Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane

xlomafota13 shared this article with you from Inoreader Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 15:S1808-8694(21)00186-5. doi: 10.1016/j.bjorl.2021.10.005. Online ahead of print. ABSTRACT OBJECTIVES: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. METHODS: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. RESULTS: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20 dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. CONCLUSION: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG t hreshold, only for PT. EVIDENCE LEVEL: 4. PMID:34896036 | DOI:10.1016/j.bjorl.2021.10.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Orbital schwannoma with hyposmia as the only presentation: Case report and a literature review on differential diagnosis

xlomafota13 shared this article with you from Inoreader Orbital schwannoma with hyposmia as the only presentation: Case report and a literature review on differential diagnosis Via ear nose throat Ear Nose Throat J. 2021 Dec 13:1455613211059862. doi: 10.1177/01455613211059862. Online ahead of print. ABSTRACT Orbital schwannoma is a rare benign tumor, originating from the Schwann cells of the orbital peripheral nerve sheath. Orbital schwannoma is easily misdiagnosed if the patient shows atypical presentations and atypical appearance on MRI imaging. A 56-year-old male experienced hyposmia for 1 year and was misdiagnosed with cavernous hemangioma pre-operation. This case was treated by surgery through the endoscopic trans-nasal approach. After operation, the patient had no recurrence or complications. Preoperative diagnosis for these cases remains difficult. Combined imaging modalities including computed tomography (CT) and magnetic resonance imaging (MRI) can help in differential diagnosis. Surgery is the main treatment modality for treating orbital schwannoma. Outcomes in most cases are favorable without complications or recurrence. PMID:34894799 | DOI:10.1177/01455613211059862 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A systematic review of immunomodulatory strategies used in skin-containing preclinical vascularized composite allotransplant models

xlomafota13 shared this article with you from Inoreader A systematic review of immunomodulatory strategies used in skin-containing preclinical vascularized composite allotransplant models Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 13:S1748-6815(21)00548-9. doi: 10.1016/j.bjps.2021.11.003. Online ahead of print. ABSTRACT BACKGROUND: Acute rejection remains a vexing problem in vascularized composite allotransplantation (VCA). Available immunosuppressive regimens are successful at minimizing alloimmune response and allowing VCA in humans. However, repeated rejection episodes are common, and systemic side effects of the current standard regimen (Tacrolimus, MMF, Prednisone) are dose limiting. Novel immunomodulatory approaches to improve allograft acceptance and minimize systemic toxicity are continuously explored in preclinical models. We aimed to systematically summarize past and current approaches to help guide future research in this complex field. METHODS: We conducted a systematic review of manuscripts listed in the MEDLINE and PubMed databases. For inclusion, articles had to primarily investigate the effect of a th erapeutic approach on prolonging the survival of a skin-containing preclinical VCA model. Non-VCA studies, human trials, anatomical and feasibility studies, and articles written in a language other than English were excluded. We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: The search retrieved 980 articles of which 112 articles were ultimately included. The majority of investigations used a rat model. An orthotopic hind limb VCA model was used in 53% of the studies. Cell and drug-based approaches were investigated 58 and 52 times, respectively. We provide a comprehensive review of immunomodulatory strategies used in VCA preclinical research over a timeframe of 44 years. CONCLUSION: We identify a transition from anatomically non-specific to anatomical models mimicking clinical needs. As limb transplants have been most frequently performed, preclinical research focused on using the hind limb model. We also id entify a transition from drug-based suppression therapies to cell-based immunomodulation strategies. PMID:34895853 | DOI:10.1016/j.bjps.2021.11.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group

xlomafota13 shared this article with you from Inoreader UK Guidelines for Lipomodelling of the Breast on behalf of Plastic, Reconstructive and Aesthetic Surgery and Association of Breast Surgery Expert Advisory Group Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 19:S1748-6815(21)00473-3. doi: 10.1016/j.bjps.2021.09.033. Online ahead of print. ABSTRACT Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications, training, technique, audit and outcomes in lipomodelling and also highlight areas for further research. PMID:34895855 | DOI:10.1016/j.bjps.2021.09.033 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long-term results of a standardized enhanced recovery protocol in unilateral, secondary autologous breast reconstructions using an abdominal free flap

