Unilateral Choanal Atresia: Indications of Long-Term Olfactory Deficits and Volumetric Brain Changes Postsurgically

xlomafota13 shared this article with you from Inoreader Unilateral Choanal Atresia: Indications of Long-Term Olfactory Deficits and Volumetric Brain Changes Postsurgically Via O.R.L. Journal for oto-rhino-laryngology and its borderlands Background: Very few studies have investigated whether unilateral choanal atresia is associated with permanent olfactory deficits. Objective: This study aimed to evaluate the olfactory performance of patients with unilateral choanal atresia postsurgically. Methods: Three patients with unilateral atresia were examined in terms of olfactory performance with the Sniffin' Sticks test (odor identification, threshold, and discrimination), size of the olfactory bulb, and volumetric brain changes. Results: All p atients demonstrated significantly lower olfactory performance in terms of odor threshold on the same side with the choanal atresia. Grey matter reductions were found ipsilaterally in the hippocampus. Conclusions: This pilot study indicates that persistent olfactory deficits and volumetric brain changes are present in patients with unilateral choanal atresia. ORL View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outdoor Temperature as an Independent Risk Factor for Acute Pharyngitis Incidence: A Preliminary Study

xlomafota13 shared this article with you from Inoreader Outdoor Temperature as an Independent Risk Factor for Acute Pharyngitis Incidence: A Preliminary Study Via ear nose throat Ear Nose Throat J. 2021 Nov 26:1455613211057637. doi: 10.1177/01455613211057637. Online ahead of print. ABSTRACT Objective: Acute pharyngitis is common worldwide. Meteorological changes contribute to respiratory infections. This study aims to explore the correlation between acute pharyngitis and meteorological parameters. Methods: We collected the monthly acute pharyngitis cases in our hospital and the meteorological data, including temperature, relative humidi ty, and air quality index (AQI) of Shanghai, China, from January, 2015, to December, 2017. Pearson correlation and multivariable regression analysis were used to explore the association between meteorological parameters and the monthly hospital visits. Results: A total of 8287 patients were included in this study, and the monthly number of hospital visits was 230.2 ± 39.0. The best air quality index was 46.4 and the worst was 113.2. Temperature ranged from 5.2°C to 32.0°C, and relative humidity ranged from 59.4% to 83.1%. The monthly hospital visits of acute pharyngitis were negatively correlated with temperature (r = -.558, 95% CI -.746, -.274) and relative humidity (r = -.480, 95% CI -.695, -.137). A decrease of 1°C could cause an increase in hospital visits by 1.9. No significant correlation was found were found between acute pharyngitis cases and AQI (P = .051, 95% CI -.005, .590). Multivariable linear regression analysis showed the temperature was the independ ent risk factor of acute pharyngitis (coefficient = -1.906, P = .022). Conclusion: Low temperature might cause an increased incidence of acute pharyngitis. PMID:34823378 | DOI:10.1177/01455613211057637 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

National audit to assess standards of care for deliberate self-harm patients presenting to trauma centres with penetrating wounds and recommendations for action

xlomafota13 shared this article with you from Inoreader National audit to assess standards of care for deliberate self-harm patients presenting to trauma centres with penetrating wounds and recommendations for action Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00504-0. doi: 10.1016/j.bjps.2021.09.063. Online ahead of print. ABSTRACT BACKGROUND: The authors assessed the standard of care for patients presenting with deliberate self-harm (DSH) injuries to major trauma centres (MTCs) in England as well as hospitals within the major trauma network in Scotland. This was to generate an understanding of current practice, identify any shortfall and develop recommendations to improve safety and patient care. METHODS: We contacted all MTCs in England and hospitals in the major trauma network in Scotland, asking their permission to be included in this study. Emergency department (ED) consultants at each unit were then invited to complete a telephone questionnaire clarifying their current management policies of DSH patients against NICE guidance. The telephone questionnaire was carried out by the same author to ensure interpretation was consi stent. RESULTS: Twenty-seven MTCs within England as well as the four hospitals in the major trauma network within Scotland were contacted. There was a total of 15 responses - 14 responses from MTCs within England and 1 response from a hospital in the trauma network in Scotland. The clear deficit in practice was identified and recommendations were generated. CONCLUSION: Our study has shown that patients are transferred following DSH without a clear review of their physical, psychological and social needs. We hope to share our recommendations for the implementation of a local protocol to improve standards and safety. PMID:34824024 | DOI:10.1016/j.bjps.2021.09.063 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Preoperative multimodal protocol reduced postoperative nausea and vomiting in patients undergoing mastectomy with reconstruction

