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Αλέξανδρος Γ. Σφακιανάκης

Thursday, February 18, 2021

Do not operate on your patients on your birthday!

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Publication date: Available online 12 February 2021

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): F. Rubin, O. Laccourreye

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Accuracy of infrared thermography for perforator mapping: A systematic review and meta-analysis of diagnostic studies.

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Accuracy of infrared thermography for perforator mapping: A systematic review and meta-analysis of diagnostic studies.

J Plast Reconstr Aesthet Surg. 2021 Jan 11;:

Authors: Berner JE, Pereira N, Troisi L, Will P, Nanchahal J, Jain A

Abstract
INTRODUCTION: Infrared thermography allows the detection of infrared radiation which can be reliably associated with skin temperature. Modern portable thermography devices have been used to identify the location of skin perforators by detecting subtle differences in skin temperature. The aim of this study is to conduct a diagnostic accuracy systematic review to determine the specificity and sensitivity of infrared thermography.
MATERIALS AND METHODS: A PRISMA-compliant systematic review and meta-analysis was conducted, scrutinising PUBMED and EMBASE databases for diagnostic studies measuring the accuracy of infrared thermography for perforator identification. Article screening, review and data gathering was conducted in parallel by two independent authors. Eligible studies were subject to a formal risk of bias was assessment using the QUADAS2 instrument.
RESULTS: A total of 254 entries were obtained, of which 7 satisfied our pre-established inclusion criteria. These studies reported a total of 435 perforators in 133 individuals. The most commonly investigated locations were the antero-lateral thigh and abdominal wall. Reported sensitivity values ranged from 73.7% to 100%. A meta-analysis demonstrated a cumulative sensitivity of 95%. Specificity was not routinely reported. All studies presented a moderate to high risk of bias according to QUADAS2.
DISCUSSION: Affordable infrared thermography devices are an interesting alternative to traditional preoperative investigations for perforator mapping. They are sensitive enough to reliably identify a large proportion of perforators as "hot-spots". However, there is limited evidence to estimate the specificity of this technology, as studies have failed to report true negative values associated with "cold-spots".

PMID: 33573886 [PubMed - as supplied by publisher]

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Pretibial lacerations among elderly patients

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Pretibial lacerations among elderly patients: A province-wide study from Kymenlaakso, Finland, 2015-2019.

J Plast Reconstr Aesthet Surg. 2021 Jan 23;:

Authors: Seppälä T, Grünthal V, Koljonen V

Abstract
In this retrospective cohort study, we analysed treatment and outcomes among ≥65-year-old patients who experienced a traumatic pretibial laceration in the province of Kymenlaakso, Finland, between 2015 and 2019. We reviewed computerised medical records for 116 patients with a pretibial laceration, 107 of whom we analysed in further detail. Patients were traced from injury to healing, including rehabilitation periods in health care centres. As expected, the majority of patients were elderly women (67%). Most lacerations were superficial and small, explaining why treatment was mostly conservative. Only 11 (9.48%) patients were treated operatively with surgical debridement or a split-thickness skin graft. The number of overall complications in wounds was high, with a complication rate of 30.2%. Most complications were local wound infections. We found that wound healing took more than 3 months in 32% of patients. Thorough patient tracing revealed numerous follow-up visits and l ong rehabilitative hospitalisation periods, indicating a significant decline in patient independence and the excessive use of resources. Successful wound healing was eventually observed in 89.66% patients. Furthermore, no terminology regarding pretibial lacerations was found in patient records. This study indicates that pretibial lacerations remain poorly recognised and understood in Finland.

PMID: 33573887 [PubMed - as supplied by publisher]

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Effect of chemotherapy on survival in patients with stage T3–4N0M0 nasopharyngeal carcinoma

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ABSTRACT

Purpose

To identify whether chemoradiotherapy improves survival in patients with stage T3–4N0M0 nasopharyngeal carcinoma (NPC).

Materials and methods

The data of patients with stage T3–4N0M0 NPC were extracted from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. The patients were divided into radiotherapy and chemoradiotherapy groups. Overall survival (OS) and cancer‐specific survival (CSS) were assessed using the Kaplan–Meier method and propensity score matching (PSM) analyses.

