Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial

xlomafota13 shared this article with you from Inoreader Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial Via Head & Neck Abstract Background Donor site pain after osteocutaneous free flap surgery contributes to postoperative morbidity and impairs recovery. We evaluated the efficacy of local infusion of ropivacaine for treating donor‐site pain after surgery. Methods We conducted a randomized, double‐blind, placebo‐controlled trial of patients undergoing osteocutaneous fibula or scapular tip free flaps for head and neck reconstruction at Mount Sinai Hospital. Patients were randomized to receive local infusion of ropivacaine or saline. We compared Visual Analog Scale pain scores for donor‐site specific pain 48 hours after surgery. Results There were 8 fibular free flap and 10 scapular free flap reconstructions. Average donor‐site pain scores were 29 ± 22 and 31 ± 28 mm (P = .88) for placebo and ropivacaine arms, respectively. The trial was stopped after the planned interim analysis for futility of the intervention. Conclusions Local infusion of ropivacaine did not affect donor‐site specific pain scores in this population. ClinicalTrials.gov Identifier: NCT03349034. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The prognostic significance of race in nasopharyngeal carcinoma by histological subtype

xlomafota13 shared this article with you from Inoreader The prognostic significance of race in nasopharyngeal carcinoma by histological subtype Via Head & Neck Abstract Background Race has been shown to have variable prognostic importance in nasopharyngeal carcinoma (NPC). However, previous studies are limited by a lack of comprehensive treatment, epidemiologic, and comorbidity data. Methods This was a retrospective cohort study utilizing the National Cancer Database from 2004 to 2016. Multivariable Cox proportional hazards regressions were used to calculate adjusted hazard ratios (aHR) for overall survival. Results A cohort of 9995 patients met inclusion and exclusion criteria. Race, insurance, comorbidity, treatment, stage, age, and histology were independent prognosticators. Among patients with keratinizing NPC, Asians and Hispanics had superior survival (aHR 0.58 [95% confidence interval (CI) 0.48–0.69], aHR 0.76 [95% CI 0.61–0.96]) compared to white patients. Among patients with non‐keratinizing differentiated NPC, Asians and black patients had improved survival (aHR 0.71 [95% CI 0.56–0.91], aHR 0.72 [95% CI 0.54–0.95]) compared to white patients. Race was not prognostic in non‐keratinizing undifferentiated NPC. Conclusion The prognostic significance of race varies across histological subtypes of NPC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of Finding the Speech-Language Pathologist Likeable on Postlaryngectomy Speech Intelligibility Outcomes

xlomafota13 shared this article with you from Inoreader Effects of Finding the Speech-Language Pathologist Likeable on Postlaryngectomy Speech Intelligibility Outcomes Via Folia Phoniatrica et Logopaedica Introduction: Speech-language pathologists (SLPs) work with patients after total laryngectomy (TL) to regain verbal communication. The influence of the quality of the therapeutic relationship on the success of TL voice rehabilitation in terms of speech intelligibility is not known. Finding each other likeable is an important factor in establishing and maintaining interpersonal relationships in everyday life. The fit of therapist and client is relevant to the therapeutic relation ship. The purpose of this study therefore was to assess the association between the degree of SLPs' likeability ratings and postlaryngectomy speech intelligibility. Methods: In a multicentre prospective cohort study, participants rated their SLPs' likeability after finishing TL rehabilitation. Speech intelligibility was measured objectively with the Post-Laryngectomy Telephone Intelligibility Test and subjectively with the Questionnaire for Adjustment after Laryngectomy. The association of SLPs' likeability with speech intelligibility was analysed using hierarchical logistic regression, expressed with odds ratios (OR) with corresponding 95% confidence intervals (CI). Results: Altogether 124 patients from 13 institutions participated. The degree of finding the SLP likeable was not significantly associated with objective speech intelligibility (OR 1.30; 95% CI 0.78–2.18; p = 0.32) or subjective speech intelligibility (OR 1.01; 95% CI 0.60–1 .72; p = 0.96) after controlling for age, sex and education factors. Discussion/Conclusion: In this patient cohort, there was no evidence for an association between ratings of SLPs' likeability and speech intelligibility outcomes after rehabilitation. Future studies could consider the use of alternative instruments for measuring likeability. Folia Phoniatr Logop View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Relationship between Endolymphatic Hydrops and Symptoms of Meniere Disease in Acoustic Hearing

