Bespoke regional blocks for axillary sentinel node biopsy

xlomafota13 shared this article with you from Inoreader Bespoke regional blocks for axillary sentinel node biopsy Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 2:S1748-6815(21)00259-X. doi: 10.1016/j.bjps.2021.05.007. Online ahead of print. ABSTRACT INTRODUCTION: Axillary sentinel node biopsy for melanoma is routinely performed under general anaesthesia. Emerging evidence has shown general anaesthetics are associated with increased mortality in the context of the COVID-19 pandemic. In the interest of patient safety, we have designed a series of bespoke axillary regional blocks enabling surgeons to remove nodes up to and including level III without the need for a general anaesthetic. The aim of this study was to assess the feasibility of performing axillary sentinel node biopsy under such blocks. METHODS: Approval was granted by the Joint Study Review Committee on behalf of the Research and Ethics Department. Ten consecutive patients having axillary sentinel node biopsy for melanoma were included in this prospective study. Patients completed a Qual ity of Recovery-15 (QoR15) questionnaire preoperatively and 24 h postoperatively. DISCUSSION: One patient had a positive sentinel node, the remining were negative. A significant reduction in time spent in hospital post-operatively (p = 0.0008) was observed. QoR15 patient reported outcome measures demonstrated high levels of satisfaction evidenced by lack of statistical difference between pre and post-operative scores (p = 0.0118). 80% of patients were happy to have a regional block and 90% were happy to attend hospital during the pandemic. CONCLUSION: ASNB under regional block is safe, negates risks associated with performing GAs during the COVID-19 pandemic and facilitates quicker theatre turnover and discharge from hospital. Collaboration between anaesthetic and surgical teams has enabled this change in practice. There is a learning curve with both patient selection, education and development of technique. PMID:34229958 | DOI:10.1016/j.bjps.2021.05.007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of radiation on toxicity, complications, revision surgery and aesthetic outcomes in breast reconstruction: An argument about timing and techniques

xlomafota13 shared this article with you from Inoreader Effects of radiation on toxicity, complications, revision surgery and aesthetic outcomes in breast reconstruction: An argument about timing and techniques Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 9:S1748-6815(21)00279-5. doi: 10.1016/j.bjps.2021.05.027. Online ahead of print. ABSTRACT BACKGROUND: Radiotherapy (RT) combined with breast reconstruction can reduce the risk of cancer recurrence and increase the survival rate. However, this approach seems to worsen aesthetic outcomes and increase complication rates. The impact of breast reconstruction timing and techniques on clinical outcomes, however, remains unclear. For this reason, we aimed to perform a more comprehensive analysis of a series of patients undergoing RT and breast reconstruction. METHODS: Patients were divided into 4 groups according to the timing of reconstruction (before RT and after RT) and surgical technique (heterologous reconstruction and autologous reconstruction (AR)). The median time between RT and reconstruction, number of revision surgeries, incidence of complications, toxicity, aesthetics and associated cli nical risk factors were used to assess the clinical outcomes. An objective system of skin toxicity evaluation was performed. RESULTS: Ninety-five patients were included in this study. No significant differences in the median time between RT and reconstruction, incidence of complications, toxicity or aesthetics were noted between different timings or techniques of reconstruction. Patients undergoing AR needed more revision surgeries to complete reconstruction. However, the total number of surgical procedures was similar between the groups. In a comparison between the treated and untreated breasts by an objective system, RT produced an increase in erythema and pigmentation and a decrease in elasticity in the treated breast (p<0.05 for all parameters). On multivariate analysis, smoking was a significant predictor associated with complications. CONCLUSIONS: Combined breast reconstruction and RT seem to be successful regardless of the order of treatment or the type of reco nstruction. PMID:34229955 | DOI:10.1016/j.bjps.2021.05.027 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Determining the real site of peroneal nerve injury with knee dislocation: Earlierier is easier

xlomafota13 shared this article with you from Inoreader Determining the real site of peroneal nerve injury with knee dislocation: Earlierier is easier Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00322-3. doi: 10.1016/j.bjps.2021.05.063. Online ahead of print. ABSTRACT Common peroneal nerve (CPN) injury is a recognised complication of traumatic knee dislocation with a direct association between the degree of ligamentous injury and the degree of CPN injury. It is essential explore and repair these injuries in good time to reduce morbidity. Often exploration only involves the portion of this nerve associated with the joint as it courses around the fibular head. However, a recent case highlighted the importance of proximal exploration to its branching point from the sciatic nerve, a known point of fragility, even if other defects have been identified. PMID:34229957 | DOI:10.1016/j.bjps.2021.05.063 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline?

