Management of Chyle Leak After Head and Neck Surgery; Our Meritorious Experience in 52 Cases and Review of Literature

xlomafota13 shared this article with you from Inoreader Management of Chyle Leak After Head and Neck Surgery; Our Meritorious Experience in 52 Cases and Review of Literature Via Otolaryngology Indian Abstract Iatrogenic chyle leak is commonly seen when dissection happens very low in neck. Management of chyle leak is conservative with compression dressing, fat restricted diet, somatostatin analogues. Surgery is required in extreme cases with failure of conservative treatment. This is a retrospective observational study carried out from a prospectively maintained database. A total of 6482 head and neck surgeries with neck dissections were carried out between January 2015 till July 2020 at our tertiary cancer center. Out of which there were 52 cases of chyle leak reported post neck dissection. All details regarding age, sex, primary tumor location, surgery performed, level of nodal dissection performed, details related to chyle leak from beginning day and its progression and management offered. The median age in the study group was 42 years (24–70 years). Chyle leak was most commonly seen on left side (88.5%). Low output leaks(n = 43) resolved wi thin a median period of 9 days (5–13 days) period of conservative management. High output leak (n = 9) had leak resolution within a median period of 12 days (7–19 days). Patients who had received preoperative radiotherapy and who had extra nodal extension in lymph nodes had significantly higher incidence of high output leaks. Chyle leak is a rare but serious complication in head and neck surgery. Timely identification and management is crucial. Conservative management is mainstay. Surgical management is instituted in cases of failure of conservative management. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Morphologic analysis of alveolar bone in maxillary and mandibular incisors on sagittal views

xlomafota13 shared this article with you from Inoreader Morphologic analysis of alveolar bone in maxillary and mandibular incisors on sagittal views Via radiol anat Surg Radiol Anat. 2021 May 22. doi: 10.1007/s00276-020-02640-2. Online ahead of print. ABSTRACT PURPOSE: The aim of this study was to analyze the morphologic features of alveolus in relatively healthy maxillary and mandibular incisors using cone-beam-computed tomography (CBCT). METHODS: CBCT images of 318 patients were retrospectively acquired. Alveolar bone in incisive area was divided into: type 1 (thick), type 2 (relatively thick with mono-plate concavity), type 3 ( thin with double-plate concavities), and type 4 (vulnerably thin). Alveolus prevalence and widths were analyzed statistically relative to age, gender, and molar relationship. RESULTS: Prevalence of type 1 alveolus was 78.9% in maxillary central incisors, 15.1% in maxillary lateral incisors, 24.1% in mandibular central incisors, and 5.0% in mandibular lateral incisors. Type 2 alveolus was commonly observed in the maxillary lateral incisors (82.2%), mandibular central incisors (66.2%), and mandibular lateral incisors (87.9%). Prevalence of type 3 and 4 alveoli ranged from 0.0 to 9.4%. As for maxillary central incisors, type 1 was the widest both at the alveolar crest (7.77 ± 0.58 mm) and apical area (9.05 ± 1.86 mm), while type 3 had the lowest width at the apical region (4.08 ± 0.51 mm). Among maxillary central incisors, prevalence of type 1 tended to decrease with age. At all maxillary and mandibular incisor sites, alveolus widths were significantly thicker in males than in females. At maxillary lateral incisor and mandibular incisor sites, prevalence of alveolus type was significantly different among three molar relationships. CONCLUSION: A 4-type classification system was suggested for alveolus morphology in incisive region. Identification of alveolus type might aid in the corresponding treatment. PMID:34023911 | DOI:10.1007/s00276-020-02640-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hairy cell leukemia: What are the best treatment options for relapsed or refractory patients?

