 44.3years. Out of the 8 patients, 5 (62.5%) were females and 3 (37.5%) were males. The maxilla was found to be the most common subsite of origin in the head and neck area, followed by the masseter and temporal fossa. At the time of diagnosis, 2 (25%) patients were found to have unresectable disease. Multidisciplinary management therapies, including surgery, chemotherapy, hormonal, targeted therapy, and radiotherapy, were used. Out of the 6 patients who underwent surgery, 5 (83.3%) experienced tumor recurrence. In conclusion, the retrospective analysis underscores the complexity of managing fibromatoses of the head and neck region; complete tumor resection is not achievable always due to the inherent challenges, complex anatomy, and proximity of vital structures in the head and neck. Adjuvant strategies including radiotherapy, chemotherapy, and hormonal therapy have demonstrated efficacy in disease management. The rarity of these tumors necessitates the development of standardized treatment protocols to guide clinical practice effectively. Moving forward, collaborative efforts are crucial to enhance our understanding of fibromatoses and refine therapeutic strategies for improved patient outcomes.

Efficacy of Post-Isometric Relaxation vs. Sustained Stretching for Improving Cervical Spine Mobility in Upper Cross Syndrome-A Randomized Controlled Trial

Background: Upper Crossed Syndrome (UCS) is a common musculoskeletal disorder characterized by muscle imbalance in the head and shoulder areas, often exacerbated by poor posture. Muscle Energy Technique (MET), including Post-Isometric Relaxation (PIR) and sustained stretching, is commonly used to alleviate symptoms associated with UCS. Methodology: This randomized controlled trial compared the efficacy of PIR versus sustained stretching in reducing muscle tightness of the upper trapezius and levator scapulae muscles among 30 participants at Al-Sehat Rehabilitation Centre, Karachi, Pakistan. Pain intensity was assessed using the Numeric Pain Rating Scale (NRS), and cervical range of motion (ROM) was measured with an inclinometer. Results: PIR and sustained stretching significantly reduced pain and improved cervical ROM. PIR showed superior pain reduction, while sustained stretching enhanced ROM, particularly in left rotation and lateral flexion. Conclusion: PIR and sustained stretching are effective treatments for managing UCS-related symptoms. PIR excels in pain management, whereas sustained stretching enhances cervical ROM. Clinicians should consider these findings when designing treatment protocols for UCS. Keywords: Disability, Pain Management, Range of Motion, Upper Cross Syndrome.

MYOEPITHELIAL CARCINOMA OF SOFT TISSUES OF THE RIGHT AXILLARY REGION WITH METASTASIS TO THE CECUM: A CLINICAL CASE

Relevance: Myoepithelial carcinoma is a morphologically diverse tumor that arises either de novo or due to the malignant transformation of its benign counterpart, myoepithelium. These are relatively lesser-known lesions rarely found in the head and neck area. Myoepithelial carcinoma (MC) is a rare malignancy primarily found in the salivary gland. MK can be confused with many other tumors outside the salivary glands, as a wide range of cytomorphological and immunohistochemical features characterizes them. Soft tissue MCs are extremely rare, although a salivary gland MC is relatively common and well-known with similar morphology. The histogenesis of soft tissue MC is still unknown. The tumor may have myoepithelial differentiation but is not derived from myoepithelial cells. Due to the rarity of soft tissue MCs, the number of studies and data on this tumor’s clinical and pathological characteristics are limited. In addition, the limited number of diagnostic criteria and prognostic parameters makes diagnosing and treating soft tissue MC difficult. The article describes a rare case of MC, formed from the soft tissues of the axillary region, with metastasis to the cecum. The purpose was to describe the imaging and clinicopathological features of axillary myoepithelial carcinoma of soft tissues with metastasis to the cecum and to form an understanding of this disease. Methods: A rare case of soft tissue CM of the axillary region with metastasis to the cecum is described. A 57-year-old woman complained of lymphadenopathy in the right axillary region in October 2020. Results: According to ultrasound examination, the lymph node is up to 3.0x3.5 cm in the right axillary region. Based on histopathological and immunohistochemical (IHC) data, on 02/03/2022, the final diagnosis was made: MK of the soft tissues of the right axillary region. According to positron emission tomography/computed tomography (PET/CT), after 4 months, a local focus of active accumulation was detected in the projection of the cecum, with an adjacent enlarged regional lymph node of the paracolic group. On January 18, 2023, surgical treatment was performed in the following volume: “Right-sided hemicolectomy.” Histological examination confirmed MC. According to the multidisciplinary team’s (MDG) decision, the patient received 3 courses of targeted therapy. Conclusion: This case report raises awareness and improves MC diagnostics and treatment.

