Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Thursday, July 15, 2021

Cost‐effectiveness of oral cancer screening approaches by visual examination: A systematic review

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Abstract

The present study is the first systematic review of papers that have performed a full economic evaluation on oral cancer screening strategies using visual oral examination. The review questions were (1) Is screening a cost-effective strategy in oral cancer? (2) What is the most cost-effective strategy among the different screening approaches in oral cancer? The main outcome measure was the incremental cost-effectiveness ratio. The study identifies and reviews seven full economic evaluations. The included studies scored 75%–100% on the methodological appraisal. Majority of the studies reports that oral cancer screening is a cost-effective strategy, especially in an opportunistic setting and high-risk subset of patients. The results were sensitive to cost and effectiveness parameters. Oral cancer screening, though found cost-effective, the uncertainty around these parameters necessitates additional studies that include better estimates in the modeling assessments. The heterogeneit y in studies limited comparison and generalization.

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The Study of Association between Laryngopharyngeal Reflux and Vocal Fold Leukoplakia Requires Pepsin and Bile Salt Tissue Analyses

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ORL
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An irrigation system for noninvasively estimating intrarenal pressure during flexible ureteroscopy

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ABSTRACT

Background

High intrarenal pressure (IRP) during flexible ureteroscopy (FURS) may lead to severe complications. Reported methods for measuring IRP are often inconvenient to use, expensive and involve instruments that occupy the narrow ureter.

Methods

We proposed an irrigation system, which can noninvasively estimate IRP based on the principle of fluid mechanics. To determine the feasibility of our system, we conducted irrigation experiments on a kidney phantom and a porcine kidney. The estimated IRPs were compared with the ground truth IRPs.

Results

When no surgical instrument was inserted into the flexible ureteroscope's working channel, our system can estimate IRP with high accuracy. When a surgical instrument was inserted, our system can approximately estimate the level of IRP.

Conclusions

Our proposed irrigation system can noninvasively estimate IRP, presenting a new thought for clinical practice. In future studies, in vivo experiments are needed to further validate and improve the system.

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Robotic‐Assisted Completion Cholecystectomy A Safe and Effective Approach to a Challenging Surgical Scenario ‐ A Single Center Retrospective Cohort Study ‐

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Abstract

Background

Reoperation following a previous subtotal or aborted cholecystectomy presents a challenging surgical scenario that has traditionally required an open completion cholecystectomy. The aim of this study was to describe an institutional experience with a robotic-assisted approach to completion cholecystectomy.

Methods

A database was retrospectively audited to identify all patients who underwent robotic-assisted cholecystectomy performed by two hepatopancreatobiliary surgeons at a single center from 2010 to 2019.

Results

26 patients who underwent a robotic-assisted completion cholecystectomy were identified. Median operative time was 142 minutes (48-247 minutes) with 50cc (0-500cc) blood loss. Minor complications (Clavien-Dindo ≤II 90 days) occurred in 3 patients (11.5%) with no major complication or mortality reported. Median hospital length of stay was one day (0-6 days) with one patient readmitted.

Conclusion

This study represents to our knowledge the largest series of robotic-assisted completion cholecystectomies to date. The robotic approach appears to be a safe and effective procedure associated with a low morbidity and high success rate.

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Malignant salivary gland tumours: Single‐centre experience of 108 patients

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Abstract

●A functioning facial nerve is a critical structure that limits the margin of resection in parotid malignancies. There was no difference in disease-free survival with close or negative resection margins. ●Microscopic positive (R1) resection margins were associated with poorer disease free survival, but this was not statistically significant, implying that more functional and less radical surgery may be acceptable when followed by adjuvant therapy. ●Perineural invasion was found in 37% of tumours ●Five-year overall and disease-free survival were 82% and 71%. ●Age >50, pT classification 3-4, higher tumour grade, perineural invasion, and advanced TNM stage were all associated with worse overall and disease-free survival.