Results

We examined 496 patients: 88 who received radiotherapy and 408 who received chemoradiotherapy. Before PSM, chemoradiotherapy was associated with a better 5‐year OS (52.58% vs. 38.13%; P=0.005) and similar CSS (63.62% vs. 59.26%; P=0.196) compared to those associated with radiotherapy. However, chemoradiotherapy was not an independent prognostic factor for OS [hazard ratio (HR)=0.95, 95% confidence interval (CI): 0.68–1.32; P=0.760] or CSS (HR=1.02, 95% CI: 0.66–1.56; P=0.935). After PSM, similar OS (45.15% vs. 42.78%; P=0.626) and CSS (58.22% vs. 60.37%; P=0.730) were found between the radiotherapy and chemoradiotherapy groups.

Conclusion

Radiotherapy and chemoradiotherapy are associated with similar OS and CSS in patients with stage T3–4N0M0 NPC.

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Peak nasal inspiratory airflow measurements for assessing laryngopharyngeal reflux treatment

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Abstract

Objectives

To evaluate the effect of laryngopharyngeal reflux (LPR) and antireflux treatment on peak nasal inspiratory airflow (PNIF).

Design

Prospective observational study was conducted.

Setting

Tertiary otorhinolaryngology clinic.

Participants

Adults with LPR and healthy controls

Main outcome measures

PNIF measurements were performed on 60 patients who applied with complaints suggestive of LPR having higher Reflux Symptom Index (RSI) (> 13) and Reflux Finding Scores (RFS) scores (> 7). Proton pump inhibitor (PPI) treatment was started and PNIF measurements were repeated two months later. A total of 100 patients without any history of LPR and sinonasal disease were included in the study.

Results

A statistically significant increase was observed in PNIF values after proton pump inhibitor treatment. The mean PNIF values of the LPR patients were 133.83 ± 27.99 L/min and 149.92 ± 23.23 L/min before and after treatment, respectively. The mean PNIF value in the control group was 145.0 ± 25.92 L/min. PNIF values were significantly lower in the LPR relative to the control group (p <0.05).

Conclusion

Laryngopharyngeal reflux decreases PNIF. This negative effect on PNIF disappears after anti‐reflux medication. The results of the study indicate that PNIF measurements may be an appropriate method for clinical diagnosis of LPR and evaluation of treatment results.

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Revisions and Complications with Gore‐Tex Medialization Laryngoplasty: A 19‐year Experience

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Abstract

Medialization laryngoplasty, also known as type I thyroplasty is widely accepted as a definitive treatment for paralytic and nonparalytic glottal incompetence. This technique uses material to medialize the vocal fold to restore glottal contact and function. Common materials that are used include Gore‐Tex (expanded polytetrafluoroethylene), silicone, calcium hydroxyapatite and titanium.

Gore‐Tex has been in use since the 1970s in vascular surgery and facial reconstruction with good biocompatibility and first described for use as a medialization implant in 1998 by McCulloch and Hoffman.1,2 In a 2010 national survey, the percentage of surgeons using Gore‐Tex increased from 36% to 64% compared to the decrease in surgeons carving Silastic from 76% to 24%.3 Gore‐Tex is increasing in popularity as an implant material because of its pliability, ease of placement and removal, and biocompatibility.

Despite the apparent short‐term effectiveness of Gore‐Tex in treating glottal incompetence, there is a lack of long‐term data related to its use reported in the literature. To understand the long‐term effectiveness of Gore‐Tex and its associated complications, we performed a review of cases at our institution over the past 19 years.

Materials and Methods

The Partners Institutional Review Board approved this retrospective case series (IRB 2109P0002165). Electronic medical record data from consecutive patients who underwent medialization laryngoplasty by the senior author (R.A.F.) between 1 January 2001 and 30 June 2019 at Massachusetts Eye and Ear were reviewed in this study. Patients included were adults (≥18 years old) who underwent medialization laryngoplasty with Gore‐Tex. Exclusion criteria consisted of patients who had an adduction arytenopexy and/or cricothyroid subluxation performed at time of surgery. The study aims included understanding the long‐term effectiveness by analyzing the revision rate and complications associated with Gore‐Tex. The primary outcome measures were revision procedures and complications. The revision procedures were categorized as either a touch‐up injection laryngoplasty or revision surgery and complications included but were not limited to hematoma, dyspnea, implant extrusion, and need f or emergency tracheotomy. The STROCSS (Strengthening the Reporting of Cohort Studies in Surgery) 2019 reporting guideline was followed.

