Τρίτη 15 Φεβρουαρίου 2022

The radial forearm snake flap: An underutilized technique for fasciocutaneous and osteocutaneous forearm flaps with primary closure

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Abstract

Background

The radial forearm free flap (RFFF) is associated with troublesome donor site morbidity related to split thickness skin grafting (STSG). The radial forearm snake flap with primary closure of the donor site may reduce donor site complications.

Methods

Single institution, retrospective cohort study comparing rates of delayed donor site wound healing and tendon exposure in 52 patients undergoing radial forearm snake flap and 95 patients undergoing conventional RFFF with STSG closure of the donor site.

Results

Tendon exposure occurred in zero (0%) patients undergoing snake flap and four (4.2%) patients undergoing conventional RFFF (0/52 vs. 4/95; p = 0.297). Delayed wound healing occurred in zero (0%) patients undergoing snake flap and 19 (20.0%) patients undergoing conventional RFFF (0/52 vs. 19/95; p < 0.001).

Conclusions

The radial forearm snake flap provides an alternative to conventional RFFF harvest, which enables primary donor site closure with reduced rates of delayed donor site healing.

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How to Maximize the Outcomes of Cochlear Implantation in Common Cavity and Cochlear Aplasia With Dilated Vestibule, the Most Severe Inner Ear Anomalies?

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Clin Exp Otorhinolaryngol. 2022 Feb 15. doi: 10.21053/ceo.2022.00164. Online ahead of print.

NO ABSTRACT

PMID:35158419 | DOI:10.21053/ceo.2022.00164

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Donor site complications and satisfaction in autologous fat grafting for breast reconstruction: A systematic review

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J Plast Reconstr Aesthet Surg. 2022 Jan 25:S1748-6815(22)00043-2. doi: 10.1016/j.bjps.2022.01.029. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer in females worldwide. One option for total breast reconstruction following total breast amputation is autologous fat transfer (AFT). However, this is still an upcoming reconstruction technique, and little is known about the donor site complications and their influence on the patient's overall satisfaction.

OBJECTIVES: This systematic review aims to review the current literature regarding donor site complications and donor site satisfaction following AFT for total breast reconstruction.

SEARCH METHODS: A literature search was performed in PubMed, Web of Science, Embase, Cochrane, TRIP pro, and Prospero. All published original literature reporting on complications or satisfaction at the donor site in patients who underwent liposuction, followed b y high-volume lipofilling was considered.

MAIN RESULTS: This systematic review resulted in the inclusion of 21 cohort studies, consisting of 2241 participants. None of the studies reported donor site satisfaction scores of any kind. The most frequently reported donor site complication was ecchymosis (268 cases), followed by pain (122 cases), haematoma (58 cases), irregularities (12 cases), burns (four cases), and infection (three cases). Reports on follow-up and management of donor site complications were generally lacking.

AUTHOR'S CONCLUSIONS: Results regarding the donor site are inconclusive. Pre-specified complications, a standardized manner of reporting, long-term follow-up, and patient-reported outcome measures are lacking in most of the studies. The impact of the donor site on quality of life after autologous fat grafting in breast reconstruction remains a blind spot. PROSPERO registration number: CRD42020222870.

PMID:35165073 | DOI:10.1016/j.bjps.2022.01.029

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Studies on newly recognized chronic sialadenitis

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Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Feb 18;54(1):13-17.