xlomafota13 shared this article with you from Inoreader Preoperative multimodal protocol reduced postoperative nausea and vomiting in patients undergoing mastectomy with reconstruction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00498-8. doi: 10.1016/j.bjps.2021.09.059. Online ahead of print. ABSTRACT BACKGROUND: Mastectomy with immediate reconstruction is a high-risk cohort for postoperative nausea and vomiting (PONV). Known risk factors for PONV include female gender, prior PONV history, nonsmoker, age < 50, and postoperative opioid exposure. The objective of this observational, cohort analysis was to determine whether a standardized preoperative protocol with nonopioid and anti-nausea multimodal medications would reduce the odds of PONV. METHODS: After IRB approval, retrospective data were collected for patients undergoing mastectomy with or without a nodal resection, and immediate subpectoral tissue expander or implant reconstruction. Patients were grouped based on treatment: those receiving the protocol - oral acetaminophen, pregabalin, celecoxib, and transdermal scopolamine (APCS); those r eceiving none (NONE), and those receiving partial protocol (OTHER). Logistic regression models were used to compare PONV among treatment groups, adjusting for patient and procedural variables. MAIN FINDINGS: Among 305 cases, the mean age was 47 years (21-74), with 64% undergoing a bilateral procedure and 85% having had a concomitant nodal procedure. A total of 44.6% received APCS, 30.8% received OTHER, and 24.6% received NONE. The APCS group had the lowest rate of PONV (40%), followed by OTHER (47%), and NONE (59%). Adjusting for known preoperative variables, the odds of PONV were significantly lower in the APCS group versus the NONE group (OR=0.42, 95% CI: 0.20, 0.88 p = 0.016). CONCLUSIONS: Premedication with a relatively inexpensive combination of oral non-opioids and an anti-nausea medication was associated with a significant reduction in PONV in a high-risk cohort. Use of a standardized protocol can lead to improved care while optimizing the patient experience. < p>PMID:34824026 | DOI:10.1016/j.bjps.2021.09.059 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Introducing minimally invasive inguinal lymph node dissection in a UK tertiary skin cancer service: Initial experience & outcomes

xlomafota13 shared this article with you from Inoreader Introducing minimally invasive inguinal lymph node dissection in a UK tertiary skin cancer service: Initial experience & outcomes Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00495-2. doi: 10.1016/j.bjps.2021.09.054. Online ahead of print. ABSTRACT AIMS: We report the first UK case series of minimally invasive inguinal lymphadenectomy (MILND) for patients with metastatic cutaneous pathology. METHODS: This was a retrospective, single-centre, single-surgeon cohort study. Twenty-one patients who underwent MILND from May 2015 to February 2019 were included. Demographic data, disease burden, and surgical quality assurance parameters were analysed. RESULTS: Median age was 69 (IQR: 58-76) with 14 women (66%) and 7 men (33%). Eighteen (85%) patients had melanoma with the rest having other skin malignancies. The median number of nodes resected was eight (IQR:6-11) and the median N-ratio was 0.18 [0.05-1.00]. The median surgical time for the procedure was 180 minutes (IQR: 147-225) Seven (33%) patients had complications--three trivial and four (19%) grade IIIB. Only one case (the first) was converted to an open procedure. CONCLUSIONS: We report the first UK series of MILND in a cutaneous oncology service. Our results show that MILND is a safe technique that can be introduced into a busy NHS practice with a structured training program, with surgical quality assurance outcomes identical to open inguinal lymphadenectomy. Our learning curve was similar to previously published data. PMID:34824023 | DOI:10.1016/j.bjps.2021.09.054 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Trends in Nasal Spray Prescribing Patterns by Otolaryngologists

