An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension

xlomafota13 shared this article with you from Inoreader An Endoscopic Endonasal Nasopharyngectomy with Posterolateral Extension Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1735557 Background Invasion depth influences the choice for extirpation of nasopharyngeal malignancies. This study aims to validate the feasibility of endoscopic endonasal resection of lesions with a posterolateral invasion. As a secondary goal, the study intends to propose a classification system of endoscopic endonasal nasopharyngectomy determined by the depth of posterolateral invasion. Methods Eight cadaveric specimens (16 sides) underwent progressive nasopharyngectomy using an endoscopic endonasal approach. Resection of the torus tubarius, Eustachian tube (ET), medial pterygoid plate and muscle, lateral nasal wall, and lateral pterygoid plate and muscle were sequentially performed to expose the fossa of Rosenmüller, petroclival region, parapharyngeal space (PPS), and jugular foramen, respectively. Results Technical feasibility of endonasal nasopharyngectomy toward a posterolateral direction was validated in all 16 sides. Nasopharyngectomy was classified into four types as follows: (1) type 1: resection restricted to the posterior or superior nasopharynx; (2) type 2: resection includes the torus tubarius which is suitable for lesions extended into the petroclival region; (3) type 3: resection includes the distal cartilaginous ET, medial pterygoid plate, and muscle, often required for lesions extending laterally into the PPS; And (4) type 4: resection includes the lateral nasal wall, pterygoid plates and muscles, and all the cartilaginous ET. This extensive resection is required for lesions involving the carotid artery or extending to the jugular foramen region. Conclusion Selected lesions with posterolateral invasion into the PPS or jugular foramen is amenable to a resection via expanded endonasal approach. Classification of nasopharyngectomy based on tumor depth of posterolateral invasion helps to plan a surgical approach. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vidian Canal as a Transcranial Landmark: Anatomy, Technique, and Illustrative Cases

xlomafota13 shared this article with you from Inoreader Vidian Canal as a Transcranial Landmark: Anatomy, Technique, and Illustrative Cases Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1735589 Objective The vidian nerve can be accessed in transcranial approaches in carefully selected patients to ensure its preservation and to serve as a landmark for sphenoid sinus entry. This report is to review a technique, evaluate it in laboratory settings, and present two illustrative cases. Design The study involves cadaveric dissection and illustrative cases. Setting The study conducted in a cadaveric dissection laboratory. Participants The object of the study is one cadaveric head and two illustrative clinical cases. Main Outcome Measures Two cases using this approach were illustrated, and a cadaver dissection was performed in a step-by-step fashion. Results: The vidian canal can be accessed by drilling the anterolateral triangle. Two illustrated cases were presented; in one, the vidian nerve was used as part of a corridor to access the sphenoid sinus for tumor delivery, and in the other, the technique was used to find and preserve the vidian nerve during transcranial resection. Conclusion Careful identification of the vidian canal in transcranial surgery is a beneficial technique in carefully selected cases which allows identification of the nerve both for its preservation in selected cases and to create the vidian–maxillary corridor for tumor resection. Knowing the anatomy and pneumatization variants is important in the surgical approach. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract & nbsp;|  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment Modality and Second Primary Tumors of the Head and Neck

