Composite gelfoam/fascia graft: a novel technique in tympanoplasty surgery

xlomafota13 shared this article with you from Inoreader Composite gelfoam/fascia graft: a novel technique in tympanoplasty surgery 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 Aug 21. doi: 10.1007/s00405-021-07042-7. Online ahead of print. ABSTRACT BACKGROUND: Traditional tympanoplasty techniques require graft placement and then supporting material (GelFoam) as a two-step process. Both steps potentially disrupt accurate graft placement leading to failure and persistence of the perforation. METHODS: We demonstrate a novel technique for graft preparation and placement using composite gelfoam/fascia in which the gelfoam and fascia are compressed into a common layer and applied to the perforation and drum remnant in a single step. Placement is ergonomically efficient and effective. CONCLUSION: This novel modification of traditional graft preparation and placement is simple and ergonomically efficient. PMID:34420076 | DOI:10.1007/s00405-021-07042-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Identifying epithelial borders in cholesteatoma surgery using narrow band imaging

xlomafota13 shared this article with you from Inoreader Identifying epithelial borders in cholesteatoma surgery using narrow band imaging 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 Aug 22. doi: 10.1007/s00405-021-07045-4. Online ahead of print. ABSTRACT PURPOSE: To quantify changes in the perceived epithelial border with narrow band imaging (NBI) and white light imaging (WLI) during cholesteatoma surgery and to objectify possible benefits of NBI in otology. METHODS: Perioperative digital endoscopic images were captured during combined approach tympanoplasty at our tertiary referral center using WLI and NBI (415 nm and 540 nm wavelengths). Sixteen otologic surgeon defined the epithelial borders within 16 identical WLI and NBI photos. Pixels of these selections were calculated to analyze the quantitative difference between WLI and NBI. A questionnaire also analyzed the qualitative differences. RESULTS: Sixteen otologic surgeons participated in the study. Stratified per photo, only two photos yielded a significant difference: less pixels were selected with NBI than WLI. A Bland-Altman plot showed no systemic error. Stratified per otologist, four participants selected significantly more pixels with WLI than with NBI. Overall, no significant difference between selected pixels was found. Sub-analyses of surgeons with more than 5 years of experience yielded no additional findings. Despite these results, 60% believed NBI could be advantageous in defining epithelial borders, of which 83% believed NBI could reduce the risk of residual disease. CONCLUSION: There was no objective difference in the identification of epithelial borders with NBI compared to WLI in cholesteatoma surgery. Therefore, we do not expect the use of NBI to evidently decrease the risk of residual cholesteatoma. However, subjective assessment does suggest a possible benefit of lighting techniques in otology. LEVEL OF EVIDENCE: 3. PMID:34420082 | DOI:10.1007/s00405-021-07045-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hsp27 and Hsp60 in human submandibular salivary gland: Quantitative patterns in healthy and cancerous tissues with potential implications for differential diagnosis and carcinogenesis

xlomafota13 shared this article with you from Inoreader Hsp27 and Hsp60 in human submandibular salivary gland: Quantitative patterns in healthy and cancerous tissues with potential implications for differential diagnosis and carcinogenesis Via histochem Acta Histochem. 2021 Aug 19;123(6):151771. doi: 10.1016/j.acthis.2021.151771. Online ahead of print. ABSTRACT Tumors of the submandibular salivary gland (SMG) are uncommon but sufficiently frequent for the physician to consider them in routine examinations and for the pathologist to be prepared to differentiate them from other tissue abnormalities. However, scarcity of specimens makes training difficult, a situation compounded by the lack of accepted universal diagnostic gui delines. Furthermore, there is little information on the chaperone system (CS) of the gland, despite the increasing evidence of its participation in carcinogenesis as a biomarker for diagnosis and patient follow up, and in the mechanisms by which the tumor cells thrive. We are investigating this aspect of various tumors, and here we describe standardized methods for assessing the tissue levels of two chaperones, Hsp27 and Hsp60, in normal SMG and its tumors. We present illustrative results obtained with immunohistochemistry (IHC) and immunofluorescence-confocal microscopy (IF-CM), which we propose as a platform onto which a data base could be built by adding new information and which would provide material for developing guidelines for tumor identification and monitoring. The initial findings are encouraging in as much as the tumors surveyed showed quantitative patterns of Hsp27 and Hsp60 that distinguished tumoral from normal tissue and certain tumors from the others, and the resul ts from IHC were confirmed by IF-CM. PMID:34419757 | DOI:10.1016/j.acthis.2021.151771 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Periodontitis and peri-implantitis tissue levels of Treponema denticola-CTLP and its MMP-8 activating ability

