Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Tuesday, May 18, 2021

Treatment failure in hyperthyroid cats after radioiodine (I-131) injection

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J Vet Intern Med. 2021 May 17. doi: 10.1111/jvim.16161. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited published information on the outcome for cats where total thyroxine concentration (TT4) remains elevated after treatment with radioactive iodine (RAI).

OBJECTIVE: To determine the frequency of, and predictors for, subsequent treatment failure in cats for which TT4 remains elevated at hospital discharge, and to report clinical outcomes for cats requiring repeat treatment.

ANIMALS: One hundred twenty-one cats with TT4 ≥40 nmol/L after treatment with RAI (out of an original, treated study sample of 959 cats).

METHODS: Retrospective study. Data regarding signalment, weight, TT4 concentration (before RAI treatment, at discharge, and percentage change), day of sampling, and I-131 dose were acquired. Logistic regression was performed to evaluate predictors of treatment failure.

RESULTS: In the 87 cats for which classification was possible, 35 (40%) became euthyroid without further treatment. All TT4 variables and weight normalized RAI dose were independently predictive of subsequent treatment failure. In multivariate analysis, TT4 concentration at discharge (P < .001) and weight normalized RAI dose (P = .04) remained in the final model. All 28 cats with TT4 concentration ≥150 nmol/L at discharge ultimately failed treatment, compared with 13/40 (32.5%) and 11/19 (57.9%) cats with TT4 concentrations of 40-100 nmol/L and 10 0-150 nmol/L, respectively. Of the 52 cats that failed treatment, 14 were subsequently managed medically, 12 underwent thyroidectomy (4 with carcinoma), 14 had repeat RAI treatment which was successful in 12/14 (86%) cats, and 13 had no further treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with TT4 >150 nmol/L at discharge after RAI might be candidates for immediate repeat treatment.

PMID:33999452 | DOI:10.1111/jvim.16161

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Plasma Cell Granuloma of the Maxillary Sinus-A Case Report and Review

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Abstract

Plasma cell granuloma is a rare, benign, space occupying lesions occurring after recurrent infections. It most commonly involves young adults with lungs being the most common site. They are usually rounded masses with bony expansion and destruction without any life threatening complications and surgery being the best choice of treatment. Here we reported a 33 year-old female with plasma cell granuloma of the maxillary sinus treated with surgery and no recurrence has been noted.

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Obstruction nasale et vertiges : des symptômes pas si banals

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Publication date: June 2021

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 138, Issue 3

Author(s): S. Bartier, I. Delacroix, A. Coste, E. Bequignon

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Rupture traumatique d’un adénome parathyroïdien de forme kystique responsable d’hypercalcémie maligne

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Publication date: June 2021

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 138, Issue 3

Author(s): J. Schmitt, J.B. Morvan, D. Pascaud, E. Meaudre

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Impact of smoking on stage‐specific survival in human papilloma virus–associated oropharyngeal squamous cell carcinoma

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Abstract

Background

The American Joint Committee on Cancer (AJCC) released a new staging system for human papilloma virus (HPV) positive oropharyngeal cancer (OPC) in their eighth edition. The role of smoking in HPV positive oropharyngeal cancer remains controversial and is not factored into the updated staging system.

Methods

Single institutional, retrospective chart review of patients with HPV positive OPC from 2009 to 2017 was completed. Dichotomized smoking data were collected into 0–9 and ≥10 pack-year histories. Kaplan–Meier survival curves compared overall survival (OS) for smokers and nonsmokers.

Results

Five-year OS was not statistically different in stage I or stage II HPV positive OPC comparing nonsmokers versus smokers, but worse in stage III smokers (38% vs. 76%, p < 0.05).

Conclusion

Greater than 10 pack-year smoking status may negatively affect survival in late stage HPV positive OPC but not in early stage disease. HPV positive smokers may require additional risk stratification.

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Antifibrotic Role of Nintedanib in Tracheal Stenosis After a Tracheal Wound

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Objectives/Hypothesis

Tracheal stenosis is an obstructive disease of the upper airway that commonly develops as a result of abnormal wound healing. We evaluated the anti-inflammatory and antifibrotic properties of nintedanib on tracheal stenosis both in vitro and in vivo.

Study Design

Prospective controlled animal study and in vitro comparative study of human cells.

