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Αλέξανδρος Γ. Σφακιανάκης

Monday, February 8, 2021

Helicobacter pylori gastric infection in patients with laryngeal cancer.

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Helicobacter pylori gastric infection in patients with laryngeal cancer.

Eur Arch Otorhinolaryngol. 2021 Feb 02;:

Authors: Lai SW

PMID: 33528654 [PubMed - as supplied by publisher]

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Outcome of uncorrected CSF leak and consequent recurrent meningitis in a patient: a case presentation and literature review.

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Outcome of uncorrected CSF leak and consequent recurrent meningitis in a patient: a case presentation and literature review.

Br J Neurosurg. 2020 Oct;34(5):492-494

Authors: Soni AJ, Modi G

Abstract
Purpose: Post-traumatic CSF leaks are a complication in 2% of all head injuries. Majority of these patients will recover spontaneously. Whilst recent literature has predominantly centred on CSF leaks and their general investigations and management thereof, there is a paucity of information when it comes to those patients who have persistent post-traumatic CSF leaks, as well as the complication of recurrent meningitis. We present a patient with a persistent post-traumatic CSF leak who presented with recurrent bacterial meningitis thirteen times- the highest documented amount in an adult. We reviewed the literature with regards to the above as well.Material and Methods: We reviewed a vast array of journal articles on the topic of CSF leaks from the PubMed resource, and focused this review specifically on those that documented patients who had uncorrected CSF leaks and their outcomes.Results: Complications include meningitis and rhinorrhoea with brain abscesses and pneumocephalu s occurring less frequently. Mortality has been documented to be 9% after 1 year. The rates of persistent CSF leaks were within the same range with an average calculated rate of 21%. Whilst meningitis was recorded and is common, it was not stipulated whether the incidences were recurrent.Conclusion: Post-traumatic persistent CSF leaks remain a therapeutic challenge and continued follow-up with early surgical intervention is highly recommended to prevent complications. One of the more serious complications of a persistent leak is meningitis. The long-term outcomes of recurrent meningitis could include cumulative focal neurological deficitis and cognitive impairment.

PMID: 29807467 [PubMed - indexed for MEDLINE]

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The importance of repeat digital subtraction myelography in the diagnosis of cryptogenic CSF-venous fistula causing spontaneous intracranial hypotension.

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The importance of repeat digital subtraction myelography in the diagnosis of cryptogenic CSF-venous fistula causing spontaneous intracranial hypotension.

Interv Neuroradiol. 2021 Feb 01;:1591019921991398

Authors: Nagesh CP, Devaraj R, Joshi G, Shafi P, Krishna KN, Satischandra P

Abstract
Spontaneous intracranial hypotension (SIH) is a rare disorder that occurs secondary to acquired cerebrospinal fluid (CSF) leaks in the spine. Treatment involves either an epidural blood patch or surgical ligation. Essential to the selecting the optimal management strategy is classifying the type of leak and accurate localization of its level. Hitherto, this has been achieved using conventional imaging methods such as static CT or MR myelography which are adequate for the demonstration of only high flow leaks. Digital subtraction myelography (DSM) is a novel technique which provides superior temporal and spatial resolution in the localization of more challenging slow flow leaks. However, DSM may also be initially non-diagnostic. We report a case of SIH in which repeat DSM revealed a type 3 CSF-venous fistula and demonstrate a possible mechanism of transient CSF leak block resulting in the initial false negative findings based on morphological changes in the culprit nerve sheat h diverticulum-pseudomeningocoele complex. The patient underwent successful surgical ligation with clinicoradiological resolution of SIH.

PMID: 33525918 [PubMed - as supplied by publisher]

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Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases.

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Hydroxyapatite Prostheses in Endoscopic Transcanal Stapes Surgery for Otosclerosis Cases.

Ear Nose Throat J. 2021 Feb 02;:145561321989143

Authors: Hosoya M, Fujioka M, Ogawa K

Abstract
OBJECTIVES: Hydroxyapatite is a commonly used material for medical applications due to its excellent biocompatibility. We use hydroxyapatite prosthesis for the reconstruction of the ossicular chain in stapes surgery. In this study, we report a case series of endoscopic ear surgery using a basket-type hydroxyapatite prosthesis.
METHODS: We retrospectively examined 8 cases of endoscopic transcanal stapes surgery using hydroxyapatite prostheses. We evaluated the postoperative results and complications.
RESULTS: The average postoperative air-bone gaps were within 10 dB in all cases. Postoperative sensorineural hearing loss was not observed in any case. There was an intraoperative complication with the chorda tympani in 1 patient. We were able to preserve the chorda tympani of all patients, including this case. Postoperative transient dizziness and transient taste disorder were observed in 50% of cases. No other complications, including facial nerve palsy, tympanic membrane perforation, or postoperative infection, were observed.
CONCLUSIONS: The postoperative results and complications were comparable to those of surgery under a microscope. The hydroxyapatite prosthesis could be a possible alternative for the piston-type titanium or polytetrafluoroethylene prosthesis.