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Intraparotid Recurrence of Papillary Thyroid Carcinoma After Thyroidectomy Coincident With Declining Thyroglobulin Levels: A Case Report and Review of the Literature

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Ear Nose Throat J. 2021 Jul 14:1455613211033124. doi: 10.1177/01455613211033124. Online ahead of print.

ABSTRACT

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Intraparotid recurrence of PTC is, however, rare. Most parotid malignancies are either primary or metastatic from cancer outside the head and neck. We report a case of a 71-year-old man who had undergone lobectomy and completion thyroidectomy for PTC and presented to our clinic with an insi dious intraparotid recurrence, for which he underwent a superficial parotidectomy and radioactive iodine therapy. We also present a review of the literature on similar cases. Intraparotid metastasis of PTC should be considered in the differential diagnosis of a parotid mass.

PMID:34261350 | DOI:10.1177/01455613211033124

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Traumatic Pseudoaneurysm Arising From Proximal Facial Artery: A Case Report and Literature Review

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Ear Nose Throat J. 2021 Jul 14:1455613211033110. doi: 10.1177/01455613211033110. Online ahead of print.

ABSTRACT

Pseudoaneurysms of facial artery usually arise from the distal part of the vessel. Only 4 cases were described in the literature involving the proximal part of facial artery. We present a case of a traumatic pseudoaneurysm involving the proximal part of facial artery. A 50-year-old man was referred to our department for a progressively growing submandibular mass. He was injured by a sharp object during a car crash 30 days ago. After 3 weeks, the patient noted the appearance of a subcutaneous mass in the left submandibular area. Physical examination revealed a freely movable, painful, and pulsatile swelling. Ultrasound and computerized tomography scan showed a nodular lesion in the left submandibular area in continuity with the facial artery. The diagnosis of pseudoaneurysm of facial artery was suspected. The patient was treated by surgery. The pseudoaneurysm was resected with ligation of the proximal and distal ends of the facial artery.

PMID:34261366 | DOI:10.1177/01455613211 033110

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Evidence of the Efficacy of Flurbiprofen 8.75 mg Lozenges for Patients Receiving Antibiotics for Laboratory-Confirmed Streptococcal Pharyngitis

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Ear Nose Throat J. 2021 Jul 14:1455613211025754. doi: 10.1177/01455613211025754. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the efficacy of flurbiprofen 8.75 mg lozenges for patients with laboratory-confirmed streptococcal pharyngitis both before and concomitant with antibiotics.

METHODS: This post hoc analysis comprised adult participants from 2 earlier randomized, double-blind, placebo-controlled studies evaluating the analgesic efficacy of flurbiprofen 8.75 mg lozenges in acute pharyngitis. Throat swabs were obtained to diagnose streptococcal infection. Prior to and 2 hours after each dose of study medication (flurbiprofen or placebo lozenges), patients rated 3 symptoms of acute pharyngitis (sore throat pain, difficulty swallowing, and swollen throat) using visual analogue scales. Appropriate antibiotic treatment was initiated when culture results were reported. Mean changes in each pharyngeal symptom were compared over the immediate 24 hours before and during the initial 24 hours of antibiotic treatment.

RESULTS: Twenty-four patients provided both preantibiotic and concomitant antibiotic efficacy outcomes. Relief of throat pain was 93% greater in the flurbiprofen group than in the placebo group before antibiotic coadministration and 84% greater than placebo during antibiotic administration (both P < .05). Relief of difficulty swallowing was 71% greater in the flurbiprofen group than in the placebo before antibiotic admi nistration (P = .16) and 107% greater during concomitant antibiotic administration (P = .04). Relief of the sensation of throat swelling was 295% greater with flurbiprofen than placebo before antibiotic administration (P = .008) and 70% greater during concomitant antibiotic administration (P = .06). For placebo-treated patients, relief from throat pain and difficulty swallowing were similar before and during antibiotic treatment (P > .05), indicating no benefit with antibiotic administration for these symptoms. No treatment-related discontinuations or serious adverse events were reported.