Methods

An animal model of tracheal stenosis was induced via tracheal trauma. Postsurgical rats were orally administered with nintedanib (10 or 20 mg/kg/d) or saline (negative control) for 2 weeks, and tracheal specimens were harvested after 3 weeks. Degree of stenosis, collagen deposition, fibrotic surrogate markers expression, and T-lymphocytic infiltration were evaluated. Human fetal lung fibroblast-1 (HFL-1) cells were cultured to determine the effects of nintedanib on changes of cellular biological function induced by transforming growth factor-β1 (TGF-β1).

Results

Rat tracheal stenotic tissues exhibited thickened lamina propria with irregular epithelium, characterized by significantly increased collagen deposition and elevated TGF-β1, collagen I, α-SMA and fibronectin expressions. Nintedanib markedly attenuated the tracheal stenotic lesions, reduced the collagen deposition and the expression of fibrotic marker proteins, and mitigated CD4+ T-lymphocyte infiltration. Additionally, cellular proliferation and migration were decreased dose-dependently in TGF-β1-stimulated HFL-1 cells when treated with nintedanib. Furthermore, nintedanib inhibited TGF-β1-induced HFL-1 differentiation and reduced the mRNA levels of the profibrotic genes. TGF-β1-activated phosphorylation of the TGF-β/Smad2/3 and ERK1/2 pathways were also blocked by nintedanib.

Conclusion

Nintedanib effectively prevented tracheal stenosis in rats by inhibiting fibrosis and inflammation. The antifibrotic effect of nintedanib may be achieved by inhibiting fibroblasts' proliferation, migration and differentiation and suppressing the TGF-β1/Smad2/3 and ERK1/2 signaling pathways.

Level of Evidence

NA Laryngoscope, 2021

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Diagnostic Accuracies of Laryngeal Diseases Using a Convolutional Neural Network‐Based Image Classification System

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Objectives/Hypothesis

There may be an interobserver variation in the diagnosis of laryngeal disease based on laryngoscopic images according to clinical experience. Therefore, this study is aimed to perform computer-assisted diagnosis for common laryngeal diseases using deep learning-based disease classification models.

Study Design

Experimental study with retrospective data

Methods

A total of 4106 images (cysts, nodules, polyps, leukoplakia, papillomas, Reinke's edema, granulomas, palsies, and normal cases) were analyzed. After equal distribution of diseases into ninefolds, stratified eightfold cross-validation was performed for training, validation process and remaining onefold was used as a test dataset. A trained model was applied to test sets, and model performance was assessed for precision (positive predictive value), recall (sensitivity), accuracy, F1 score, precision–recall (PR) curve, and PR-area under the receiver operating characteristic curve (PR-AUC). Outcomes were compared to those of visual assessments by four trainees.

Results

The trained deep neural networks (DNNs) outperformed trainees' visual assessments in discriminating cysts, granulomas, nodules, normal cases, palsies, papillomas, and polyps according to the PR-AUC and F1 score. The lowest F1 score and PR-AUC of DNNs were estimated for Reinke's edema (0.720, 0.800) and nodules (0.730, 0.780) but were comparable to the mean of the two trainees' F1 score with the best performances (0.765 and 0.675, respectively). In discriminating papillomas, the F1 score was much higher for DNNs (0.870) than for trainees (0.685). Overall, DNNs outperformed all trainees (micro-average PR-AUC = 0.95; macro-average PR-AUC = 0.91).

Conclusions

DNN technology could be applied to laryngoscopy to supplement clinical assessment of examiners by providing additional diagnostic clues and having a role as a reference of diagnosis.

Level of Evidence

3 Laryngoscope, 2021

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Head and Neck Injuries and Electronic Scooter Use in the United States

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Objective

To quantify electric scooter injuries encountered in United States emergency departments, focusing on the head and neck, to understand the safety impact of these scooters to improve safe usage.

Study Design

Retrospective cross-sectional study from January 2009 to December 2019 of patients presenting to United States emergency departments with electric scooter injuries collected from a national database. About 2,823 cases of injuries were related to electric scooter use from January 2009 to December 2019. Stratified weighted counts and incidence rates were estimated for injury characteristics. Piecewise linear regression quantified the yearly change in incidence of injuries before and after introduction of rideshare programs.

