Benign paroxysmal positional vertigo: is hypothyroidism a risk factor for recurrence?

xlomafota13 shared this article with you from Inoreader Benign paroxysmal positional vertigo: is hypothyroidism a risk factor for recurrence? Via Acta Otorhinolaryngol Ital Acta Otorhinolaryngol Ital. 2022 Feb 7. doi: 10.14639/0392-100X-N1775. Online ahead of print. ABSTRACT OBJECTIVE: To investigate the relationship between risk of Benign Paroxysmal Positional Vertigo (BPPV) recurrence and hypothyroidism treated with hormone replacement therapy (HRT). METHODS: 797 patients with idiopathic BPPV were divided into two groups: 250 patients with recurrence of BPPV (R-BPPV) and 547 patients without recurrence (NR-BPPV). Regarding patients with thyroid disease on HRT, we collected serum test results of thyroidstimulating hormone (TSH), free triiodothyronine f-T3, free thyroxine f-T4, thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab). RESULTS: Hypothyroidism in long-term HRT was found in 61/250 (24.4%) patients of the RBPPV group vs 79/547 (14.4%) of the NR-BPPV-group (p = 0.0006). Hashimoto thyroiditis (HT) was associated with recurrence (p < 0.0001). A significant correlation was found between recurrence and level of serum TPO-Ab (p = 0.0117) and TG-Ab (p = 0.0025), but not with mean serum TSH, f-T3 and f-T4. CONCLUSIONS: We assume that patients with hypothyroidism in HRT have an increased risk of BPPV recurrence, which is particularly strong for patients with HT and positive thyroid antibodies, suggesting an association between autoimmunity and recurrent vertigo. PMID:35129542 | DOI:10.14639/0392-100X-N1775 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sphenoidotomy kinetics in patients with chronic rhinosinusitis without nasal polyps

xlomafota13 shared this article with you from Inoreader Sphenoidotomy kinetics in patients with chronic rhinosinusitis without nasal polyps Via Acta Otorhinolaryngol Ital Acta Otorhinolaryngol Ital. 2022 Feb 7. doi: 10.14639/0392-100X-N1545. Online ahead of print. ABSTRACT OBJECTIVE: Stenosed sphenoid sinus ostia are among the most common findings in revision endoscopic sinus surgery. This study sought to identify the optimal intraoperative sphenoidotomy size for prevention of postoperative stenosis. METHODS: 32 patients affected by chronic rhinosinusitis not associated with nasal polyps (CRSsNP) underwent 52 sphenoidotomies. Sphenoidot omy size was assessed using a ruler intraoperatively and at the first, third and sixth months postoperatively. Ostia sizes, SNOT-22 questionnaire findings, episodes of recurrent sinusitis and need for revision surgery were recorded. RESULTS: All sphenoidotomies exhibited a significant size reduction (mean 43.4 ± 6.8%) at the first month postoperatively, with a tendency to enlarge at 3 months and stabilise at 6 months. Ostia larger than 61.3 mm2 did not exhibit stenoses postoperatively. Stenosis was observed in 11 sphenoidotomies (21.2%); however, only five presented with recurrent symptoms (9.6%), while three required revision sphenoid surgery (5.8%). CONCLUSIONS: Sphenoidotomy size significantly reduced during the first postoperative month and then stabilised. A baseline sphenoidotomy size of 61.3 mm2 at the time of the operation seemed sufficient to prevent ostium stenosis. Half of stenosed ostia presented with recurrent symptoms. PMID:35129538 | DOI:10.14639/0392-100X-N1545 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective, Multi‐Center Study of the Anatomic Distribution of Recurrent Respiratory Papillomatosis

