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Ectopic pancreas, also known as heterotopic pancreas, is a rare condition in which the pancreatic tissue is found outside its usual location in the gastrointestinal (GI) tract. It is commonly asymptomatic and benign, and is often discovered incidentally during routine imaging, endoscopy, surgery, or autopsy. However, complications can arise, such as inflammation, bleeding, obstruction, or even malignant transformation, necessitating surgical intervention in some cases. Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition and a diagnostic and therapeutic nightmare. Most cases have been diagnosed through invasive surgery due to concerns for malignancy, which carries significant morbidity and mortality. In our case, endoscopic snare papillectomy (ESP) was employed to establish a diagnosis. Thus far, only one other case has been reported in which ESP was used to diagnose and resect a pancreatic heterotopia at the ampulla.

Infectious esophagitis (IE) is the leading cause of esophagitis, second only to gastroesophageal reflux disease. Infectious esophagitis is typically observed in immunocompromised individuals due to neutropenia, HIV/AIDS, solid organ malignancies, cancer-directed therapy, or chronic steroid use. The most common causes of IE are herpes simplex virus (HSV), cytomegalovirus (CMV), and Candida albicans . Acute bacterial esophagitis is exceedingly rare, particularly in immunocompetent patients. Herein, we describe a unique case of acute streptococcal esophagitis in a male patient with no pertinent medical history. The patient’s substernal chest pain and odynophagia resolved after antibiotic treatment.

Acute esophageal necrosis (AEN), also known as Gurvits syndrome, is a rare and potentially life-threatening condition characterized by necrosis of the esophageal mucosa. Acute esophageal necrosis is often associated with critical conditions, such as myocardial infarction, diabetic ketoacidosis (DKA), coronavirus disease 2019 (COVID-19) infection, or post-surgical complications. Patients typically present with nausea, hematemesis, acute dysphagia, and melena. Given its high mortality rate, prompt detection with upper endoscopy and early initiation of treatment are crucial. Most cases of Gurvits syndrome are managed conservatively using intravenous fluids, proton pump inhibitors, and antibiotics. Herein, we present a case series of AEN in the setting of DKA. Both patients received supportive care and were discharged in a stable condition.

In response to the urgent requirement for rapid, precise, and cost-effective detection in intensive care units (ICUs) for ventilated patients, as well as the need to overcome the limitations of traditional detection methods, researchers have turned their attention towards advancing novel technologies. Among these, biosensors have emerged as a reliable platform for achieving accurate and early diagnoses. In this study, we explore the possibility of using Pyocyanin analysis for early detection of pathogens in ventilator-associated pneumonia (VAP) and lower respiratory tract infections in ventilated patients. To achieve this, we developed an electrochemical sensor utilizing a graphene oxide–copper oxide-doped MgO (GO − Cu − Mgo) (GCM) catalyst for Pyocyanin detection. Pyocyanin is a virulence factor in the phenazine group that is produced by Pseudomonas aeruginosa strains, leading to infections such as pneumonia, urinary tract infections, and cystic fibrosis. We additionally investigated the use of DNA aptamers for detecting Pyocyanin as a biomarker of Pseudomonas aeruginosa, a common causative agent of VAP. The results of this study indicated that electrochemical detection of Pyocyanin using a GCM catalyst shows promising potential for various applications, including clinical diagnostics and drug discovery.

Objective: Ototoxicity is an important side effect of cisplatin. Recent animal and in vitro studies suggest metformin may protect hearing, though human studies are lacking. We report the first retrospective clinical study exploring the effects of metformin on cisplatin-induced ototoxicity., Study Design: Retrospective case-control., Setting: Tertiary-care center., Methods: We reviewed all diabetic patients treated with cisplatin who were enrolled in an auditory monitoring program between January 1, 2000 and December 31, 2018. Patients were grouped according to their use of metformin at the time of chemotherapy. Demographics, oncologic diagnosis and treatment, and prior noise exposure were recorded. Audiometric thresholds were compared before and after chemotherapy. The primary outcome measure was a change in hearing as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). Secondary measures of ototoxicity included changes in hearing using the American Speech-Language-Hearing Association (ASHA) and TUNE criteria., Results: Seventy-two diabetic patients met the inclusion criteria. Forty-six patients had taken metformin while on chemotherapy and 26 had not. The proportion of hearing loss as defined by both, CTCAE and ASHA criteria, was more than double in the metformin group relative to the nonmetformin group (CTCAE: 54.4% vs 19.2%, P = .004; ASHA: 62.2% vs 28.0%, P = .003). None of the potential covariates believed to be confounders were significantly associated with the outcome of multivariable analysis., Conclusion: Contrary to expectations from preclinical data, metformin did not reduce the incidence of hearing loss in patients receiving cisplatin and may, in fact, be associated with an increased risk., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Cisplatin, a commonly used chemotherapy drug, is well-established for its ototoxic effects, primarily attributed to the damage it inflicts on cochlear hair cells. However, its impact on the vestibular system remains inadequately understood. Here, we provide a comprehensive review of existing literature concerning cisplatin-induced vestibulotoxicity. Animal studies have shown that cisplatin induces a vestibular hair cell loss that is dose-dependent, with the severity of damage also varying according to the route of administration. Notably, intratympanic and systemic injections in animal models have manifested significant damage primarily to utricular hair cells, with a lesser degree of damage observed for the other vestibular end organs. The underlying mechanisms of cisplatin induced vestibular hair cell loss include apoptosis, oxidative stress, and inflammatory cytokines. Several protective agents, such as Pifithrin-α, DAPT, Ginkgolide B, and heat shock proteins, have demonstrated efficacy in inhibiting cisplatin-induced vestibular damage in preclinical studies. Human clinical findings indicate that cisplatin treatment can cause vestibular dysfunction, characterized by symptoms ranging from transient dizziness to persistent vertigo. Challenges in diagnosis, including the limited utilization of comprehensive vestibular testing for many patients, contribute to the variability in reported outcomes. Cisplatin-induced vestibulotoxicity is a significant complication of chemotherapy, necessitating further research to understand its mechanisms and to improve diagnosis and management, ultimately aiming to enhance the quality of life for cancer patients undergoing cisplatin therapy., Competing Interests: MN reports stock ownership in 3M, Amgen, Kimberly-Clark, Johnson & Johnson, Medtronic, Nestle, and Pfizer. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Fleihan, Nader and Dickman.)

