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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, March 9, 2021

A Case Report of Chondrosarcoma of Temporomandibular Joint

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Abstract

In this case report we describe a rare case of chondrosarcoma of the Temporomandibular joint in a 70 years old female who presented with a right preauricular swelling, trismus and neuralgic pain. On examination, firm and tender swelling was noted in the right preauricular region. CT Scan revealed 3.48 × 3.0 cm size mass lesion in the region of mandibular condyle and extending into the right temporomandibular joint space. The cytopathological report was suggestive of chondroid malignancy. The tumor was excised and histopathological examination showed large sheets of atypical tumor cells with cartilaginous matrix and diagnosis of a well differentiated Chondrosarcoma was confirmed. Post-surgical resection, patient remains disease free at 15 months follow up.

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Effects of CROS hearing aids on audiologic and school performance in school-age children with unilateral hearing loss

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Clin Exp Otorhinolaryngol. 2021 Feb 26. doi: 10.21053/ceo.2020.02523. Online ahead of print.

NO ABSTRACT

PMID:33677849 | DOI:10.21053/ceo.2020.02523

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Significance of Pseudo-conductive Hearing Loss and Positional Nystagmus on Perilymphatic Fistula: Are they related to third window effects?

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Clin Exp Otorhinolaryngol. 2021 Feb 26. doi: 10.21053/ceo.2020.01942. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical presentation is critical to identify suspected perilymphatic fistula (PLF). To explain characteristic of PLF, it was hypothesized that a third window lesion might be involved in the pathomechanism. The purpose of this study is to investigate clinical features in PLF and figure out the relationship of third window effect and PLF.

METHODS: Sixty patients underwent surgical exploration under suspicion of PLF and reinforecmenet of oval window and round window was performed. Clinical features including demographics, pure tone audiometry (PTA), and videonystagmography (VNG) were evaluated preoperatively and 1 month after operation. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap (ABG)) were measured, and the re lationship between ABG closure after surgery and hearing improvement was analyzed. In addition, the postoperative subjective dizziness was assessed by interview in clinic. The change of positional nystagmus was analyzed according to ABG closure and hearing improvement.

RESULTS: ABG at lower frequencies (LFABG, 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, the PTA was significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). The subjective dizziness improved in 56 patients (91.8%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, the positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 (64.7%) patients.

CONCLUSION: . Pseudo-conductive hearing loss at the lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the RW and OW improved hearing threshold accompanied by closure of ABG. The third window lesion might explain these clinical features that indicate PLF.

PMID:33677850 | DOI:10.21053/ceo.2020.01942

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Genetic variants and clinical phenotypes in Korean patients with hereditary hemorrhagic telangiectasia

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Clin Exp Otorhinolaryngol. 2021 Feb 26. doi: 10.21053/ceo.2020.02124. Online ahead of print.

ABSTRACT

OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasias, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and Endoglin (ENG) are the principal genes whose mutations cause HHT. A multicenter study to investigate the correlation between genetic variations and clinical outcomes in Korean HHT patients has been lacking.

METHODS: Seventy-two members from 40 families suspected of HHT based on symptoms were genetically screened for pathogenic variants in ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated.

RESULTS: In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogen ic strong, pathogenic moderate, or pathogenic supporting) based on ACMG Standards and Guidelines in either ENG or ACVRL1; 26 from 12 families (50%) in ENG, and 16 from 12 families (50%) in ACVRL1. The diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were in the definite group, 17 patients (41%) were in the probable group, and 1 patient (2%) was in the unlikely group. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%), and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms.

CONCLUSION: Among patients having ACVRL1 or ENG genetic variants, only about half of them could be clinically diagnosed as definite HHT, suggesting that genetic screening is important to confirm the diagnosis.

PMID:33677851 | DOI:10.21053/ceo.2020.02124

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The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial

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Neurocirugia (Astur). 2021 Mar 3:S1130-1473(21)00011-7. doi: 10.1016/j.neucir.2021.01.002. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws.

MATERIALS AND METHODS: This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six mont hs after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent).

RESULTS: In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001).

CONCLUSIONS: Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory.

TRIAL REGISTRATION NUMBER: IRCT20120527009878N3.

PMID:33676794 | DOI:10.1016/j.neucir.2021.01.002

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Feasibility of immunotherapy administration to patients with bronchial cancer in a Hospital-at-Home setting

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Bull Cancer. 2021 Mar 3:S0007-4551(21)00043-6. doi: 10.1016/j.bulcan.2020.11.017. Online ahead of print.

NO ABSTRACT

PMID:33676724 | DOI:10.1016/j.bulcan.2020.11.017

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Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users?

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Hear Res. 2021 Feb 18;404:108206. doi: 10.1016/j.heares.2021.108206. Online ahead of print.

ABSTRACT

INTRODUCTION: Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system.