ABSTRACT

Some kinds of chronic sialadenitis were recognized during the recent years. They have specific pathogenesis, clinical and histopathologic appearances, and require specific treatment. IgG4-related sialadenitis (IgG4-RS) is one of the immune-mediated diseases, characterized by tumefactive lesions. The incidence of IgG4-RS obviously increased during the past 30 years. The study on the potential relationship between o ccupational exposure to chemical substances and the incidence of IgG4-RS showed that subjects with occupational exposure to agents known to cause IgG4-RD had an increased risk for IgG4-RS. Surgical excision of involved SMG could not control the disease progression, which is not recommended for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents is effective for treating IgG4-RS, and restores salivary gland function. Radioiodine induced sialadenitis (RAIS) is one of the common complications of postoperative adjuvant treatment of differentiated thyroid cancer by 131I. The incidence of the disease is related to radiation dosage. Clinically, the patients suffered from swelling and tenderness in the buccal or submandibular regions, especially during the mealtime. Imaging appearances are similar to those of chronic obstructive sialadenitis. Conservative managements, such as gland massage, sialagogues, are the mainstream methods in the treatment of RAIS. Sialendoscopy is feasible for RAIS, but not as effective as conventional obstructive sialadenitis (COS). Therefore the prevention of RAIS is crucial. Eosinophilic sialodochitis (ES) is a new type of chronic inflammatory disease of the salivary gland related to allergy. It has characteristics of swelling of multiple major salivary glands, strip-like gelatinous plugs discharged from the duct orifice of the gland, elevated level of serum IgE and eosinophils in peripheral blood, infiltration of eosinophils and IgE positive plasma cells in the tissues, allergic history, increased expression of allergy-related cytokines, such as IL-4, IL-5, IL-13, and eotaxin, which suggest allergic reactions as a potential pathogenesis of the disease. The clinical, laboratory, histological, and immunohistochemical characteristics of ES are significantly different from conventional obstructive sialadenitis (COS). Therefore, it is suitable to separate ES from COS. Conservative managements, such as s elf-maintenance therapy and anti- allergic modality are the choices of treatment for ES. Based on the results of our comprehensive studies a new classification of chronic sialadenitis is suggested.

PMID:35165462

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New AMM: Nivolumab as an adjuvant for oesophageal and gastroesophageal junction cancer

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Bull Cancer. 2022 Feb 11:S0007-4551(22)00009-1. doi: 10.1016/j.bulcan.2021.11.018. Online ahead of print.

NO ABSTRACT

PMID:35164916 | DOI:10.1016/j.bulcan.2021.11.018

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Secondary primary malignancy in patients with head and neck squamous cell carcinoma

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by Shih-Wei Wang, Leong-Perng Chan, Ling-Feng Wang, Che-Wei Wu, Sheng-Hsuan Lin, Tzu-Yen Huang, Ka-Wo Lee

Background

The survival rate of head and neck squamous cell carcinoma (HNSCC) patients with secondary primary malignancy (SPM) showed no significant improvement for decades, however, the impact of advances in diagnostic tools is rarely mentioned. This study investigated the clinical characteristic of HNSCC with SPM over a 27-year period especially from the perspective of diagnostic tools.

Methods

This study evaluated 157 HNSCC patients with SPM. The patients were divided into two groups according to the time of SPM diagnosis (Group A:1992–2003; Group B: 2004–2014). Age, gender, stage of first primary malignancy (FPM), SPM interval, overall survival, and disease-free survival were compared between groups.

Results

Group B had significantly more SPM developed rate (p = 0.002), more SPM patients with advanced stage of FPM (p = 0.001), synchronous SPM (p = 0.006), and shorter SPM interval (p Conclusion

Among patients diagnosed with HNSCC recently, more SPMs are diagnosed in a shorter time interval and in a more advanced stage. The overall advances in diagnostic tools cannot significantly improve SPM survival, however, it enables more patients to receive corresponding treatment.

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The Extent of Thyroid Surgery in Differentiated Thyroid Cancer Patients with Low and Intermediate Risks of Recurrence

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Clinical Thyroidology, Volume 34, Issue 2, Page 63-66, February 2022.
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Predisposition to and Prognosis of Thyroid Cancer May Not Be Affected by Graves’ Disease, But Some Questions Still Remain

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Clinical Thyroidology, Volume 34, Issue 2, Page 59-62, February 2022.
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Diagnostic Value of Preoperative Serum Calcitonin Levels in Medullary Thyroid Carcinoma

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Clinical Thyroidology, Volume 34, Issue 2, Page 85-88, February 2022.
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Herpes Zoster of The Larynx: A Narrow Diagnostic and Therapeutic Window

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Ear Nose Throat J. 2022 Feb 15:1455613221077594. doi: 10.1177/01455613221077594. Online ahead of print.