Abstract: A high-riding jugular bulb can complicate standard otologic and neurotologic approaches and must be taken into account during surgical planning., Competing Interests: M.-E.N. discloses that he is a shareholder of the following companies: 3M, Amgen, Pfizer, Johnson & Johnson, Kimberly Clark, Medtronic, and Nestle. P.W.G. discloses that he is a shareholder of the following companies: Amgen, Eli Lily, Medtronic, Merck, Novartis, Pfizer, and Roche. The remaining authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Objective: Temporal bone squamous cell carcinoma (TBSCC) is a rare malignancy with poor prognosis, and optimal treatment for advanced cases is uncertain. Our systematic literature review aimed to assess 5-year survival outcomes for advanced TBSCC across different treatment modalities., Data Sources: EMBASE, Medline, PubMed, and Web of Science., Review Methods: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles published between January 1989 and June 2023., Results: The review yielded 1229 citations of which 31 provided 5-year survival data for TBSCC. The final analysis included 1289 patients. T classification data was available for 1269 patients and overall stage for 1033 patients. Data for 5-year overall survival (OS) was 59.6%. Five-year OS was 81.9% for T1/2 and 47.5% for T3/4 (P < .0001). OS for T1/T2 cancers did not significantly differ between surgery and radiation (100% vs 81.3%, P  = .103). For advanced-stage disease (T3/T4), there was no statistical difference in OS when comparing surgery with postoperative chemoradiotherapy (CRT) (OS 50.0%) versus surgery with postoperative radiotherapy (XRT) (OS 53.3%) versus definitive CRT (OS 58.1%, P  = .767-1.000). There was not enough data to assess the role of neoadjuvant CRT., Conclusion: Most patients will present with advanced-stage disease, and nodal metastasis is seen in nearly 22% of patients. This study confirms the prognostic correlation of the current T classification system. Our results suggest that OS did not differ significantly between surgery and XRT for early stage disease, and combined treatment modalities yield similar 5-year OS for advanced cancers., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To evaluate the impact of losartan on vestibular schwannoma (VS) growth and related hearing loss during observation., Study Design: Retrospective cohort study., Setting: Tertiary referral center., Patients: Sporadic VS patients undergoing initial observation with at least two magnetic resonance imaging and audiologic examinations., Intervention: Losartan., Main Outcome Measures: Endpoints included VS growth, quantitative audiologic changes, survival free of tumor growth, and survival free of nonserviceable hearing. Patient characteristics and endpoints were compared by losartan use., Results: Seventy-nine patients were included, of which 33% were taking losartan. Tumor growth was observed in 50% of patients in the losartan group and 36% in the non-losartan group (p = 0.329). Survival analysis failed to show a significant difference in the hazard rate of VS growth between groups (hazard ratio, 1.38; 95% confidence interval, 0.70-2.70; p = 0.346). Throughout observation, mean decreases in normalized pure-tone average were 5.5 and 9.3 dB in the losartan and non-losartan groups, respectively (p = 0.908). Mean decreases in normalized word recognition score were 11.0 and 16.6% in the losartan and non-losartan groups, respectively (p = 0.757). Nonserviceable hearing developed in 19% of patients in the losartan group and 28% in the non-losartan group (p = 0.734). Survival analysis did not demonstrate a significant difference in the hazard rate of developing nonserviceable hearing between groups (hazard ratio, 1.71; 95% confidence interval, 0.56-5.21; p = 0.337)., Conclusions: Losartan use may not reduce the risk of VS growth or hearing loss during observation. A randomized trial would be ideal to further identify the true effect on growth and hearing., Competing Interests: Conflicts of interest: M.E.N. reports stock ownership in 3M, Amgen, Cardinal Health, Johnson & Johnson, Medtronic, and Pfizer. P.W.G. reports stock ownership in Amgen, Eli Lily, Merck, Medtronic, Novartis, Pfizer, and Roche. There are no conflicts of interest to declare for the remaining authors., (Copyright © 2024, Otology & Neurotology, Inc.)

Objective: To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis., Databases Reviewed: PubMed, Cochrane Library, and Embase., Methods: We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change., Results: The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%)., Conclusion: Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon., Competing Interests: Conflicts of interest and disclosures: M.E.N. reports stock ownership in 3M, Amgen, Cardinal Health, Johnson & Johnson, Medtronic, and Pfizer., (Copyright © 2024, Otology & Neurotology, Inc.)