xlomafota13 shared this article with you from Inoreader Treatment Modality and Second Primary Tumors of the Head and Neck Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Introduction: Second primary tumors (SPTs) in head and neck cancer are thought to occur from premalignant lesions that are present at the time of the primary tumor diagnosis. The association of the modality used to treat the primary lesion with SPT occurrence is not clear. Objective: The aim of the study was to assess the incidence of SPTs in patients with head and neck malignancies, according to treatment modality. Methods: We conducted a retrospective cohort study. All patients who were treated at Soroka Medical Cente r between 2000 and 2013 for a head and neck squamous cell carcinoma were assessed. Data analysis included tumor site of the primary and second primary and treatment modality of the primary tumor. In addition, demographics as well as habits were recorded as well. Results: Of the 184 patients included in the cohort, SPT developed in 31 patients (17%) with a median time to diagnosis of 4.3 years. Smoking was reported in 74% of those with SPT and 78% of those without. The most common site for SPT was the lungs, with 13 cases, 42% of the total SPTs. Among patients who developed an SPT, for 12 of those with an index tumor in the oral cavity or oro-hypopharynx, 8 (67%) developed an SPT in the same location; for 18 of those with an index tumor in the larynx, 11 (61%) developed a SPT in the lungs and bronchi (p = 0.001). On multivariate analysis, the treatment modality used was not found to be associated with the occurrence of SPTs and the radiotherapy showed no protecti ve or harmful effect (HR 0.64 p = 0.24). Conclusion: Treatment modality used for head and neck cancer does not seem to be associated with the occurrence of SPTs. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience

xlomafota13 shared this article with you from Inoreader Superior Semicircular Canal Dehiscence Revision Surgery Outcomes: A Single Institution's Experience Via leak of cerebrospinal fluid World Neurosurg. 2021 Sep 25:S1878-8750(21)01426-1. doi: 10.1016/j.wneu.2021.09.083. Online ahead of print. ABSTRACT BACKGROUND: Superior semicircular canal dehiscence (SSCD) is an abnormality of the otic capsule which normally overlies the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. Given the complexity of the disease, there are patients who experience less favorable surgical outcomes and require revision surgery. The purpose of this study was to report to the rate of postoperative symptomatic improvement in patients who required revision surgery. METHODS: A retrospective analysis of patients undergoing SSCD surgical repair at a single institution was performed. Information on patient demographics, primary and secondary surgical approaches, surgical outcomes, and follow-up length was collected. RESULTS: 17 patients underwent 20 revision surgeries. There were eleven (65%) females and six (35%) males. Mean age of the cohorts was 50 years (range 30-68 years), and mean follow-up length was 6.8 months (range 0.1-31.1 months). Cerebrospinal fluid (CSF) leak was noted in 67% of cases. The greatest postoperative symptomatic resolution was reported in oscillopsia (100%), headache (100%), and internal sound amplification (71%), while the least postoperative symptomatic resolution was reported in tinnitus (42%), aural fullness (40%), and dizziness (29%). CONCLUSION: Revision surgery can provide symptomatic improvement in select SSCD patients; however, patients should be cautioned about the possibility of less favorable outcomes than in index surgery. Revision surgeries are associated with a considerably higher rate of perioperative CSF leak. PMID:34583007 | DOI:10.1016/j.wneu.2021.09.083 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Investigating Cortical Responses to Noise-Vocoded Speech in Children with Normal Hearing Using Functional Near-Infrared Spectroscopy (fNIRS)

xlomafota13 shared this article with you from Inoreader Investigating Cortical Responses to Noise-Vocoded Speech in Children with Normal Hearing Using Functional Near-Infrared Spectroscopy (fNIRS) Via Journal of the Association for Research in Otolaryngology Abstract Whilst functional neuroimaging has been used to investigate cortical processing of degraded speech in adults, much less is known about how these signals are processed in children. An enhanced understanding of cortical correlates of poor speech perception in children would be highly valuable to oral communication applications, including hearing devices. We utilised vocoded speech stimuli to investigate brain responses to degraded speech in 29 normally hearing children aged 6–12 years. Intelligibility of the speech stimuli was altered in two ways by (i) reducing the number of spectral channels and (ii) reducing the amplitude modulation depth of the signal. A total of five different noise-vocoded conditions (with zero, partial or high intelligibility) were presented in an event-related format whilst participants underwent functional near-infrared spectroscopy (fNIRS) neuroimaging. Participants completed a word recognition task during imaging, as well as a sep arate behavioural speech perception assessment. fNIRS recordings revealed statistically significant sensitivity to stimulus intelligibility across several brain regions. More intelligible stimuli elicited stronger responses in temporal regions, predominantly within the left hemisphere, while right inferior parietal regions showed an opposite, negative relationship. Although there was some evidence that partially intelligible stimuli elicited the strongest responses in the left inferior frontal cortex, a region previous studies have suggested is associated with effortful listening in adults, this effect did not reach statistical significance. These results further our understanding of cortical mechanisms underlying successful speech perception in children. Furthermore, fNIRS holds promise as a clinical technique to help assess speech intelligibility in paediatric populations. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Safe and Effective Anastomotic Technique for Robot‐Assisted Minimally Invasive Esophagectomy：Reverse‐Puncture Anastomosis

