Fat plug myringoplasty: Analysis of a safe procedure for small tympanic perforations

Objective: Assessment of value of fat plug myringoplasty as office-based procedure in small tympanic membrane perforations. Material and Methods: Prospective study of consecutive patients undergoing fat plug myringoplasty under local anesthesia. Minimum follow-up considered was 6 months, which included several microscopic examinations. All data were recorded and analyzed statistically. Results: 33 patients matched the inclusion criteria; the mean perforation size was 2.8 mm. No change in PTA was noted after surgery in the whole series. Recurrence of perforation was detected in 7 cases (21%), which was statistically related with the cause of perforation rather than location or size (p-value <0.01). Conclusions: Fat plug myringoplasty is a safe procedure with very low rate of complications, and it is an office-based procedure well tolerate by all patients. Results in case of primary surgery are excellent, with a high success rate (90%). In case of recurrent perforation after traditional surgery, success rate get decreased

Changes in plasma phenylalanine, isoleucine, leucine, and valine are associated with significant changes in intracranial pressure and jugular venous oxygen saturation in patients with severe traumatic brain injury

Changes in plasma aromatic amino acids (AAA = phenylalanine, tryptophan, tyrosine) and branched chain amino acids (BCAA = isoleucine, leucine, valine) levels possibly influencing intracranial pressure (ICP) and cerebral oxygen consumption (SjvO(2)) were investigated in 19 sedated patients up to 14 days following severe traumatic brain injury (TBI). Compared to 44 healthy volunteers, jugular venous plasma BCAA were significantly decreased by 35% (p < 0.001) while AAA were markedly increased in TBI patients by 19% (p < 0.001). The BCAA to AAA ratio was significantly decreased by 55% (p < 0.001) which persisted during the entire study period. Elevated plasma phenylalanine was associated with decreased ICP and increased SjvO(2), while higher plasma isoleucine and leucine levels were associated with increased ICP and higher plasma leucine and valine were linked to decreased SjvO(2). The amount of enterally administered amino acids was associated with significantly increased plasma levels with the exception of phenylalanine. Contrary to the initial assumption that elevated AAA and decreased BCAA levels are detrimental, increased plasma phenylalanine levels were associated with beneficial signs in terms of decreased ICP and reduced cerebral oxygen consumption reflected by increased SjvO(2); concomitantly, elevated plasma isoleucine and leucine levels were associated with increased ICP while leucine and valine were associated with decreased SjvO(2) following severe TBI, respectively. The impact of enteral nutrition on this observed pattern must be examined prospectively to determine if higher amounts of phenylalanine should be administered to promote beneficial effects on brain metabolism and if normalization of plasma BCAA levels is without cerebral side effects