ROLE OF INTEGRINS IN HUMAN SPERM CELLS ON THE REPRODUCTION PROCESS

Ovum and spermatozoa cells, namely male and female reproductive cells that unite at the time of fertilization, are synchronized molecular events that occur sequentially. Apart from being present in the egg cell, adhesion molecules called integrins are also involved in this molecular process. However, recently, these integrins have also been found in spermatozoa cells, especially in the head and tail areas. Because this problem is intended as an introduction to the laboratory which is part of the thesis research, the method used in this research is a literature review whose publication age is not more than 10 years. Research findings indicate that integrins play a crucial role in egg-sperm recognition, their interaction, and fusion, potentially addressing infertility issues in couples of reproductive age.

Collision Lesions in Head and Neck Area: A Retrospective Study of 97 Reported Cases

Background: Collision (hybrid) lesions consist of two or more distinct histologic types occurring separately but within the same area. This review focuses on discussing all related and available case reports of hybrid lesions in the head and neck area. Methods: The literature was searched using several databases, including Scopus, Web of Science, PubMed, and Google Scholar. Papers published from 1990 to 2022 with full text available were considered for inclusion in the study. For a more comprehensive understanding, all lesions were categorized into cutaneous, jaw, and salivary gland groups and lesions in miscellaneous tissues. Results: In general, 97 reported collision lesions developed in the head and neck region. Among them, 31 (32%) and 34 (35%) cases were cutaneous hybrid lesions and in the jaws, respectively. In addition, 27 (27.8%) and 5 (5.1%) cases were in salivary glands and miscellaneous tissues, respectively. Conclusion: While the presence of true hybrid tumors is well-established, some reported cases have prompted researchers to categorize them as biphasic differentiations. The rarity of these cases contributes to limited knowledge regarding their clinical behavior, prognosis, and optimal treatment. It is crucial to emphasize the characteristic and potentially perplexing histological appearances.

The brain skull of an Anglo-Nubian goat

Currently, the classical study of the anatomy of the skull bones in the form of fine anatomical preparation and morphometry are the standard in veterinary anatomy. The use of modern methods of visual diagnostics such as computed tomography significantly enriches the theoretical and practical material on the osteology of domestic and farm animals. Having studied the bibliographic data, we found a sufficient volume on the anatomy of the skull bones of goats of various breeds and ages. However, we did not establish the presence of data on the osteology of the skull of the Anglo-Nubian goat. In this regard, the purpose of our study is to study the anatomical, topographic and morphometric characteristics of the bones of the cranial skull of the Anglo-Nubian goat using classical anatomical methods and using computed tomography. The material for the study was the corpses of Anglo-Nubian goats (n = 20). The cadaver material was obtained farm located in the Moscow region. The age of the animals was 1-2 years. The study was conducted by morphometry and fine anatomical dissection, as well as visual diagnostics – computed tomography. Based on the results of the study, the anatomical and topographic characteristics of the bones of the cranial skull of the Anglo-Nubian goat were established and the morphometric characteristics of their structures were determined. The data obtained can be used for comparative anatomy with other farm animals, as well as in veterinary practice and experimental studies, where goats can be used as an anatomical model in the study of surgical approaches for performing surgical manipulations in the head area.