xlomafota13 shared this article with you from Inoreader Relationship between Endolymphatic Hydrops and Symptoms of Meniere Disease in Acoustic Hearing Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Hypothesis: The endolymphatic hydrops (EH) does not affect hearing loss significantly at low frequencies, whereas the hydrops affects the diplacusis. Background: There have been many arguments whether the EH cause the Meniere disease. Despite a lot of experimental studies to investigate the Meniere disease, there have been little modeling studies, which are helpful to understand the mechanism. Methods: A 3D finite element model of the human cochlea an d the middle ear was used for investigation of the relationship between EH and hearing loss at low frequencies and diplacusis (2 specific symptoms of Meniere disease). While the cochlear geometry was simplified as a tapered box shape, the middle ear was based on the real geometry obtained from μCT images. EH is implemented by prestress on the basilar membrane surface in the simulation. Results: The EH did not cause significant hearing loss at low frequencies in both air- and bone-conducted hearing. Rather, this disorder caused a shift in best frequency (BF) position to the base at low frequencies below about 250 Hz. The BF shift can explain the diplacusis because a low-frequency sound can be perceived as a slightly higher frequency so that Meniere patients can perceive 2 different frequency sounds corresponding to a given single-frequency sound. Conclusion: The EH cannot be a sufficient condition for Meniere disease, whereas the hydrops can cause the diplacusis. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A modified microvascular 'Tube-in-Tube' concept for penile construction in female-to-male transsexuals: Combined radial forearm free flap with anterolateral thigh flap

xlomafota13 shared this article with you from Inoreader A modified microvascular "Tube-in-Tube" concept for penile construction in female-to-male transsexuals: Combined radial forearm free flap with anterolateral thigh flap Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Feb 5:S1748-6815(21)00059-0. doi: 10.1016/j.bjps.2021.01.016. Online ahead of print. ABSTRACT INTRODUCTION: Phalloplasty is a complex surgical task and remains a significant challenge in plastic surgery. To date, there are various techniques; however, complication rates are still not satisfactory. Here, we present our surgical approach of a modified tube-in-tube concept combining a radial forearm free flap and an anterolateral thigh flap and assess its outcome in a series of female-to-male transsexuals. PATIENTS AND METHODS: In this report, 21 female-to-male transsexual patients were included. The first surgical step includes colpectomy and elongation of the fixed part of the urethra with a full-thickness skin graft. Subsequently, a radial forearm free flap was adapted to build the inner tube which represents the neourethra. For the last step, a free anterolateral thigh flap is utilized as the outer tube of the neophallus. All patients were evaluated regarding aesthetic and functional outcomes as well as postoperative complications and revision surgeries. RESULTS: Our results showed a 100% flap survival rate with a mean follow-up of 4.4 years (range, 2.7-6). Three radial forearm free flaps and one free anterolateral thigh flap presented with partial flap necrosis. Generally, complications occurred in 11 patients (52.4%). The most common complications were related to urethral reconstruction including fistula formation (n = 8) and stenosis (n = 5). All except one patient obtained the ability to void while standing. CONCLUSION: Despite the complexity, the initial results are very promising for a single-stage phalloplasty with complete functional creation of a neophallus. Further improvements have to be implemented for reduction of postoperative complications particularly regarding urethral reconstruction. LEVEL OF EVIDENCE: IV (Therapeutic). PMID:33622542 | DOI:10.1016/j.bjps.2021.01.016 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon

xlomafota13 shared this article with you from Inoreader Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Feb 23. doi: 10.1007/s00405-021-06696-7. Online ahead of print. ABSTRACT BACKGROUND: Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. METHODS: Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. RESULTS: The mean nose VAS for nasal obstruction (0-100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septop lasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. CONCLUSIONS: In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty. PMID:33624151 | DOI:10.1007/s00405-021-06696-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How to prevent hypoxia during surgical and percutaneous tracheostomies in COVID-19 patients

xlomafota13 shared this article with you from Inoreader How to prevent hypoxia during surgical and percutaneous tracheostomies in COVID-19 patients Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Feb 24. doi: 10.1007/s00405-021-06640-9. Online ahead of print. NO ABSTRACT PMID:33624152 | DOI:10.1007/s00405-021-06640-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Differentiated Thyroid Carcinoma Having Distant Metastasis: A Comparison With Thyroglobulin-doubling Rate and Tumor Volume-doubling Rate