xlomafota13 shared this article with you from Inoreader A Safe and Effective Anastomotic Technique for Robot‐Assisted Minimally Invasive Esophagectomy：Reverse‐Puncture Anastomosis Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background Esophagogastric anastomosis is mainly complicated by its tediousness. We hope to modified an esophagogastric anastomotic technique that simplifies anastomosis. Methods We conducted a retrospective analysis of 57 cases executed using reverse-puncture anastomotic (RPA) technique and 64 cases of manual purse anastomosis(MPA) technique for robot-assisted minimally invasive esophagectomy (RAMIE). Baseline characteristics, perioperative outcomes were analyzed. Results There were no significant differences between the 2 groups with regards to demographic data and clinical features. All patients had R0 resection. Relative to MPA, RPA group experienced significantly shorter operation times (232.5±33.84 vs 262.3±83.94 min, p = 0.038).RPA group patients had shorter anastomotic times relative to MPA group patients (10.5±3.4 vs 18.3±4.1min, p = 0.014). No adverse events were observed. Conclusions Reverse-Puncture Anastomosis is safe, feasible in RAMIE. This approach has the potential to efficiently shorten the anastomotic time and ensure safe operation. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ultra-high-frequency ultrasound monitoring of melanomas arising in congenital melanocytic nevi: a case series

xlomafota13 shared this article with you from Inoreader Ultra-high-frequency ultrasound monitoring of melanomas arising in congenital melanocytic nevi: a case series Via Melanoma Research - Published Ahead-of-Print The aims of our study were to evaluate with ultra-high-frequency ultrasound (UHFUS) the ultrasound features of congenital melanocytic nevi (CMNs) and malignant melanomas (MMs) arising in CMNs and the correlation between ultrasonographic thickness and histological thickness in MMs. We evaluated 10 patients with small-medi um CMNs and 10 patients with MMs arising in small-medium CMNs. We collected patient's data, clinical and dermoscopic features. The UHFUS was performed using a 70 MHz frequency probe to study the ecostructure, shape and vascularization. Breslow thickness was compared with ultrasonographic thickness. In the MMs group the following dermoscopic features were described: hyperpigmentation (n = 9), regression area (n = 6), whitish-blue veil (n = 5), thickened network (n = 5), irregular globules (n = 3), inverse network (n = 2) and striae (n = 1). Hyperpigmentation (n = n = 9), thickened network (n = 7), irregular globules (n = 5), regression area (n = 5), striae (n = 1) and whitish-blue veil (n = 1) were found in the CMNs group. The multicomponent pattern was present in both MMs (n = 4) and in CMNs (n = 5). Moreover, the parameters indicative of suspected malignancy were variously combined in the two groups, without showing significant differences in the statistical analysis; with the ex ception of the blue veil that correlated with the diagnosis of MM. Ultrasonoghaphic vascularization was an ever-present parameter in MMs (100%), with high intensity of intratumoral signal, as opposed to CMNs. We also found a statistically significant correlation between ultrasound thickness and Breslow thickness. In the future, this technique could implement the diagnostic preoperative phase of MMs arising in CMNs in combination with standard clinical-dermatoscopic evaluation. Received 20 May 2021 Accepted 22 August 2021 Correspondence to Agata Janowska, MD, Department of Dermatology, University of Pisa, Via Roma 67, 56127, Pisa, Italia, Tel: +39 050 992436; fax: +39 050 992556; e-mail: dottoressajanowska@gmail.com Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The potential of using artificial intelligence to improve skin cancer diagnoses in Hawai‘i’s multiethnic population

