Neck Circumference Predicts Mortality in Hospitalized COVID-19 Patients

We aimed to determine whether neck circumference predicts mortality among hospitalized COVID-19 patients with respiratory failure. We performed a prospective multicenter (Italy and Brasil) study carried out from March to December 2020 on 440 hospitalized COVID-19 patients with respiratory failure. Baseline neck circumference was measured. The study outcome was 30- and 60-days mortality. Female and male participants were classified as “large neck” when exceeding fourth-quartile. Patients had a median age of 65 years (IQR 54–76), 68% were male. One-quarter of patients presented with grade-1 or higher obesity. The median neck circumference was 40 cm (IQR 38–43): 38 cm (IQR 36–40) for female and 41 cm (IQR 39–44) for male subjects. “Large neck” patients had a significantly higher prevalence of hypertension (63 vs. 48%), diabetes (33 vs. 19%), obesity (26 vs. 14%), and elevated C-reactive protein (CRP) (98 vs. 88%). The cumulative mortality rate was 13.1% (n = 52) and 15.9% (n = 63) at 30 and 60 days, respectively. After adjusting for age, BMI, relevant comorbidities, and high C-reactive protein to albumin ratio, “large neck” patients showed a significantly increased risk of death at 30- (adjusted HR 2.50; 95% CI 1.18–5.29; p = 0.017) and 60-days (adjusted HR 2.26; 95% CI 1.14–4.46; p = 0.019). Neck circumference is easy to collect and provides additional prognostic information to BMI. Among hospitalized COVID-19 patients with respiratory failure, those with large neck phenotype had a more than double risk of death at 30 and 60 days.

The contralateral based Cervico-pectoral rotation flap for large neck defects

Purpose We here describe our technique of contralateral based cervico-pectoral (CCP) flap for the reconstruction of large neck defect following resection of primary tumour or recurrence particularly due to the lymph node mass. Methods The study included the patients who underwent major head and neck surgical ablative procedures followed by CCP flap reconstruction between July 2020 and November 2020. Patients were kept on rigorous regular follow-up to evaluate for flap related complications like flap necrosis, flap dehiscence and oro-cutaneous fistula. Among the 5 patients included and presented in the series, 2 patients were salvage cases post adjuvant treatment. Results Five patients who have undergone head and neck reconstruction using CCP flap were included. No major flap related complications occurred in post-operative period. Conclusion The CCP flap is simple to perform and reproducible and can be added to the armamentarium for the reconstruction of large upper neck defect following resection of primary tumour or recurrence involving the cervical skin in resource limited setting and in contraindication for microvascular reconstruction. Proper planning, meticulous dissection and adequate release or rotation and tension free closure would provide best outcomes.

Neck circumference as an independent predictor for NAFLD among postmenopausal women with normal body mass index

Background Neck circumference, a proxy for upper-body subcutaneous fat, is a unique and pathogenic fat depot that confers additional metabolic risk. The purpose of present study was to determine whether neck circumference associates with nonalcoholic fatty liver disease (NAFLD) in postmenopausal women with normal body mass index. Methods A cross-sectional survey (n = 2492) and a 3.1-year follow-up investigation (n = 1354) were conducted among Chinese postmenopausal women with normal BMI (18.5 to < 25 kg/m2). Neck circumference was measured horizontally at the lower margin of the laryngeal prominence. Results In the cross-sectional analysis, large neck circumference was associated with the presence of NAFLD (odds ratio 2.28; 95% CI 1.74–2.98; highest tertile versus lowest tertile) after adjustment for confounding factors. Among 1354 subjects without the NAFLD at baseline, 429 (31.7%) incident NAFLD cases occurred at 3.1 years. Neck circumference was positively associated with triglycerides, homeostasis model assessment of insulin resistance, C-reactive protein, and negatively associated with high-density lipoprotein cholesterol and adiponectin. Individuals with large baseline neck circumference had a significantly higher risk of NAFLD than those with small neck circumference. The multivariable adjusted hazard ratio was 1.42 (95% CI 1.15–1.97; p for trend = 0.004) for the highest versus the lowest tertile of neck circumference, and was 1.22 (95% CI 1.10–1.41; p = 0.006) per 1-standard deviation increment in neck circumference. Conclusions Among postmenopausal women with normal BMI, relatively large neck circumference levels are associated with an increased risk of NAFLD.

Neck circumference as an independent predictor for NAFLD among postmenopausal women with normal body mass index

Background: Neck circumference, a proxy for upper-body subcutaneous fat, is a unique and pathogenic fat depot that confers additional metabolic risk. The purpose of present study was to determine whether neck circumference associates with nonalcoholic fatty liver disease (NAFLD) in postmenopausal women with normal body mass index.Methods: A cross-sectional survey (n=2,492) and a 3.1-year follow-up investigation (n=1,354) were conducted among Chinese postmenopausal women with normal BMI (18.5 to <25 kg/m2). Neck circumference was measured horizontally at the lower margin of the laryngeal prominence.Results: In the cross-sectional analysis, large neck circumference was associated with the presence of NAFLD (odds ratio 2.28; 95% CI 1.74-2.98; highest tertile versus lowest tertile) after adjustment for confounding factors. Among 1,354 subjects without the NAFLD at baseline, 429 (31.7 %) incident NAFLD cases occurred at 3.1 years. Neck circumference was positively associated with triglycerides, homeostasis model assessment of insulin resistance, C-reactive protein, and negatively associated with high-density lipoprotein cholesterol and adiponectin. Individuals with large baseline neck circumference had a significantly higher risk of NAFLD than those with small neck circumference. The multivariable adjusted hazard ratio was 1.42 (95% CI 1.15-1.97; p for trend =0.004) for the highest versus the lowest tertile of neck circumference, and was 1.22 (95% CI 1.10-1.41; p =0.006) per 1-standard deviation increment in neck circumference.Conclusions: Among postmenopausal women with normal BMI, relatively large neck circumference levels are associated with an increased risk of NAFLD.