xlomafota13 shared this article with you from Inoreader Long-term results of a standardized enhanced recovery protocol in unilateral, secondary autologous breast reconstructions using an abdominal free flap Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 14:S1748-6815(21)00563-5. doi: 10.1016/j.bjps.2021.11.019. Online ahead of print. ABSTRACT BACKGROUND: In 2015, we published one of the first reports using an enhanced recovery protocol (ERP) in microsurgery1, and in 2016, our final ERP setup in autologous breast reconstruction (ABR) using free abdominal flaps2. We showed that by adhering to a few simple, easy to measure, functional discharge criteria, it was possible to safely discharge the patients by the third postoperative day (POD). However, one of the challenges of interpreting studies using ERP in ABR is the often heterogenous patient populations and the need to clearly distinguish between primary and secondary and unilateral and bilateral reconstructions. MATERIALS AND METHODS: In the 5-year period from 2016-2020, the same surgical team, performed 147 unilateral, delayed breast reconstructions (135 DIEP, 9 MS-T RAM-2, and 3 SIEA flaps) according to our previous analgesic protocol and surgical strategy. Data were collected prospectively. RESULTS: Three flaps were lost (2%) and 82% of the patients(n=128) were discharged to home by POD 2 (n=8%) or 3 (74%). The remaining 18% (n=26) were discharged by POD 4 (12.5%) or 5 (5.5%). Ten patients (7%) were reoperated, and 17 patients (12%) had minor complications within POD 30 (infection, seroma, etc.) that did not necessitate hospital admission. CONCLUSION: Using our ERP, unproblematic discharge directly to home is possible on POD 3 in more than 80% of patients after ABR. ERP is no longer a research tool but considered standard of care in microsurgical breast reconstruction. PMID:3489 5856 | DOI:10.1016/j.bjps.2021.11.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical risk prediction for nasolacrimal duct obstruction in radioactive iodine treated thyroid cancer: A nationwide cohort study

xlomafota13 shared this article with you from Inoreader Surgical risk prediction for nasolacrimal duct obstruction in radioactive iodine treated thyroid cancer: A nationwide cohort study Via radioactive iodine Thyroid. 2021 Dec 12. doi: 10.1089/thy.2021.0418. Online ahead of print. ABSTRACT BACKGROUND: To estimate the incident risk of surgical intervention for nasolacrimal duct obstruction after radioactive iodine (RAI) treatment and elucidate the high-risk group of patients with thyroid cancer (TC). METHODS: This is a nationwide, population-based, cohort study using data from the Korean National Health Claims database. Among the entire South Korean population aged between 20 and 8 0 years from 2007 to 2019, all patients with TC were included. Among all TC patients, a cohort was established by classifying it into the RAI and non-RAI groups according to whether RAI treatment was performed during the recruitment period. A log-rank analysis was used to evaluate the risk of nasolacrimal duct obstruction surgery in the RAI group compared to that in the non-RAI group. The cox proportional hazards regression analysis was performed to calculate the adjusted hazard ratio (HR). The analysis was performed stratified by the age group, sex, frequency of RAI treatment, and cumulative dose of I131. RESULTS: Among 55371 TC patients, who received RAI treatment, 515 (0.93%) underwent NLDO surgeries, and among 56950 TC patients, who did not receive RAI treatment, 72 (0.13%) underwent the surgeries. The average timing of incident nasolacrimal duct obstruction surgery was 3.8 ± 2.1 years after the first exposure to RAI. The incidence rate of nasolacrimal duct obstruction su rgery was 104.04/100000 person-years in the RAI group. There was a significantly higher risk of nasolacrimal duct obstruction surgery (HR 7.50, 95% confidence interval [CI]: 5.86-9.60, p < 0.001) in the RAI group than in the non-RAI group. The risks significantly increased in the high-dose group (HR 14.15, 95% CI: 10.88-18.39) and those younger than 50 years (HR 15.54, 95% CI: 9.76-24.72). CONCLUSION: We quantified the risk of RAI-induced nasolacrimal duct obstruction surgery through a long-term follow-up of 9 years, which may contribute to estimating the general health care burden related to RAI treatment for TC patients in a practical setting. Great attention should be paid to its risk in patients younger than 50 years, especially in those treated with high doses. PMID:34894720 | DOI:10.1089/thy.2021.0418 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery

