EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Bilateral synchronous squamous cell tonsil carcinoma treated with chemoradiotherapy

The incidence of numerous head and neck tumours is a known issue though bilateral synchronous tonsillar carcinoma reports are so uncommon that only 20 cases were found in a literature review. Most of these patients were treated with bilateral tonsillectomy followed by adjuvant radiotherapy. We report, to our knowledge, the first case of bilateral synchronous tonsillar squamous cell carcinoma treated only with chemoradiotherapy without tonsillectomy

Could radiofrequency myringotomy be an alternative to incisional myringotomy?

Objective: To evaluate the usefulness of radiofrequency myringotomy (RFM) and the closure time of the myringotomy site in comparison to incisional myringotomy (IM). Methods: We performed conventional surgical myringotomy on the right ears and RFM on the left ears of 40 rabbits. In order to investigate the effect of the power of energy delivered on the patency period we arranged the animals into two groups: three power grade in RFM group 1 (RFMg1; n: 20) and six power grade in RFM group 2 (RFMg2; n: 20). The follow-up of the myringotomy procedure was performed on days 5, 8, 11, 14 and 17 with examination under the operating microscope. Results: At the first examination on day 5 after the procedure, all IM openings were found to be closed while seven and eight (36 and 44%) of the tympanic membranes in the radiofrequency groups 1 and 2 remained open, respectively. In these remaining ears, RFM site was patent up to days 11 and 14, respectively in the two RFM groups. None of the RFMs was patent on study day 17. The difference between the closure time of myringotomy sites of the radiofrequency and IM groups was statistically significant (p < 0.05). In comparison of the two RFM groups, we found approximately equal rates regarding the myringotomy patency (p > 005; ?2 yates: 0.02). The complication rates were 5 and 2% for the IM and RFM groups, respectively. Conclusions: Radiofrequency myringotomies last longer than incisional myringotomies. With the low complication rate, it is possible to perform this bloodless RF procedure in an office setting. Increased power grade of radiofrequency has no effect on prolonging the myringotomy patency. RFM appears to be a safe and simple procedure that can be used as an alternative to IM. © 2008 Elsevier Ireland Ltd. All rights reserved

Pneumatization of the inferior turbinate

Pneumatized inferior turbinate (PIT) is a very rarely encountered variation. Extensive turbinate pneumatization may lead to turbinate enlargement and may be responsible for persistent nasal obstruction. The gold standard method for diagnosis is sinus computerized tomography. We present a 25-year-old male patient who had nasal obstruction due to unilateral PIT and septal deviation and underwent surgical correction with improvement in his symptoms. © 2004 Elsevier Ireland Ltd. All rights reserved

Congenital cholesteatoma: A case report

Congenital cholesteatoma is a rare entity characterized by a white mass behind an intact tympanic membrane. It arises from ectopic epidermoid remnants in the middle ear. In this article, a case of congenital cholesteatoma is discussed with regard to the presentation, localization and treatment of the disease

Giant mucocele originating from the middle concha in a 5-year-old child: A case report

Introduction. Mucoceles are mucus-filled, epithelial-lined sacs that slowly develop in the paranasal sinuses when sinus or concha bullosa drainage is obstructed by inflammatory processes, trauma, or prior surgery. They are extremely rare in children. Symptoms usually arise from the nasal obstruction or compression of neighboring structures. Case presentation. This case report describes a 5-year-old Turkish boy with a 3-year history of nasal obstruction. A computed tomography scan showed a well-defined soft tissue density lesion, seemingly originating in the region of the middle concha and was suggestive of a middle concha mucocele. The mass was removed by endoscopic sinus surgery. Conclusions: In the case of a child presenting with nasal obstruction, mucocele should be remembered in the differential diagnosis of intranasal tumors. Computed tomography and magnetic resonance imaging are helpful in making the diagnosis and endoscopic nasal surgery has proven successful in the treatment. © 2013 Aslan et al.; licensee BioMed Central Ltd

Cervical sympathetic chain schwannoma mimicking a carotid body tumor: A case report

Carotid body tumor (CBT), the most common tumor of the carotid bifurcation, presents as a pulsatile mass. Cervical sympathetic chain (CSC) schwannomas are slow growing lesions originating from myelin-producing Schwann cells. They may appear pulsatile due to the displacement of vascular structures by the non-vascular mass and thus may mimic a CBT. A case of CSC schwannoma masquerading as CBT in a 25-year-old woman is presented and discussed here

Retropharyngeal abscess [Retrofarengeal apse]

Retropharyngeal abscess is a rare but serious disease, which is seen especially in childhood. It may lead to symptoms like neck swelling, sudden airway obstruction and etc. The most common findings are fever, neck swelling, swallowing and feeding problems. The duration of symptoms and signs can be variable. Diagnosis is confirmed by lateral neck radiographs. The most helpful diagnostic means are direct visualization and computerized tomography scan of the cervical area. Early diagnosis and surgical treatment prevents serious complications such as mediastinal spread, aspiration of pus, airway obstruction or erosion into a major vessel. In this paper, we present a seventy four-year-old case with retropharyngeal abscess who admitted with severe respiratory distress and severe feeding problems

An unusual movement of the tongue [18]

[No abstract available

Three-dimensional CT of Eagle's syndrome

This case report presents three-dimensional computed tomography (3D-CT) findings in the diagnosis of Eagle's syndrome that is characterized with an elongated styloid process or a calcified stylohyoid ligament causing craniofacial or cervical pain. We have performed 3D-CT in three patients suspected to have this condition. Coronal images were taken in two patients and axial images in one patient with a spiral CT scanner. 3D-CT images were then produced. The length of the styloid process in the case suspected of right elongated styloid process was 45.6 mm (left styloid process, 37 mm). In the second case suspected of left elongated styloid process, the length of the left styloid process was 41.1 mm (right styloid process, 40.2 mm). In the last case suspected of right elongated styloid process, the length of the right styloid process was 40.6 mm (left styloid process, 38.9 mm). 3D-CT is a valuable diagnostic tool in the diagnosis of Eagle's syndrome because of its ability to facilitate accurate measurement of the length of the styloid process. © Turkish Society of Radiology 2005