xlomafota13 shared this article with you from Inoreader Hairy cell leukemia: What are the best treatment options for relapsed or refractory patients? Via Association française pour l'étude du cancer Bull Cancer. 2021 May 19:S0007-4551(21)00166-1. doi: 10.1016/j.bulcan.2021.03.011. Online ahead of print. ABSTRACT Hairy cell leukemia is a rare form of leukemia: three hundred new cases are diagnosed each year in France. The diagnosis is based on: (1) morphological examination of the blood and bone marrow smear, (2) analysis by flow cytometry of hairy cells, which express three or the four following markers: CD11c, CD25, CD103 and CD123, (3) identification of the BRAFV600E mutation, a true molecular marker of the disease. The management of treatment has evolved considerably in recent years. As of today, the purine analogues remain the standard treatment in the first line. Relapses are however observed in about 40% of cases. In the event of a first relapse, the preferred option is treatment with immunochemotherapy i.e. a combination of cladribine plus rituximab. Subsequent relapses are treated with moxetumomab pasudotox or B RAF inhibitors which provide indisputable benefits if third-line treatment is required. We will discuss in patients with relapsed/refractory hairy cell leukemia the needs for personalized medicine and the advantages and disadvantages of each treatment modality. The good prognosis for LT requires treatments that are not immunosuppressive, non-myelotoxic, and do not increase the risk of secondary cancers. PMID:34023063 | DOI:10.1016/j.bulcan.2021.03.011 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Drug approval: Selpercatinib and pralsetinib - RET-altered non-small cell lung cancer

xlomafota13 shared this article with you from Inoreader Drug approval: Selpercatinib and pralsetinib - RET-altered non-small cell lung cancer Via Association française pour l'étude du cancer Bull Cancer. 2021 May 19:S0007-4551(21)00172-7. doi: 10.1016/j.bulcan.2021.04.003. Online ahead of print. NO ABSTRACT PMID:34023064 | DOI:10.1016/j.bulcan.2021.04.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients

xlomafota13 shared this article with you from Inoreader Combined approach to treatment of advanced stages of medication-related osteonecrosis of the jaw patients Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 May 6:S1808-8694(21)00076-8. doi: 10.1016/j.bjorl.2021.04.004. Online ahead of print. ABSTRACT INTRODUCTION: Increased incidence of localized osteonecrosis in the jaw bones caused by bisphosphanate use and reduced quality of life of the patients led researchers to diagnose the disease in the early period and to investigate the effective treatment modality. OBJECTIVE: Treatment of medication-related osteonecrosis of the jaw patients is based on individual protocols from clinical experience, as there are no definitive treatment guidelines. In view of the lack of consensus on the effectiveness of medication-related osteonecrosis of the jaw treatments in the literature, the aim of this study was to evaluate the surgical technique described in the treatment of advanced stages of medication-related osteonecrosis of the jaw patients. METHODS: Twenty-one patients affected by Stage 2-3 medication-relate d osteonecrosis of the jaw were treated with ultrasonic piezoelectric bone surgery for necrotic bone removing, leukocyte and platelet-rich fibrin concentrate obtained from the patient's peripheral blood and Nd:YAG laser for biostimulation. Success was assessed as the maintenance of full mucosal coverage without signs of residual infection at 1-month (T1), 3-months (T2), 6-months (T3) and 1-year (T4) after surgery. Logistic regressions were used to evaluate the association between the different independent variables and treatment outcomes. RESULTS: Two Stage 3 patients had delayed healing at 1 month after the operation. Complete mucosal healing was achieved in all patients at the third month. Multivariate analysis demonstrated that different variables were not significantly correlated with delayed healing (p > 0.05). CONCLUSION: The surgical protocol presented in this study shows promising results for surgical management of advanced stages of medication-related osteone crosis of the jaw patients. PMID:34023243 | DOI:10.1016/j.bjorl.2021.04.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Robot-assisted breast reconstruction using the prepectoral anterior tenting method