xlomafota13 shared this article with you from Inoreader Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline? Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 5:S1748-6815(21)00266-7. doi: 10.1016/j.bjps.2021.05.015. Online ahead of print. ABSTRACT BACKGROUND: The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. METHODS: Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages : before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. RESULTS: Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). CONCLUSION: Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone. PMID:34229956 | DOI:10.1016/j.bjps.2021.05.015 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Oral tegafur-uracil as a metronomic therapy in stage IVa and IVb cancer of the oral cavity

xlomafota13 shared this article with you from Inoreader Oral tegafur-uracil as a metronomic therapy in stage IVa and IVb cancer of the oral cavity Via American Journal of Otolaryngology Publication date: November–December 2021 Source: American Journal of Otolaryngology, Volume 42, Issue 6 Author(s): Wen-Yen Huang, Ching-Liang Ho, Tsu-Yi Chao, Jih-Chin Lee, Jia-Hong Chen View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Decompressive craniectomy is a life-saving procedure in malignant MCA infarction

xlomafota13 shared this article with you from Inoreader Decompressive craniectomy is a life-saving procedure in malignant MCA infarction Via leak of cerebrospinal fluid Neurosciences (Riyadh). 2021 Jul;26(3):248-253. doi: 10.17712/nsj.2021.3.20200187. ABSTRACT OBJECTIVES: To investigate the indications, timings, and outcomes of decompressive craniectomy (DC) performed for malignant middle cerebral artery (MCA) infarctions at our tertiary care center. METHODS: This retrospective case series involved patients who underwent DC for malignant MCA infarction at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, between January 2012 and December 2018. Demographic, clinical, and radiological data were collected, and stroke- and surgery-related complications and discharge outcomes were assessed. RESULTS: Eighteen patients (mean age: 50±10 years), of whom 13 (72%) were men, underwent DC during the study period. Of the patients, 9 (50%) had severe stroke (NIHSS 16-25), 10 (56%) had right MCA infarction, and 11 (61%) received either intravenous thrombolysis or endovascular throm bectomy or their combination. Indications for surgery included clinical deterioration as seen in 16 (89%) patients, ipsilateral pupillary dilatation as seen in 11 (61%) patients, and signs of raised intracranial pressure in 6 (33%) patients. Surgery was performed within 48 h in 14 (78%) patients. The mean Intensive Care Unit stay was 15±7 days. Seven (39%) patients were discharged home and 3 (17%) were transferred to an inpatient rehabilitation unit, and 2 (11%) patients died. All patients had stroke-related complications; one (6%) patient developed cerebrospinal fluid leak, 3 (17%) had sunken skin flap syndrome and wound infection each, and 2 (11%) developed epidural hematoma. CONCLUSION: The DC was life-saving in the our patients with malignant MCA infarction. Most of the patients had surgery within 48 hours. More than one-third of the patients were discharged home, while mortality occurred in only 2 patients. Moreover, stroke- and surgery-related complications were common in our cohort. PMID:34230079 | DOI:10.17712/nsj.2021.3.20200187 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study

xlomafota13 shared this article with you from Inoreader Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study Via oto-rhino-laryngologie Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Jul 3:S1879-7296(21)00136-8. doi: 10.1016/j.anorl.2021.06.002. Online ahead of print. ABSTRACT OBJECTIVES: Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS: This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS: Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION: EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability. PMID:34229983 | DOI:10.1016/j.anorl.2021.06.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study

