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Πέμπτη 2 Σεπτεμβρίου 2021

Iatrogenic Vocal Fold Paralysis: A Population-Based Cohort Study in Taiwan

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Ann Otol Rhinol Laryngol. 2021 Sep 1:34894211041226. doi: 10.1177/00034894211041226. Online ahead of print.

ABSTRACT

OBJECTIVE: Iatrogenic vocal fold paralysis is an important issue in laryngology, yet there are few population-based studies regarding the epidemiology. This study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of iatrogenic unilateral and bilateral vocal fold paralysis (UVFP/ BVFP) among the general adult population in Taiwan.

METHOD: This study analyzed patients (20-90 years old) who underwent thyroid, parathyroid, thoracic, cardiac, or anterior cervical spine operations with vocal fold paralysis among adults in Taiwan from January 1, 2007 to December 31, 2013. The codes for vocal fold paralysis were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Claims data in the Taiwan National Health Insurance Research Database were used.

RESULTS: The most commonly performed operations which were related to vocal fold paralysis in Taiwan were, in descending order of frequency, thyroid, cervical spine, cardiac, thoracic (esophagectomy), and parathyroid operations. The operations that put laryngeal nerves at risk (ONRs) most commonly associated with a diagnosis of UVFP were, in descending order of frequency, thoracic, thyroid, parathyroid, cardiac, and cervical spine. For both UVFP and BVFP, the most commonly associated age group was 51 to 60. For both UVFP and BVFP, the more commonly associated sex was women. Increased length of stay was associated with a higher incidence of UVFP and BVFP. Charlson medical co-morbidity index (CCI) was not associated with UVFP but BVFP was associated with higher Charlson medical co-morbidity scores.

CONCLUSIONS: Thyroid operations, age 51 to 60, longer hospital stays are associated with vocal fold paralysis. Overall women are more surgically affected than men. This is the first population-based study of iatrogenic vocal fold paralysis.

PMID:34470521 | DOI:10.1177/00034894211 041226

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Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy

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To the Editor My attention was arrested by the article by Quinn et al on the use of intraoperative parathyroid hormone (ioPTH) in minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism (PHP). To our knowledge, it is the first meta-analysis on this topic showing a beneficial association of ioPTH with cure rates—98% vs 94.8% without ioPTH. It will have a considerable effect on surgical treatment for PHP. Nonetheless, I have some comments on the methodology, results, and conclusion of the trial.
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Neoadjuvant PD-1/PD-L1 Inhibitors for Resectable Head and Neck Cancer

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This systematic review and meta-analysis assesses the efficacy and safety of neoadjuvant immunotherapy for resectable head and neck squamous cell carcinoma.
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Is extracellular matrix (ECM) a promising scaffold biomaterial for bone repair?

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Histol Histopathol. 2021 Sep 2:18370. doi: 10.14670/HH-18-370. Online ahead of print.

ABSTRACT

The increasing demand for bone grafts and the scarcity of donors worldwide are promoting researchers to seek alternatives. The extracellular matrix (ECM) has been reported to enhance properties of osteoconduction and osteoinduction by simulating the molecular structure of bone and facilitating cell infiltration for bone repair. As one of several novel biomaterials, ECM has many desirable properties, including biocompatibility, bioactivity, and biosafety. Thus, we evaluated whether ECM is a promising scaffold biomaterial for bone repair. In this review, we explore ECM composition, the sources and fabrication methods, especially the decellularization technique, of ECM scaffolds. Furthermore, we highlight recent progress in the use of ECM as a scaffold biomaterial for bone repair. Generally, ECM is used in 1) three-dimensional (3D) cell cultures to promote osteogenic differentiation, 2) combinations with other biomaterials to increase their osteogenic effects, 3) 3D printing to produce customized or patient-tailored scaffolds for bone repair, and 4) hydrogels derived from ECM used for bone repair. In addition, we focus on future prospects for application of ECM as a scaffold material used for bone repair. From this review, we expect to have a perfect understanding of ECM-based scaffold materials in the hope that this leads to further research of the production of ECM biomaterials to meet the clinical needs for bone repair.

PMID:34472621 | DOI:10.14670/HH-18-370

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Schwannoma of the Zygomatic Branch of the Facial Nerve

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Ear Nose Throat J. 2021 Sep 2:1455613211041235. doi: 10.1177/01455613211041235. Online ahead of print.

ABSTRACT

SIGNIFICANCE STATEMENT: Facial nerve schwannoma is extremely uncommon. Despite its rarity, it is considered the most common facial nerve tumor and potentially affects any segment of the nerve. Presenting symptoms vary depending on the location of the neoplasm. Tumors pertaining to the extratemporal course of the nerve mainly appear as an asymptomatic parotid mass. We present a rare case of schwannoma of the zygomatic branch of the right facial nerve that was surgically resected, without facial nerve injury.

PMID:34472361 | DOI:10.1177/01455613211041235

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In Situ Preservation of Parathyroid Gland With Vasculature for Papillary Thyroid Carcinoma Is Associated With Higher PTH Levels After Total Thyroidectomy

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Ear Nose Throat J. 2021 Sep 2:1455613211039807. doi: 10.1177/01455613211039807. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of parathyroid gland vasculature preservation in-situ technique (PGVPIST) on postoperative parathyroid hormone (PTH) and calcium plasma levels in thyroid patients undergoing total thyroidectomy for papillary thyroid carcinoma (PTC).