PMID: 33528270 [PubMed - as supplied by publisher]

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Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments.

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Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments.

Ear Nose Throat J. 2021 Feb 02;:145561321992509

Authors: Sayin I, Yazıcı ZM, Abakay MA, Gülüstan F, Devecioğlu İ, Akgül A

Abstract
OBJECTIVE: To evaluate the attitudes of physicians and patients toward physical examination in physically separated environments using a laryngoscopic examination model.
MATERIALS AND METHODS: Six experienced laryngologists performed laryngoscopic examinations in 30 patients in a closed-chamber examination unit. The physicians and patients were asked to compare all domains with their previous standard laryngoscopic examination experience using a 10-point visual analog scale (0, poor performance; 10, good performance), including effectiveness of communication, difficulty of examination, perception of safety against airborne transmission of COVID-19, applicability of the unit for future examinations, perception of protective environment, and overall comfort.
RESULTS: All laryngoscopic examinations were performed successfully. Effectiveness of communication, difficulty of examination, perception of protective environment, and overall comfort did not differ between physicians and patients (P > .05 for all comparisons). However, both physicians and patients found the examination to be difficult. While physicians evaluated the system as safe against airborne transmission of COVID-19, patients were not confident that the system was safe (8.70 ± 1.93 vs 2.87 ± 2.37, respectively, P = .001). Physicians also gave a higher score to future applicability of the unit for examinations than patients (8.90 ± 1.42 vs 7.10 ± 2.62, respectively, P = .001).
CONCLUSION: Physically separating the physician and patient is a feasible method of physical examination in aerosol-contaminated environments.

PMID: 33528271 [PubMed - as supplied by publisher]

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Auditory Mapping With MEG: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines.

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Auditory Mapping With MEG: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines.

J Clin Neurophysiol. 2020 Nov;37(6):574-584

Authors: Shvarts V, Mäkelä JP

Abstract
Auditory evoked fields (AEFs) are well suited for studies of auditory processing in patients. Their sources have been localized to Heschl's gyri and to the supratemporal auditory cortices. Auditory evoked fields are known to be modulated by peripheral and central lesions of auditory pathways and to reflect group-level pathophysiology of neurodevelopmental and psychiatric disorders. They are useful in lateralization of language processes for planning neurosurgery and for localization of language-related cortex. The recently developed artifact rejection and movement compensation methods will enhance and extend the use of AEFs in studies of clinical patients and pediatric groups. New pediatric magnetoencephalography systems will facilitate clinical AEF studies of developmental disorders. In addition to their established use in planning neurosurgery, AEF findings in several new clinical patient groups suffering, e.g., from developmental, neurodegenerative, or psychiatric disorder s have been reported. Several recent investigations report the correlations with clinical symptoms and sensitivity and specificity profiles of AEFs in studies of these disorders; this development is mandatory in gaining wider clinical approval for the use of AEFs in clinical practice dealing with individual patients. Most promising future research lines of clinical applicability of AEFs focus on developmental and psychiatric disorders.

PMID: 33165230 [PubMed - indexed for MEDLINE]

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Prediction error signaling explains neuronal mismatch responses in the medial prefrontal cortex.

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Prediction error signaling explains neuronal mismatch responses in the medial prefrontal cortex.

PLoS Biol. 2020 12;18(12):e3001019

Authors: Casado-Román L, Carbajal GV, Pérez-González D, Malmierca MS

Abstract
The mismatch negativity (MMN) is a key biomarker of automatic deviance detection thought to emerge from 2 cortical sources. First, the auditory cortex (AC) encodes spectral regularities and reports frequency-specific deviances. Then, more abstract representations in the prefrontal cortex (PFC) allow to detect contextual changes of potential behavioral relevance. However, the precise location and time asynchronies between neuronal correlates underlying this frontotemporal network remain unclear and elusive. Our study presented auditory oddball paradigms along with "no-repetition" controls to record mismatch responses in neuronal spiking activity and local field potentials at the rat medial PFC. Whereas mismatch responses in the auditory system are mainly induced by stimulus-dependent effects, we found that auditory responsiveness in the PFC was driven by unpredictability, yielding context-dependent, comparatively delayed, more robust and longer-lasting mismatch responses mostl y comprised of prediction error signaling activity. This characteristically different composition discarded that mismatch responses in the PFC could be simply inherited or amplified downstream from the auditory system. Conversely, it is more plausible for the PFC to exert top-down influences on the AC, since the PFC exhibited flexible and potent predictive processing, capable of suppressing redundant input more efficiently than the AC. Remarkably, the time course of the mismatch responses we observed in the spiking activity and local field potentials of the AC and the PFC combined coincided with the time course of the large-scale MMN-like signals reported in the rat brain, thereby linking the microscopic, mesoscopic, and macroscopic levels of automatic deviance detection.