xlomafota13 shared this article with you from Inoreader Prospective, Multi‐Center Study of the Anatomic Distribution of Recurrent Respiratory Papillomatosis Via The Laryngoscope Objectives/Hypothesis To create a model of the anatomic distribution, recurrence, and growth patterns of recurrent respiratory papillomatosis (RRP). Study Design Prospective, multi-institutional cohort study. Methods Adult patients with a diagnosis of RRP evaluated between August 1, 2018 and February 1, 2021 at six participating centers were invited to enroll. At each office or operating room encounter, laryngologists recorded the location and size of RRP lesions using a 22-region schematic. A generalized linear mixed effects model was used to compare region variations in lesion prevalence and recurrence. Results The cohort comprised 121 patients: 74% were male, 81% had been diagnosed with adult-onset RRP, and a plurality (34%) had undergone 0 to 3 RRP interventions prior to enrollment. Across the study period, the odds of a lesion occurring in the glottis was significantly higher (odds ratio [OR]: 26.51; 95% confidence interval [CI]: 11.76–59.75, P < .001) compared with all other areas of the larynx and trachea. Within the true vocal folds, the membranous vocal folds had significantly higher odds (OR: 6.16; 95% CI: 2.66–14.30, P < .001) of lesion occurrence compared to the cartilaginous vocal folds. Despite these strong trends in lesion distribution, there were no differences in the odds of lesion recurrence, growth, or in the time to recurrence, between anatomic subsites. Conclusions RRP lesions are most likely to occur in the glottis, particularly the membranous vocal folds, compared with other regions of the larynx or trachea. However, all lesions demonstrate similar behavior with respect to recurrence, growth, and time to recurrence regardless of anatomic location. Level of Evidence 3 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Machine‐learning‐based approach for predicting postoperative skeletal changes for orthognathic surgical planning

xlomafota13 shared this article with you from Inoreader Machine‐learning‐based approach for predicting postoperative skeletal changes for orthognathic surgical planning Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background Manually surgical planning becomes an increasing workload of surgeons because of the fast-growing patient population. This study introduced a machine-learning-based approach to assist surgical planning in orthognathic surgery. Methods Both preoperative and one-year-later postoperative CT images of 56 patients were collected. A 12-layers cascaded deep neural network structure with two successive models was proposed to yield an end-to-end solution, where the first model extracts landmarks from 2D patches of 3D volume and the second model predicts postoperative skeletal changes. Results The experimental results showed that the model obtained a prediction accuracy of 5.4 mm at the landmark level in 42.9 s. It also represented 74.4% of 3D regions at volume level when compared with the ground truth of human surgeons. Conclusions This study demonstrated the feasibility of predicting postoperative skeletal changes for orthognathic surgical planning by using machine learning, showing great potential for reducing the workload of surgeons. 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.

Functional imaging in thyroid cancer patients with metastases and therapeutic implications

xlomafota13 shared this article with you from Inoreader Functional imaging in thyroid cancer patients with metastases and therapeutic implications Via radioactive iodine Presse Med. 2022 Feb 4:104113. doi: 10.1016/j.lpm.2022.104113. Online ahead of print. ABSTRACT Functional imaging plays a central role in the management of thyroid cancer patients. In patients with a differentiated thyroid cancer (DTC), radioactive iodine (RAI) is used mostly with a therapeutic intent, either post-operatively or as the first line systemic treatment in patients with known structural disease. A whole body scan is performed a few days after the RAI administration, and this procedure is very sensitive to detect all tumor foci with RAI uptake. PET/CT with 18F-FDG complements the use of RAI at the initial evaluation of patients with high-risk DTC, during follow-up in those with rising serum thyroglobulin levels over time, for the work-up of patients with documented structural disease and for assessing the efficacy of focal or systemic treatment modalities. 18F-FDG uptake is a prognostic indicator in all these clinical conditions. A dosimetric approach with 124I PET/CT showed encouraging results. Several functional imaging modalities are currently available for medullary thyroid carcinoma (MTC) patients. 18F-FDG-PET/CT may be sensitive in MTC patients with high FDG uptake that signals aggressive disease. 18F-DOPA is the most sensitive imaging technique to visualize small tumor foci, and is also highly specific in patients with a known MTC, but should be complemented by a CT scan of the chest and by a MRI of the liver to detect small metastases. PMID:35131318 | DOI:10.1016/j.lpm.2022.104113 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnosis and Management of Barosinusitis: A Systematic Review

xlomafota13 shared this article with you from Inoreader Diagnosis and Management of Barosinusitis: A Systematic Review Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 8:34894211072353. doi: 10.1177/00034894211072353. Online ahead of print. ABSTRACT OBJECTIVE: To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. METHODS: A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the f ollowing search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. RESULTS: Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments a re as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). CONCLUSION: Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment. PMID:35130739 | DOI:10.1177/00034894211072353 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Convulsive Syncope From Carotid Sinus Syndrome as a Manifestation of Laryngeal Cancer