xlomafota13 shared this article with you from Inoreader The potential of using artificial intelligence to improve skin cancer diagnoses in Hawai'i's multiethnic population Via Melanoma Research - Published Ahead-of-Print Skin cancer remains the most commonly diagnosed cancer in the USA with more than 1 million new cases each year. Melanomas account for about 1% of all skin cancers and most skin cancer deaths. Multiethnic individuals whose skin is pigmented underestimate their risk for skin cancers and melanomas and may delay seeking a diagnosis. The use of artificial intelligence may help improve the diagnostic precision of dermatologists/physicians to identify malignant lesions. To validate our artificial intelligence's efficiency in distinguishing between images, we utilized 50 images obtained from our International Skin Imaging Collaboration dataset (n = 25) and pathologically confirmed lesions (n = 25). We compared the ability of our artificial intelligence to visually diagnose these 50 skin cancer lesions with a panel of three dermatologists. The artificial intelligence model better differentiated between melanoma vs. nonmelanoma with an area under the curve of 0.948. The three-panel member dermatologists correctly diagnosed a similar number of images (n = 35) as the artificial intelligence program (n = 34). Fleiss' kappa (ĸ) score for the raters and artificial intelligence indicated fair (0.247) agreement. However, the combined result of the dermatologists panel with the artificial i ntelligence assessments correctly identified 100% of the images from the test data set. Our artificial intelligence platform was able to utilize visual images to discriminate melanoma from nonmelanoma, using de-identified images. The combined results of the artificial intelligence with those of the dermatologists support the use of artificial intelligence as an efficient lesion assessment strategy to reduce time and expense in diagnoses to reduce delays in treatment. Received 1 March 2021 Accepted 6 August 2021 Correspondence to Mark Lee Willingham Jr., MS, Department of Sociology, Community Health Educator, University of Hawai'i Cancer Center, 701 Ilalo St., Suite #414, Honolulu, HI 96813, Hawai'i, USA, Tel: 1 808 441 8186; fax: 1 808 586 3052; e-mail: Mlw237@hawaii.edu Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A novel prognostic biomarker for cutaneous malignant melanoma: red cell distribution width (RDW) to lymphocyte ratio

xlomafota13 shared this article with you from Inoreader A novel prognostic biomarker for cutaneous malignant melanoma: red cell distribution width (RDW) to lymphocyte ratio Via Melanoma Research - Published Ahead-of-Print It is well-known that inflammation plays a significant role in cancer formation and prognosis. Both lymphocyte count and red cell distribution width (RDW) has been used to predict prognosis in various cancers as an indicator of inflammation. Yet, the role of RDW-lymphocyte ratio (RLR) in determining prognosis is still unkn own. We aimed to determine the prognostic role of RLR in cutaneous malignant melanoma (MM). One hundred fifteen patients with MM were included in the study retrospectively. The relationship of the clinical-pathological data with overall survival (OS) and progression-free survival (PFS) was analyzed using Kaplan–Meier curves. The cut-off values of neutrophil to lymphocyte ratio, systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and RLR were determined as 2, 487, 51.5 and 6.52, respectively. OS was significantly longer in the low SII, high PNI, low RLR group, while PFS was longer in groups with high PNI and low RLR. In univariate analysis, it was determined that PFS was significantly correlated with Eastern Cooperative Oncology Group (ECOG) performance, TNM stage, PNI and RLR. Moreover, in univariate analysis, a significant correlation was determined between OS and age, ECOG performance, TNM stage, adjuvant interferon, SII, PNI and RLR. In multivariate ana lysis, ECOG performance, TNM stage and RLR were determined as independent prognostic factors for PFS, while TNM stage and RLR were found to be independent prognostic factors for OS. RLR could be a novel prognostic marker for both PFS and OS in patients with cutaneous MM. Received 15 June 2021 Accepted 4 September 2021 Correspondence to Zekeriya Hannarici, Department Of Medical Oncology, Atatürk University Faculty of Medicine, Yakutiye, Erzurum 25100, Turkey, Tel: +905303768489; e-mail: hannarici@hotmail.com Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Risk factors in pediatric melanoma: a retrospective study of 39 cases

