Rhinogenic Optic Neuropathy with No Light Perception Secondary to Onodi Cell Mucocele with Visual Recovery after Optic Nerve Decompression

Rhinogenic optic neuropathy (RON) results from ethmoid or sphenoid sinus inflammation or infection causing optic nerve impairment.1 Treatment often requires endoscopic surgery and vision restoration occurs in select cases. There is no clear evidence for the benefit of optic nerve decompression (OND) in these situations. We present a unique case of RON caused by an Onodi cell mucocele for which isolated endoscopic mucocele drainage was not enough and further OND was needed to improve vision.

eHealth Literacy in Otolaryngology Patients

Objectives:

The aim of this study was to compare eHealth literacy—one’s perception of one’s ability to use the Internet for health care—among otolaryngology patients in 3 geographic settings of the same department.

Setting:

An academic otolaryngology department.

Method:

Patients’ opinions and perceptions of their eHealth literacy were assessed with a validated paper survey administered in the summer of 2017.

Results:

Of 381 asked, 351 people completed the survey, 149 at a university town teaching hospital clinic (group A), 101 at a nearby rural clinic (group B), and 101 at a remote rural clinic (group C). Mean scores were 30.80, 28.97, and 29.03 for groups A, B, and C, respectively. The overall mean was 29.76 ± 5.97. Three surveys reported the minimum score of 8, and 26 reported the maximum score of 40. Results were statistically significantly different among all sites ( P = .001), between groups A and B ( P = .027), and between groups A and C ( P = .0175). Women reported higher eHealth literacy (30.13 ± 6.27) than men (28.87 ± 5.11) ( P = .045). Participant age and role (patient or parent of a patient) were statistically insignificant. Mean scores were similar to those previously reported in other patient populations.

Conclusions:

Otolaryngology patients in a university town had better eHealth literacy than patients in more rural settings, suggesting that online medical resources and access points are less likely to be useful in rural populations.

Gastric duplication cyst masquerading as a mucinous pancreatic cyst: case report and literature review

Gastric duplication cysts are rare cystic neoplasms that are often difficult to distinguish from other entities. We describe a healthy 44-year-old woman who presented with acute right lower quadrant abdominal and flank pain as well as chronic nausea and constipation. Her physical examination was unremarkable but contrasted computed tomography revealed a 6 cm cystic lesion between the stomach and body of the pancreas. Endoscopic ultrasonography and fluid analysis were consistent with a mucinous cyst with a markedly elevated fluid carcinoembryonic antigen level. The patient subsequently underwent a laparoscopic distal pancreatectomy, which was converted to an open procedure when the lesion was noted to be adherent to the coeliac axis. Intraoperative endoscopy revealed no abnormality. Final pathology revealed a gastric duplication cyst. The patient recovered well and was asymptomatic on follow-up. In this report, we discuss the incidence, natural history and management of this rare entity.

A content analysis of research in family therapy journals

In order to assess trends in family therapy research, empirical articles (N = 195) from three family therapy journals over a 5-year period were coded for several variables: authorship, external funding, methodology, sample, purpose, cost effectiveness, use of therapeutic model, and topic. Results indicated that a large pecentage of research in these journals focused on nonclinical issues and used nonclinical samples. Authors were affiliated with a wide variety of disciplines and reported low levels of external funding for their research. While a majority of the studies used quantitative methods, there appeared to be a growing number of studies using qualitative methods. Implications of these findngs are discussed in light of research reviews over the past two decades.

Enhancing ethical decision making in sexuality and AIDS education

Traditionally, sexuality education has consisted of teaching adolescents about human anatomy, reproduction, and sexually transmitted diseases. Most sexuality and AIDS education curricula have emphasized neither the relational aspects nor the ethical meaning of sexual behavior. However, current guidelines for comprehensive sexuality education from the National Guidelines Task Force acknowledge the ethical dimensions of sexuality. This paper advocates providing sexuality and AIDS education in a way that helps adolescents explore the ethical meaning of their sexual behavior. Principles from Rest's model of moral development are presented as one example of an ethical framework that could inform sexuality and AIDS education curricula. Rest describes four internal processes that produce moral behavior: moral sensitivity, moral judgment, moral motivation, and moral character. For each of these processes, illustrative questions and activities are suggested here which can be used by sexuality and AIDS educators to facilitate discussions with adolescents about the ethical meaning and implications of their sexual behavior.

The technique of visceral packing: recommended management of difficult fascial closure in trauma patients

Since 1986, we have cared for 17 patients whose abdomen could not be closed because of bowel edema and loss of abdominal wall compliance. These patients were managed by a technique of visceral packing with the intestines kept in place by a combination of rayon cloth, gauze packs, and retention sutures. This packing was changed in the operating room under general anesthesia until the edema was sufficiently resolved to allow for closure. Two patients died within 24 hours of operation from irreversible shock. The remaining 15 patients had their fascia successfully closed with an average of two additional anesthetics. There was one case of fasciitis associated with the development of an intra-abdominal abscess and one patient died of late sepsis. There was no early postoperative ventilatory compromise or acute oliguric renal failure. Other direct complications have been minor with no enterocutaneous fistulae, dehiscence, or incisional hernia. Visceral packing of posttraumatic abdominal wounds circumvents expected complications of intraperitoneal hypertension and enhances the chance for survival. Its ease and low morbidity also lends itself to a wide variety of other uses.

A comparison of gastrostomy techniques in patients with advanced head and neck cancer

Patients with advanced head and neck carcinomas often suffer from impaired deglutition and require prolonged enteral feedings during therapy. This retrospective study analyzed 75 patients managed with three different gastrostomy techniques. Thirty patients received a percutaneous endoscopic gastrostomy; 28 patients had an open tube gastrostomy using a Foley or Malecot catheter through a purse-string stay suture; and 17 patients received an open-tube gastrostomy with a 1-cm Dacron-cuffed Silastic catheter enclosed in a 3-cm Witzel tunnel with the cuff buried in the subperitoneal pocket. The complication rate for 100 days of tube use was 0.21 for cuffed Silastic gastrostomy, 0.35 for open tube gastrostomy, and 1.41 for the percutaneous endoscopic gastrostomy group. We conclude that the cuffed Silastic gastrostomy technique is superior in this patient population.