Clinical Value of Fine Needle Aspiration Cytology and Core Needle Biopsy in Head and Neck Pathology - A Nationwide Survey in Germany.

Fine-needle aspiration cytology (FNA) and core needle biopsy (CNB) of the thyroid gland, salivary glands, and lymph nodes are considered simple and rapid methods for minimally invasive tissue collection. We performed a postal survey to analyse the diagnostic value and complication rate of FNA and CNB in Germany. A questionnaire comprising 11 questions was sent to all 161 German ENT departments in September 2015. The response rate was 45%. In 33 of the 73 responding clinics neither FNA nor CNB were carried out. Of the 26 clinics that provided detailed reasons, the majority (n=18) cited a lack of expertise among the collaborating pathologists. Overall, FNA was used more often, regardless of the anatomical region investigated. The study was based on a total of 36,684 FNAs and 9,624 CNBs. The rate of estimated meaningful and correct findings was 63% (10%-90%) for FNA, and 83% (50%-100%) for CNB. In eight cases (<0.001%) a potential tumor cell spread was reported. This is the first nationwide survey in Germany to investigate the utility of FNA and CNB across different localizations in the head and neck region. This study revealed comparable results to the literature regarding the diagnostic value of FNA and CNB. Cell spreading was only observed in individual cases. The appraisal of needle biopsies in the head and neck area seems to be rather inhomogeneous in Germany.

Effects of Anti-CGRP Monoclonal Antibodies on Neurophysiological and Clinical Outcomes: A Combined Transcranial Magnetic Stimulation and Algometer Study.

the aim of this study was to investigate the neurophysiological effect of anti-CGRP monoclonal antibodies on central and peripheral levels in migraine patients. An observational cohort study in patients with migraine was performed. All subjects underwent Single-Pulse and Paired-Pulse Transcranial Magnetic Stimulation, as well as a Pressure Pain Threshold assessment. The same protocol was repeated three and four months after the first injection of anti-CGRP monoclonal antibodies. A total of 11 patients with a diagnosis of migraine and 11 healthy controls were enrolled. The main findings of this study are the significant effects of anti-CGRP mAb treatment on the TMS parameters of intracortical inhibition and the rise in the resting motor threshold in our group of patients affected by resistant migraine. The clinical effect of therapy on migraine is associated with the increase in short-interval intracortical inhibition (SICI), resting motor threshold (RMT), and Pressure Pain Threshold (PPT). In all patients, all clinical headache parameters improved significantly 3 months after the first injection of mAbs and the improvement was maintained at the 1-month follow-up. At baseline, migraineurs and HCs had significant differences in all TMS parameters and in PPT, while at follow-up assessment, no differences were observed on RMT, SICI, and PPT between the two groups. After anti-CGRP monoclonal antibody injection, a significant increase in the intracortical inhibition, in the motor threshold, and in the Pressure Pain Threshold in critical head areas was observed in patients with migraine, which was related to significant clinical benefits. Anti-CGRP monoclonal antibodies improved clinical and neurophysiological outcomes, reflecting a normalization of cortical excitability and peripheral and central sensitization. By directly acting on the thalamus or hypothalamus and indirectly on the trigeminocervical complex, treatment with anti-CGRP monoclonal antibodies may modulate central sensorimotor excitability and peripheral sensitization pain.