STUDY DESIGN: Retrospective cohort study.

METHODS: Patients with PTC who underwent total t hyroidectomy by either the conventional technique (group 1, January 2019 to January 2020) or PGVPIST (group 2, January 2020 to January 2021) were compared. Postoperative blood calcium levels and PTH levels were assessed in these groups.

RESULTS: Totally 149 patients with consecutive PTC underwent total thyroidectomy, including 60 patients in group 1 and 89 patients in group 2. Postoperative serum calcium levels in group 1 were insignificantly lower than in group 2 at day 1 (2.18 ± 0.02 vs 2.15 ± 0.01 mmol/L) and day 30 (2.27 ± 0.02 vs 2.38 ± 0.11) after surgery. But postoperative serum PTH levels in group 1 were significantly lower than that in group 2 at day 1 (23.68 ± 2.54 vs 31.46 ± 2.11 pg/mL) and day 30 (45.63 ± 3.21 vs 55.65 ± 2.89 pg/mL) after surgery.

CONCLUSION: Parathyroid gland vasculature preservation in-situ technique for PTC is associated with higher PTH level after total thyroidectomy. The parathyroid gland vasculature mostly strongly adheres with adjacent thyroid parenchyma. Therefore, deferred processing of tiny thyroid parenchyma of parathyroid gland vessels is essential to prevent devascularization.

PMID:34472380 | DOI:10.1177/01455613211039807

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Adverse Drug Reaction of Antifungals in the Management of Black Fungus: A Tertiary Care Centre Experience

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Abstract

In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as "black fungus." Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india… The pati ents were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despi te a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required.

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Audio-Vestibular Findings in Individuals with Takayasu’s Arteritis

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Abstract

Takayasu's Arteritis is defined as inflammatory disease of the large blood vessels with unknown cause mostly affecting the aorta and its main branches. The patients diagnosed with Takayasu's arteritis are reported to have complaint of chronic dizziness. However, literature lacks detailed clinical evaluation of the auditory vestibular function in such patients. The current study documents the findings of auditory and vestibular evaluations in a rare syndrome. It was observed that patients with Takayasu's arteritis had abnormal auditory and vestibular evoked potentials.

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Preparation of docetaxel-loaded, glycyrrhetinic acid-modified nanoparticles and their liver-targeting and antitumor activity

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Exp Ther Med. 2021 Oct;22(4):1144. doi: 10.3892/etm.2021.10578. Epub 2021 Aug 9.

ABSTRACT

Liver cancer is one of the most common malignancies worldwide and poses a serious threat to human health. The most important treatment method, liver cancer chemotherapy, is limited due to its high toxicity and poor specificity. Targeted drug delivery systems have emerged as novel therapeutic strategies that deliver precise, substantial drug doses to target sites via targeting vectors and enhance the therapeutic efficacy. In the present study, glycyrrhetinic acid-modified hyaluronic acid (GA-HA) was used as a carrier for the model drug docetaxel (DTX) to prepare DTX-loaded GA-HA nanoparticles (DTX/GA-HA-NPs). The results indicated that the DTX/GA-HA-NPs exhibited high monodispersity (particle dispersity index, 0.209±0.116) and desirable particle size (208.73±5.0 nm) and zeta potential (-27.83±3.14 mV). The drug loading capacity and encapsulation efficiency of the NPs were 12.59±0.68 and 85.38±4.62%, respectively. Furthermore, it was determined that FITC-GA-HA was taken up by cells and distributed in the cytoplasm. DTX and DTX/GA-HA (just the DTX delivered by the nanoparticle) aggregated and altered the structure of cellular microtubules. Compared with DTX alone, DTX/GA-HA-NPs had a stronger inhibitory effect on HepG2 cell proliferation and promoted apoptosis of HepG2 cells. All experimental results indicated that DTX/GA-HA-NPs were successfully prepared and had liver-targeting and antitumor activities in vitro, which provided a foundation for future in vivo studies of the antitumor effects of DTX/GA-HA-NPs.

PMID:34471430 | PMC:PMC8404033 | DOI:10.3892/etm.2021.10578

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Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs

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Indian J Otolaryngol Head Neck Surg. 2021 Sep;73(3):290-295. doi: 10.1007/s12070-020-02107-1. Epub 2020 Sep 5.

ABSTRACT

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 0' Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40 min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up.

PMID:34471616 | PMC:PMC8364608 | DOI:10.1007/s12070-020-02107-1

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Τετάρτη 1 Σεπτεμβρίου 2021

Intrabony mandibular metastases caused by papillary thyroid carcinoma masquerading as a parotid swelling

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Ann R Coll Surg Engl. 2021 Sep;103(8):e264-e265. doi: 10.1308/rcsann.2020.7091.

ABSTRACT

Papillary carcinoma is the most common type of thyroid cancer, accounting for 80-90% of cases. Distant metastasis of papillary thyroid cancer is uncommon, but when it does occur, it is most commonly to the lungs, liver and bone. Bone metastases to the mandible are rarely reported. We present a 68-year-old man who was referred due to a right parotid mass. Appropriate imaging and biopsy revealed a thyroid malignancy with bone metastases. The patient subsequently underwent thyroidectomy, with histology revealing multifocal papillary carcinoma. Radioactive iodine treatment was then commenced to control the metastatic disease.

PMID:34464554 | DOI:10.1308/rcsann.2020.7091

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Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology?

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Thyroid, Ahead of Print.
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