xlomafota13 shared this article with you from Inoreader Risk factors in pediatric melanoma: a retrospective study of 39 cases Via Melanoma Research - Published Ahead-of-Print Pediatric melanoma is a rare form of the tumor whose epidemiology is widely increasing thanks to the improvement of dermoscopic and anatomopathologic diagnostic techniques. Although it is a tumor of considerable interest in adults, little has been described about the pediatric field. The objective of our study was then to ident ify the possible risk factors for the development of melanoma in the pediatric population. We performed a retrospective study conducted in the Melanoma and Skin Cancer Unit and Unit of Dermatology (Livorno, Italy). We analyzed a population of 38 children under 21 years with a diagnosis of melanoma. This population was compared with a control population of 114 children followed up in our dermatologic clinic. From our combined univariate-multivariate statistics analysis, the number of nevi [regression coefficient (RC) of 1.04 and odds ratio (OR) of 2.8 confidence interval (Cl, 1.2–6.6)], and family history of melanoma [RC of 1.99 and OR of 7.3 (Cl, 2.3–22.7)] emerged as possible risk factors for the development of melanoma. The identification of these elements would allow the physician to carry out a more targeted preliminary assessment of the patient, potentially decisive in cases of diagnostic doubt of the lesion. Our study also lays the foundations for identifying those child ren who, despite not having received a diagnosis of melanoma on histologic examination, should be considered as patients susceptible to a focused follow-up, because of the presence of the risk factors that emerged from our research. Received 16 June 2021 Accepted 3 August 2021 Correspondence to Giovanni Bagnoni, MD, Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Specialist Surgery Area, Department Of General Surgery, Livorno Hospital, Viale Vittorio Alfieri 36, Livorno, LI 57124, Italy, Tel: +39 0586 223243; e-mail: giovanni.bagnoni@uslnordovest.toscana.it Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of estrogen receptor low positive status in breast cancer: Implications for pathologists and oncologists

xlomafota13 shared this article with you from Inoreader Assessment of estrogen receptor low positive status in breast cancer: Implications for pathologists and oncologists Via Cellular and Molecular Biology Histol Histopathol. 2021 Sep 29:18376. doi: 10.14670/HH-18-376. Online ahead of print. ABSTRACT Estrogen receptor (ER) status assessment by immunohistochemistry (IHC) is the gold standard test for the identification of patients with breast cancer who may benefit from endocrine therapy (ET). Whilst most ER+ breast cancers have a high IHC score, about 3% of cases display a low positivity, with 1% to 10% of cells being weakly stained. These tumors are generally classified within the luminal-like category; however, their risk profile seems to be more similar to that of ER-negative breast cancers. The decision on ET for patients with a diagnosis of ER-low breast cancer should be carefully considered in light of the risks and possible benefits of the treatment. Potential pitfalls hinder pathologists and oncologists from establishing an appropriate threshold for "low positivity". Furthermore, several pre-analytical and analytical variables mi ght trouble the pathological identification of these clinically challenging cases. In this review, we sought to discuss the adversities that can be accounted for the pathological identification of ER-low breast cancers in real-world clinical practice, and to provide practical suggestions for the perfect ER testing in light of the most updated recommendations and guidelines. PMID:34585734 | DOI:10.14670/HH-18-376 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.