Results

The estimated national total of electric scooter cases from 2009 to 2019 was 103,943 (95% CI: 79,650–128,237). Incidence grew in 2019 to 8.63 cases per 100,000 person-years from 4.46 in 2018 to 2.42 in 2017. Head and neck injuries represented 28.5% of total injuries (weighted estimate = 29,610). The most common age group of head and neck injuries before 2018 was ≤17 years, but injuries in 18- to 44-year-olds grew significantly to become the most injured group in 2018 to 2019 (P < .001). From 2009 to 2017, incidence of head and neck injuries fell by 0.02 cases per 100,000 person-years, but cases grew by 1.22 cases per 100,000 person-years post-2017 (P < .001).

Conclusion

Injuries following the launch of rideshare electric scooter programs increased significantly, especially in patients 18 to 44 years of age. Head and neck injuries represent many of these injuries. User safety education must be addressed to prevent injury as programs become more pervasive in the United States.

Level of Evidence

Level 2 Laryngoscope, 2021

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Risk Factors of Postoperative Facial Palsy for Benign Parotid Tumors: Outcome of 1,018 Patients

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Objective

The aim of this study was to evaluate the rate of postoperative facial palsy in benign parotid tumors, as well as its risk factors, pathology, and clinical results.

Study Design

Retrospective analysis.

Methods

We performed a retrospective analysis of data from patients whose initial operation for a benign parotid tumor had been performed in our department between 1999 and 2020.

Results

We included 1,018 patients in this study. The most common tumor observed was pleomorphic adenoma (614 patients), followed by Warthin tumor (234 patients). Fine-needle aspiration cytology and frozen section biopsy were used to identify the tumor histopathology. The overall rate of postoperative facial nerve palsy was 19.5%; the rate was significantly higher in patients with large-diameter tumors or deep lobe tumors. Postoperative facial palsy improved within 24 months of surgery in all cases. There were no cases with permanent facial palsy.

Conclusions

Postoperative facial nerve palsy developed regularly after surgery to remove benign parotid tumors despite preservation of the nerve. Palsy rate was high in patients with large tumors or deep lobe tumors. Despite the high risk of facial palsy in these patients and the benign nature of the tumor, we recommend surgery rather than follow-up observation, as the risk of postoperative facial palsy may increase as the tumor grows. It is important to provide an accurate explanation on the risks of postoperative complications to all patients to obtain appropriate informed consent for surgery.

Level of Evidence

4 Laryngoscope, 2021

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Development of Cushing Syndrome After Serial In‐office Subglottic Steroid Injections

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In-office subglottic intralesional steroid injections (SILSI) have gained popularity as an adjunct to operating room dilation in the treatment of subglottic stenosis. They are generally thought to have a low risk profile for development of systemic side effects. Here, we present a case of a 55 year old woman who developed symptoms of Cushing syndrome after receiving SILSI, including weight gain, striae, dorsal hump and alopecia. This case illustrates that despite the localized nature of SILSI, there is still a risk of developing systemic effects as a result of the treatment. Laryngoscope, 2021

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Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections

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Objectives/Hypothesis

To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans-tympanostomy tube (TyT).

Study Design

Case series, systematic review and meta analysis.

Methods

Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed and meta-analysis was established.

Results

Eighteen studies describing 818 ears were included in the quantitative meta-analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%–3.27% and 0.028%–2.38%) in the TyT and trans-tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques.

Conclusion

IT steroid therapy via trans-TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections.

Level of Evidence

N/A Laryngoscope, 2021

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Beneficial effects of Coagulase‐negative Staphylococci on Staphylococcus aureus skin colonization

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Abstract

Our skin is constantly exposed to a large number of pathogens while at the same time undergoing selective colonization by commensal microorganisms such as coagulase-negative Staphylococci. Staphylococcus aureus, however, is a facultative pathogen that is usually absent from healthy skin but frequently colonizes the inflamed skin of atopic dermatitis patients, where it further promotes inflammation. Enhanced S. aureus skin colonization was shown to correlate with a loss of microbiome diversity indicating a role for skin commensals to shape pathogen colonization. Together, keratinocytes and immune cells in the skin need to discriminate commensals from pathogens and orchestrate subsequent immune reactions in response to colonizing microbes. However, the mechanisms how individual commensals cooperate with keratinocytes and the immune system of the skin to prevent pathogen colonization are barely understood. In this review, we discuss the current knowledge on the f unctional effects of coagulase-negative staphylococci, the most frequently isolated skin commensals, on S. aureus skin colonization.

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