Factors influencing water intake in dairy cows: a review

Water is a very critical nutrient in the diet of lactating animals as it performs several functions, viz., transfer of nutrients and excretions of waste products produced during metabolism, digestion, and body temperature regulation of all living organisms. Besides growth, other parameters like milk production, reproduction, adaptive potential, and feed consumption are also influenced by water status in feed and body reserves. Water intake in dairy cows is influenced directly or indirectly by several factors; direct factors include animal-related factors such as breed, body size, physiological stage, age, health, stress, and ecological adaptations and environmental factors, viz., season of the year, environmental temperature, humidity, wind speed, and precipitation. These factors significantly influence the drinking water intake of dairy cows. Nonetheless, different managemental practices such as rearing type, feeding practices, housing, water availability, and its quality can also affect water intake indirectly. However, overall understanding of these factors affecting water intake in dairy cows could help to improve the dairy husbandry practices and subsequently health, production, and welfare of dairy cows.

Sinonasal glomangiopericytoma: Is anything new?

More than 100 cases of sinonasal hemangiopericytoma have been reported in the literature, but only a handful of cases of nasal glomangiopericytoma. In this article, we report a case of a nasal glomangiopericytoma that was treated with endonasal surgical excision. We also attempt to clarify the confusion that attends to the nomenclature surrounding the terms glomangiopericytoma and hemangiopericytoma, which are often used interchangeably. Although glomangiopericytomas are histologically similar to sinonasal hemangiopericytomas, they sometimes behave in a different clinical manner. To further enhance our understanding of nasal glomangiopericytomas, more cases need to be reported. This may improve our ability to establish specific treatment modalities for this type of neoplasm and to predict clinical outcomes.

Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice

BACKGROUND

Meniere's syndrome or disease (MS/D) is typically characterised by episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss. There are multiple options available for treatment with variation in consensus on the best intervention.

OBJECTIVE

To evaluate the evidence on the efficacy of intratympanic therapies [steroids, gentamicin, antivirals and other therapies] on the frequency and severity of vertigo and other symptoms of MS/D.

SEARCH STRATEGY

A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders group trials register using various MeSH. The search was restricted to English and human subjects, and the last date of search was December 2014.

SELECTION CRITERIA

Randomised controlled trials of intratympanic therapies [steroids, gentamicin antivirals and latanoprost] versus a placebo or another treatment.

RESULTS

We analysed 8 RCT's comparing intratympanic steroids, gentamicin, ganciclovir (antiviral) and latanoprost versus another form of intratympanic treatment or placebo.

CONCLUSIONS

On the basis of 6 RCT's (n = 242), there is evidence to support the effectiveness of intratympanic steroids and gentamicin to control symptoms of vertigo in MS/D albeit with a risk of hearing loss with gentamicin. However, there was no consensus found on doses or treatment protocols. There was no evidence to support the use of other forms of intratympanic therapy (antivirals and latanoprost) in MS/D.

The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis

OBJECTIVE

To critically evaluate the evidence comparing success rates of endonasal dacryocystorhinostomy (EN-DCR) with and without silicone tubing and to thus determine whether silicone intubation is beneficial in primary EN-DCR.

DESIGN

Systematic review and meta-analysis.

SEARCH STRATEGY

A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials register using a combination of various MeSH. The date of last search was January 2016. This review was limited to randomised controlled trials (RCTs) in English language. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Chi-square and I² statistics were calculated to determine the presence and extent of statistical heterogeneity.

EVALUATION METHOD

Study selection, data extraction and risk of bias scoring were performed independently by two authors in concordance with the PRISMA statement.

RESULTS

Five RCTs (447 primary EN-DCR procedures in 426 patients) were included for analysis. Moderate interstudy statistical heterogeneity was demonstrated (Chi² = 6.18; d.f. = 4; I² = 35%). Bicanalicular silicone stents were used in 229 and not used in 218 procedures. The overall success rate of EN-DCR was 92.8% (415/447). The success rate of EN-DCR was 93.4% (214/229) with silicone tubing and 92.2% (201/218) without silicone tubing. Meta-analysis using a random-effects model showed no statistically significant difference in outcomes between the two groups (P = 0.63; RR = 0.79; 95% CI = 0.3-2.06).