CONCLUSIONS: Irrespective of antibiotic use, flurbiprofen 8.75 mg lozenges provide well-tolerated, effective relief of pharyngeal symptoms in patients with streptococcal infection. In the 24 hours after administration, antibiotics provide no relief of throat pain or difficulty swallowing beyond the topical demulcent effects of placebo lozenges.

PMID:34261371 | DOI:10.1177/01455613211025754

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(cRGD)2 peptides modified nanoparticles increase tumor-targeting therapeutic effects by co-delivery of albendazole and iodine-131

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Anticancer Drugs. 2021 Jul 12. doi: 10.1097/CAD.0000000000001135. Online ahead of print.

ABSTRACT

BACKGROUND: Albendazole (ABZ), a clinical antiparasitic drug, has shown potential antitumor effects in various tumors. Herein, we prepared dimeric cRGD [(cRGD)2] modified human serum albumin (HSA) nanosystem to co-delivery of albendazole (ABZ) and iodine-131 (131I) for chemoradiotherapy of triple-negative breast cancer (TNBC).

MATERIALS METHODS: HSA@ABZ NPs were synthesized by th e self-assembly method. 131I-(cRGD)2/HSA@ABZ NPs were fabricated through covalently binding HSA@ABZ NPs with (cRGD)2 peptides, followed by chloramine T direct labeling with 131I. In vitro therapeutic effects on TNBC (MDA-MB-231 and 4T1 cells) were determined using MTT assay, crystal violet assay, wound-healing assay and western blotting analysis. In vivo treatment was performed using 4T1-bearing mice, and the tumor-targeting efficacy was assessed by gamma imaging. The distribution of NPs was quantitatively analyzed by detecting the gamma counts in tumor and main organs.

RESULTS: The nanoparticles possessed negative charge, moderate size and good polydispersity index. Dual responding to pH and redox, the in vitro release rate of ABZ was more than 80% in 72 h. In vitro, NPs inhibited the proliferation of TNBC cells in a concentration-dependent manner and decreased cell migration. Western blotting analysis showed that the NPs, as well as free ABZ, cell-dependently induced autopha gy and apoptosis by restraining or promoting the expression of p-p38 and p-JNK MAPK. In vivo, gamma imaging exhibited an earlier and denser radioactivity accumulation in tumor of 131I-(cRGD)2/HSA@ABZ NPs compared to NPs free of (cRGD)2 conjugating. Furthermore, 131I-(cRGD)2/HSA@ABZ NPs significantly suppressed tumor growth by restraining proliferation and promoting apoptosis in vivo.

CONCLUSIONS: Our study suggested that the nanoparticles we developed enhanced tumor-targeting of ABZ and increased antitumor effects by combination of chemotherapy and radiotherapy.

PMID:34261920 | DOI:10.1097/CAD.000000000000113 5

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Intraparotid Recurrence of Papillary Thyroid Carcinoma After Thyroidectomy Coincident With Declining Thyroglobulin Levels: A Case Report and Review of the Literature

xlomafota13 shared this article with you from Inoreader

pubmed-meta-image.png

Ear Nose Throat J. 2021 Jul 14:1455613211033124. doi: 10.1177/01455613211033124. Online ahead of print.

ABSTRACT

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Intraparotid recurrence of PTC is, however, rare. Most parotid malignancies are either primary or metastatic from cancer outside the head and neck. We report a case of a 71-year-old man who had undergone lobectomy and completion thyroidectomy for PTC and presented to our clinic with an insidious i ntraparotid recurrence, for which he underwent a superficial parotidectomy and radioactive iodine therapy. We also present a review of the literature on similar cases. Intraparotid metastasis of PTC should be considered in the differential diagnosis of a parotid mass.

PMID:34261350 | DOI:10.1177/01455613211033124

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Pulsatile Tinnitus in a Patient With a Skull Base Lesion

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An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness; her symptoms were more prominent at night and in the quiet and improved when upright. What is your diagnosis?
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A Rapid Olfactory Test as a Potential Screening Tool for COVID-19

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This prospective study assesses the feasibility of a novel, objective olfactory test as part of an initial screening of COVID-19 in adults with unknown disease status.
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