Surgical technique

Medialization laryngoplasty was performed according to techniques previously described by McCullough and Hoffman1 with the following modifications. Surgery was performed under local anesthesia through an open approach using 1.0 mm thick Gore‐Tex soft tissue patch (W.L. Gore & Associates, Inc., Flagstaff, AZ). The Gore‐Tex patch is cut into a ribbon that is 1cm in width (Figure 1). A thyrotomy window was planned 5‐7 mm from midline and 2‐3 mm from the inferior border of the thyroid cartilage. The sagittal saw with a 1 mm blade was used to create the thyrotomy window (approximately 2 mm by 3 mm). The window should be sufficiently large enough to enable insertion of the Gore‐Tex strip and the manipulating instrument (Figure 2). The inner perichondrium was incised but not removed, to improve precise placement of the implant. The length of Gore‐Tex inserted and unilateral versus bilateral nature of medialization was determined intra‐operatively based on voi ce quality and surgeon preference. Surgical end‐points were based on improved voice quality and medialization of the true vocal fold viewed with a fiberoptic nasolaryngoscope. The technique was not modified during the duration of the study period.

Statistical Analysis

Preoperative and postoperative data were compared, and all data were analyzed using SPSS Statistics (version 25.0; IBM). The continuous variables were reported as mean with ranges (minimum‐maximum). Categorical variables were reported as numbers (n) and proportions (%).

Results:

We identified 73 patients who met inclusion and exclusion criteria (Table 1). There were a total of 46 unilateral and 27 bilateral Gore‐Tex cases. The mean duration of follow up was 1303 ± 1445 days (62‐5214). There were 8 patients who were lost to follow‐up. There were no cases of hematoma or need for emergency tracheotomy. In the 3 patients who had revision surgery within 48 hours due to dyspnea, 2 cases were unilateral and 1 case was bilateral. Touch‐up injections were performed in 10/73 patients (13.7%) and revision surgeries were performed in 7 patients (9.6%). The overall complication rate was 11% (8/73 patients): 3 patients experienced dyspnea within 48 hours after Gore‐Tex insertion and 5 patients had delayed Gore‐Tex extrusion (Table 2). There were 2/60 patients with a history of neck radiation in the non‐extrusion group. There were 2/5 with radiation exposure in the extrusion group (P‐value=0.027). There were 1/5 with excessing coughing in the extrusion group and 1/60 in the non‐extrusion group (P‐value=0.149).

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The impact of close surgical margins on recurrence in oral squamous cell carcinoma

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Close margins influence treatment and outcome in patients with oral squamous cell carcinoma (OSCC). This study evaluates 187 cases of surgically treated OSCC regarding the impact of close margins on recurrence...
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Two-step treatment of a giant skull vault hemangioma: A rare case report and literature review.

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Two-step treatment of a giant skull vault hemangioma: A rare case report and literature review.

Neurocirugia (Astur). 2021 Feb 08;:

Authors: Anagnostou E, Lagos P, Plakas S, Mitsos A, Samelis A

Abstract
Skull vault hemangiomas are benign vascular tumours of the calvaria that are usually asymptomatic or present as firm, painless lumps. We present a case of a 59-year-old female with a giant intraosseous calvarial hemangioma that was admitted in our department with a palpable mass over the left frontoparietal region, personality changes and impaired emotional and cognitive functions. The patient was treated with a two-step approach involving endovascular and surgical treatment, and suffered two rare, but recognized complications, a contrecoup intracerebral haemorrhage and valproate-induced stupor and parkinsonism. At the 6-month follow-up, the patient had complete recovery with a good neurological outcome.

PMID: 33573868 [PubMed - as supplied by publisher]

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Efficacy of a Comprehensive Dysphagia Intervention Program Tailored for the Residents of Nursing Homes.

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Efficacy of a Comprehensive Dysphagia Intervention Program Tailored for the Residents of Nursing Homes.