CONCLUSIONS

Our review and meta-analysis did not demonstrate an additional advantage of silicone stenting. A high-quality well-powered prospective multicentre RCT is needed to further clarify on the benefit of silicone stents.

The behaviour of residual tumour after the intentional incomplete excision of a vestibular schwannoma: is it such a bad thing to leave some behind?

OBJECTIVES

To evaluate the biological behaviour of tumour remnants intentionally left in the surgical bed following the incomplete excision of vestibular schwannomas (VS) and to review the relation between extent of resection and preservation of facial nerve function.

METHODS

A retrospective chart review of 450 patients who underwent surgery for resection of VS over 23 years (1992-2014). Of these, 50 (11%) patients had residual tumour intentionally left on/around the facial nerve (near-total or subtotal excision) to preserve facial nerve function intra-operatively. The growth of residual tumour was evaluated using serial magnetic resonance imaging scanning; pre- and postoperative facial nerve function was assessed using the House-Brackmann grading scale.

SETTING

Tertiary referral neurotology unit.

RESULTS

Of the 42 non-NF2 cases where the tumour was intentionally incompletely excised, 28 (67%) patients underwent subtotal resection (mean follow-up 68.5 ± 39.0 months) and 14 (33%) underwent near-total resection (mean follow-up 72.9 ± 48.3 months). Three patients (all in subtotal resection group) showed regrowth. This was not statistically different from the near-total resection group (χ² = 0.92, P = 0.31). The mean overall growth for these cases was 0.68 mm ± 0.32 mm/year. 5 (one near total, four subtotal) of the eight NF2 patients (62.5%) were excluded from our analysis. In the non-NF2 group, poor facial nerve outcomes (House-Brackmann scores of III-IV) were seen in 2/14 and V-VI in 3/14 of the near total compared with 7/25 and 4/25 respectively in the subtotal group.

CONCLUSIONS

Given that the primary surgery for the VS was only for tumours that were relatively large or grew during conservative treatment, the low rate of tumour remnant growth (7%) is reassuring. It may be appropriate to have a lower threshold for leaving tumour on the facial nerve in non-NF2 patients where complete resection may jeopardise facial nerve function.

Positive pressure therapy for Meniere's syndrome/disease with a Meniett device: a systematic review of randomised controlled trials

BACKGROUND

Incidence rates of Meniere's syndrome/disease vary considerably from 157 per 100 000 in the United Kingdom to 15 per 100 000 in the United States. A wide range of treatments are used for the treatment of the condition with no consensus on the most effective intervention.

OBJECTIVES

To assess the effectiveness of the Meniett device in reducing the frequency and severity of vertigo in Meniere's syndrome/disease.

SEARCH METHODS

The Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific abstracts; ICTRP and additional sources for published and unpublished trials were searched. The date of the last search was 13th May 2014.

SELECTION CRITERIA

Four randomised controlled trials (RCTs) were identified that compared the efficacy of the Meniett device versus a placebo device in patients with Meniere's 'disease' as defined by the AAOO criterion.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility and risk of bias and extracted data. The outcome data were dichotomous for all the included trials.

MAIN RESULTS

The four RCTs compared 123 patients with the Meniett device against 114 patients with the placebo device from four RCT's over a follow-up period of 2 weeks to 4 months. There was a significant overall 61% reduction in the frequency of vertigo in both groups (mean no vertigo days per month of 8-3). However, this reduction was not significantly different between the two groups in any study or on meta-analysis [mean difference in vertigo-free days between Meniett and placebo device of 0.77 days over a 1-month period (95% CI - 0.82, 1.83) P = 0.45]. There were also no substantive data to support a greater reduction in the severity of the vertigo or any other outcome with the Meniett device compared with the placebo device.

AUTHORS CONCLUSIONS

No evidence was found to justify the use of the Meniett device in Meniere's syndrome/disease.

Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children

BACKGROUND

Grommets are frequently inserted in children's ears for acute otitis media and otitis media with effusion. A common complication is postoperative ear discharge (otorrhoea). A wide range of treatments are used to prevent the discharge, but there is no consensus on whether or not intervention is necessary nor which is the most effective intervention.

OBJECTIVES

To assess the effectiveness of prophylactic interventions, both topical and systemic, in reducing the incidence of otorrhoea following the surgical insertion of grommets in children.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 3 July 2012.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared the efficacy of prophylactic interventions against placebo/control and/or with other prophylactic interventions for postoperative otorrhoea in children.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility and risk of bias, and extracted data. The outcome data were dichotomous for all the included trials. We calculated individual and pooled risk ratios (RR) using the Mantel-Haenszel fixed-effect method. We also calculated the numbers needed to treat to benefit (NNTB).

MAIN RESULTS

We found 15 eligible RCTs (2476 children, aged from four months to 17 years). We graded seven RCTs as being at a low risk of bias (n = 926 children) and for an eighth RCT we also graded two of the arms as being at a low risk of bias. We graded the other seven trials as being at a high risk of bias.For a single application at surgery, there was evidence from two low risk of bias trials that at two weeks postoperatively the risk of otorrhoea was reduced by multiple saline washouts (from 30% to 16%; RR 0.52, 95% confidence interval (CI) 0.27 to 1.00; NNTB 7; one RCT; 140 children) and antibiotic/steroid ear drops (from 9% to 1%; RR 0.13, 95% CI 0.03 to 0.57; NNTB 13; one RCT; 322 ears). A meta-analysis of two low risk of bias trials (222 ears) failed to find an effect of a single application of antibiotic/steroid ear drops at four to six weeks postoperatively.For a prolonged application of an intervention, there was evidence from four low risk of bias trials that the risk of otorrhoea was reduced two weeks postoperatively by antibiotic ear drops (from 15% to 8%; RR 0.54, 95% CI 0.30 to 0.97; NNTB 15; one RCT; 372 children), antibiotic/steroid ear drops (from 39% to 5%; RR 0.13, 95% CI 0.05 to 0.31; NNTB 3; one RCT; 200 children), aminoglycoside/steroid ear drops (from 15% to 5%; RR 0.37, 95% CI 0.18 to 0.74; NNTB 11; one RCT; 356 children) or oral antibacterial agents/steroids (from 39% to 5%; RR 0.13, 95% CI 0.03 to 0.51; NNTB 3; one RCT; 77 children).Only one trial assessed the secondary outcome of ototoxicity, but no effect was found. There were no trials that assessed quality of life.

AUTHORS' CONCLUSIONS

Our review found that each of the following were effective at reducing the rate of otorrhoea up to two weeks following surgery: (1) multiple saline washouts at surgery, (2) a single application of topical antibiotic/steroid drops at surgery, (3) a prolonged application of topical drops (namely antibiotic ear drops, antibiotic/steroid eardrops or aminoglycoside/steroid ear drops) and (4) a prolonged application of oral antibacterial agents/steroids. However, the rate of otorrhoea between RCTs varied greatly and the higher the rates of otorrhoea within a RCT, the smaller the NNTB for therapy.We conclude that if a surgeon has a high rate of postoperative otorrhoea in children then either saline irrigation or antibiotic ear drops at the time of surgery would significantly reduce that rate. If topical drops are chosen, it is suggested that to reduce the cost and potential for ototoxic damage this be a single application at the time of surgery and not prolonged thereafter.

Paraganglioma of the skull base presenting as nasal polyps

The authors report a case of paraganglioma of the skull base presenting as nasal polyps. A 29-year-old patient presented with epistaxis and was found to have nasal polyps. The patient underwent a nasal polypectomy. After pathology showed an unusual appearance, the mass was subsequently excised endoscopically using radiofrequency coblation, and it was found to be originating from the skull base. The diagnosis was made using a combination of clinical findings, radiology, and histopathology examination. It is important to consider paraganglioma in the differential diagnosis of unusual tumors of the nose and skull base.

