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Αλέξανδρος Γ. Σφακιανάκης

Monday, April 19, 2021

Use of Orthopaedic Impactor to Assist the Fine Reduction of Rotated Zygomaticomaxillary Complex Fractures

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Abstract

Anatomic reduction of Zygomaticomaxillary complex (ZMC) fractures is quite challenging and technically demanding. Various methods and instruments are mentioned in the literature to achieve the same. However, a precise anatomic reduction is still a difficult task. We propose the use of a simple orthopaedic impactor in reducing laterally rotated ZMC fractures.

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Intermuscular Fibrolipoma of the Neck: A Rare Case Report

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Abstract

Lipomas are slow growing tumors rarely found in children. We report a very rare case of an intermuscular fibrolipoma found deep within the posterior triangle of the neck. A 3 year old child was brought with the complaints of right sided neck mass and an inability to fully turn his head for two months. Ultrasound and computed tomography of the neck suggested a diagnosis of intermuscular lipoma. The patient was successfully managed by complete surgical resection of the mass. Histopathological examination confirmed the diagnosis as intermuscular fibrolipoma. Due to the rarity of the case, we are prompted to report it.

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First renal metastasis report from tongue cancer

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Braz J Otorhinolaryngol. 2021 Apr 8:S1808-8694(21)00066-5. doi: 10.1016/j.bjorl.2021.03.007. Online ahead of print.

NO ABSTRACT

PMID:33865742 | DOI:10.1016/j.bjorl.2021.03.007

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Predictive factors of radioiodine therapy failure in Graves' Disease: A meta-analysis

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Am J Surg. 2021 Apr 14:S0002-9610(21)00229-4. doi: 10.1016/j.amjsurg.2021.03.068. Online ahead of print.

ABSTRACT

BACKGROUND: I-131 therapy is a common treatment modality for adults with Graves' Disease (GD). Utilizing meta-analysis, we examined patient specific factors that predict I-131 therapy failure.

METHODS: Literature search followed PRISMA. Comprehensive Meta-analysis (version 3.0) was used. Mantel-Haenszel test with accompanying risk ratio and confidence intervals ev aluated categorical variables. Continuous data was analyzed using inverse variance testing yielding mean difference or standardized mean difference. Decision tree algorithms identified variables of high discriminative performance.

RESULTS: 4822 collective patients across 18 studies were included. Male sex (RR = 1.23, 95%CI = 1.08-1.41, p = 0.002), I-131 therapy 6 months after GD diagnosis (RR = 2.10, 95%CI = 1.45-3.04, p < 0.001) and history of anti-thyroid drugs (RR = 2.05, 95%CI = 1.49-2.81, p < 0.001) increased the risk of I-131 therapy failure. Elevated free thyroxine, 24-h radioactive iodine uptake scan ≥60.26% and thyroid volume ≥35.77 mL were also associated with failure.

CONCLUSION: Patient characteristics can predict the likelihood of I-131 therapy failure in GD. Definitive surgical treatment may be a reasonable option for those patients.

PMID:33865565 | DOI:10.1016/j.amjsurg.2021.03.068

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Stimulated serum thyroglobulin but not RAIU level is a prognostic factor for ablation efficacy with a 3.7GBq (100mCi) fixed 131I dose in patients with differentiated thyroid cancer

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Hell J Nucl Med. 2021 Apr 20:s002449912306. doi: 10.1967/s002449912306. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to determine prognostic value of radioactive iodine uptake (RAIU) and stimulated thyroglobulin (sTg) regarding the ablation efficacy in patients with differentiated thyroid cancer.

SUBJECTS AND METHODS: We studied 466 differentiated thyroid cancer (DTC) patients without distant metastases after thyroidectomy who underwent iodine-131 (131I) ablation and were pre-therapy assessed by RAIU. The patients were divided into four groups according to the RAIU result, including: A) RAIU<2%, B) 2%≤RAIU<5%, C) 5%≤RAIU<10% and D) RAIU≥10%. Every group was divided into four subgroups according to sTg levels, namely: 1) sTg<2ng/mL, 2) 2ng/mL≤sTg<5ng/mL, 3) 5ng/mL≤sTg<10ng/mL and 4) sTg≥10ng/mL subgroup. The ablation success was defined as a negative scan 6 months to 1 year and other imaging like US did not detect anything suspicious after ablation. Excellent response was considered as: sTg<1ng/mL with negative thyroglobulin antibodies (TgAb) and negative image scans.

RESULTS: The rate of successful ablation was 88.3%, 88.7%, 88.4% and 79% between group A to D, respectively (P=0.779). There was also no significant difference about the excellent response rate (64.5% vs 63.6% vs 48.8% vs 57.1%, P=0.256) between group A to D. The ablation success rate did not differ significantly betw een subgroups 1 to 4 in every group. However, the rates of excellent response were 86.8%, 52.1%, 25% and 15.2% between subgroups 1 to 4 for group A, respectively (P<0.001). Similarly, there was a significant difference about excellent response rate between subgroups 1 to 4 for groups B, C and D.