Proximal Subclavian artery injury managed without performing median sternotomy: a case report

Subclavian artery runs from chest to upper arm and is in close proximity to many important structures in the limited space. Subclavian artery injuries are rare and tough to manage. It is challenging to achieve proximal arterial control which in most cases require median sternotomy with its associated morbidity. Iatrogenic injuries to subclavian artery can happen in a hostile operative field as with patients with large neck tumors. We present a 35-year-male who had right subclavian artery injury during neck dissection which was repaired successfully via supra-clavicular approach. Continuous...

Neck circumference as an independent predictor for NAFLD among postmenopausal women with normal body mass index

Background Neck circumference, a proxy for upper-body subcutaneous fat, is a unique and pathogenic fat depot that confers additional metabolic risk. The purpose of present study was to determine whether neck circumference associates with nonalcoholic fatty liver disease (NAFLD) in postmenopausal women with normal body mass index. Methods A cross-sectional survey (n = 2492) and a 3.1-year follow-up investigation (n = 1354) were conducted among Chinese postmenopausal women with normal BMI (18.5 to < 25 kg/m2). Neck circumference was measured horizontally at the lower margin of the laryngeal prominence. Results In the cross-sectional analysis, large neck circumference was associated with the presence of NAFLD (odds ratio 2.28; 95% CI 1.74–2.98; highest tertile versus lowest tertile) after adjustment for confounding factors. Among 1,354 subjects without the NAFLD at baseline, 429 (31.7%) incident NAFLD cases occurred at 3.1 years. Neck circumference was positively associated with triglycerides, homeostasis model assessment of insulin resistance, C-reactive protein, and negatively associated with high-density lipoprotein cholesterol and adiponectin. Individuals with large baseline neck circumference had a significantly higher risk of NAFLD than those with small neck circumference. The multivariable adjusted hazard ratio was 1.42 (95% CI 1.15–1.97; p for trend = 0.004) for the highest versus the lowest tertile of neck circumference, and was 1.22 (95% CI 1.10–1.41; p = 0.006) per 1-standard deviation increment in neck circumference. Conclusions Among postmenopausal women with normal BMI, relatively large neck circumference levels are associated with an increased risk of NAFLD.

Average of neck circumference in Latin American adults: protocol for a systematic review and meta-analysis

Background Because these are inexpensive and (fairly) easy to conduct, anthropometric measurements have been widely used as risk factors for many diseases (e.g., cardiovascular or cancer). Recently, there have been several reports pinpointing the association between neck circumference and obstructive sleep apnea, cardiovascular and metabolic diseases. These conditions are highly prevalent Latin American and the Caribbean (LAC), where they carry a large disease and disability burden. Neck circumference arises as a potential complement of established anthropometric measurements, namely weight, height and waist/hip circumference. However, unlike these well-known measurements, evidence about neck circumference is scarce and has not been systematically collected in LAC. Objective To summarize the average neck circumference in LAC adults; and, exploratorily, to summarize the prevalence of large neck circumference (i.e., neck/cervical obesity). Methods Systematic review and meta-analysis. We will conduct a search in OVID (MEDLINE, Embase, Global Health) and LILACS. Search terms include those related to neck circumference, along with countries in LAC. We seek observational studies with a random sample of the general population, closed populations (e.g., workers), and patients; results will be presented for each of these groups. We will screen titles and abstracts; we will study in detail the selected papers. Both phases will be conducted by two reviewers independently. We will develop an extraction form to collate: country/year of data collection, methods of data collection, average neck circumference and, if available, prevalence of large neck circumference. Data extraction will be conducted by two reviewers independently. We will use the tool proposed by Hoy et al. and the Newcastle-Ottawa scale to assess the risk of bias. Conclusions This systematic review and meta-analysis will provide the average neck circumference in LAC adults. Currently, evidence about neck circumference in LAC has not been systematically studied, appraised or summarized. This work will provide information about this novel anthropometric measurement, and spark attention about its role as a potential anthropometric indicator and health risk factor.

The Bilobed Flap as an Option for Large Neck

The bilobed flap has been extensively used in the reconstruction of distal nasal defects. It is a local flap that recruits skin from areas where there is relative skin mobility to close defects in areas where the skin has less plasticity. Besides its usefulness in the reconstruction of small to moderate cutaneous nasal defects it can also be used to reconstruct large defects located in other anatomical areas. We present a clinical case in which the bilobed skin flap was employed to reconstruct a large surgical defect of the neck resulting from excision of a basal cell carcinoma, with excellent functional and cosmetic results.