Early experience of radio frequency coblation in the management of intranasal and sinus tumors

The purpose of this study was to evaluate the safety and efficacy of the use of radiofrequency coblation for endoscopic resection of intranasal and sinus tumors. A review was conducted of 15 adult patients with intranasal and or sinus tumors endoscopically treated with radio frequency coblation between November 2008 and November 2010 at St. John's Hospital at Livingston, a tertiary referral center that covers otolaryngology services for the southeast of Scotland. Fifteen patients with intranasal and sinus tumors were treated with transnasal endoscopic resection using radiofrequency coblation. The tumors included inverted papilloma (seven), paraganglioma (one), glomangiopericytoma (one), capillary hemangioma (one), hemangiopericytoma (one), juvenile angiofibroma (one), juvenile ossifying fibroma (one), oncocytic adenoma (one), and transitional cell carcinoma (one). We found that radiofrequency coblation is a useful and safe tool associated with minimal blood loss (<200 mL to 600 mL) in the resection of these tumors, and the average operating time was 1.67 hours. Radio frequency is a rapidly evolving technique and in the future will have an increasing role to play in the endoscopic resection of intranasal and sinus tumors.

Hemoglobin monitoring in head and neck cancer patients undergoing radiotherapy

OBJECTIVES

Anemia is a well-recognized factor for local recurrence and decreased survival in cancer patients undergoing radiotherapy. Additionally, lower hemoglobin (Hb) levels have a negative impact on radiotherapy efficacy and response rates. The objective of this audit was to investigate how frequently Hb levels were observed in head and neck cancer patients receiving radiotherapy within a multidisciplinary team setting.

METHODS

We performed a retrospective first-cycle audit in a university hospital in Glasgow that is a tertiary referral center for head and neck cancer. Included were 78 patients with head and neck cancer who were undergoing radiotherapy. Online laboratory services and clinical case sheets were checked for each patient to monitor the frequency of observation of Hb levels before, during, and after radiotherapy.

RESULTS

Of these 78 patients, only 49 had their Hb level checked before radiotherapy treatment, only 9 during radiotherapy, and only 27 after completion of radiotherapy treatment (p < 0.0001). Of the 49 patients with preradiotherapy Hb levels available, 24% were found to be anemic; none of these patients had their Hb monitored during radiotherapy, and only 4 had Hb levels recorded after completion of treatment.

CONCLUSIONS

This audit has highlighted that despite evidence emphasizing that anemia in cancer is an independent prognostic factor for recurrence, there is no formal protocol for Hb monitoring in head and neck cancer patients undergoing radiotherapy. The audit has also demonstrated that Hb monitoring is infrequently performed and that subsequent observation of the Hb level is suboptimal.

Gamma tubulin: A promising indicator of recurrence in squamous cell carcinoma of the larynx

Objective: Centrosome amplification as detected by gamma tubulin (GT) immunostaining is associated with genetic instability and tumor aggressiveness. We assessed GT for its ability to predict recurrence of squamous cell carcinoma of the larynx (SCCL).

Study Design: Case series with chart review.

Materials and Methods: Five micron sections of 35 archival SCCL samples were subjected to antigen retrieval and immunostaining with antibody to GT. The keratin antibody CK5 served as a positive control for antigen retrieval, and tonsillar tissue was used as a negative control.

Results: Of the 35 tumors analyzed, 22 were associated with recurrence(R) and 13 were not (NR). Fourteen of the 22 R tumors, but 0 of 13 of the NR tumours had a GT staining score of 2+ or 3+ ( P < 0.0002). GT was also related to recurrence in node-negative tumors ( P < 0.006) but was unrelated to T stage ( P = 0.726).

Conclusions: GT staining appears to be a better predictor of tumor recurrence than T stage and also predicts recurrence in N0 tumors.