xlomafota13 shared this article with you from Inoreader Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Nov 26:34894211060902. doi: 10.1177/00034894211060902. Online ahead of print. ABSTRACT OBJECTIVES: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population. METHODS: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticaso ne propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017. RESULTS: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states. CONCLUSIONS: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States. PMID:34823366 | DOI:10.1177/00034894211060902 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Comparison of Near-Infrared Imaging and Computerized Tomography Scan for Detecting Maxillary Sinusitis

xlomafota13 shared this article with you from Inoreader A Comparison of Near-Infrared Imaging and Computerized Tomography Scan for Detecting Maxillary Sinusitis Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Nov 26:34894211060623. doi: 10.1177/00034894211060623. Online ahead of print. ABSTRACT OBJECTIVE: To investigate the use of near-infrared (NIR) imaging as a tool for outpatient clinicians to quickly and accurately assess for maxillary sinusitis and to characterize its accuracy compared to computerized tomography (CT) scan. METHODS: In a prospective investigational study, NIR and CT images from 65 patients who presented to a tertiary care rhinology clinic were compared to determine the sensitivity and specificity of NIR as an imaging modality. RESULTS: The sensitivity and specificity of NIR imaging in distinguishing normal versus maxillary sinus disease was found to be 90% and 84%, normal versus mild maxillary sinus disease to be 76% and 91%, and mild versus severe maxillary sinus disease to be 96% and 81%, respectively. The average pixel intensity was also calculated and compared to the modified Lund-Mackay scores from CT scans to assess the ability of NIR imaging to stratify the severity of maxillary sinus disease. Average pixel intensity over a region of interest was significantly different (P < .001) between normal, mild, and severe disease, as well as when comparing normal versus mild (P < .001, 95% CI 42.22-105.39), normal versus severe (P < .001, 95% CI 119.43-174.14), and mild versus severe (P < .001, 95% CI 41.39-104.56) maxillary sinus disease. CONCLUSION: Based on this data, NIR shows promise as a tool for identifying patients with potential maxillary sinus disease as well as providing information on severity of disease that may guide administration of appropriate treatments. PMID:34823368 | DOI:10.1177/00034894211060623 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Submental Island Flap After Prior Contralateral Neck Dissection: A Case Series and Technical Considerations

xlomafota13 shared this article with you from Inoreader Submental Island Flap After Prior Contralateral Neck Dissection: A Case Series and Technical Considerations Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Nov 26:34894211059307. doi: 10.1177/00034894211059307. Online ahead of print. ABSTRACT OBJECTIVES: The submental island flap is a dependable workhorse in head and neck reconstruction. However, the viability of this flap has not been established for oral cavity reconstruction when a contralateral neck dissection has already been performed in an earlier surgical setting. The aim of this study is to highlight technical considerations and outcomes of this approach with a small case series. METHODS: Three cases of oral cavity reconstruction with a submental island flap elevated in the context of a prior contralateral neck dissection are presented. RESULTS: In all cases, a doppler was used to identify the maintenance of the submental perforator in the neck opposite the previous neck dissection. In 2 cases, level IA was included within the dissection field of the previous neck dissection. Additionally, the old neck scar was included within the skin paddle of the submental island flap in 2 cases. In all cases, excellent healing of the flap was observed without partial or complete loss. CONCLUSIONS: The submental island flap appears to be a reliable reconstruction when a previous contralateral neck dissection has been performed, even when level IA was included in the prior dissection. PMID:34823369 | DOI:10.1177/00034894211059307 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes

xlomafota13 shared this article with you from Inoreader Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes 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 Nov 25. doi: 10.1007/s00405-021-07182-w. Online ahead of print. ABSTRACT BACKGROUND: Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines, aiming to preserve laryngeal function. However, long-term survival is often compromised by deep infiltration of the tumor. Vertical hemipharyngolaryngectomy (VHPL) was previously reported to be a feasible surgical approach for organ preservation. The aim of this study was to evaluate the functional and oncological outcomes of VHPL in patients. METHODS: Patients who underwent VHPL type II (total VHPL, which includes the removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage) for pyriform sinus cancer with vocal cord fixation at the authors' institute between 1999 and 2015 were retrospectively analyzed. Functional outcomes concerning swallowing and decannulation were evaluated. Successful functional preservation was defined as laryngeal preservation as well as oral realimentation and decannulation within 6 months after surgery. The oncological outcomes were measured by overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier curves and comparisons were performed between the VHPL-treated patients and patients who underwent non-surgical treatment within the same period. RESULTS: A total of 23 patients (stage T3, 17 patients; stage T4, 6 patients) whose initial treatment was VHPL type II were studied, and a cohort of 123 patients was selected as the control group. Pedicle and free flap reconstructions were performed on 12 and 11 patients, respectively. Postoperative radiation and chemoradiation was performed on 14 and 3 patients, respectively. Flap failure and pharyngeal fistula were detected in 2 and 5 patients, respectively. Oral realim entation and decannulation within 6 months were achieved in 82.6% (19 patients) and 87.0% (20 patients) of patients, respectively, and the total functional preservation rate of the study cohort at 6 months was similar to that of the control cohort. (78.3% vs. 82.9%, p = 0.28). After a median follow-up period of 49 months, 9 recurrences and 8 deaths had occurred in the study cohort. According to the Kaplan-Meier analysis, the study cohort had superior DFS (5-year DFS 60.3% vs. 44.6%, p = 0.04) and similar OS (5-year OS 63.8% vs 57.0% p = 0.28) compared with those in the control group. CONCLUSION: VHPL yielded favorable oncological and functional outcomes in patients with unilateral pyriform sinus carcinoma and vocal cord fixation. PMID:34825265 | DOI:10.1007/s00405-021-07182-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Maternal and neonatal outcomes following in vitro fertilization: A cohort study in Romania

xlomafota13 shared this article with you from Inoreader Maternal and neonatal outcomes following <em>in vitro</em> fertilization: A cohort study in Romania Via Experimental and therapeutic medicine Exp Ther Med. 2022 Jan;23(1):34. doi: 10.3892/etm.2021.10956. Epub 2021 Nov 9. ABSTRACT Although in recent years the number of pregnancies obtained through in vitro fertilization (IVF) has increased significantly, a higher incidence of complications has been identified in this group. The widespread development and use of IVF has led to an increasing rate of multiple pregnancies and thus their associated complications. However, whether these complications occur due to assisted reproduction or infertility problems remains to be elucidated. In the present study, a comparison was made of IVF pregnancies with spontaneous conception, and the risk of obstetric and neonatal complications was assessed. An ambispective observational cohort study was carried out between January 2017 and October 2021 at Elias University Emergency Hospital, Romania. The exposed cohort included 132 IVF pregnancies and the control cohort included 157 spontaneo us pregnancies. The IVF group included 110 pregnancies with fresh embryo-transfer and 22 pregnancies with cryopreserved embryo-transfer. Obstetric, perinatal and neonatal complications were analysed by multivariable logistic analysis. The results showed that, IVF pregnancies had a higher risk of pregnancy-induced hypertension (OR=6.42, 95% CI=1.72-23.92) and placental abnormalities (OR=5.49, 95% CI=1.07-28.17). Neonates obtained through IVF had a higher risk of prematurity (OR=6.52, 95% CI=2.99-14.20), low birth weight (LBW) (OR=17.18, 95% CI=7.06-41.87), small for gestational age (OR=4.10, 95% CI=1.95-8.59) and were more frequently hospitalized in the Neonatal Intensive Care Unit (NICU) (OR=11.91, 95% CI=5.72-24.81). Nulliparous women were associated with an increased risk of NICU admission (OR=0.46, 95% CI=0.25-0.88) and risk of LBW (OR=0.37, 95% CI=0.19-0.75). Maternal age ≥35 years had no influence as a confounding variable. In conclusion, this cohort study showed that IVF pre gnancies have a higher risk of obstetric and neonatal complications than pregnancies obtained by spontaneous conception. PMID:34824642 | PMC:PMC8611488 | DOI:10.3892/etm.2021.10956 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.