Biomechanical comparison of the therapeutic effect of a novel proximal femoral bionic intramedullary nail and traditional inverted triangle hollow screw on femoral neck fracture

ObjectiveA novel Proximal Femoral Bionic Nail (PFBN) has been developed by a research team for the treatment of femoral neck fractures. This study aims to compare the biomechanical properties of the innovative PFBN with those of the conventional Inverted Triangular Cannulated Screw (ITCS) fixation method through biomechanical testing.MethodsSixteen male femoral specimens preserved in formalin were selected, with the donors’ age at death averaging 56.1 ± 6.3 years (range 47–64 years), and a mean age of 51.4 years. The femurs showed no visible damage and were examined by X-rays to exclude diseases affecting bone quality such as tumors, severe osteoporosis, and deformities. The 16 femoral specimens were randomly divided into an experimental group (n = 8) and a control group (n = 8). All femurs were prepared with Pauwels type III femoral neck fractures, fixed with PFBN in the experimental group and ITCS in the control group. Displacement and stress limits of each specimen were measured through cyclic compression tests and failure experiments, and vertical displacement and strain values under a 600 N vertical load were measured in all specimens through vertical compression tests.ResultsIn the vertical compression test, the average displacement at the anterior head region of the femur was 0.362 mm for the PFBN group, significantly less than the 0.480 mm for the ITCS group (p < 0.001). At the fracture line area, the average displacement for the PFBN group was also lower than that of the ITCS group (0.196 mm vs. 0.324 mm, p < 0.001). The difference in displacement in the shaft area was smaller, but the average displacement for the PFBN group (0.049 mm) was still significantly less than that for the ITCS group (0.062 mm, p = 0.016). The situation was similar on the posterior side of the femur. The average displacements in the head area, fracture line area, and shaft area for the PFBN group were 0.300 mm, 0.168 mm, and 0.081 mm, respectively, while those for the ITCS group were 0.558 mm, 0.274 mm, and 0.041 mm, with significant differences in all areas (p < 0.001). The average strain in the anterior head area for the PFBN group was 4947 μm/m, significantly less than the 1540 μm/m for the ITCS group (p < 0.001). Likewise, in the fracture line and shaft areas, the average strains for the PFBN group were significantly less than those for the ITCS group (p < 0.05). In the posterior head area, the average strain for the PFBN group was 4861 μm/m, significantly less than the 1442 μm/m for the ITCS group (p < 0.001). The strain conditions in the fracture line and shaft areas also showed the PFBN group was superior to the ITCS group (p < 0.001). In cyclic loading experiments, the PFBN fixation showed smaller maximum displacement (1.269 mm vs. 1.808 mm, p < 0.001), indicating better stability. In the failure experiments, the maximum failure load that the PFBN-fixated fracture block could withstand was significantly higher than that for the ITCS fixation (1817 N vs. 1116 N, p < 0.001).ConclusionThe PFBN can meet the biomechanical requirements for internal fixation of femoral neck fractures. PFBN is superior in biomechanical stability compared to ITCS, particularly showing less displacement and higher failure resistance in cyclic load and failure experiments. While there are differences in strain performance in different regions between the two fixation methods, overall, PFBN provides superior stability.

Anatomy of the Buccal Space: Surgical and Radiological Perspectives.

Among the anatomical spaces in the head and neck area, the buccal space has often been studied in dental/oral surgery and cosmetic surgery because it contains the facial vessels, mandibular and facial nerves, and adipose tissue called the buccal fat pad. In addition, as the space can communicate with other spaces, it can be significant in infections. Although the anatomy of the buccal space has been reported in several studies, there have been discrepancies concerning its boundaries, and its communications have often been overlooked. The aim of this review is to examine the anatomy of buccal space including its boundaries, contents, continuity with adjacent spaces, and clinical significance. A literature review was performed on Google Scholar and PubMed. The literature has depicted the anterior, medial, and lateral boundaries more or less consistently, but descriptions of the posterior, superior, and inferior borders are controversial. The buccal space includes the facial arteries, veins, facial nerves, parotid duct, and lymph nodes, which can be described differently depending on definitions and the extent of the space. As it communicates with other anatomical spaces including the masticatory space, it can be a reservoir and a channel for infections and tumors. Buccal fat pads have various clinical applications, from a candidate for flap reconstruction to a target for removal for cosmetic purposes. This review will help understand the anatomy of the buccal space including its boundaries, residing structures, and communication with other spaces from surgical and radiological perspectives.

