Induction chemotherapy followed by intensity‐modulated radiotherapy versus concurrent chemoradiotherapy in nasopharyngeal carcinoma: A retrospective analysis

xlomafota13 shared this article with you from Inoreader Induction chemotherapy followed by intensity‐modulated radiotherapy versus concurrent chemoradiotherapy in nasopharyngeal carcinoma: A retrospective analysis Via Clinical Otolaryngology Abstract Objectives The optimal treatment strategy of combining systemic chemotherapy and radiotherapy for nasopharyngeal carcinoma (NPC) is controversial. This study aimed to compare the efficacy and toxicities of induction chemotherapy followed by intensity‐modulated radiotherapy (IC‐RT) versus concurrent chemoradiotherapy (CCRT) in NPC. Methods Of 448 stage II‐IVb NPC patients treated with IC‐RT or CCRT were retrospectively analysed. The primary outcome was overall survival, which was analysed by using Kaplan‐Meier curves and log‐rank (Mantel‐Cox) test. Results The median follow‐up was 66 months (interquartile range, 46‐84 months). There was no statistically significant difference in the estimated 5‐year overall survival (OS), progression‐free survival (PFS), distance metastasis‐free survival (DMFS) and locoregional relapse‐free survival (LRFS) between IC‐RT group and CCRT group (OS: 89.5% vs 91.7%, P = .568; PFS: 85.2% vs 87.5%, P = .615; DMFS: 90.9% vs 91.7%, P = .847; LRFS: 92.0% vs 96.9%, P = .104). In the multivariate analysis, the treatment group (IC‐RT vs CCRT) was not an independent prognostic factor for OS, PFS, DMFS and LRFS. Less advanced tumour stage and lymph node stage were predictive of higher OS. EBV‐DNA level was an independent prognostic factor that was only significantly associated with LRFS. Conclusions IC‐RT achieves similar survival outcomes and treatment‐related toxicities as CCRT in OS, PFS, DMFS and LRFS for patients with NPC. We need multicentre randomised controlled trials to reconfirm our data. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Deep periocular trauma with affection of the lacrimal ducts during Caesarean section

xlomafota13 shared this article with you from Inoreader Deep periocular trauma with affection of the lacrimal ducts during Caesarean section Via hno HNO. 2021 Apr 6. doi: 10.1007/s00106-021-01039-8. Online ahead of print. ABSTRACT Periocular injuries during a caesarean section are extremely rare. The case report of a five hour old newborn addresses the trauma management concerning diagnostics, therapy, and post-operative care of a deep periocular soft tissue injury. The pattern of injury consisted of full thickness wounds of the medial and lateral lid margins, opening of the superior conjunctival fornix, and penetration of Tenon's capsule. The reconstruction was performed layer by layer while an autostable monocanaliculonasal lacrimal intubation was inserted. PMID:33822270 | DOI:10.1007/s00106-021-01039-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Interdisciplinary surgery to the central skull base-current status

xlomafota13 shared this article with you from Inoreader Interdisciplinary surgery to the central skull base-current status Via hno HNO. 2021 Apr 6. doi: 10.1007/s00106-021-01022-3. Online ahead of print. ABSTRACT BACKGROUND: The skull base is a surgically complex unit and is often only accessible via combined access routes. Newly developed surgical techniques using microsurgical visualization procedures and active instruments ("powered instruments") as well as multiport accesses enable new, less traumatic surgical corridors. This requires close interdisciplinary cooperation between ENT and neurosurgeons . Currently established access routes to the central skull base are systematized based on the authors' own clinical experience, and discussed in relation to the entity and the current study situation. MATERIALS AND METHODS: A retrospective, qualitative, and descriptive evaluation of the surgical reports of patients with pathologies of the central skull base who were jointly treated by neurosurgery and otorhinolaryngologic/head and neck surgery between 2006 and 2019 was performed. RESULTS: The surgical access routes to the central skull base can be categorized as so-called multiport access routes, partly also in combination, as follows: transnasal-transsphenoidal, subfrontal, subtemporal, transzygomatic, transpterygonal, transpetrous, translabyrinthine, and suboccipital. The choice of access route was based on the location and type of pathology, its inflammatory or space-occupying (benign or malignant tumor) nature, and the possibilities of functional preservation and com plete removal. CONCLUSION: Due to the complexity of central skull base structures, the different tumor entities, and the required expertise of different medical specialties, surgery of the central skull base remains a challenge and should only be performed at special competence centers certified according to the criteria of the German Society of Skull Base Surgery. PMID:33822265 | DOI:10.1007/s00106-021-01022-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Molecular laryngology : A new chapter in the understanding of laryngeal diseases