OBJECTIVE: To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users.

MATERIAL AND METHODS: This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with mi nimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC- (map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT- (map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 6000Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test.

RESULTS: Thirty individuals were selected and signed an informed consent form. The MC- map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT- map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT+ map improved free field thresholds except 6000Hz, worsening speech recognition, without statistical significance.

CONCLUSIONS: The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.

PMID:33677193 | DOI:10.1016/j.heares.2021.108206

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Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis

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Eur Arch Otorhinolaryngol. 2021 Mar 6. doi: 10.1007/s00405-021-06724-6. Online ahead of print.

ABSTRACT

PURPOSE: This meta-analysis study was designed to analyze endoscopic surgery's role in treating rhinogenic contact point headache.

METHODS: We performed a comprehensive review of the last 20 years' English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale.

RESULTS: We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p < 0.0001). At quantitative analysis on 660 patients (11 papers), surgical treatment demonstrated significantly better post-operative scores than medical (p < 0.0001).

CONCLUSION: At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.

PMID:33677741 | DOI:10.1007/s00405-021-06724-6

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Typical symptoms of common otorhinolaryngological diseases may mask a SARS-CoV-2 infection

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Eur Arch Otorhinolaryngol. 2021 Mar 7. doi: 10.1007/s00405-021-06726-4. Online ahead of print.

ABSTRACT

PURPOSE: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) replicates predominantly in the upper respiratory tract and is primarily transmitted by droplets and aerosols. Taking the medical history for typical COVID-19 symptoms and PCR-based SARS-CoV-2 testing have become established as screening procedures. The aim of this work was to describe the clinical appearance of SARS-CoV-2-PCR positive patients and to determine the SARS-CoV-2 contact risk for health care workers (HCW).

METHODS: The retrospective study included n = 2283 SARS-CoV-2 PCR tests from n = 1725 patients with otorhinolaryngological (ORL) diseases performed from March to November 2020 prior to inpatient treatment. In addition, demographic data and medical history were assessed.

RESULTS: n = 13 PCR tests (0.6%) were positive for SARS-CoV-2 RN A. The positive rate showed a significant increase during the observation period (p < 0.01). None of the patients had clinical symptoms that led to a suspected diagnosis of COVID-19 before PCR testing. The patients were either asymptomatic (n = 4) or had symptoms that were interpreted as symptoms typical of the ORL disease or secondary diagnoses (n = 9).

CONCLUSION: The identification of SARS-CoV-2-positive patients is a considerable challenge in clinical practice. Our findings illustrate that taking a medical history alone is of limited value and cannot replace molecular SARS-CoV-2 testing, especially for patients with ORL diseases. Our data also demonstrate that there is a high probability of contact with SARS-CoV-2-positive patients in everyday clinical practice, so that the use of personal protective equipment, even in apparently "routine cases", is highly recommended.

PMID:33677653 | DOI:10.1007/s00405-021-06726-4

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The Feasibility of Gastroesophageal Manometry for Continuously Evaluating the Degree of Expiratory Effort During Successful Crescendo Phonation

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This study aimed to assess the feasibility of gastroesophageal manometry for continuously evaluating the degree of expiratory effort by measuring the pressures in the digestive tract during crescendo phonation.
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The arcade of Frohse: a systematic review and meta-analysis

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Surg Radiol Anat. 2021 Mar 6. doi: 10.1007/s00276-021-02718-5. Online ahead of print.

ABSTRACT

PURPOSE: The structure of the proximal margin of the superficial layer of the supinator muscle is of high interest to many researches. Its tendinous appearance, called the arcade of Frohse, may be clinically important because of its close relationship to the deep branch of the radial nerve passing beneath it and is considered to be the cause of several syndromes. Given the importan ce of this structure, we aimed to provide a comprehensive and evidence-based review with meta-analytic techniques.

MATERIALS AND METHODS: The meta-analysis was performed in adherence to the PRISMA guidelines. Three medical databases were searched in order to identify all potentially eligible articles. Included studies were assessed for quality and the extracted morphological and morphometric data from the relevant articles was analyzed with the use of random effects meta-analysis.

RESULTS: A total of 20 studies were included into this meta-analysis. The pooled prevalence of the arcade of Frohse was calculated to be 66% within the adult population and 0% in the fetuses. Other variations regarding the arcade of Frohse were identified as very rare. Analysis of the morphometric parameters revealed the average proportions to be 23.22 mm for the length, 11.05 mm for the width and the mean thickness is 0.67 mm.

CONCLUSIONS: The arcade of Frohse is a commonly found structu re in adults and thoughtful knowledge of its texture and morphology is especially useful in neurology, neurosurgery, orthopedics, trauma surgery and hand surgery, because it is considered to be the most common source of compression for the deep branch of the radial nerve.

PMID:33677682 | DOI:10.1007/s00276-021-02718-5

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