Evaluation of traumatic spinal injuries: a pediatric perspective.

The aim of the present study is to provide information about pediatric patients with spinal trauma. A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded. A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8years (mean ± SD)] were included. The most common age group was that of 14-18years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%). Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.

Epidemiology, prognostic factors, and treatment of head and neck mucoepidermoid carcinoma: Analysis of the surveillance, epidemiology, and end results database

ObjectivesTo investigate prognostic factors in patients with head and neck Mucoepidermoid Carcinoma (MEC), especially the impact of treatment modalities on survival. MethodsPatients with primary head and neck MEC between 2000 and 2015 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors related to Overall Survival (OS) and Cancer-Specific Survival (CSS), as well as the impact of treatments, were evaluated by multivariable Cox regression analysis. ResultsWe identified 2692 patients diagnosed with head and neck MEC, of whom 1397 (51.89%) had a parotid gland primary, 569 (22.14%) died, and 341 (12.67%) died of MEC. Older age (≥53 years), males, unmarried, lower income, tumor site in other head and neck areas, higher tumor grade, larger tumor size, and higher stage were related to poorer OS and CSS. Patients who did not undergo surgery (HR=3.20, 95% CI 2.45‒4.18) had worse OS, while no significant difference was detected between partial and total organ excision on patients’ OS (p=0.729). For combination therapy, patients who received radiotherapy only (HR=3.21, 95% CI 2.27–4.53) or no surgery and no radiotherapy (HR=2.59, 95% CI 1.83–3.67) were correlated with worse OS (vs. surgery only), but no significant difference was detected between surgery only and surgery combined with radiotherapy on patients’ OS (p=0.218). For CSS, the corresponding results were consistent with OS. ConclusionSurgical resection only may be a better survival option for head and neck MEC.

Karyotype depends on sperm head morphology in some amniote groups.

The karyotype of an organism is the set of gross features that characterize the way the genome is packaged into separate chromosomes. It has been known for decades that different taxonomic groups often have distinct karyotypic features, but whether selective forces act to maintain these differences over evolutionary timescales is an open question. In this paper we analyze a database of karyotype features and sperm head morphology in 103 mammal species with spatulate sperm heads and 90 sauropsid species (birds and non-avian reptiles) with vermiform heads. We find that mammal species with a larger head area have more chromosomes, while sauropsid species with longer heads have a wider range of chromosome lengths. These results remain significant after controlling for genome size, so sperm head morphology is the relevant variable. This suggest that post-copulatory sexual selection, by acting on sperm head shape, can influence genome architecture.

First evidence of vampyromorph cephalopod jaw structures from the Sinemurian, Lower Jurassic of Dorset

A new specimen of the Coleoidea from the Charmouth Mudstone Formation of the Dorset Coast has been identified as Loligosepia bucklandi (Voltz, 1840). The specimen includes the gladius and jaw fragments, which represent one of few records of its kind, but the head area, arms, hooks and suckers are not discernible. It can be favourably compared to other L. bucklandi fossils in the Natural History Museum in London and the J.F. Jackson Collection in the National Museum Wales in Cardiff. The range of L. bucklandi is determined to be from the Turneri Zone, Brooki Subzone to the Obtusum Zone, Stellare Subzone of the lower Sinemurian, with the new specimen stratigraphically a little older than the precisely located specimens in the J.F. Jackson Collection.

Treatments using elements of Kobido massage for anti-ageing prevention and relaxation

The growing emphasis on maintaining a youthful appearance is driven by increased public awareness of the importance of good health and an attractive appearance, which going hand in hand with social development. Kobido massage is a suggested technique for enhancing the look and state of facial skin, serving as a non-surgical alternative to a facelift. The procedure employs specific manual techniques executed by a skilled specialist. This study aimed to evaluate the effectiveness of selected elements of kobido massage on improving the appearance of the skin, relaxing facial muscles, reducing their tension and improving blood and lymph circulation in the head area. The study included a group of 27 women who received 10 of the same treatments. The most frequently observed effects of the sequence of procedures were a reduction in tension and smoothing of facial skin folds, as well as a change in facial contour. The obtained results were consistent with the expectations of the majority of the participants. Kobido massage can be an effective method of improving the appearance of facial skin and may be a safe alternative to surgical lifting.

