Reduction of seroma and improvement of quality of life after early drain removal in immediate breast reconstruction with tissue expander. Preliminary report from a randomized controlled study

xlomafota13 shared this article with you from Inoreader Reduction of seroma and improvement of quality of life after early drain removal in immediate breast reconstruction with tissue expander. Preliminary report from a randomized controlled study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 9:S1748-6815(21)00074-7. doi: 10.1016/j.bjps.2021.02.005. Online ahead of print. ABSTRACT Seroma is the most common complication of breast reconstruction with tissue expander (incidence 0.2-20%) with increased risk of infection and implant loss by 4-6 fold. About 90% of plastic surgeons routinely placed drains for its prevention. We theorized that early drain removal is a safe procedure that improves postoperative quality of life (QoL), reducing pain, length of hospital stay, and limitations on daily activities. We divided 49 patients operated on between September 2016 and March 2018 (follow-up: 9-26 months) into two groups: Group1 (output-based; drains removed when <30 ml/day); and Group2 (early-removal; at 3-4 days postop.). A study-specific questionnaire about the patient's QoL was conducted 3 weeks after surgery. We performed an intention-to-treat analysis. A comparison was performed using a Fisher test and a Mann-Whitney U test with p = 0.05. We observed lower production of wound fluid (641±49 ml vs 231±20 ml; p = 0.004), and a shorter time until wound healing (31.3±4.2 days vs 22±3.9 days; p = 0.031) for Group 2. The difference for infection (p = 0.36), impaired wound healing (p = 0.22), and the seroma formation period (p = 0.11) was not significant. Group 2 experienced less breast pain (8% vs 87.5%; p = 0.001), fewer limitations in daily activities (16% vs 50%; p = 0.002), in mobility (20% vs 83.3%; p = 0.001), and in social life (8% vs 91.7%; p < 0.001), and a better quality of sleep than Group 1 (36% vs 75%; p = 0.002). Group 2 did not require home care after hospital discharge (p < 0.001). The limitations of study are: its small sample size, the wound healing assessment, and the use of a non-validated questionnaire. PMID:33781704 | DOI:10.1016/j.bjps.2021.02.005 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak: A single centre experience

xlomafota13 shared this article with you from Inoreader The role of teleconsultation in the management of suspected skin malignancy in plastic surgery during COVID-19 outbreak: A single centre experience Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 19:S1748-6815(21)00092-9. doi: 10.1016/j.bjps.2021.03.003. Online ahead of print. ABSTRACT The COVID-19 pandemic has had a profound impact on the provision of skin cancer treatment in the UK. To preserve the service, the department transformed the outpatient skin cancer clinic into teleclinic service. This study examines the safety and efficacy of a teleclinic consultation, in comparison to a face-to-face consultation. We assessed efficacy in terms of accuracy of the clinical diagnosis in comparison to the histopathological result and whether treatment was designated the appropriate clinical priority/urgency. A total of 120 lesions in 98 patients were assessed, 55 patients in the face-to-face clinic cohort, and 43 patients in the teleclinic cohort. Diagnostic accuracy was better in face-to-face clinic compared to teleclinic; 85.0% and 63.6% respectively (χ2 (1, N = 120) = 7.35, p = 0. 0067). The accuracy of listing patients on the correct pathway was slightly higher for teleclinic patients. Of the teleclinic patients listed through the urgent pathway, 45.7% justified their urgent status, compared with 37.5% of those listed urgent in face-to-face clinic (p = 0.67). For those listed as routine, 100% of teleclinic patients were listed appropriately whereas the accuracy was 96.8% for the face-to-face clinic counterpart. In conclusion, despite teleclinic having slightly reduced diagnostic accuracy, teleclinics show comparable accuracy in listing patients to urgent or routine skin cancer pathways. It offers convenience to patients in addition to reducing time to treatment and cost effectiveness. The lessons learned in the pandemic can be applied to the post-COVID healthcare environment. PMID:33781705 | DOI:10.1016/j.bjps.2021.03.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Detection and staging of recurrent or metastatic nasopharyngeal carcinoma in the era of FDG PET/MR

