Current management of skull base osteomyelitis

xlomafota13 shared this article with you from Inoreader Current management of skull base osteomyelitis Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients. Recent findings Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases. Summary The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty

xlomafota13 shared this article with you from Inoreader Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Options for segmental mandibular reconstruction in patients poorly suited to undergo fibula free flap (FFF). Recent findings Although FFF is the current 'gold standard' for segmental mandibular reconstruction, other reconstructive options must be considered when FFF is contraindicated or disfavoured and/or patient frailty precludes a lengthy anaesthetic. In addition to various nonvascularized and soft tissue only reconstructions, excellent osseous free flap alternatives for functional segmental mandibular reconstruction may be employed. The subscapular system free flaps (SSSFF) may be ideal in frail and/or elderly patients, as SSSFF allows for early mobility and does not alter gait. In extensive and/or symphyseal defects, functional mandibular reconstruction in lieu of a free flap is extremely limited. Pedicled segmental mandibular reconstructions remain reasonable options, but limited contemporary literature highlights unpredictable bone graft perfusion and poor long-term functional outcomes. Summary There are several excellent free flap alternatives to FFF in segmental mandibular reconstruction, assuming adequate cervical recipient vessels are present. On the basis of the current literature, the optimal mandibular reconstruction for the medically frail, elderly and/or patients with extreme vessel-depleted necks is limited and debatable. In qualifying (i.e. limited, lateral) defects, soft tissue only reconstructions should be strongly considered when osseous free flaps are unavailable. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skull base osteomyelitis imaging

xlomafota13 shared this article with you from Inoreader Skull base osteomyelitis imaging Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO. Recent findings This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included. Summary Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Response of canine thyroid carcinomas to radioiodine

xlomafota13 shared this article with you from Inoreader Response of canine thyroid carcinomas to radioiodine Via radioactive iodine Vet Comp Oncol. 2021 Sep 2. doi: 10.1111/vco.12770. Online ahead of print. ABSTRACT Radioactive iodine (131 I) has previously been reported to prolong survival in dogs with thyroid carcinoma. This study aimed to describe tumour response and progression-free interval (PFI) in dogs with thyroid carcinomas treated with 131 I. Secondary aims were to describe overall survival time (OST) and prognostic factors. A bi-institutional retrospective review of records iden tified 66 dogs with thyroid carcinoma treated with 131 I from January 2010-April 2020. Response was described using RECIST, or a subjective response assessment where specific tumour measurements were not available. Forty-eight dogs (72.7%) were treatment-naïve and 18 dogs (27.3%) had received prior therapy at the time of 131 I treatment. Objective responses were available for 34 dogs and subjective responses for 58 dogs. The overall response rate (ORR) was 35.3% (4 complete and 8 partial responses). Improvement of clinical signs was seen in 76.2% of dogs (32/42). Kaplan-Meier-estimated median PFI (95%CI) was 301 (217-578) days and OST (95%CI) was 564 (421-865) days. Prior therapy was associated with a lower hazard for progression (HR 0.260 95%CI 0.123-0.548, P=0.0004). Treatment of thyroid carcinoma using 131 I can effectively alleviate clinical signs and reduce disease burden in a proportion of dogs. This article is protected by copyright. All righ ts reserved. PMID:34476889 | DOI:10.1111/vco.12770 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association between the circulating superoxide dismutase and obstructive sleep apnea: a meta-analysis

xlomafota13 shared this article with you from Inoreader Association between the circulating superoxide dismutase and obstructive sleep apnea: a meta-analysis Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Sep 2. doi: 10.1007/s00405-021-07064-1. Online ahead of print. ABSTRACT PURPOSE: Although it has been reported that superoxide dismutase (SOD) is related to obstructive sleep apnea (OSA), the results are controversial. In addition, the effects of the continuous positive airway pressure (CPAP) treatment on SOD levels are also inconsistent. The primary purpose of the present meta-analysis is to determine the relationship between the circulating SOD levels and OSA. METHODS: The studies included in this meta-analysis were selected from the PubMed, Embase, Cochrane Library, and Scopus databases. Two researchers independently reviewed the studies. Data analysis was performed using Stata 15.1. The overall effects were measured using the standardized mean difference (SMD) with a 95% confidence interval (CI). A random-effects model or a fixed-effects model was used, depending on the heterogeneity of the stu dies. RESULTS: A total of 14 studies were included, comprising 1240 patients and 457 controls. The results showed that the circulating SOD levels of the patients with OSA were significantly lower than that of the control group (SMD = - 1.645, 95% CI = - 2.279 to - 1.011, P < 0.001). We also studied changes in the circulating SOD levels in patients with OSA after the CPAP treatment. No significant difference was observed in the circulating SOD levels after the CPAP treatment (SMD = - 0.028, 95% CI = - 0.218 to 0.162, P = 0.772). CONCLUSION: The results suggested that patients with OSA have reduced levels of SOD and were related to disease severity. The results also indicated that circulating SOD levels may be a reliable marker for detecting systemic oxidative stress in patients with OSA. However, the circulating SOD levels were not affected by the short-term (4-12 weeks) CPAP treatment. Therefore, further large-scale, well-designed randomized controlled trials with a l onger CPAP therapy (more than 6 months preferably) and good adherence to the treatment are needed to investigate this issue. PMID:34476593 | DOI:10.1007/s00405-021-07064-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of peak inspiratory flow in the management of acute inspiratory dyspnoea