Exosomics integrates digital imaging for head and neck cancer diagnosis

AbstractCancers that can manifest in the oral cavity, nasal cavity, larynx, pharynx, sinuses, and other head and neck areas are collectively called “head and neck cancers” (HNC). HNC can be broadly classified into five types: salivary gland; oral and oropharyngeal; nasal cavity and paranasal sinus; nasopharyngeal, and laryngeal and hypopharyngeal cancers. HNC accounts for one million new diagnoses annually, making it the seventh most common form of the disease globally. Among all HNCs, 90% are head and neck squamous cell carcinoma (HNSCC) which is highly heterogenous, relapsing, and metastatic with poor survival. Despite the availability of new treatments, the five‐year survival rate for HNSCC patients has been reported to be approximately 50%. An early diagnosis may increase the disease management and outcomes, but it is challenging to detect smaller‐sized lesions and differentiate malignant and non‐malignant lesions with the available tools. Current circumstances demand an improvement in existing diagnostic strategies and the advent of novel diagnostic tools.

A randomised, controlled, multicentre trial of imiquimod versus radiotherapy for lentigo maligna.

9502 Background: Lentigo maligna (LM) is a form of melanoma in situ that occurs mainly on sun exposed skin. For patients with LM who are not suitable for surgery due to location, size, patient preference or co-morbidities, topical imiquimod or radiotherapy are alternative non-surgical treatments. There are no prospective randomized controlled trial data to form the basis of any recommendations for the management of LM. This multi-institutional, international randomized phase 3 trial evaluated the efficacy and safety of imiquimod verus radiotherapy for patients with LM. The primary hypothesis was that treatment of LM with topical imiquimod would result in fewer treatment failures than radiotherapy. Methods: Patients aged &gt; 18 years old with LM not suitable for surgery were randomly assigned (1:1) to imiquimod or radiotherapy. The primary endpoint was treatment failure within 24 months. Secondary endpoints included development of invasive disease within the area, side effects and patient-reported quality of life (QOL) assessed with validated questionnaires (skin-specific Skindex-16 and generic EQ-5D-5L). Results: Between August 2015 and November 2021, 126 patients were randomised from 8 centres (imiquimod 60, radiotherapy 58 in final analysis). The median age was 72 years and 94.9% of lesions were on the head and neck area. Median follow-up was 27 months (range 3-62 months). Six (10.5%) patients in the imiquimod group and 12 (24.0%) patients in the radiotherapy group developed recurrence within 24 months (OR 2.68, 95% CI, 0·92-7.8, p = 0.063). Median time to recurrence was not reached in either group. Treatment failure was significantly different within the subgroup of patients who had reflectance confocal microscopy (RCM) follow up of the LM (imiquimod 4/46, 8.7% radiotherapy 13/52 25.0%; OR 3.50 95% CI 1.05-11.65, p = 0.033). Only one RCM feature was associated with failure at 24 months and significantly different between treatment groups : the presence of atypical round cells at the dermal-epidermal junction (6.9 % of imiquimod failure and 27% of radiotherapy failure: p = 0.035). There were no differences between trial groups in patient-reported skin symptoms (itching, burning/stinging, pain, irritation), skin-specific emotional and functional QOL impacts, or generic QOL at any time points. Conclusions: Both imiquimod and radiotherapy are valid, well-tolerated and efficient non-surgical options for LM. There is no significant difference in the acute or long term QoL for the two treatments. Clinical trial information: NCT02394132 .