xlomafota13 shared this article with you from Inoreader Convulsive Syncope From Carotid Sinus Syndrome as a Manifestation of Laryngeal Cancer Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 7:34894221076573. doi: 10.1177/00034894221076573. Online ahead of print. ABSTRACT OBJECTIVE: Carotid sinus syndrome (CSS) is a rare yet serious presentation of head and neck malignancy. To our knowledge, syncope and seizure-like episodes as a manifestation of carotid sinus syndrome secondary to laryngeal cancer has not been reported to date. We report a case of laryngeal cancer causing convulsive syncope masquerading as seizures due to CSS. METHODS: Case report. The patient's medical record was reviewed for demographic and clinical information. RESULTS: A 62-year-old male presented with multiple episodes of syncope and hoarseness of voice. On nasoendoscopic examination, left vocal cord palsy and left aryepiglottic fold tumor were visualized. Computerized tomography (CT) neck showed a large 2.4 × 3.6 cm left supraglottic tumor with local invasion and extensive cervical lymphadenopathy compressing the carotid sinus. CT guided biopsy of the tumor revealed invasive squamous cell carcinoma. While undergoing evaluation, the patient developed seizure-like episodes. Inpatient telemetry monitoring revealed significant bradycardia and hypotension during these episodes. A permanent pacemaker was inserted which resulted in resolution of the syncopal and seizure-like episodes. CONCLUSION: In patients with unexplained syncope or seizure-like episodes and a background of head and neck cancer, clinicians should con sider the diagnosis of CSS. CSS is a poor prognostic factor due to the associated higher stage of disease. PMID:35130751 | DOI:10.1177/00034894221076573 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Vitamin D status in Dupuytren's disease: Association with clinical status and vitamin D receptor expression

xlomafota13 shared this article with you from Inoreader Vitamin D status in Dupuytren's disease: Association with clinical status and vitamin D receptor expression Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 20:S1748-6815(22)00024-9. doi: 10.1016/j.bjps.2022.01.012. Online ahead of print. ABSTRACT BACKGROUND: Dupuytren's disease (DD) is a progressive fibroproliferative condition involving contractures of the fascia of the palm. Up to now, there are no relevant investigations on patients with DD in case of serum vitamin D deficiency. We hypothesized that transforming growth factor-β1 (TGF-β1) is increased in patients with DD in consequence of vitamin D deficiency, thereby leading to myofibroblast differentiation and subsequent progression of contractures. METHODS: The aim of this study was to analyze serum vitamin D levels and explore possible clinical and immunohistochemical correlates with vitamin D concentrations in a group of patients with DD. Vitamin D levels were measured in all patients with DD and healthy controls. In the patient group, clinical characteristics were compared between vi tamin D deficient and nondeficient subgroups. Diseased palmar fascia samples were obtained from 14 patients undergoing fasciectomy for DD. Correlations between vitamin D levels and vitamin D receptor(VDR), TGF-β1 expression levels in collected fascia samples were evaluated. RESULTS: Vitamin D concentrations were significantly lower in patients than in healthy controls. In addition, total extension deficit of involved fingers was higher in vitamin D deficient patients. Moreover, a positive correlation was found between vitamin D levels and expression of VDR in pathologic fascia in patients undergoing fasciectomy for contracture. Serum vitamin D levels were found to be low in patients with DD. Expression of VDR was lower in the vitamin D deficient group. CONCLUSIONS: The results suggest a potential link between vitamin D status and DD but causation is not yet established. The potential role of vitamin D and its interaction with VDR and the TGF-β1 signaling pathway in the pathogenesis of DD needs to be explored further. PMID:35131190 | DOI:10.1016/j.bjps.2022.01.012 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Racial disparities in short-term outcomes after breast reduction surgery-A National Surgical Quality Improvement Project Analysis with 23,268 patients using Propensity Score Matching