CONCLUSION: After total thyroidectomy, not RAIU but sTg is a prognostic factor for ablation efficacy with a 3.7GBq (100mCi) fixed 131I dose in patients with DTC.

PMID:33866339 | DOI:10.1967/s002449912306

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The value of serum thyroglobuline alteration after ultrasonography-guided fine-needle biopsy of suspicous cervical lymph nodes in the diagnosis of metastasis in patients with differentiated thyroid cancer

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Int J Clin Pract. 2021 Apr 18:e14218. doi: 10.1111/ijcp.14218. Online ahead of print.

ABSTRACT

AIM: It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules.We aimed to determine whether TG is increased after ultrasonography guided fine needle capillary biopsy (FNC) of suspicious cervical LNs in thyroidectomized patients and investigate the possible association between change in TG and cytology results.

METHODS: Data of 188 patients w ho underwent FNC of suspicious cervical LNs were retrospectively evaluated.Demographical, laboratory,and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined.Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results.

RESULTS: TGa-FNC , TGb-FNC /TGa-FNC , and rate of patients with increased TG were significantly higher in malignant cytology group than other groups(p<0.001).The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%.TG increase was not associated with age,sex, TSH level, antiTG positivity and US features of LNs while signficantly lower in patients who received radioactive iodine (RAI) treatment.Among 31 patients w ith positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups.

CONCLUSIONS: Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients.Increase in TG after FNC might be an additional tool for determining LN metastasis.

PMID:33866655 | DOI:10.1111/ijcp.14218

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Preoperative perforator mapping: Accuracy, bias, concordance and the devil

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J Plast Reconstr Aesthet Surg. 2021 Apr 1:S1748-6815(21)00129-7. doi: 10.1016/j.bjps.2021.03.040. Online ahead of print.

NO ABSTRACT

PMID:33865731 | DOI:10.1016/j.bjps.2021.03.040

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Salvage surgery improves the treatment outcome of patients with residual/recurrent maxillary sinus cancer after superselective intra-arterial cisplatin infusion with concomitant radiation therapy

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Eur Arch Otorhinolaryngol. 2021 Apr 18. doi: 10.1007/s00405-021-06822-5. Online ahead of print.

ABSTRACT

PURPOSE: We have performed superselective intra-arterial cisplatin infusion with concomitant radiotherapy (RADPLAT) for patients with maxillary sinus cancer. The promising treatment outcomes of this non-surgical treatment were reported in past studies. However, few clinical studies have been conducted to evaluate the outcome of salvage surgery following RADPLAT. The purpose of this study was to analyze the treatment outcomes of salvage surgery for patients with recurrent maxillary sinus cancer after RADPLAT.

METHODS: We assessed 45 patients who had recurrence following RADPLAT between 1999 and 2017, and conducted a retrospective analysis. We excluded patients who did not complete RADPLAT. Patients were not considered to have completed RADPLAT if they underwent intra-arterial cisplatin less than three times or received a total radiation dose of less than 60 Gy. The primary endpoint was overall survival. The median follow-up period for surviving patients after recurrence was 5.1 years.

RESULTS: Twenty-five of the 45 (56%) patients underwent salvage surgery. The 5-year overall survival rate was 68% in patients who underwent salvage surgery, while all patients who did not undergo salvage surgery died during the observation period. Fifteen of 24 (63%) patients with local recurrence underwent salvage surgery. Eight patients did not undergo salvage surgery because of unresectable disease; five of the eight patients had unresectable posterior extension. All nine patients with nodal recurrence underwent neck dissection.

CONCLUSION: Treatment outcomes of salvage surgery following RADPLAT were favorable enough for it to be generally recommended. To reduce unresectable recurrence, the posterior section should be eradicated by RADPLAT.

PMID:33866400 | DOI:10.1007/s00405-021-06822-5

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Cochlear implantation versus auditory brainstem implantation in children with auditory nerve deficiencies

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Eur Arch Otorhinolaryngol. 2021 Apr 18. doi: 10.1007/s00405-021-06792-8. Online ahead of print.

ABSTRACT

BACKGROUND: Cochlear nerve deficiency is one of the known causes of congenital sensorineural hearing loss. Management of hearing loss in children with cochlear nerve deficiency poses a multidimensional challenge. The absent or hypoplastic cochlear nerve may prevent electrical stimulation from reaching the brainstem and the auditory cortex. A deficient cochlear nerve can be associated with other inner ear malformations, which may diminish the success of cochlear implantation in those children. Promising results in adults after auditory brainstem implantation led to the expansion of candidacy to include the pediatric populations who were contraindicated for CIs.