xlomafota13 shared this article with you from Inoreader Periodontitis and peri-implantitis tissue levels of Treponema denticola-CTLP and its MMP-8 activating ability Via histochem Acta Histochem. 2021 Aug 19;123(6):151767. doi: 10.1016/j.acthis.2021.151767. Online ahead of print. ABSTRACT BACKGROUND AND AIMS: Chymotrypsin-like-proteinase of Treponema denticola (Td-CTLP) can stimulate the protein expression and activation of matrix metalloproteinase (MMP)-8 (or collagenase-2), a potent tissue destructive enzyme from gingival cells in vitro. The aims of this study were 1) to demonstrate the proMMP-8 (or latent MMP-8) activation by Td-CTLP in vitro and 2 ) to detect Td-CTLP and MMP-8 protein levels in the tissue samples of peri-implantitis and periodontitis patients. MATERIALS AND METHODS: proMMP-8 activation by Td-CTLP was analyzed by immunoblots. Tissue specimens were collected from 38 systemically healthy and non-smoking patients; 14 of whom had moderate to severe periodontitis, 10 of whom were suffering from peri-implantitis, and finally 14 of whom showed no sign of periodontal inflammation nor radiological bone decay (control group). The immune-expression levels of MMP-8 and Td-CTLP in the epithelium and the connective tissue were analyzed immunohistochemically. A pixel color-intensity analyze was performed with ImageJ software (version 1.46c; Rasband WS, National Institutes of Health, Bethesda, MD, USA) to obtain a comparable numeral score for each patient's epithelium and connective tissue MMP-8 and Td-CTLP enzyme level. RESULTS: Td-CTLP activated proMMP-8 in vitro by converting the 70-75 kDa proMMP-8 to 65 kDa ac tive MMP-8. Also, lower molecular size 25-50 kDa parts of MMP-8 were formed. There was no statistically significant difference between the study groups in terms of their MMP-8 and Td-CTLP levels in the epithelium or in the connective tissue. CONCLUSION: Regarding the limits of this study, it can thus be said that the Td-CTLP enzyme can activate the host proMMP-8 enzyme. Tissue protein levels of MMP-8 and Td-CTLP do not seem to be changed in peri-implantitis and in periodontitis. PMID:34419758 | DOI:10.1016/j.acthis.2021.151767 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals

xlomafota13 shared this article with you from Inoreader Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Aug 6:S1808-8694(21)00135-X. doi: 10.1016/j.bjorl.2021.06.011. Online ahead of print. ABSTRACT INTRODUCTION: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently. OBJECTIVES: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and furth er standardization. METHODS: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy. RESULTS: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals. CONCLUSION: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management. PMID:34419386 | DOI:10.1016/j.bjorl.2021.06.011 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

SuP‐Ring: A pneumatic tactile display with substitutional representation of contact force components using normal indentation

xlomafota13 shared this article with you from Inoreader SuP‐Ring: A pneumatic tactile display with substitutional representation of contact force components using normal indentation Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background Shear force is important for tumor detection and can contribute to minimally invasive surgery (MIS). A popular method uses lateral skin stretch to produce shear force but has some limitations. Methods We have developed a ring-type pneumatic tactile display that employs normal indentation substituted for lateral skin stretch to represent normal and shear feedback, called SuP-Ring. Psychophysical experiments were conducted to evaluate how users perceive the provided feedback and the effectiveness of SuP-Ring in tumor localization. Results The experimental results show that the participants could perceive the provided normal and shear feedback well. Shear feedback enables users to enhance their performance in localizing the tumor and normal feedback could contribute to ensuring the safety requirements in MIS. Conclusions The proposed tactile display could be useful for intraoperative tumor localization and has the potential to be used in a wide variety of applications. 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.