Clinical profile, otologic, and auditory outcomes in patients with Down syndrome

Introduction and objectivesEven though the incidence has decreased in recent years, Down syndrome (DS) remains the most common chromosomal disorder today. Despite being a condition with multisystemic involvement, it often tends to affect the head and neck area, making it a frequent reason for consultation with pediatric otolaryngologists or otologists. The purpose of this work is to be one of the first in Spain to characterize and describe the pathology and therapeutic approach typically provided to these patients, analyzing the evolution from a clinical and auditory perspective. Material and methodsWe aim to analyze a sample of 16 pediatric patients recruited over the past 24 years, diagnosed with Down syndrome, and experiencing a wide range of diseases affecting the ear and its auditory function. Results62.50% of the patients were women, whose main reason for seeking specialist care was acute and serous otitis media, accounting for 31.25%. These patients have an indication for treatment for various entities within the otological sphere that usually do not differ from those of a healthy child. However, the evolution and response to treatments can take on a torpid character due to the anatomical characteristics of the ears of these patients. ConclusionsAlthough the frequency of children with DS in the pediatric otolaryngologist's clinic is decreasing, these patients have a predisposition to ear diseases with auditory repercussions, with variable evolution depending on the disease and the child's intrinsic characteristics.

Sex- and cycle-dependent changes in spine density and size in hippocampal CA2 neurons

Sex hormones affect structural and functional plasticity in the rodent hippocampus. However, hormone levels not only differ between males and females, but also fluctuate across the female estrous cycle. While sex- and cycle-dependent differences in dendritic spine density and morphology have been found in the rodent CA1 region, but not in the CA3 or the dentate gyrus, comparable structural data on CA2, i.e. the hippocampal region involved in social recognition memory, is so far lacking. In this study, we, therefore, used wildtype male and female mice in diestrus or proestrus to analyze spines on dendritic segments from identified CA2 neurons. In basal stratum oriens, we found no differences in spine density, but a significant shift towards larger spine head areas in male mice compared to females. Conversely, in apical stratum radiatum diestrus females had a significantly higher spine density, and females in either cycle stage had a significant shift towards larger spine head areas as compared to males, with diestrus females showing the larger shift. Our results provide further evidence for the sexual dimorphism of hippocampal area CA2, and underscore the importance of considering not only the sex, but also the stage of the estrous cycle when interpreting morphological data.

The utility of computed tomography at a district-level public hospital in Cape Town.

Computed tomography (CT) has become an invaluable aid in medical diagnostic workup, and its global usage has been shown to be consistently increasing across all departments. While typically located in regional or central hospitals in South Africa, its recent introduction at the district level has many foreseeable benefits. We evaluated its utility at one of the first district hospitals in the Western Cape to obtain a CT suite. This study aimed to describe the type of CT scans ordered, the clinical indications, the prevalence of significant abnormal findings and the agreement between the clinical opinion and radiological diagnosis. A descriptive cross-sectional study was conducted over a 1-year period at Khayelitsha Hospital, an entry-level hospital just outside of Cape Town. A total of 3242 CT scans were analysed. The mean age of patients was 46 years; 51.4% were males. A mean of 13 scans were performed per working day. The head and neck area were the most scanned region (n= 1841, 52.3%). Predominantly requested by the Emergency Centre (n= 1382, 42.6%), indications were mainly for general medical conditions workup (n= 2151, 66.4%). Most scans showed abnormalities (n= 2710, 83.6%), with 2115 (65.2%) considered relevant ('positive yield'). Clinical and CT diagnoses agreed in 1610 (49.7%) cases. Computed tomography usage at the district level demonstrated positive yield rates comparable to that of tertiary centres. This implies an appropriate utilisation of the service with a potential decrease in the burden on the referral centre.Contribution:Computed tomography scanners at district-level facilities are appropriately utilised and can provide greater access to care while potentially decreasing the burden on referral centres.