xlomafota13 shared this article with you from Inoreader Assessment of peak inspiratory flow in the management of acute inspiratory dyspnoea Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Sep 2. doi: 10.1007/s00405-021-07066-z. Online ahead of print. ABSTRACT PURPOSE: Assessment of inspiratory dyspnoea associated with upper airway obstruction is based on subjective clinical and nasal fibreoptic laryngoscopy (NFL) signs. The aim of this study was to determine whether peak inspiratory flow (PIF) measurement could indicate the need for upper airway release surgery in patients with acute inspiratory dyspnoea during emergency. METHODS: A retrospective single-institution study (February 2018-March 2020) of 48 patients with acute inspiratory dyspnoea and PIF measurement (Peak Flow In-Check Dial G16®-Harlow-England) was conducted. The surgical decision was based on the clinical evaluation of the patient's respiratory tolerance and NFL. RESULTS: Forty-eight patients were included in this study. Thirty-five patients underwent surgery (PIF: 36 L/min), and 13 patients did not (PIF: 58 L/min) (p = 0.0009). Three of these 13 patients underwent an operation later (PIF value: 42 L/min versus 63 L/min for the 10 others [p = 0.25]). CONCLUSION: PIF measurement is a quantitative, objective, inexpensive, non-invasive, and quick test that is potentially useful for general practitioners, mobile medical teams, or for ear-nose-and-throat specialists. A threshold of 42 L/min can help doctors in emergency decision making to refer patients to an ear-nose-and-throat specialist to release the upper airway and perform surgery or to choose medical monitoring for patients with emergency inspiratory dyspnoea. PMID:34476594 | DOI:10.1007/s00405-021-07066-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The new WHO classification of gastrointestinal neuroendocrine tumors and immunohistochemical expression of somatostatin receptor 2 and 5

xlomafota13 shared this article with you from Inoreader The new WHO classification of gastrointestinal neuroendocrine tumors and immunohistochemical expression of somatostatin receptor 2 and 5 Via Experimental and therapeutic medicine Exp Ther Med. 2021 Oct;22(4):1179. doi: 10.3892/etm.2021.10613. Epub 2021 Aug 13. ABSTRACT The 2019 World Health Organization (WHO) classification of gastrointestinal tumors defines well-differentiated grade 3 neuroendocrine tumors, the mixed neuroendocrine-non-neuroendocrine tumors (MiNENs) and classifies goblet cell carcinoid as goblet cell adenocarcinoma. The expression of somatostatin receptors (SSTRs) is the foundation for somatostatin analogue therapy. At present, there are only a few studies that have analyzed the immunohistochemical reactivity of SSTRs in gastrointestinal neuroendocrine neoplasms (NENs). The aim of the present study was to evaluate the immunohistochemical expression of SSTR2 and SSTR5 in gastrointestinal NENs and goblet cell adenocarcinomas and the correlation of these markers with clinical and morphological factors. The study included 67 patients with NENs and 4 patients with adenocarcinoma ex-goblet cell carc inoid diagnosed between January 2008 and December 2018. Tumors were reclassified according to the 2019 WHO classification. Immunohistochemical staining for chromogranin A, synaptophysin, Ki-67, p53, SSTR2, and SSTR5 were performed in all the cases. The results showed that, G1 and G2 neuroendocrine tumors were more common SSTR2-positive in comparison with G3 carcinomas (P<0.0001). In addition, 33.3% of neuroendocrine carcinomas and 2 cases of low-grade adenocarcinoma ex-goblet cell carcinoid were SSTR2-positive. Neuroendocrine carcinomas had significantly lower SSTR2 and SSTR5 expression compared with well-differentiated neuroendocrine tumors (P=0.0130; P=0.0437, respectively). The SSTR2 expression in the early tumor stages was 100%, more often than in advanced stages (55.6%; P=0.0011). The results demonstrated the decrease in SSTR2 expression with increasing malignancy and tumor stage. The SSTR2-positive expression in neuroendocrine carcinomas and adenocarcinoma ex-goblet cell ca rcinoid provides evidence for the benefits of somatostatin analog treatment associated with surgery and chemotherapy. PMID:34475969 | PMC:PMC8406677 | DOI:10.3892/etm.2021.10613 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.