Apnea-hypopnea index severity as an independent predictor of post-tonsillectomy respiratory complications in pediatric patients: A retrospective study

xlomafota13 shared this article with you from Inoreader Apnea-hypopnea index severity as an independent predictor of post-tonsillectomy respiratory complications in pediatric patients: A retrospective study Via ear nose throat Ear Nose Throat J. 2021 Dec 1:1455613211059468. doi: 10.1177/01455613211059468. Online ahead of print. ABSTRACT INTRODUCTION: Despite the presence of clinical practice guidelines for overnight admission of pediatric patients following adenotonsillectomy, variance in practice patterns exists between pediatric otolaryngologists. The purpose of this study is to examine severity of apnea-hypopnea index (AHI) as an independent predictor of postoperative respiratory complications in children undergoing adenotonsillectomy. METHODS: Retrospective chart review of all children undergoing adenotonsillectomy at a large tertiary referral center between January 2015 and December 2019 who underwent preoperative polysomnography and were admitted for overnight observation. Charts were reviewed for total adverse events and respiratory events occurring during admission. RESULTS: Overall, respiratory events were seen in 50.6% of patients with AHI ≥10 and in 39.6% of patients with AHI <10. The overall mean AHI was 19.2, with a mean of 28.1 in the AHI ≥10 subgroup vs 4.6 in the AHI <10 subgroup. There was no statistical correlation or increased risk between an AHI ≥10 and having a pure respiratory event, with a relative risk of 1.19 (.77-1.83, P = .43). There was a statistically significant difference between the mean AHI of those with any adverse event and those without (21.6 vs 13.4, P = .008). There is additionally an increased risk of any event with an AHI over 10, with a relative risk of 1.51 (1.22-1.88, P < .0001). CONCLUSION: Preoperative AHI of 10 events per hour was not a predictor of postoperative respiratory complications. However, there was a trend for those with a higher AHI requiring additional supportive measures or a prolonged stay. Practitioners should always use their best judgment in deciding whether a child warrants postoperative admission following adenotonsillectomy. PMID:34851765 | DOI:10.1177/01455613211059468 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined Transcranial and Endoscopic Endonasal Approach for Resection of a Complex Sinonasal Squamous Cell Carcinoma: Two-Dimensional Operative Video

xlomafota13 shared this article with you from Inoreader Combined Transcranial and Endoscopic Endonasal Approach for Resection of a Complex Sinonasal Squamous Cell Carcinoma: Two-Dimensional Operative Video Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1736629 Sinonasal squamous cell carcinoma (SCC) is a rare head-and-neck neoplasm that has a propensity to locally invade vital structures. Currently, the combination of surgical resection and radiation remains the optimal treatment.1 However, the extent of disease burden and involvement of surrounding anatomy may make these inoperable. Here, we demonstrate the successful application of multidisciplinary approach for surgical resection of a large, complex SCC lesion centered at the superior nasal cavity with extension into the eye orbits and brain. A two-step approach was performed; transcribiform, endoscopic piecemeal resection with reconstruction of the skull base, followed by a bifrontal craniotomy. Reconstruction was achieved using an inlay of DuraMatrix allograft (Stryker Inc., Kalamzoo, Michigan, United States) followed by an inlay of AlloDerm (Allergan Inc., Irvine, California, United States), anchored anteriorly and posteriorly with wide wings placed over the respective orbital roofs. Major steps include (1) a summary of the patient presentation and preoperative imaging, (2) resection of the tumor endonasally, (3) resection of the tumor intracranially from a bifrontal craniotomy, and (4) a review of the postoperative imaging. The patient tolerated the procedure (Fig. 1) well, returned to his baseline with no new neurologic deficits, and was placed on 6-week antibiotics regimen for osteomyelitis discovered during the operation. Approximately, 2 months after discharge, the patient unfortunately returned with altered mental status, was found to have sepsis, and expired shortly thereafter. This operative video illustrates the technical steps and capa bilities of surgical treatment, achieving near-complete gross total resection of a complex SCC lesion using a multidisciplinary approach.The link to the video can be found at: https://youtu.be/8ffckKIuBzM. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Efficacy and Safety of Anlotinib in Neoadjuvant Treatment of Locally Advanced Thyroid Cancer: A Single-Arm Phase II Clinical Trial