J Frailty Aging. 2021;10(2):156-159

Authors: Fong R, Wong SWK, Chan JKL, Tong MCF, Lee KYS

Abstract
Oropharyngeal dysphagia is a widespread condition in older people and thus poses a serious health threat to the residents of nursing homes. The management of dysphagia relies mainly on compensatory strategies, such as diet and environmental modification. This study investigated the efficacy of an intervention program using a single-arm interventional study design. Twenty-two participants from nursing homes were included and had an average of 26 hours of intervention, including oromotor exercises, orosensory stimulation and exercises to target dysphagia and caregiver training. Four of the 22 participants exhibited improvement in functional oral intake scale (FOIS) but was not statistically significant as a group. All oromotor function parameters, including the range, strength, and coordination of movements, significantly improved. These results indicate that this intervention program could potentially improve the oromotor function, which were translated into functional improve ments in some participants' recommended diets. The validity of this study could be improved further by using standardized swallowing and feeding assessment methods or an instrumental swallowing assessment.

PMID: 33575705 [PubMed - in process]

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Prevalence of Synchronous ESCN in Head and Neck Cancer: A Single‐Institution Perspective

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Objectives

The primary objective was to determine the prevalence of synchronous esophageal squamous cell carcinoma in head and neck squamous cell carcinoma (HNSCC) patients. The secondary objective was to determine risk factors for the development of synchronous esophageal squamous cell carcinoma (ESCN).

Study Design: Cross sectional observation study.

Methods

A prospective cross sectional, observational study on consecutive 300 newly diagnosed oral cavity, oropharynx, hypopharynx, and laryngeal squamous cell carcinoma patients who underwent trans‐nasal esophageal endoscopy with white light imaging and narrow band imaging.

Results

Among 300 patients, index HNSCCs were located in the oral cavity (n = 154, 51.3%), oropharynx (n = 63, 21%), larynx (n = 53, 17.7%), and hypopharynx (n = 30, 10%). The prevalence of synchronous ESCN was 2.7% (n = 8), including four low‐grade, two high‐grade dysplasia, and two squamous cell carcinomas. On logistic regression analysis, moderate to heavy alcohol consumption (OR 8.7, P = .01) and primary HNSCC involving supraglottis [(OR 12.5, P = .02) were risk factors for synchronous ESCN. The association of pyriform sinus carcinoma and synchronous ESCN was of borderline significance (P = .054, OR 10.92).

Conclusion

The prevalence of synchronous ESCN in HNSCC was 2.7%. Routine trans‐nasal esophagoscopy should be performed in all newly diagnosed patients with carcinoma of the supraglottis and pyriform sinus, and those with consumption of moderate to heavy alcohol for the screening of synchronous ESCN.

Level of Evidence

2b Laryngoscope, 131:E807–E814, 2021

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Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

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Objectives

To determine the safety and effectiveness of the middle cranial fossa (MCF) approach in repairing spontaneous cerebrospinal fluid (sCSF) leaks.

Study Design

Retrospective cohort study.

Methods

Patient with sCSF leaks repaired by MCF approach between January 1, 2014 and August 31, 2019 were included. Demographic information, clinical and surgical findings, and postoperative outcomes were recorded.

Results

The cohort (n = 45) included 24 tegmen repairs by multilayer reconstruction using hydroxyapatite cement and 21 cases of multilayer repair without hydroxyapatite cement. Ten MCF repairs were performed on patients ≥65 years old. Twenty (53%) ears had multiple tegmen defects (range, 1–9 tegmen defects) and 78% of patients had ≥1 encephaloceles. All sCSF leaks were resolved with one surgical intervention. There were no major intracranial complications. Transient expressive aphasia occurred in 2 patients. Medical complications occurred in four patients. There were no short‐term postoperative CSF leaks with bone cement reconstruction and two postoperative leaks without bone cement. One resolved with lumbar drain (LD) and the other resolved without treatment. The average (SD) length of stay (LOS) with bone cement was shorter than in patients without bone cement (2.54 [0.83] days vs. 3.52 [1.99] days, P < .05). There have been no long‐term CSF leak recurrences with an average (SD) follow‐up of 13.5 (12.9) months (range 0.25–46 months).

Conclusions

MCF approach for sCSF repairs demonstrate efficacious outcomes, particularly with tegmen reconstruction using hydroxyapatite cement. The approach exhibited no serious adverse events and few complications requiring intervention. Therefore, MCF is a safe and effective approach to resolve sCSF leaks.

Level of Evidence

3 Laryngoscope, 131:624–632, 2021

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