xlomafota13 shared this article with you from Inoreader Molecular laryngology : A new chapter in the understanding of laryngeal diseases Via Laryngologie HNO. 2021 Apr 6. doi: 10.1007/s00106-021-01016-1. Online ahead of print. ABSTRACT BACKGROUND: Despite considerable advances in laryngological research, there is still a plethora of (benign) vocal fold pathologies that cannot be treated causally. This is due to the limited accessibility and sensitive microarchitecture of the vocal folds, which cannot be investigated at a cellular level. Consequently, current pathophysiological knowledge is frequently based on macroscopic findings. The impact of interventions is mainly evaluated endoscopically or via indirect diagnostic methods. OBJECTIVE: The aim of this article is to discuss state-of-the-art biotechnological methods used in laryngological research, illustrated by practical examples. RESULTS: In recent years, animal and in vitro experiments have significantly contributed to a continuous expansion of knowledge in this field, particularly regarding vocal fold inflammation and scar fo rmation. Vocal fold fibroblasts, the most important cellular component of the lamina propria, can be accredited a central role in these processes. CONCLUSION: Our knowledge regarding macroanatomy and macropathophysiology of several pathologies has increased considerably in recent years. In vitro trials have shown, e.g., that vocal fold fibroblasts in an inflammatory setting secrete less profibrotic and proinflammatory cytokines when exposed to vibration. Early vocal exercises after surgical interventions on the vocal folds may therefore promote better wound healing and consequently improved phonation. Research in molecular laryngology should create a solid basis of knowledge for subsequent clinical studies. PMID:33822268 | DOI:10.1007/s00106-021-01016-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function

xlomafota13 shared this article with you from Inoreader Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function Via leak of cerebrospinal fluid Endocrine. 2021 Apr 6. doi: 10.1007/s12020-021-02713-1. Online ahead of print. ABSTRACT BACKGROUND: Non-functioning pituitary macroadenomas (NFPAs) with visual field defects are ideally managed by transsphenoidal tumour resection to improve vision, and long-term postsurgical follow up is necessary to monitor for tumour recurrence. Regular updates from global data are necessary for developing optimal management strategies of these tumours. METHODS: Pre- and postoperative visual and endocrine profile, imaging characteristics and details of surgical interventions among patients with NFPAs managed between 2008 and 2019 in a UK regional centre were assessed. The radiological and surgical outcomes including postoperative complications, recurrence risk and the factors influencing outcomes also were assessed. RESULTS: 105 cases with mean (SD) age 60.1 (14.3) years and follow-up duration 60 (37) months were studied. 67 (64%) patients were male. Five-year recurrence-free survival rate was 71.5% (95% confidence interval [CI] 62.7% to 81.6%) with 33 (31%) tumour recurrences of whom 20 (60%) received radiotherapy and 9 (27%) underwent further surgery. Younger age, tumour volume, and bilateral cavernous sinus extension were the predictors of recurrence on univariate analysis, while younger age was the only factor on multivariate analysis (Hazard ratio 0.95; 95% CI: 0.92, 0.97). 72/78 patients (92%) with preoperative visual field defects improved after surgery, of whom 27 (35%) had full recovery. 20 (24%) patients had recovery of an abnormal hormone axis. 15 patients (16%) developed perioperative complications such as cerebrospinal fluid leak (12 cases), meningitis (2 cases), and bleeding (2 cases). CONCLUSIONS: Five-year recurrence-free survival after transsphenoidal resection for NFPAs was 71.5% with older age at surgery conferring lower risk of recurrence. Visual recovery/ improvement occurred in 92% of cases with preoperative visual defects following surgery. PMID:33822319 | DOI:10.1007/s12020-021-02713-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

REAL ROBOTIC TOTAL MESOPANCREAS EXCISION(TMpE) ASSISTED BY HANGING MANEUVER(HM): STANDARDIZED TECHNIQUE

xlomafota13 shared this article with you from Inoreader REAL ROBOTIC TOTAL MESOPANCREAS EXCISION(TMpE) ASSISTED BY HANGING MANEUVER(HM): STANDARDIZED TECHNIQUE Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Pancreaticoduodenectomy (PD) is one of the most demanding interventions for digestive surgeons. Therefore, minimally invasive approach is still a topic of discussion(1,2). Many authors have described minimally invasive PD (laparoscopic or robotic) as feasible, safe, and reproducible(3–5). This article is protected by copyright. All rights reserved. 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.

Persistent primitive olfactory artery associated with early bifurcated accessory anterior cerebral artery

xlomafota13 shared this article with you from Inoreader Persistent primitive olfactory artery associated with early bifurcated accessory anterior cerebral artery Via radiol anat Surg Radiol Anat. 2021 Apr 6. doi: 10.1007/s00276-021-02744-3. Online ahead of print. ABSTRACT Five types of persistent primitive olfactory artery (PPOA), a rare variation of the proximal anterior cerebral artery (ACA), have been reported. Type 1 is most common, generally following an extreme anteroinferior course and taking a hairpin turn before continuing to the distal A2 segment of the ACA. Triple ACAs are a common variation of the A2 segment of the ACA, and a centrally l ocated artery is called an "accessory ACA" or "median artery of the corpus callosum". This artery usually does not bifurcate or else bifurcates distally and continues to the pericallosal artery. We herein report a 74-year-old woman with type 1 PPOA and early bifurcated accessory ACA, an extremely rare combination of ACA variations, that was diagnosed using magnetic resonance angiography. PMID:33825050 | DOI:10.1007/s00276-021-02744-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.