xlomafota13 shared this article with you from Inoreader Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery Via Polyps Auris Nasus Larynx. 2021 Dec 9:S0385-8146(21)00270-4. doi: 10.1016/j.anl.2021.11.011. Online ahead of print. ABSTRACT OBJECTIVES: Latest literature proposes laryngopharyngeal reflux (LPR) as the underlying contributory factor for chronic inflammation in both upper and lower airways. In this study, we investigated LPR symptoms and signs of CRS patients and the various factors on their LPR symptoms and signs. We also evaluated the effect of the LPR symptoms and signs of CRS patients after endoscopic sinus surgery (ESS). METHODS: We performed a retrospective analysis from 91 patients who underwent primary ESS. They were assessed for LPR symptoms with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before ESS. Sino-Nasal Outcome Test (SNOT)-22, Lund-Mackay (LM) scoring system, and Lund-Kennedy (LK) scoring system were evaluated for CRS severity. They had to fulfill SNOT-22, RSI, and RFS at 6 months after surgery. RESULTS: N asal polyps, smoking, asthma, allergy, LM scores and LK scores didn't have significant correlations with preoperative RSI and RFS (P > .05 for all). RSI had significant correlations with SNOT-22 preoperatively and postoperatively (P < .05 for all). RFS had a significant correlation with postoperative SNOT-22 (P = 0.034). RSI and RFS decreased significantly more after ESS (P < 0.001 for both). Smoking had a significant effect on the postoperative RFS (P = 0.003). Non-smoker showed significantly lower scores of postoperative RFS (P = .0.003). CONCLUSION: Our study suggests that subjective CRS symptoms were related with subjective LPR symptoms and ESS was effective in reducing signs and symptoms of LPR in CRS patients. Especially, smoking was associated with less improvement of laryngoscopic findings after ESS. PMID:34895940 | DOI:10.1016/j.anl.2021.11.011 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Differentialdiagnostik intraorbitaler Raumforderungen – eine Übersicht

xlomafota13 shared this article with you from Inoreader Differentialdiagnostik intraorbitaler Raumforderungen – eine Übersicht Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1580-7371 Hintergrund Aufgrund der unmittelbaren Nähe zum visuellen System stellen intraorbitale Raumforderungen eine Bedrohung für den Patienten und eine besondere Herausforderung für jede in Diagnostik und Therapie involvierte Fachdisziplin dar. Material/Methoden Narratives Review mit Diskussion von relevanten Originalarbeiten und Expertenempfehlungen. Zur Veranschaulichung beschreiben wir den Fall eines 71-jährigen Patienten, der 3 Monate nach einer Nasennebenhöhlenoperation in unserer Abteilung aufgenommen wurde. Ein postoperatives intraorbitales Hämatom der rechten Orbita war extern konservativ mit Antibiotika/Kortikosteroiden behandelt worden, was zu einem nahezu vollständigen einseitigen Sehverlust geführt hatte. Die folglich durchgeführte Orbita- und Optikusdekompression verhinderte nicht die Bildung eines intraorbitalen Lipogranuloms. Gegenwärtig werden die damit verbundenen rezidivierenden Entzündungsphasen erfolgreich konservativ auf der Grundlage multidisziplinärer Empfehlungen behandelt. Ergebnisse In dem berichteten Fall mündete eine verzögerte Orbita- und Optikusdekompression bei retrobulbärem Hämatom nach Nasennebenhöhlenoperation in der Bildung eines intraorbitalen Lipogranuloms. Die Literatur unterstützt unsere Empfehlung einer sofortigen chirurgischen Intervention im Falle eines akuten retrobulbären Hämatoms. Neben akuten Zuständen können intraorbitale Raumforderungen Zeichen systemischer Erkrankungen sein. In jedem Fall ist ein multidisziplinärer Therapieansatz für ein adäquates Management erforderlich. Schlussfolgerung Intraorbitale Raumforderungen können u.a. als akute Komplikation nach Nasennebenhöhlenoperationen auftreten oder Zeichen maligner Entartung und chronischer Erkrankungen sein. Differenzialdiagnostische Kenntnisse zu intraorbitalen Raumforderungen sind daher für jede im Kopf-Hals-Bereich tätige Fachdisziplin unerlässlich. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

PD-1 Inhibitor Maintenance Therapy Combined Iodine-125 Seed Implantation Successfully Salvage Recurrent Cervical Cancer after CCRT: A Case Report