xlomafota13 shared this article with you from Inoreader Racial disparities in short-term outcomes after breast reduction surgery-A National Surgical Quality Improvement Project Analysis with 23,268 patients using Propensity Score Matching Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 16:S1748-6815(22)00014-6. doi: 10.1016/j.bjps.2022.01.001. Online ahead of print. ABSTRACT BACKGROUND: Evidence of widespread disparities in healthcare for racial and ethnic minorities is well documented. This study aims to evaluate differences in surgical outcomes after breast reduction surgery (BRS) according to patients' ethnicities. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2018) was utilized to analyze two propensity score matched patient cohorts-White and non-White-that underwent BRS. Preoperative variables assessed included demographic data and comorbidities such as diabetes mellitus, hypertension, and obesity. Postoperative outcomes assessed were medical complications, minor and major surgical complications, as well as mortality. RESULTS: In total, 23268 patients underwent BRS and met the inclusion criter ia. After propensity score matching, the two cohorts were matched with respect to these preoperative variables, and 7187 patients were included in each cohort of White and non-White patients (total 14374). After matching, overall 30-day major complications were not significantly different between White and non-White cohort (2.25% vs 2.14%, p=0.65). After accounting for differences in confounding variables at the patient and socioeconomic level, racial and ethnic minorities who underwent breast reduction were found to experience fewer minor surgical complications. The analysis of temporal trends identified an overall rise in the number of patients seeking BRS, with a higher increase noted in the non-White population. CONCLUSION: Overall, our findings are reassuring exemptions to prevalent racial and ethnic health inequalities and can serve as a positive example for adequate and fair provision of surgical care. PMID:35131191 | DOI:10.1016/j.bjps.2022.01.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Usage trends, perceptions and ethical views regarding social media: A survey of Canadian plastic surgeons

xlomafota13 shared this article with you from Inoreader Usage trends, perceptions and ethical views regarding social media: A survey of Canadian plastic surgeons Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 31:S1748-6815(22)00052-3. doi: 10.1016/j.bjps.2022.01.039. Online ahead of print. ABSTRACT Parallel to the rise in usage of Social Media (SoMe) worldwide, plastic surgeons are becoming increasingly present online. Although more are being published, there is a paucity of studies regarding academic and international plastic surgeons. The authors sought to determine current usage trends among Canadian plastic surgeons. A 16-item survey concerning usage, post content, perceptions and ethics towards SoMe was sent to academic and esthetic plastic surgeons across Canada. The survey yielded a 14.2% response rate, from which 37% had a single SoMe account for both personal and professional use, with Instagram (36%) being the most preferred platform and only 10% of post content being academically inclined. Surgeons without a professional account seemed to be more likely to believe it is unethical to discuss procedures with patients over SoMe (75% vs. 29%) and were more likely to believe it is unethical to post procedural/intra-operative videos on SoMe (75% vs. 21%). This survey highlights the diverging views regarding the ethics surrounding SoMe usage, which can be influenced by the type of accounts managed by surgeons. The authors hope this can help elucidate more ethical, safe and effective practices of SoMe. PMID:35131195 | DOI:10.1016/j.bjps.2022.01.039 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction

xlomafota13 shared this article with you from Inoreader Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 14:S1748-6815(22)00003-1. doi: 10.1016/j.bjps.2021.12.004. Online ahead of print. ABSTRACT BACKGROUND: One of the complications of free flap breast reconstruction is the occurrence of skin and fat necrosis. Intra-operative use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) has the potential to predict these complications. In this study, the quantification of the fluorescence intensity measured in free flap breast reconstruction was performed to gain insight into the perfusion patterns observed with ICG NIR fluorescence imaging. METHODS: ICG NIR fluorescence imaging was performed in patients undergoing free flap breast reconstruction following mastectomy. After completion of the arterial and venous anastomosis, 7.5 mg ICG was administered intravenously. The fluorescence intensity over time was recorded using the Quest Spectrum Platform®. Four regions of interest (R OI) were selected based on location and interpretation of the NIR fluorescence signal: (1) The perforator, (2) normal perfusion, (3) questionable perfusion, and (4) low perfusion. Time-intensity curves were analyzed, and two parameters were extracted: Tmax and Tmax slopes. RESULTS: Successful ICG NIR fluorescence imaging was performed in 13 patients undergoing 17 free flap procedures. Region selection included 16 perforators, 17 normal perfusions, 8 questionable perfusions, and 5 low perfusion ROIs. Time-intensity curves of the perforator ROIs were comparable to the ROIs of normal perfusion and demonstrated a fast inflow. No outflow was observed for the ROIs with questionable and low perfusion. CONCLUSION: This study provides insight into the perfusion patterns observed with ICG NIR fluorescence imaging in free flap breast reconstruction. Future studies should correlate quantitative parameters with clinical perfusion assessment and outcome. PMID:35131194 | DOI:10.1016/j.bjps.2021.12.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.