Πέμπτη 2 Σεπτεμβρίου 2021

Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy

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To the Editor My attention was arrested by the article by Quinn et al on the use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (PHP). To our knowledge, it is the first meta-analysis on this topic showing a beneficial association of ioPTH with cure rates—98% vs 94.8% without ioPTH. It will have a considerable effect on surgical treatment for PHP. Nonetheless, I have some comments on the methodology, results, and conclusion of the trial.
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Neoadjuvant PD-1/PD-L1 Inhibitors for Resectable Head and Neck Cancer

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This systematic review and meta-analysis assesses the efficacy and safety of neoadjuvant immunotherapy for resectable head and neck squamous cell carcinoma.
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Is extracellular matrix (ECM) a promising scaffold biomaterial for bone repair?

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Histol Histopathol. 2021 Sep 2:18370. doi: 10.14670/HH-18-370. Online ahead of print.

ABSTRACT

The increasing demand for bone grafts and the scarcity of donors worldwide are promoting researchers to seek alternatives. The extracellular matrix (ECM) has been reported to enhance properties of osteoconduction and osteoinduction by simulating the molecular structure of bone and facilitating cell infiltration for bone repair. As one of several novel biomaterials, ECM has many desirable properties, including biocompatibility, bioactivity, and biosafety. Thus, we evaluated whether ECM is a promising scaffold biomaterial for bone repair. In this review, we explore ECM composition, the sources and fabrication methods, especially the decellularization technique, of ECM scaffolds. Furthermore, we highlight recent progress in the use of ECM as a scaffold biomaterial for bone repair. Generally, ECM is used in 1) three-dimensional (3D) cell cultures to promote osteogenic differentiation, 2) combinations with other biomaterials to increase their osteogenic effects, 3) 3D printing to produce customized or patient-tailored scaffolds for bone repair, and 4) hydrogels derived from ECM used for bone repair. In addition, we focus on future prospects for application of ECM as a scaffold material used for bone repair. From this review, we expect to have a perfect understanding of ECM-based scaffold materials in the hope that this leads to further research of the production of ECM biomaterials to meet the clinical needs for bone repair.

PMID:34472621 | DOI:10.14670/HH-18-370

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Schwannoma of the Zygomatic Branch of the Facial Nerve

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Ear Nose Throat J. 2021 Sep 2:1455613211041235. doi: 10.1177/01455613211041235. Online ahead of print.

ABSTRACT

SIGNIFICANCE STATEMENT: Facial nerve schwannoma is extremely uncommon. Despite its rarity, it is considered the most common facial nerve tumor and potentially affects any segment of the nerve. Presenting symptoms vary depending on the location of the neoplasm. Tumors pertaining to the extratemporal course of the nerve mainly appear as an asymptomatic parotid mass. We present a rare case of schwannoma of the zygomatic branch of the right facial nerve that was surgically resected, without facial nerve injury.

PMID:34472361 | DOI:10.1177/01455613211041235

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In Situ Preservation of Parathyroid Gland With Vasculature for Papillary Thyroid Carcinoma Is Associated With Higher PTH Levels After Total Thyroidectomy

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Ear Nose Throat J. 2021 Sep 2:1455613211039807. doi: 10.1177/01455613211039807. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of parathyroid gland vasculature preservation in-situ technique (PGVPIST) on postoperative parathyroid hormone (PTH) and calcium plasma levels in thyroid patients undergoing total thyroidectomy for papillary thyroid carcinoma (PTC).

STUDY DESIGN: Retrospective cohort study.

METHODS: Patients with PTC who underwent total t hyroidectomy by either the conventional technique (group 1, January 2019 to January 2020) or PGVPIST (group 2, January 2020 to January 2021) were compared. Postoperative blood calcium levels and PTH levels were assessed in these groups.

RESULTS: Totally 149 patients with consecutive PTC underwent total thyroidectomy, including 60 patients in group 1 and 89 patients in group 2. Postoperative serum calcium levels in group 1 were insignificantly lower than in group 2 at day 1 (2.18 ± 0.02 vs 2.15 ± 0.01 mmol/L) and day 30 (2.27 ± 0.02 vs 2.38 ± 0.11) after surgery. But postoperative serum PTH levels in group 1 were significantly lower than that in group 2 at day 1 (23.68 ± 2.54 vs 31.46 ± 2.11 pg/mL) and day 30 (45.63 ± 3.21 vs 55.65 ± 2.89 pg/mL) after surgery.

CONCLUSION: Parathyroid gland vasculature preservation in-situ technique for PTC is associated with higher PTH level after total thyroidectomy. The parathyroid gland vasculature mostly strongly adheres with adjacent thyroid parenchyma. Therefore, deferred processing of tiny thyroid parenchyma of parathyroid gland vessels is essential to prevent devascularization.

PMID:34472380 | DOI:10.1177/01455613211039807

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Adverse Drug Reaction of Antifungals in the Management of Black Fungus: A Tertiary Care Centre Experience

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Abstract

In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as "black fungus." Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india… The pati ents were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despi te a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required.

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Audio-Vestibular Findings in Individuals with Takayasu’s Arteritis

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Abstract

Takayasu's Arteritis is defined as inflammatory disease of the large blood vessels with unknown cause mostly affecting the aorta and its main branches. The patients diagnosed with Takayasu's arteritis are reported to have complaint of chronic dizziness. However, literature lacks detailed clinical evaluation of the auditory vestibular function in such patients. The current study documents the findings of auditory and vestibular evaluations in a rare syndrome. It was observed that patients with Takayasu's arteritis had abnormal auditory and vestibular evoked potentials.

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