xlomafota13 shared this article with you from Inoreader Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Differentiated Thyroid Carcinoma Having Distant Metastasis: A Comparison With Thyroglobulin-doubling Rate and Tumor Volume-doubling Rate Via radioactive iodine In Vivo. 2021 Mar-Apr;35(2):1125-1132. doi: 10.21873/invivo.12358. ABSTRACT BACKGROUND/AIM: To date, thyroglobulin-doubling rate (Tg-DR) and tumor volume-doubling rate (TV-DR) of metastatic lesions have been identified as dynamic prognostic factors for differentiated thyroid carcinoma (DTC). In this study, we investigated the prognostic impact for another dynamic factor, the neutrophil-to-lymphocyte ratio (NLR), for DTC with distant metastasis. PATIENTS AND METHODS: We enroll ed 321 patients in total, and NLR at the first detection of distant metastasis (initial NLR) was collected for 312. RESULTS: Patients with initial NLR >3 had a significantly poorer cause-specific survival than those with initial NLR ≤3. On multivariate analysis, initial NLR >3 was recognized as an independent prognostic factor together with Tg-DR >1/year, TV-DR >1/year, radioactive iodine-refractory distant metastasis, and distant metastasis to organs other than the lung. CONCLUSION: Careful observation and active therapies, including multitarget kinase inhibitors, are recommended for patients with NLR >3 at the first detection of distant metastasis or during follow-up. PMID:33622910 | DOI:10.21873/invivo.12358 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sorafenib and Lenvatinib Treatment for Metastasis/Recurrence of Radioactive Iodine-refractory Differentiated Thyroid Carcinoma

xlomafota13 shared this article with you from Inoreader Sorafenib and Lenvatinib Treatment for Metastasis/Recurrence of Radioactive Iodine-refractory Differentiated Thyroid Carcinoma Via radioactive iodine In Vivo. 2021 Mar-Apr;35(2):1057-1064. doi: 10.21873/invivo.12350. ABSTRACT BACKGROUND/AIM: Radioactive iodine-refractory differentiated thyroid carcinoma (RR-DTC) has been treated with multi-kinase inhibitors (MKIs), e.g., sorafenib (SOR) and lenvatinib (LEN). We analyzed the outcomes of RR-DTC patients who underwent SOR or LEN treatment at Kuma Hospital. PATIENTS AND METHODS: We enrolled 21 and 18 patients treated with SOR and LEN, respectively. RESULTS: The incidence of partial response in the LEN group was significantly higher than that in the SOR group. Serum thyroglobulin significantly decreased from the beginning of treatment to 1 month later in the LEN group (not in the SOR group). The neutrophil-lymphocyte ratio (NLR) was significantly decreased at 1 month later in both groups. An NLR ≥3 at the start of MKI treatment had a prognostic impact. CONCLUSION: For RR-DTC, LEN could be more effective than SOR, at least in the short term. The first-line drug should be selected based on other factors (e.g., adverse events, patient background). PMID:33622902 | DOI:10.21873/invivo.12350 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ipilimumab-nivolumab as first-line treatment in metastatic NSCLC

xlomafota13 shared this article with you from Inoreader Ipilimumab-nivolumab as first-line treatment in metastatic NSCLC Via Association française pour l'étude du cancer Bull Cancer. 2021 Feb 20:S0007-4551(21)00040-0. doi: 10.1016/j.bulcan.2021.01.005. Online ahead of print. NO ABSTRACT PMID:33622569 | DOI:10.1016/j.bulcan.2021.01.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Traumatic brain injury: Estimate of the age of the injury based on neuroinflammation, endothelial activation markers and adhesion molecules

xlomafota13 shared this article with you from Inoreader Traumatic brain injury: Estimate of the age of the injury based on neuroinflammation, endothelial activation markers and adhesion molecules Via Cellular and Molecular Biology Histol Histopathol. 2021 Feb 24:18319. doi: 10.14670/HH-18-319. Online ahead of print. ABSTRACT Studies on traumatic brain injury (TBI) are applicable not only in the clinical context, but also in the forensic field. Over time, the literature has accumulated scientific evidence supporting the use of specific histopathological tests in dating traumatic brain injuries. In primary damage, cell death occurs by necrosis/apoptosis. In secondary injury, the underlying mechanisms are inflammation and ischemia. The inflammatory response of the central nervous system (CNS) follows the common steps of the innate response. In head injury, the blood brain barrier (BBB) undergoes both functional damage and, subsequently, finer structural changes. Scientific evidence has shown modifications of the junctional-endothelial system that favors the extravasation of immunocompetent cells. The histological evaluation of the subdural hematoma, of the cerebral contusions, of the diffuse axonal damage can certainly bring useful elements, with limitations, to the chronological evaluation of the lesions. Many markers have been used to better define the dating of the head injury. Several authors also analyzed the usefulness of secondary damage markers in brain tissue. The progress achieved with immunohistochemistry is significant compared to the use of routine staining. With immunohistochemistry it is possible to identify much narrower and more precise time intervals and, above all, with greater probative reliability. Recently attention has been paid to the modification of structural proteins and miRNAs. Future research is already started and entrusted to multidisciplinary teams that know how to combine their specific skills in search of a reproducible standard of known and sufficient accuracy. PMID:33625724 | DOI:10.14670/HH-18-319 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.