xlomafota13 shared this article with you from Inoreader Detection and staging of recurrent or metastatic nasopharyngeal carcinoma in the era of FDG PET/MR 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 Mar 29. doi: 10.1007/s00405-021-06779-5. Online ahead of print. ABSTRACT PURPOSE: The aim of this pilot study was to evaluate the accuracy of 18 fluorodeoxyglucose (FDG) PET/MR imaging in detection and staging of recurrent or metastatic NPC. PATIENTS AND METHODS: The PET/MR scans of 60 patients with clinically diagnosed recurrent or metastatic NPC between April 2017 and November 2019 were included in this study. Findings were evaluated according to the eighth edition of the American Joint Committee on Cancer staging system. Final diagnosis was confirmed at biopsy or imaging follow-up for at least 6 months. RESULTS: Of the 60 patients, 25, 26 and 42 had developed local lesions, regional nodal metastases and distant metastases, respectively. The overall accuracy of PET/MR imaging for staging of recurrent or metastatic NPC was 88.3%. CONCLUSIONS: For recurrent or metastatic NPC, 18 FDG PET /MRI might serve as a single-step staging modality. PMID:33782748 | DOI:10.1007/s00405-021-06779-5 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Course, Weaning, and Awareness of Patients With Reflux Toward Proton Pump Inhibitor Therapy

xlomafota13 shared this article with you from Inoreader Chronic Course, Weaning, and Awareness of Patients With Reflux Toward Proton Pump Inhibitor Therapy Via Journal of Voice To assess the feasibility of middle-term proton pump inhibitor (PPI) weaning in patients with laryngopharyngeal reflux (LPR) and evaluate patient awareness of PPI adverse events. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of Age on Loudness-Dependent Auditory ERPs in Young Autistic and Typically-Developing Children

xlomafota13 shared this article with you from Inoreader Effects of Age on Loudness-Dependent Auditory ERPs in Young Autistic and Typically-Developing Children Via cortical auditory Neuropsychologia. 2021 Mar 26:107837. doi: 10.1016/j.neuropsychologia.2021.107837. Online ahead of print. ABSTRACT Limited research has investigated the development of auditory ERPs in young children, and particularly how stimulus intensity may affect these auditory ERPs. Previous research has also yielded inconsistent findings regarding differences in the development of auditory ERPs in autism and typical development. Furthermore, stimulus intensity may be of particular interest in autism insofar as autistic people may have atypical experiences of sound intensity (e.g., hyperacusis). Therefore, the present study examined associations between age and ERPs evoked by tones of differing intensities (50, 60, 70, and 80 dB SPL) in a large sample of young children (2 - 5 years) with and without an autism diagnosis. Correlations between age and P1 latencies were examined, while cluster-based permutation testing was used to examine associations betwe en age and neural response amplitudes, as well as group differences in amplitude, over all electrode sites in the longer time window of 1 - 350 ms. Older autistic participants had faster P1 latencies, but these effects only attained significance over the right hemisphere in response to soft 50 dB sounds. Autistic participants had slower P1 responses to 80 dB sounds over the right hemisphere. Over the scalp regions associated with the later N2 response, more negative response amplitudes (that is, larger N2 responses) were observed in typically-developing than autistic participants. Furthermore, continuous associations between response amplitudes and age suggested that older typically-developing participants exhibited stronger N2 responses to all intensities, though this effect may have at least in part reflected the absence of small positive voltage deflections in the N2 latency window. Age was associated with amplitudes of responses to 50 dB through 70 dB sounds in autism, but in co ntrast to Typical Development (TD), little evidence of relationships between age and amplitudes in the N2 latency window was found in autism in the 80 dB condition. Although caution should be exercised in interpretation due to the cross-sectional nature of this study, these findings suggest that developmental changes in auditory responses may differ across diagnostic groups in a manner that depends on perceived loudness and/or stimulus intensity. PMID:33781752 | DOI:10.1016/j.neuropsychologia.2021.107837 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prolactinoma extension as a contributing factor in dopamine agonist-induced CSF rhinorrhea: a systematic review of the literature