xlomafota13 shared this article with you from Inoreader PD-1 Inhibitor Maintenance Therapy Combined Iodine-125 Seed Implantation Successfully Salvage Recurrent Cervical Cancer after CCRT: A Case Report Via radioactive iodine Curr Oncol. 2021 Nov 9;28(6):4577-4586. doi: 10.3390/curroncol28060387. ABSTRACT Cervical cancer is the fourth most common cancer in females worldwide. Patients with stage III and IV cervical cancer based on the Federation of Gynecology and Obstetrics (FIGO) classification have higher recurrence rates. Because of organs at risk (OAR) protection and the low indication rate of salvage surgery, the choice of treatment is always challenging. Systemic chemotherapy is palliative and can be performed in conjunction with surgery or radiotherapy; however, it has no significant benefit to survival. Brachytherapy and stereotactic body radiotherapy (SBRT) are characterized by extremely high radiation doses applied to tumor cells while sparing the normal tissues. Several studies have investigated the efficacy of these technologies in recurrent cervical cancer and showed promising results. The immune checkpoint inhibitors approach was also investigated and showed promising results too. Herein, we report a case of a patient with cervical cancer that recurred five months after adjuvant chemotherapy and concurrent chemoradiotherapy. The disease prognosis after interstitial implantation brachytherapy (IIB) was determined. Then, the patient underwent radioactive 125I-seed implantation combined with PD-1 inhibitor treatment. The patient exhibited a partial response after seed implantation, and up to now, the duration of this partial response was 24 months. PMID:34898560 | DOI:10.3390/curroncol28060387 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of MIF gene polymorphisms with pemphigus vulgaris: a case-control study with comprehensive review of the literature

xlomafota13 shared this article with you from Inoreader Association of <em>MIF</em> gene polymorphisms with pemphigus vulgaris: a case-control study with comprehensive review of the literature Via International Journal of Clinical and Experimental Pathology Int J Clin Exp Pathol. 2021 Nov 15;14(11):1080-1089. eCollection 2021. ABSTRACT BACKGROUND: Functional macrophage migration inhibitory factor (MIF) gene polymorphisms are associated with elevated serum levels of MIF and increased susceptibility to various autoimmune diseases. MIF levels in the sera of pemphigus vulgaris (PV) patients are increased; however, no definite association has been demonstrated between PV and MIF gene polymorphisms. The present study was conducted to ascertain any association between MIF-173*G-C and MIF-794*CATT5-8 polymorphisms and PV. METHODS: Seventy-five patients with PV and 252 healthy, unrelated, voluntary controls were enrolled randomly in the study. MIF-173*G-C polymorphism (rs755622) was genotyped using polymerase chain reaction (PCR) followed by restriction fragment length analysis, and MIF-794*CATT5-8 (rs5844572) was genotyp ed using PCR followed by capillary gel electrophoresis. Subsequently, the allelic, genotype, and haplotype frequencies were determined and compared for both groups. Data were also analyzed with respect to sex, age at onset, type of disease, and duration of disease. RESULTS: No significant association was observed in terms of allelic, genotype, and haplotype frequencies of MIF gene polymorphisms in PV patients. However, a significantly lower prevalence of the C allele (P=0.02) and CATT7 allele (P=0.03) was seen in our patient population compared to healthy controls. Analysis of the effect of various factors such as gender, age at onset, type of disease, and disease duration revealed no significant association with the genetic variants. CONCLUSIONS: MIF-173*G-C and -794*CATT5-8 polymorphisms are not associated with PV. PMID:34900076 | PMC:PMC8661066 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chromophobe renal cell carcinoma-like thyroid carcinoma: possible misdiagnosis as metastatic renal cell carcinoma

xlomafota13 shared this article with you from Inoreader Chromophobe renal cell carcinoma-like thyroid carcinoma: possible misdiagnosis as metastatic renal cell carcinoma Via International Journal of Clinical and Experimental Pathology Int J Clin Exp Pathol. 2021 Nov 15;14(11):1095-1101. eCollection 2021. ABSTRACT To date, multiple thyroid cancer variants have been reported. Herein, we report a rare case of chromophobe renal cell carcinoma-like thyroid carcinoma (CRETHCA) in a 60-year-old woman, for which the morphologic findings resembled those of chromophobe renal cell carcinoma (ChRCC). ChRCC of the kidney is characterized by large polygonal tumor cells with distinct cell borders, perinuclear clearing, multiple binucleate cells, and strongly positive immunostaining for paired box gene 8 (PAX8) and carbonic anhydrase IX (CA IX). In our case, the thyroid gland tumor was incidentally detected by routine medical screening without sufficient medical information; it showed similar histology and immunohistochemical features to ChRCC and was initially misdiagnosed as metastatic ChRCC. Additional tests, including kidney computed tomography and positron emission tomography, revealed no abnormalities in the patient's kidney; therefore, we diagnosed the tumor as CRETHCA. Focal weak staining for thyroid transcription factor 1 (TTF-1) was the only supporting evidence that it was a primary thyroid neoplasm. To the best of our knowledge, this is the second report of CRETHCA in literature. This novel variant is very difficult to distinguish from metastatic ChRCC and can be a diagnostic challenge for pathologists. Further studies of similar cases should be done to define this new entity. PMID:34900078 | PMC:PMC8661068 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.