OBJECTIVE: To review the outcomes of cochlear implantation versus that of auditory brainstem implantation in children with various conditions of the auditory nerve.

< p>METHODS: This retrospective chart review study comprised two pediatric groups. The first group consisted of seven ABI recipients with cochlear nerve aplasia and the second group consisted of another seven children with cochlear nerve deficiencies who underwent CI surgery. The participants' auditory skills and speech outcomes were assessed using different tests selected from the Evaluation of Auditory Responses to Speech (EARS) test battery.

RESULTS: There were some individual variations in outcomes depending on the status of the auditory nerve. The mean CAP score of the ABI group was 2.87, while the mean SIR score was 0.62. On the other hand, the mean CAP score of the CI group was 1.29, while the mean SIR score was 0.42.

CONCLUSION: Our results are in good agreement with the reported auditory perception and speech and language development outcomes of pediatric auditory brainstem implantation. We added to the growing body of literature on the importance of verifying and identifying the status of the cochlear nerve in the decision-making process of the surgical management of those pediatric groups.

PMID:33866399 | DOI:10.1007/s00405-021-06792-8

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Cochlear implantation versus auditory brainstem implantation in children with auditory nerve deficiencies

xlomafota13 shared this article with you from Inoreader

Eur Arch Otorhinolaryngol. 2021 Apr 18. doi: 10.1007/s00405-021-06792-8. Online ahead of print.

ABSTRACT

BACKGROUND: Cochlear nerve deficiency is one of the known causes of congenital sensorineural hearing loss. Management of hearing loss in children with cochlear nerve deficiency poses a multidimensional challenge. The absent or hypoplastic cochlear nerve may prevent electrical stimulation from reaching the brainstem and the auditory cortex. A deficient cochlear nerve can be associated with other inner ear malformations, which may diminish the success of cochlear implantation in those children. Promising results in adults after auditory brainstem implantation led to the expansion of candidacy to include the pediatric populations who were contraindicated for CIs.

OBJECTIVE: To review the outcomes of cochlear implantation versus that of auditory brainstem implantation in children with various conditions of the auditory nerve.

< p>METHODS: This retrospective chart review study comprised two pediatric groups. The first group consisted of seven ABI recipients with cochlear nerve aplasia and the second group consisted of another seven children with cochlear nerve deficiencies who underwent CI surgery. The participants' auditory skills and speech outcomes were assessed using different tests selected from the Evaluation of Auditory Responses to Speech (EARS) test battery.

RESULTS: There were some individual variations in outcomes depending on the status of the auditory nerve. The mean CAP score of the ABI group was 2.87, while the mean SIR score was 0.62. On the other hand, the mean CAP score of the CI group was 1.29, while the mean SIR score was 0.42.

CONCLUSION: Our results are in good agreement with the reported auditory perception and speech and language development outcomes of pediatric auditory brainstem implantation. We added to the growing body of literature on the importance of verifying and identifying the status of the cochlear nerve in the decision-making process of the surgical management of those pediatric groups.

PMID:33866399 | DOI:10.1007/s00405-021-06792-8

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Epidemiological, Clinical and Radiological Profile of Patients with Foreign Body Oesophagus: A Prospective Study

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Abstract

To analyse the patients with foreign body oesophagus in relation to the clinico-radiological and socio-economic profile. The present prospective study was conducted on 100 consecutive patients of all age groups who underwent oesophagoscopy for suspected foreign body ingestion in a tertiary care hospital. The most common age group affected was 0–5 years. The median age was 5 ± 14.37 years. There was preponderance in males as compared to females, male to female ratio was 2.23:1. Majority (70%) of the patients, both males and females, belonged to rural areas. Lower socio-economic group was more commonly affected (54%). The most commonly reported symptom was foreign body sensation (55%) followed by vomiting (54%) and difficulty in swallowing (51%). Foreign body ingestion was witnessed in only 19% cases by the family members. The mean time between ingestion of the foreign body and admission to the hospital was found to be 4.5 h. The majority (97% ) of foreign bodies were radio-opaque. The most common site of lodgement was just below the cricopharynx (89%). The most common foreign body retrieved in our series were coins (65%). The majority of foreign bodies (68%) were retrieved in 20–40 min after induction of general anaesthesia. In 99% of the patients we did not encounter any complications. The majority (93%) of the patient's parents/relatives had curiosity to have a glimpse of the foreign body till they actually saw the retrieved foreign body. Foreign body lodgement is more common among children of lower socio-economic strata more so in rural areas. Rigid oesophagoscopy is a safe and effective procedure for removal of the foreign body. Early intervention makes it easier to extract the foreign body without complications.

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