ABSTRACT

We hereby present a rare case of laryngeal zoster presenting with unilateral odynophagia and hemifacial pain in an immunocompetent host. Visualization of the characteristic vesicles is challenging given their short-lived and at times delayed appearance; thus, laryngeal zoster may be a largely unrecognized cause of laryngitis and cranial neuropathies. Heightened aw areness may improve prompt diagnosis, referral and initiation of antiviral therapy, while guiding patient counselling on the associated long-term sequelae such as voice and swallowing impairments, and post-herpetic neuralgia.

PMID:35166603 | DOI:10.1177/01455613221077594

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The clinicopathological and prognostic characteristics of mucinous micropapillary carcinoma of the breast

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Histol Histopathol. 2022 Feb 15:18436. doi: 10.14670/HH-18-436. Online ahead of print.

ABSTRACT

BACKGROUND: Mucinous micropapillary carcinoma (MMPC) is a unique subtype of breast cancer, and there is as yet no detailed report on the clinical characteristics of MMPC.

METHODS: MMPC, pure mucinous breast carcinoma (PMBC), and invasive micropapillary carcinoma (IMPC) samples were enrolled simultaneously, and immunohistochemistry analysis was performed to explore the clinicopathological attributes of MMPC. Moreover, survival analyses of MMPC were performed among the MMPC, PMBC, and IMPC groups and within the MMPC group.

RESULTS: The results showed that MMPC demonstrated distinct pathological features and that vascular invasion and lymph node metastasis were two significant clinical attributes of MMPC. MMPC leads to a shorter survival time than PMBC but an increased survival time compared to IMPC, while the tumor-node-metastasis stage and lymph node metastasis were identified as two independent prognostic elements for disease-free survival in discerning the MMPC prognosis.

CONCLUSIONS: The gathered data implied that further understanding and classification of MMPC may provide better individualized therapeutic strategies for MMPC treatment.

PMID:35166367 | DOI:10.14670/HH-18-436

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Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis

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BMC Neurol. 2022 Feb 12;22(1):52. doi: 10.1186/s12883-022-02574-9.

ABSTRACT

BACKGROUND: Transsphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR). The protocol of extracapsular resection(ER), which considers the pseudocapsule as the PA boundary for surgical removal, has also been introduced gradually. In this study, the clinical efficacies and complications were explored and compared between these two procedures.

METHODS: A systematic literature review was performed in the PubMed, EMBASE, Web of Science and Cochrane databases. Articles comparing between IR and ER were included.

RESULTS: There were 7 studies containing 1768 cases in accordance with the inclusion criteria. Although the meta-analysis showed no significant difference in complete resection, a sensitivity analysis revealed that ER was more conducive to total PA re section than IR. Moreover, we found a significant difference in favor of ER regarding biochemical remission. Furthermore, there was no significant difference in the incidence rate of certain complications, such as hormone deficiency, diabetes insipidus, intraoperative cerebrospinal fluid(CSF) and postoperative CSF leakage. However, a sensitivity analysis suggested that IR decreased the risk of intraoperative CSF leakage.

CONCLUSIONS: This meta-analysis unveiled that ER contributed to biochemical remission. To some extent, our results also showed that ER played a positive role in complete resection, but that IR reduced the incidence of intraoperative CSF leakage. However, the available evidence needs to be further authenticated using well-designed prospective, multicenter, randomized controlled clinical trials.

PMID:35151259 | DOI:10.1186/s12883-022-02574-9

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