The Role of Somatostatin Treatment in the Management of Chylous Fistula after Neck Dissection

Chylous fistula is a serious complication of neck dissection. The use of somatostatin after neck surgery, has been described in literature. Because of the absence of definitive guidelines, reporting of our experience in three cases may guide the surgeons to overcome this life threatening complication. We descibe three cases who underwent neck dissection. While two of them had high output (>1000 mL/day), one had a low output (250 mL/ day) chyle leakage, after neck dissection. After it was noticed in earlier days, conservative management was started immediately. While Somatostatin was started after the re-exploration in two, it was started due to the failure of conservative treatment for low output leakage in one. All of the chyleous fistulas were healed within less than two weeks. We think that somatostatin may be considered as an effective treatment in low output chyle fistulas which the leakage continues after conservative treatment; however in high output chyle fistulas, somatostatin should be used in patients due to lack of control of leakage after ligation of thoracic ductus in revision Somatostatin treatment was discussed in the light of the current literature

Is ChatGPT accurate and reliable in answering questions regarding head and neck cancer?

Background and objectiveChat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence (AI)-based language processing model using deep learning to create human-like text dialogue. It has been a popular source of information covering vast number of topics including medicine. Patient education in head and neck cancer (HNC) is crucial to enhance the understanding of patients about their medical condition, diagnosis, and treatment options. Therefore, this study aims to examine the accuracy and reliability of ChatGPT in answering questions regarding HNC.Methods154 head and neck cancer-related questions were compiled from sources including professional societies, institutions, patient support groups, and social media. These questions were categorized into topics like basic knowledge, diagnosis, treatment, recovery, operative risks, complications, follow-up, and cancer prevention. ChatGPT was queried with each question, and two experienced head and neck surgeons assessed each response independently for accuracy and reproducibility. Responses were rated on a scale: (1) comprehensive/correct, (2) incomplete/partially correct, (3) a mix of accurate and inaccurate/misleading, and (4) completely inaccurate/irrelevant. Discrepancies in grading were resolved by a third reviewer. Reproducibility was evaluated by repeating questions and analyzing grading consistency.ResultsChatGPT yielded “comprehensive/correct” responses to 133/154 (86.4%) of the questions whereas, rates of “incomplete/partially correct” and “mixed with accurate and inaccurate data/misleading” responses were 11% and 2.6%, respectively. There were no “completely inaccurate/irrelevant” responses. According to category, the model provided “comprehensive/correct” answers to 80.6% of questions regarding “basic knowledge”, 92.6% related to “diagnosis”, 88.9% related to “treatment”, 80% related to “recovery – operative risks – complications – follow-up”, 100% related to “cancer prevention” and 92.9% related to “other”. There was not any significant difference between the categories regarding the grades of ChatGPT responses (p=0.88). The rate of reproducibility was 94.1% (145 of 154 questions).ConclusionChatGPT generated substantially accurate and reproducible information to diverse medical queries related to HNC. Despite its limitations, it can be a useful source of information for both patients and medical professionals. With further developments in the model, ChatGPT can also play a crucial role in clinical decision support to provide the clinicians with up-to-date information

Sphenoid Sinus Injury Leading Pneumocephalus as a Complication of Conventional Septoplasty

Septoplasty is the most commonly performed operation in otolaryngology. Other than the more common complications such as hemorrhage, septal hematoma and abscess, perforation and postoperative deformities, the surgeon must also be aware of the rare but life-threatening ones such as skull base and intracranial injury, cerebrospinal fluid rhinorrhea, meningitis, pneumocephalus, subarachnoid hemorrhage, intracranial abscess and cavernous sinus thrombosis. Herein, we present the case of a sphenoid sinus posterior wall injury leading to pneumocephalus as a complication of conventional septoplasty treated with obliteration and a fascia lata graft endoscopically

Difficulty of Differential Diagnosis: Granulomatous Diseases of Nasal Cavity and Paranasal Sinuses

Infectious diseases are important causes of granulomatous diseases of the nasal cavity and paranasal sinuses. The most frequent bacterial agents responsible for granulomatous infections are Mycobacterium species (spp.) and Actinomyces spp. In the case of fungal pathogens, Aspergillus spp. are the most frequent. Mucor spp., Cryptococcus spp. and Histoplasma spp. are the other fungal microorganisms causing granulomatous reactions. In this case report, a patient suffering from a chronic nasal cavity lesion for 4 years with a recently developed premaxillary skin lesion is presented. Despite many biopsies having been performed and pathological studies conducted, a definitive diagnosis and an effective treatment could not be achieved. Finally, Aspergillus growth was observed in the fungal growth media when the material of the last skin biopsy was sent to microbiology as well as pathology. The patient was diagnosed as “chronic nasal fungal infection” and voricanozole treatment was initiated. Nine months after therapy, symptoms were almost totally resolved. In order to prevent similar difficulties of differential diagnosis, biopsy materials should be sent for aerobic, tuberculosis and fungal cultivation, as well as pathological examination, in order not to miss infectious diseases from the aetiology

Total And Partial Laser Arytenoidectomy For Bilateral Vocal Fold Paralysis

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.PubMedWoSScopu

Congenital Laryngeal Cyst: A Rare Cause Of Polyhydramnios

Congenital laryngeal cyst is a rare cause of airway obstruction that may require urgent diagnosis and treatment. We report a case of a neonate having history of polyhydramnios and severe respiratory distress at birth. A laryngeal cyst detected during intubation. The outcome of laryngoscopic treatment of the cyst was favorable.PubMe