xlomafota13 shared this article with you from Inoreader Prolactinoma extension as a contributing factor in dopamine agonist-induced CSF rhinorrhea: a systematic review of the literature Via leak of cerebrospinal fluid Br J Neurosurg. 2021 Mar 30:1-6. doi: 10.1080/02688697.2021.1903389. Online ahead of print. ABSTRACT BACKGROUND: Dopamine agonist-induced cerebrospinal fluid (CSF) rhinorrhea is an uncommon treatment-related complication arising in 6.1% of prolactinoma patients treated with dopamine agonists. Locally invasive prolactinomas may create CSF fistulae through formation of dural and osseous skull base defects. Tumor shrinkage secondary to dopamine agonist therapy unmasks skull base defects, thus inducing CSF rhinorrhea. In these cases, repair of the leak may be achieved through collaborative surgical intervention by rhinologists and neurosurgeons. Multiple variables have been investigated as potential contributors to the risk of CSF rhinorrhea development in medically treated prolactinoma patients, with little consensus. OBJECTIVE: The primary aim of our study was the characterization of risk factors for CSF rhinorrhea development following d opamine agonist treatment. METHODS: A systematic review of the literature was conducted to identify cases of CSF rhinorrhea following dopamine agonist treatment of prolactinoma. The clinical history, radiographic findings and treatment outcomes are discussed. RESULTS: Fifty-four patients with dopamine agonist-induced CSF rhinorrhea were identified across 23 articles published from 1979 to 2019. Description of diagnostic imaging [computed tomography (CT)/magnetic resonance imaging (MRI)] was not provided for 18/54 subjects. For the 36 cases that described prolactinoma appearance on CT or MRI, invasion of the cavernous sinuses was reported in 13 (36.1%) and invasion of the sphenoid sinus was reported in 18 (50%). CONCLUSION: Based on our systematic review, we propose that CT findings of osseous erosion of the sella or the anterior skull base may predict dopamine agonist-induced CSF rhinorrhea. We recommend obtaining a thin-slice CT of the sinuses in cases with MRI ev idence of sphenoid involvement. PMID:33783287 | DOI:10.1080/02688697.2021.1903389 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effectiveness of tinnitus therapy using a mobile application

xlomafota13 shared this article with you from Inoreader Effectiveness of tinnitus therapy using a mobile application 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 Mar 30. doi: 10.1007/s00405-021-06767-9. Online ahead of print. ABSTRACT BACKGROUND: The World Health Organization reports that the number of tinnitus sufferers is increasing year on year. Given the common use of mobile devices and the availability of applications designed to support patients in tinnitus therapy and reduce tinnitus severity, patients seeking help are likely to try this form of support. The aim of this study was to evaluate the effectiveness of a mobile application in tinnitus sound therapy, in this case ReSound Tinnitus Relief™. METHODS: The study involved 52 patients hospitalized for tinnitus. All participants used the free ReSound Tinnitus Relief application for 6 months. The application is based on sound therapy. Patients were advised to use the application for at least 30 min per day, the sounds should not completely mask the tinnitus, and they should be listened to via a lou dspeaker. The effects of the therapy were evaluated by means of standardized questionnaires for tinnitus severity: the Tinnitus Handicap Inventory and the Tinnitus Functional Index. RESULTS: The study showed a reduction in tinnitus severity as measured by both questionnaires. The general severity decreased after the first 3 months and again in the following 3 months of using the application. In both questionnaires the biggest changes were observed in the subscales of emotions. CONCLUSIONS: Results obtained here from standardized questionnaires indicate that the tested application may contribute to tinnitus reduction. However, it is advisable to conduct further research on the applicability of such technology in medical practice. PMID:33783597 | DOI:10.1007/s00405-021-06767-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A novel clinical signature predicts the survival of elderly patients with oral squamous cell carcinoma