xlomafota13 shared this article with you from Inoreader Robot-assisted breast reconstruction using the prepectoral anterior tenting method Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 22:S1748-6815(21)00224-2. doi: 10.1016/j.bjps.2021.03.120. Online ahead of print. ABSTRACT PURPOSE: Prosthetic breast reconstruction in the prepectoral plane with acellular dermal matrix (ADM) support has been gaining popularity and the use of robotic assistance could enhance this procedure. This study introduces robot-assisted prosthetic breast reconstruction using the anterior tenting method. METHODS: Sixteen patients (16 breasts) undergoing surgery from July 2019 to April 2020 were included in this study. The breast oncology team performed mastectomies with direct-to-implant (DTI) reconstruction using the da Vinci XiTM (Intuitive Surgical Corp., Sunnyvale, CA, USA) system. The prepectoral plane anterior tenting method using ADM was performed. RESULTS: Of the 16 patients, 14 underwent a nipple-sparing mastectomy and two underwent a skin-sparing mastectomy. The average pat ient age was 44.9 years, body mass index (BMI) was 22.9 kg/m2, and mastectomy weight was 367.6 g. The breast oncology team had an average operating time of 194.7 minutes, and the plastic surgery team had an average operating time of 80.8 minutes. The average postoperative drainage was 943.6 mL, and minor complications occurred in two patients. CONCLUSION: With the robot, only a small incision of approximately 4.5 cm is necessary and areas that are not readily visible, such as the side of the axilla, can be accessed during the surgery. Using a smaller ADM size, the implant pocket under the ADM can be easily created under a magnified view. Inframammary fold (IMF) restoration is also possible with robotic surgery and delayed bleeding from the pocket can be easily controlled. PMID:34023241 | DOI:10.1016/j.bjps.2021.03.120 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ideal esthetic and functional full-thickness lower eyelid 'like with like' reconstruction using a combined Hughes flap and swing skin flap technique

xlomafota13 shared this article with you from Inoreader Ideal esthetic and functional full-thickness lower eyelid "like with like" reconstruction using a combined Hughes flap and swing skin flap technique Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 22:S1748-6815(21)00223-0. doi: 10.1016/j.bjps.2021.03.119. Online ahead of print. ABSTRACT BACKGROUND: A goal in ideal lower eyelid reconstruction is to achieve not only an esthetic recovery of the shape of the eyelid but also to obtain satisfactory eyelid function without damage to the corneal surface. In this report, we introduce our "Like with Like" reconstruction technique using a combined Hughes flap and swing skin flap. The Hughes flap is a tarsoconjunctival pedicled flap from the upper eyelid, and the swing skin flap is a kind of transposition flap based on the orbicularis muscle pedicle. PATIENTS AND METHODS: Eight patients who had more than 25% of the lower eyelid affected by a full-thickness defect were included. There were five men and three women, and the average age was 68.4years old. All patients had undergone wide tumor excision of the lower eyelid due to a malignant tumor an d had also had primary two-stage eyelid reconstruction with a combined Hughes flap and swing skin flap. RESULTS: The average reconstructive time was 1:20, and no postoperative severe complications such as flap necrosis or wound dehiscence were observed. The follow-up period was an average of one year, and there were no functional problems such as ectropion, lower eyelid retraction, lid margin hypertrophy, lacrimation disorder, or corneal problems observed in any cases. Esthetically, no reconstructed eyelid bulging or asymmetry in the lid margin was observed in any of the cases. CONCLUSIONS: Combining the Hughes flap and skin swing flap technique might be the best choice for a full-thickness lower eyelid defect with regard to the esthetic and functional results. PMID:34023240 | DOI:10.1016/j.bjps.2021.03.119 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Alar Cartilage Hematoma: Case Report and Literature Review

xlomafota13 shared this article with you from Inoreader Alar Cartilage Hematoma: Case Report and Literature Review Via Otolaryngology Indian Abstract Nasal hematomas can occur after nasal trauma. It can involve the septal, alar, or all levels, with the septum being the most commonly affected site. We present a case of alar hematoma in a five-year-old boy after nasal trauma. The patient came to the emergency room complaining of nasal pain, epistaxis, and nasal deformity. A complete ear, nose, and throat examination was performed, and X-ray and computed tomography imaging of the facial bone were done to confirm the presence of a nasal alar hematoma. The alar hematoma was successfully treated via surgical evacuation. Alar cartilage hematoma is a rare entity that can lead to undesirable complications when missed. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery

xlomafota13 shared this article with you from Inoreader Comparing Efficacy of Propofol and Dexmedetomidine in Conscious Sedation During Stapedotomy Surgery Via Otolaryngology Indian Abstract Introduction We decided to compare dexmedetomidine with propofol regarding several anesthetic and surgical aspects, during stapedotomy done under conscious sedation. Materials and Method Thirty patients aged 20–50 years with (American Society of Anesthesiology) ASA class I-II, were assigned to two groups of propofol and dexmedetomidine using a random number table. In dexmedetomidine group, patients received dexmedetomidine infusion (0.5 µg/kg/h) and in the control group, propofol was administered (3 mg/kg/h).Time to reach the desired Ramsey Sedation Score (RSS) and time to reach Aldrete score ≥ 9; incidence of inadvertent movement and amnesia; as well as patients' and surgeons' level of satisfaction and degree of bleeding was recorded. Data on hemodynamic variables were monitored and recorded at several intervals. Results The mean time taken to reach the RSS (2–4) was 10.3 ± 2.1 min in dexmedetomidine group and 3.1 ± 1.2 min in propofol group. Time to reach Aldrete score ≥ 9 for patients sedated with dexmedetomidine was 8.6 ± 2.1 min and for propofol group was 4.6 ± 1.4 min (p value < 0.05).There were also significant differences between two groups in terms of surgeon's satisfaction with sedation, and the amount of intra operative bleeding. Conclusion According to the results of this study, it can be concluded that dexmedetomidine is a better choice for conscious sedation than propofol. However, the time to reach the required sedation in the dexmedetomidine group was significantly longer. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical significance of extra-thyroid 99mTc-pertechnetate uptake before initial radioiodine therapy for differentiated thyroid carcinoma

xlomafota13 shared this article with you from Inoreader Clinical significance of extra-thyroid <sup>99m</sup>Tc-pertechnetate uptake before initial radioiodine therapy for differentiated thyroid carcinoma Via radioactive iodine J Int Med Res. 2021 May;49(5):3000605211012667. doi: 10.1177/03000605211012667. ABSTRACT OBJECTIVE: To analyse the clinical characteristics of extra-thyroid 99mTc-pertechnetate uptake in order to explore the effect of the phenomenon on radioactive iodine (RAI) therapy for differentiated thyroid carcinoma (DTC) and its clinical significance. METHODS: This study retrospectively selected patients with DTC and extra-thyroid 99mTc-pertechnetate uptake. The cl inical features, location, location count and extra-thyroid 99mTc-pertechnetate uptake distribution were analysed, combined with the uptake rate, stimulated thyroglobulin (sTg) level, post-therapy whole-body scan and curative effect. RESULTS: A total of 38 patients were enrolled in the study and 65 extra-thyroid 99mTc-pertechnetate foci were detected. Thirty-four patients showed abnormal 99mTc-pertechnetate uptake in the lymph nodes (26 of 38; 68.4%), lungs (four of 38; 10.5%) and bones (four of 38; 10.5%). The corresponding uptake rates were 0.2%, 0.2% and 0.8%, respectively. The uptake rate and sTg were significantly positively correlated (r = 0.36). 131I uptake was found in 36 patients at the 99mTc-pertechnetate uptake site. The number of iodine uptake foci was significantly higher than that of 99mTc-pertechnetate uptake foci. The sTg value and pathological staging significantly differed between the ex cellent and nonexcellent response groups (Z = -2.947 and Z = -2.348, respectively). CONCLUSION: Extra-thyroid 99mTc-pertechnetate uptake mostly indicated metastases with specific clinical features, which may have prognostic value for the judgment of iodine uptake function and the RAI therapy plan. PMID:34024177 | DOI:10.1177/03000605211012667 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of Changes in Laryngeal Configuration and Voice Parameters Among Different Frequencies of Neuromuscular Electrical Stimulation (NMES) and Cumulative Effects of NMES in a Normophonic Subject: A Pilot Study

xlomafota13 shared this article with you from Inoreader Assessment of Changes in Laryngeal Configuration and Voice Parameters Among Different Frequencies of Neuromuscular Electrical Stimulation (NMES) and Cumulative Effects of NMES in a Normophonic Subject: A Pilot Study Via Journal of Voice Neuromuscular electrical stimulation (NMES) is a complementary resource to voice therapy that can be used for the treatment of hypofunctional voice disorders. Although positive clinical studies have been reported, neutral and even potentially harmful effects of NMES are also described in the literature. Furthermore, in the studies examined by the authors, the use of different methods of NMES have been identified, which further contributes to the inconsistent results found among studies. Moreover, limited rationale is provided for the chosen NMES parameters such as electrode placement, frequency of NMES and length of treatment. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.