PMID: 33347436 [PubMed - indexed for MEDLINE]

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Iodinated Choline Transport-Targeted Tracers.

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Iodinated Choline Transport-Targeted Tracers.

J Med Chem. 2020 12 24;63(24):15960-15978

Authors: Švec P, Nový Z, Kučka J, Petřík M, Sedláček O, Kuchař M, Lišková B, Medvedíková M, Kolouchová K, Groborz O, Loukotová L, Konefał RŁ, Hajdúch M, Hrubý M

Abstract
We present a novel series of radioiodinated tracers and potential theranostics for diseases accompanied by pathological function of proteins involved in choline transport. Unlike choline analogues labeled with 11C or 18F that are currently used in the clinic, the iodinated compounds described herein are applicable in positron emission tomography, single-photon emission computed tomography, and potentially in therapy, depending on the iodine isotope selection. Moreover, favorable half-lives of iodine isotopes result in much less challenging synthesis by isotope exchange reaction. Six of the described compounds were nanomolar ligands, and the best compound possessed an affinity 100-fold greater than that of choline. Biodistribution data of 125I-labeled ligands in human prostate carcinoma bearing (PC-3) mice revealed two compounds with a biodistribution profile superior to that of [18F]fluorocholine.

PMID: 33271015 [PubMed - indexed for MEDLINE]

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Minimally Invasive Ileal Ureter Replacement: Comparative Analysis of Robot‐assisted Laparoscopic versus Conventional Laparoscopic Surgery

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Abstract

Background

This study is an initial comparative analysis of perioperative and intermediate‐term functional outcomes between patients who underwent robot‐assisted laparoscopic (RALS) or conventional laparoscopic ileal ureter replacement (LS).

Materials and methods

A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared.

Results

The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14 months follow‐up, all the patients showed improved renal function and were symptom‐free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test.

Conclusions

RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick post‐operative recovery and encouraging outcomes.

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MRI‐guided focused ultrasound robotic system for transrectal prostate cancer therapy

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ABSTRACT

Background

A Magnetic Resonance Image (MRI) guided robotic device for focused ultrasound therapy of prostate cancer was developed. The device offers movement in 5 degrees of freedom (DOF) and uses a single element transducer that operates at 3.2 MHz, has a diameter of 25 mm and focuses at 45 mm.

Methods

The MRI compatibility of the system was evaluated in a 1.5 T scanner. The ability of the transducer to create lesions, was evaluated in laboratory and MRI settings, on ex vivo pork tissue and in vivo rabbit thigh tissue.

Results

Cavitational and thermal lesions were created on the excised pork tissue. In vivo experiments proved the efficacy of the system in ablating muscle tissue without damaging intervening areas.

Conclusions

The MRI compatible robotic system can be placed on the table of any commercial MRI scanner up to 7 T. The device has the ability of future use for transrectal focal therapy of prostate cancer with the patient in supine position.

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Vibration‐based drilling depth estimation of bone

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Abstract

Drilling is one of the most common forms of tissue removal procedures, and drilling to a desired depth contributes to avoid injury to the soft tissue beyond and ensure implant stability. The deformation of the human musculoskeletal system has been a common problem in many drilling processes, making it difficult to achieve accurate estimation of the drilling depth. To remedy this problem, a dynamic model is presented to describe the relationship between the axial vibration of the drill and the feed rate. During drilling process, the amplitude of the main harmonic is estimated from the high‐frequency component of the acceleration signal, while the short‐time integral of the low‐frequency part is calculated. Both the initial contact of the drilling tool to the bone and breakthrough are identified by comparing either the harmonic amplitude or the short‐time integral. The harmonic amplitude is mapped to the data from a noncontact position sensor tracking the feed rate of the dr ill. Multiple drilling experiments on both a handheld device and a robotic cutting system demonstrated the effectiveness, stability, and accuracy of the method when estimating depth. The mean maximum error for drilling depth estimation is less than 15% of the simulated bone thickness when using the handheld device, while the mean maximum error is less than 5% for the robotic cutting system.

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