xlomafota13 shared this article with you from Inoreader A novel clinical signature predicts the survival of elderly patients with oral squamous cell carcinoma 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 Mar 30. doi: 10.1007/s00405-021-06786-6. Online ahead of print. ABSTRACT BACKGROUND: The risk factors for the survival of elderly patients with oral squamous cell carcinoma (OSCC) are multifarious. Here, we developed a novel clinical signature to serve as an indicator of prognosis in these patients. MATERIALS AND METHODS: Clinicopathological data were collected for 554 patients aged ≥ 60 years who were treated for primary OSCC. Overall survival (OS), disease-specific survival, and disease-free survival were the primary outcomes. RESULTS: Multivariate cox regression analysis showed that high N stage, low hemoglobin level, low body mass index (BMI), and high neutrophil-to-lymphocyte ratio (NLR) showed a poor survival (P < 0.05). A nomogram was constructed with a c-index of 0.702. CONCLUSION: A novel clinical signature including hemoglobin level, BMI, and NLR, which are obtained throu gh noninvasive examinations can be used as prognostic indicators in clinical practice for elderly patients with OSCC. PMID:33783598 | DOI:10.1007/s00405-021-06786-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neugeborenes mit Nasenagenesie: Neonatologische Herausforderungen bei der Versorgung eines Neugeborenen mit Bosma-Arhinie-Mikrophthalmie-Syndrom (BAMS)

xlomafota13 shared this article with you from Inoreader Neugeborenes mit Nasenagenesie: Neonatologische Herausforderungen bei der Versorgung eines Neugeborenen mit Bosma-Arhinie-Mikrophthalmie-Syndrom (BAMS) Via Laryngo-Rhino-Otologie Laryngorhinootologie 2021; 100: 294-296 DOI: 10.1055/a-1307-3374 Anhand eines weiblichen Neugeborenen soll das seltene Krankheitsbild der konnatalen Nasenagenesie vorgestellt werden. In der Schwangerschaft fielen eine intrauterine Wachstumsrestriktion mit Polyhydramnion und eine Mittelgesichtshypoplasie auf. Das Atemwegsmanagement nach primärer Sectio in der 38 + 4 SSW gelang mittels Schienung durch einen Güdel- bzw. im Verlauf Rachentubus ohne Zeichen einer respiratorischen Insuffizienz. Neben der vollständigen Nasenagenesie zeigten sich bei unauffälligen zerebralen Strukturen ein Hypertelorismus, ein gotischer Gaumen, ein beidseitiger Mikrophthalmus und Iriskolobom. Die Nahrungsaufnahme wurde mit einer orogastralen Sonde sichergestellt, durch Trinktraining und einen speziellen Schnuller konnten eine bessere Koordination und Trinkleistung erzielt werden. Der sich bei assoziierten Fehlbildungen ergebende Verdacht auf ein Bosma-Arhinie-Mikrophthalmie-Syndrom (BAMS) wurde humangenetisch durch den Nachweis einer heterozygoten de novo Mutation im SMCHD1-Gen, welches eine Schlüsselfunktion in der Embryogenese der menschlichen Nase spielt, bestätigt (c.1043A > G; pHis348Arg). Aus neonatologischer Sicht ist oftmals die initiale Kreißsaal-Versorgung eine Herausforderung: Patienten mit Nasenagenesie werden häufig postpartal intubiert und elektiv tracheotomiert. Bei fehlender respiratorischer Problematik und Nahrungsaufnahme mit perzentilengerechtem Wachstum besteht jedoch keine dringliche Indikation zur frühzeitigen plastisch-chirurgischen Versorgung, insbesondere da diese mit Gefahren wie Sepsis und Wachstumsstörungen im Mittelgesicht behaftet ist. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tumornachsorge sinunasaler Papillome – Risikofaktoren für Rezidiv-Entwicklung und maligne Entartung