xlomafota13 shared this article with you from Inoreader The Efficacy and Safety of Anlotinib in Neoadjuvant Treatment of Locally Advanced Thyroid Cancer: A Single-Arm Phase II Clinical Trial Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thyroid Function and the Risk of Alzheimer's Disease: A Mendelian Randomization Study

xlomafota13 shared this article with you from Inoreader Thyroid Function and the Risk of Alzheimer's Disease: A Mendelian Randomization Study Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Graves' Autoantibodies Exhibit Different Stimulating Activities in Cultures of Thyrocytes and Orbital Fibroblasts Not Reflected by Clinical Assays

xlomafota13 shared this article with you from Inoreader Graves' Autoantibodies Exhibit Different Stimulating Activities in Cultures of Thyrocytes and Orbital Fibroblasts Not Reflected by Clinical Assays Via liebertpub1 Thyroid, Ahead of Print. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Migration of Ventriculoperitoneal Shunt to Uterus In A Child: A Case Report

xlomafota13 shared this article with you from Inoreader Migration of Ventriculoperitoneal Shunt to Uterus In A Child: A Case Report Via leak of cerebrospinal fluid J Pediatr Adolesc Gynecol. 2021 Nov 26:S1083-3188(21)00343-0. doi: 10.1016/j.jpag.2021.11.004. Online ahead of print. ABSTRACT BACKGROUND: Ventriculo-peritoneal shunt (VPS) is usually placed inside the peritoneal cavity for cerebrospinal fluid drainage. Rarely, it can migrate to various pelvic visceral organs. Inside the pelvis, the distal end of the shunt can perforate anywhere from the uterus or adnexa to the vulva and migration through the uterus is extremely rare. CASE: A three-and-a-half-year-old girl presented with CSF leak through the vagina following uterine perforation by VPS. The diagnosis was made with an ultrasound. Her symptoms resolved following revision surgery. CONCLUSION: In a patient with a VPS in situ, presenting with a watery fluid leak through vagina, perforation of fornix or uterus must always be kept in mind. Timely diagnosis and intervention can result in the prevention of complications. PMID:34843976 | DOI:10.1016/j.jpag.2021.11.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative cerebrospinal fluid leak graded by Esposito grade is a predictor for diabetes insipidus after endoscopic endonasal pituitary adenoma resection

xlomafota13 shared this article with you from Inoreader Intraoperative cerebrospinal fluid leak graded by Esposito grade is a predictor for diabetes insipidus after endoscopic endonasal pituitary adenoma resection Via leak of cerebrospinal fluid World Neurosurg. 2021 Nov 26:S1878-8750(21)01802-7. doi: 10.1016/j.wneu.2021.11.090. Online ahead of print. ABSTRACT BACKGROUND: Diabetes insipidus (DI) is a well-known complication of transsphenoidal surgery (TSS). However, the risk factors for DI remain controversial. METHODS: We conducted a retrospective study of the patients who underwent endoscopic TSS for pituitary adenoma at our institution during a 5-year period. The patients were divided into a DI group and a non-DI group. Logistic regression analyses were used to identify risk factors for postoperative DI. In subgroup analysis, the DI group was divided into transient-DI and permanent-DI groups and the perioperative factors were compared between groups. RESULTS: Among 101 patients, 58 patients were classified as non-DI (57.4%) and 43 patients as DI (42.6%) group. Permanent DI occurred in seven patients （6.9%）. In the univariate analyses, statistically significant risk factors were suprasellar extension, tumor functionality and intraoperative cerebrospinal fluid (CSF) leaks by Esposito grade. In the multivariate logistic regression analysis, Esposito grade was the only statistically significant risk factor (P=0.015). The frequency of DI increased as the Esposito grade increased (P=0.0002 for the trend). In subgroup analysis, postoperative nadir sodium concentration was lower in the permanent-DI group (128.1±2.78 mmol/L) than in the transient-DI group (135±1.22 mmol/L) (P=0.035) and the optimal cut-off value was 124.5 mmol/L, with a sensitivity of 57.1% and a specificity of 91.7% (Area Under the Curve=0.76, P=0.034). CONCLUSIONS: Intraoperative CSF leak by Esposito grade is associated with postoperative DI. These data can be applied to help identify high-risk patients who need more-aggressive follow-up and fluid management. PMID:34844009 | DOI:10.1016/j.wneu.2021.11.090 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.