Unintended benefits of immunosupression on autoimmune disease due to chemoradiation therapy for head and neck cancer

The immune system is an important factor in the host's defenses against cancer. Immunosupression by radiation and/or chemotherapy is often associated with systemic and hematologic complications, opportunistic infections, and the development of malignancies, but immunosupression can also have beneficial effects, which are sometimes incidental. We report 2 patients with autoimmune diseases where immunosupression had beneficial effects. The first case is about a patient with carcinoma of the tonsil, with severe rheumatoid arthritis, who was treated with chemoradiation, which resulted in remission of his arthritis. The second case is about a patient with severe atopic eczema who was on long-term treatment with psoralen and ultraviolet A radiation and azathioprine; the patient developed metastatic carcinoma of the lip, which was treated with surgery and radiation that resulted in complete remission of his eczema.

Life threatening hemorrhage from osteoradionecrosis of the ribs and clavicle

Osteoradionecrosis (ORN) is a familiar complication of radiotherapy. ORN of the clavicle and ribs is well documented after radiation therapy for breast and pulmonary malignancy. ORN of the clavicle after radiation therapy to the neck is very rare. We report the first case in which both clavicles and first ribs underwent ORN 14 years after neck irradiation and surgery for laryngeal malignancy. The presentation was atypical; erosion of the right internal mammary artery causing life-threatening hemorrhage. Otolaryngologists should be aware that ORN can occur at an unusual site and can have an atypical presentation.

Lemierre Syndrome: Two Cases and a Review

OBJECTIVES

Lemierre syndrome is usually caused by an acute oropharyngeal infection in previously healthy young adults, resulting in thrombophlebitis of the internal jugular vein, leading to metastatic septic embolization and bacteraemia. The usual organism is Fusobacterium necrophorum. Lemierre syndrome, not so long ago labeled as the "forgotten disease," is on the rise. Today with increasing antibiotic-resistant organisms, and decreasing awareness of the syndrome, subsequent re-emergence of this "forgotten disease" is becoming more common in clinical settings. Lemierre syndrome has significant morbidity. Cranial nerve complications associated with the condition have been increasingly diagnosed in the last few years. Looking back at literature on Lemierre syndrome, there have been review articles in medical and microbiology journals but rarely in otolaryngology journals. By presenting our cases we demonstrate the diverse presentations and severity of the illness.

METHODS

A review of the literature and a case report on two cases seen in our institution in the last year are presented. Each of these had varied presentations and neurologic complications-one developed 9th to 12th cranial nerve palsies and Horner syndrome, which have not been described in previous literature, and the other developed polyneuropathy and a frontal lobe infarct among other multisystem complications.

CONCLUSIONS

Diagnosis of Lemierre syndrome is not always straightforward as clinical features are variable and blood cultures are often negative. Awareness of the syndrome and a high degree of suspicion are needed.

Symptomatic refractures after vertebroplasty in patients with steroid-induced osteoporosis

BACKGROUND AND PURPOSE

Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis.

METHODS

A retrospective analysis was performed on all osteoporosis patients having initial vertebroplasty from August 1999 to August 2003. The follow-up period was limited to 1 year after initial vertebroplasty session, with the last follow-up date ending in August 2004. Data were collected on 387 osteoporosis patients.

RESULTS

Of the patients with primary osteoporosis, 20.6% patients refractured whereas 37.8% of the patients with steroid-induced osteoporosis had symptomatic refractures within 1 year of initial vertebroplasty. Relative risk of refracture within 1 year for the patients with steroid-induced osteoporosis was 1.84 compared with the patients with primary osteoporosis. In addition, the patients with steroid-induced osteoporosis were more likely to refracture after their second treatment session (within 1 year of initial vertebroplasty) than those with primary osteoporosis.

CONCLUSION

Patients presenting on oral steroid therapy at their initial vertebroplasty are almost twice more likely to have symptomatic refractures than primary osteoporosis patients within 1 year of initial vertebroplasty.

Fatal fat embolism after vertebroplasty: identification of the high-risk patient

We report a rare complication of autopsy-proven fat and bone marrow embolization following percutaneous vertebroplasty in a patient who had no evidence of cement leakage. Cement injection was done during one patient encounter, covering 3 vertebral levels by using a unipedicular approach. Patients may have complications even without polymethylmethacrylate leakage.