xlomafota13 shared this article with you from Inoreader Tumornachsorge sinunasaler Papillome – Risikofaktoren für Rezidiv-Entwicklung und maligne Entartung Via Laryngo-Rhino-Otologie Laryngorhinootologie 2021; 100: 261-269 DOI: 10.1055/a-1211-2889 Hintergrund Sinunasale Papillome sind Tumoren der Nasenhaupt- und Nasennebenhöhlen. Therapie der Wahl ist die vollständige Resektion unter tumorchirurgischen Kautelen. Zwei Eigenschaften machen die Tumornachsorge zu einer Herausforderung: Erstens die häufige Rezidiv-Entwicklung (auch viele Jahre nach Erstdiagnose) und zweitens die Möglichkeit der malignen Entartung. Diese Übersichtsarbeit beleuchtet diesbezügliche Risikofaktoren, um „Hochrisikopatienten" zu identifizieren, die in der Tumornachsorge besondere Aufmerksamkeit verdienen. Materialen und Methoden Es erfolgte eine ausführliche Literaturrecherche in PubMed (NCBI). Ergebnisse Hauptrisikofaktor für Rezidive ist die unvollständige Tumorresektion. Daraus ergeben sich weitere Faktoren wie unzureichend radikale Operationstechnik, ausgedehnte Tumoren, erschwerte intraoperative Verhältnisse aufgrund der Tumorlokalisation oder bei der Rezidiv-Chirurgie. Zudem neigen junge Patienten und Raucher vermehrt zu Rezidiven. Risikofaktoren für eine maligne Entartung sind große Tumoren, Rauchen, höheres Alter bei Erstdiagnose, weibliches Geschlecht, Knocheninvasion und fehlende inflammatorische Polypen. Histopathologische Risikofaktoren für Rezidive sowie für maligne Entartung sind Dysplasien, Hyperkeratose, plattenepitheliale Hyperplasie und – sofern bestimmt – eine erhöhte Proliferationsrate, Aneuploidie sowie eine Infektion mit humanen Papillomaviren. Schlussfolgerungen Eine vollständige Resektion der sinunasalen Papillome unter tumorchirurgischen Kautelen ist der Goldstandard. Postoperativ ist eine engmaschige Tumornachsorge (analog zu malignen Tumoren) zwingend erforderlich. Die meisten Autoren empfehlen einen Nachsorgezeitraum von mindestens 5 Jahren, manche sogar eine lebenslange Nachsorge. Patienten mit einem oder mehreren Risikofaktoren sollten engmaschiger nachbetreut werden. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The influences of porus acusticus internus on ethnicity and importance in preoperative and intraoperative approaches

xlomafota13 shared this article with you from Inoreader The influences of porus acusticus internus on ethnicity and importance in preoperative and intraoperative approaches Via radiol anat Surg Radiol Anat. 2021 Mar 30. doi: 10.1007/s00276-021-02741-6. Online ahead of print. ABSTRACT PURPOSE: The influences of porus acusticus internus (PAI) on ethnicity and differences between populations have not been investigated so far. Therefore, we performed this study to elucidate further the relationship between the different morphologies of PAI and ethnicity and to discuss their effects on surgery. METHODS: One hundred twenty dry adult human temporal bones (61 ma le, 59 female) were investigated in the study. Their horizontal diameter (HD), vertical diameter (VD), shape, prevalence of the shapes of PAI, and the distance from the sulcus for the sigmoid sinus (SSS), sulcus for superior petrosal sinus (SSPS), and jugular foramen (JF) of dry Turkish temporal bones were recorded. RESULTS: Forty-three (35.8%) elliptical (or transverse) and 77 (64.1%) oval (or round) PAI were detected in the Turkish dry temporal bones. On both sides, round PAI were identified more frequently than elliptical ones (32; 26.6% (left); 39; 32.5% (right)) (p < 0.05). There was a similarity between the Indian and Turkish dry temporal bones in terms of distance from the PAI to the SSPS (7-8 mm) and SSS (19-20 mm) (p = 0.01) and prevalence of morphology of PAI (oval and elliptical) (p = 0.04, p < 0.05). CONCLUSION: The findings of the present study provided a detailed understanding of the preoperative and intraoperative identification of different morpholo gies of PAI and ethnicity. The ethnicity might contribute to morphology of the PAI and it can be explain the similar forms and distances between the various ethnic populations. PMID:33783562 | DOI:10.1007/s00276-021-02741-6 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.