Study Design: A retrospective cohort of prospective data. Objective: Determine the frequency of various symptoms in a surgical cohort of cervical myelopathy (CM). Summary of Background Data: CM can be difficult to diagnose as there is no sine qua non “myelopathic symptom.” Despite extensive literature, the likelihood or frequency of symptoms at presentation remains unclear. Materials and Methods: A total of 484 patients treated at a single academic center were reviewed. Preoperative symptoms included: axial neck pain; upper extremity (UE) pain; UE sensory or motor deficit; lower extremity (LE) sensory or motor deficit; and sphincter dysfunction. It was noted whether a symptom was the chief complaint (CC) and/or one of a list of overall symptoms (OS) reported by the patient. Magnetic resonance imaging was assessed for the maximal cord compression level and T2 hyperintensity. Results: The most common CC was UE sensory deficit (46.5%), whereas the most common OS were UE and LE motor deficits (82.6% and 81.2%). Neck pain was significantly less common (32.6% CC, 55.4% OS), and sphincter dysfunction was rare (0.6% CC, 16.5% OS). UE pain as a CC was significantly higher when the maximal compression involved a more distal level. The presence of T2 hyperintensity was negatively associated with neck pain but positively associated with sensory and motor deficits of LE. Conclusions: The most common CC in CM related to UE sensation, whereas the most common OS related to upper and lower motor function. UE pain was more common with more distal cord compression. Those with T2 hyperintensity had worse myelopathy and were less likely to have neck pain, but more likely to have LE symptoms. To our knowledge, this study is the largest to quantify the frequency of myelopathic symptom presentation in a surgical population. These findings provide valuable insight into the symptomatic presentation of CM in clinical practice and can be used to better inform diagnosis and treatment in this complex patient population. Level of Evidence: Level II—retrospective study.

Objective Imaging findings play an important role in the workup and diagnosis of sinonasal disease. Unilateral versus bilateral involvement is a key finding that can differentiate between various diagnoses. Our objective is to characterize presenting symptoms, imaging findings, and most common diagnoses associated with unilateral versus bilateral sinonasal disease. Methods Patients who underwent surgical intervention for sinonasal disease at Emory University between May 2015 and December 2016 were included in the study. Information including demographic variables, comorbidities, presenting symptoms, imaging findings, and pathologic diagnosis was collected for each patient. Unilateral versus bilateral disease was determined by preoperative computer tomography and magnetic resonance imaging, and correlated to surgical and pathologic findings. Data was analyzed using quantitative methodologies and descriptive statistics. Results The study cohort consisted of 250 patients presenting for primary sinonasal surgery, including 110 patients with unilateral disease and 140 patients with bilateral disease. The most common diagnosis for patients with bilateral disease was chronic rhinosinusitis with nasal polyps (46%) followed by chronic rhinosinusitis without polyps (26%). For patients with unilateral disease the most common diagnoses were chronic rhinosinusitis without nasal polyps (21%), malignancy (19%), benign neoplasm (15%), and allergic fungal sinusitis (10%). There was a statistically significant association between unilateral sinonasal disease and the final diagnosis of benign neoplasm (OR = 7.8, P < .01) and malignancy (OR = 8, P < .01). Conclusion Patients with unilateral sinus disease on initial imaging are less likely chronic rhinosinusitis compared to patients with bilateral disease. This should be taken into consideration in the workup and management of patients with unilateral sinus disease. Level of Evidence 3 Laryngoscope, 130:E116–E121, 2020

Acute decompensated heart failure (ADHF) is the leading cause of hospital admissions in patients older than 65 years. These hospitalisations are highly risky and are associated with poor outcomes, including rehospitalisation and death. The management of ADHF is drastically different from that of chronic heart failure as inpatient treatment consists primarily of haemodynamic stabilisation, symptom relief and prevention of short-term morbidity and mortality. In this review, we will discuss the strategies put forth in the most recent American College of Cardiology/American Heart Association and Heart Failure Society of America guidelines for ADHF as well as the evidence behind these recommendations.

Background: Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. Methods: This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). Results: Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. Conclusion: Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. Level of Evidence: Level II, prospective cohort.

Level, III comparative series.