Incidental paratracheal air cyst in papillary thyroid cancer patient: a case report

xlomafota13 shared this article with you from Inoreader Incidental paratracheal air cyst in papillary thyroid cancer patient: a case report Via radioactive iodine Gland Surg. 2021 Jul;10(7):2334-2339. doi: 10.21037/gs-21-139. ABSTRACT Paratracheal air cyst (PTAC) is a collection of air in the right posterior side of the trachea with an uncertain etiology. We report a papillary thyroid cancer patient with a PTAC that was removed during thyroid cancer surgery. A 68-year-old woman was diagnosed with right papillary thyroid cancer with suspicion of central lymph node metastasis. She had a history of hypertension and a rear-end collision car acci dent 20 years prior. On computed tomography, an ovoid cyst was incidentally found in the paratracheal region at the thoracic inlet level. Emphysematous lung with an obstructive lung defect was noted without any symptoms. Bilateral total thyroidectomy with ipsilateral central compartment neck dissection was indicated for the patient. During surgery, removal of the cyst was inevitable for complete central neck dissection. Histopathologic analysis revealed an etiology of tracheal mucus sprouting through weak trachea points. No postoperative complications occurred. The patient continued on levothyroxine medication without further radioactive iodine therapy. After 6 months, follow-up ultrasound showed no evidence of recurrence. We hypothesized that obstructive lung disease with impaired lung function or trauma history might have contributed to the development of PTAC. Future studies are needed to determine if PTACs have any association with obstructive lung disease or trauma. PMID: 34422604 | PMC:PMC8340328 | DOI:10.21037/gs-21-139 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of the abilities of staging and risk stratification systems to predict the long-term structural recurrence in patients with differentiated thyroid carcinoma after total thyroidectomy and radioactive iodine remnant ablation

xlomafota13 shared this article with you from Inoreader Comparison of the abilities of staging and risk stratification systems to predict the long-term structural recurrence in patients with differentiated thyroid carcinoma after total thyroidectomy and radioactive iodine remnant ablation Via radioactive iodine Gland Surg. 2021 Jul;10(7):2200-2210. doi: 10.21037/gs-21-8. ABSTRACT BACKGROUND: In patients with differentiated thyroid carcinoma (DTC), various staging and risk stratification systems have been applied to estimate long-term recurrence, which is a major issue during the postoperative follow-up period. However, the efficacy of these systems remains unclear in this context. METHODS: The present historical cohort study included 510 patients with DTC who underwent a total thyro idectomy followed by radioactive iodine (RAI) remnant ablation. Enrolled patients were categorized according to the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) Tumor Node Metastasis (TNM) staging system, the 2015 American Thyroid Association (ATA) initial risk stratification system, and the dynamic risk stratification (DRS) system. The ability of each system to predict long-term structural recurrence was compared using proportion of variance explained (PVE) by logistic regression models. RESULTS: The median follow-up period was 108 months. Structural recurrence occurred in 7.6% of the patients (n=39/510). Disease-free survival (DFS) curves of the patients within each category in the TNM staging system, the ATA initial risk stratification system, and the DRS system were significantly different (P<0.001). The PVE of the DRS system (20.7%) was higher than those of the TNM staging system and the ATA initial ris k estimates. CONCLUSIONS: The DRS system may effectively predict long-term structural recurrence and guide long-term management and follow-up strategies in patients with DTC undergoing total thyroidectomy and RAI remnant ablation. PMID:34422591 | PMC:PMC8340347 | DOI:10.21037/gs-21-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A very dangerous facial hematoma