xlomafota13 shared this article with you from Inoreader Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study Via oto-rhino-laryngologie Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Jul 3:S1879-7296(21)00136-8. doi: 10.1016/j.anorl.2021.06.002. Online ahead of print. ABSTRACT OBJECTIVES: Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS: This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS: Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION: EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability. PMID:34229983 | DOI:10.1016/j.anorl.2021.06.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study

xlomafota13 shared this article with you from Inoreader Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study Via Laryngologie Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Jul 3:S1879-7296(21)00136-8. doi: 10.1016/j.anorl.2021.06.002. Online ahead of print. ABSTRACT OBJECTIVES: Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS: This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS: Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION: EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability. PMID:34229983 | DOI:10.1016/j.anorl.2021.06.002 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Severe Snoring in a Young Healthy Female: A Diagnostic Surprise

xlomafota13 shared this article with you from Inoreader Severe Snoring in a Young Healthy Female: A Diagnostic Surprise Via Otolaryngology Indian Abstract Laryngeal Inflammatory myofibroblastic tumors or plasma cell granulomas are unusual benign lesions. Subglottic laryngeal lesions of various benign and malignant types usually present with acute or chronic stridor and respiratory obstruction features. We describe the first case in the literature where severe snoring was the presenting complaint in a patient of subglottic mass lesion with comfortable breathing during wake hour. A 28 years old female presented with loud snoring and apneic episodes during sleep for three years which showed severe Obstructive Sleep Apnoea (OSA) (AHI, Apnoea- Hypoapnoea Index: 46.5) in polysomnography (PSG) and surprisingly smooth mucosa covered subglottic mass blocking 75% of airway lumen in the laryngoscopic examination. The patient underwent tracheostomy and coblation assisted endoscopic excision, and subsequent histopathology revealed an inflammatory myofibroblastic tumour. She was later decannulated and with no features of sl eep apnea post decannulation. Subglottic mass can rarely present with severe snoring and requires solid clinical suspicion for early diagnosis. Hence, subglottic lesion should be one of the differentials for atypical presentations of severe OSA. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sudden Sensorineural Hearing Loss after Pituitary Adenoma Resection-A Case Series with Literature Review

xlomafota13 shared this article with you from Inoreader Sudden Sensorineural Hearing Loss after Pituitary Adenoma Resection-A Case Series with Literature Review Via leak of cerebrospinal fluid Chin Med Sci J. 2021 Jun 30;36(2):120-126. doi: 10.24920/003856. ABSTRACT Objective Complications after transsphenoidal surgery for pituitary adenoma have been well documented in the literatures, but the occurrence of delayed sudden sensorineural hearing loss (SNHL) after pituitary adenoma resection is extremely rare. In this study three cases who developed sudden SNHL 3 to 7 days after pituitary adenoma surgery without experiencing cerebrospinal fluid leak or meningitis were presented, and the possible causes of SNHL were discussed. Methods Three cases with sudden hearing loss after transsphenoidal surgery for pituitary adenoma were reviewed. The past medical history, onset of sudden hearing loss, accompanying symptoms such as headache, tinnitus, dizziness and aural fullness, and the post-operative MRI images, therapy, and hearing results were reported. Results Three cases developed profound sudden SNHL on the 3rd to 7th post-operative day, all accompanied by prior headache, tinnitus and dizziness. One patient developed episodic vertigo, ear fullness accompanying with fluctuating hearing loss in the first post-operative month. Two patients had past medical history of arteriosclerosis and coronary heart disease or cerebral infarction. Two of three demonstrated obstructive hydrocephalus on MRI on the first post-operative day. Under treatment with prednisone orally, dexamethasone intratympanic injection, neurotrophic and vasodilatation drugs for 3 to 8 months, hearing of all three improved partially. Obstructive hydrocephalus and ischemia might be responsible for the hearing loss. Conclusion Post-operative obstructive hydrocephalus and ischemia of labyrinthine arteries might lead to the delayed SNHL after transsphenoidal surgery for pituitary adenoma. PMID:34231460 | DOI:10.24920/003856 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.