xlomafota13 shared this article with you from Inoreader A very dangerous facial hematoma Via oto-rhino-laryngologie Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Aug 19:S1879-7296(21)00183-6. doi: 10.1016/j.anorl.2021.08.005. Online ahead of print. NO ABSTRACT PMID:34420907 | DOI:10.1016/j.anorl.2021.08.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series

xlomafota13 shared this article with you from Inoreader Endonasal Free Flap Reconstruction Combined With Draf Frontal Sinusotomy for Complex Cerebrospinal Fluid Leak: A Technical Report & Case Series Via leak of cerebrospinal fluid Oper Neurosurg (Hagerstown). 2021 Aug 23:opab309. doi: 10.1093/ons/opab309. Online ahead of print. ABSTRACT BACKGROUND: Frontal sinus cranialization with closure via bifrontal pericranial flaps is the gold standard for separating the nasofrontal recess from the intracranial cavity for posterior table defects. Despite the high success rate, cerebrospinal fluid (CSF) leak may persist and is particularly challenging when vascularized reconstructive options from the bicoronal incision are exhausted. OBJECTIVE: To assess a novel endonasal technique using an adipofascial radial forearm free flap delivered to the frontal recess through a Draf sinusotomy to repair complex CSF leaks from the frontal sinus. METHODS: A retrospective review of 3 patients (all male; ages 42, 43, and 69 yr) with persistent CSF leak despite frontal sinus cranialization and repair with bifrontal pericranium was performed. Etiology of injury was traumatic in 2 pat ients and iatrogenic in 1 patient after anaplastic meningioma treatment. To create space for the flap and repair the nasofrontal ducts, endoscopic Draf III (Case 1, 3) or Draf IIb left frontal sinusotomy (Case 2) was performed. The forearm flap was harvested, passed through a Caldwell-Luc exposure, and placed within the Draf frontal sinustomy. The flap vessels were tunneled to the left neck and anastomosed to the facial vessels by the mandibular notch. RESULTS: Intraoperatively, the flaps were well-seated and provided a watertight seal. Postoperative hospital courses were uncomplicated. There were no new CSF leaks or flap necrosis at 12, 14, and 16 mo. CONCLUSION: Endoscopic endonasal free flap reconstruction through a Draf procedure is a novel viable option for persistent CSF leak after failed frontal sinus cranialization. PMID:34423844 | DOI:10.1093/ons/opab309 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review

xlomafota13 shared this article with you from Inoreader Outcome of Eustachian Tube Balloon Dilation in Children: A Systematic Review Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Aug 22:34894211041340. doi: 10.1177/00034894211041340. Online ahead of print. ABSTRACT OBJECTIVE: Eustachian tube dysfunction (ETD) is a chronic entity that has been historically managed with adenoidectomy and ventilation tube insertion. Recently, balloon dilation of the eustachian tube has shown promising results in recalcitrant eustachian tube dysfunction. We reviewed the literature to determine the outcome of eustachian tube balloon dilation in children. METHODS: A literature search was conducted for the period from 1990 to 2020 by searching several databases over a 1-month period (January 2021) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews for Interventions. Primary outcome was defined as the success of the intervention determined by the resolution of symptoms, and secondary outcome was determined by revisions surgery and presence of complications. RESULTS: Only 7 articles were identified based on our objectives and selection criteria. All studies included are retrospective cohort case series (Level IV) and 1 cohort of matched controls (Level III). A total of 284 patients were included in this review, with a mean age of 7.8 years. A total of 463 balloon dilation were performed either bilaterally or unilaterally. The most common finding of ETD is middle ear effusion in 5 studies. Balloon dilation of eustachian tube was second-line treatment in 6 studies and first-line treatment in 1 study. Improvement of symptoms was identified in all studies through various assessments performed. Revision surgery was performed in 1 study with no major complications reported. CONCLUSIONS: Balloon dilation of the eustachian tube may be considered as an alternative procedure following failed standard treatment in children. The quality of evidence is inadequate to recommend widespread use of the technique until a better-quality study has been completed. Future randomized controlled studies with a large sample size are warranted to determine the efficacy of this procedure amongst children. PMID:34423675 | DOI:10.1177/00034894211041340 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.