Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection

xlomafota13 shared this article with you from Inoreader Hidden intra-meatal CSF fistula related to VP shunt as a cause for fatal tension pneumocephalus after vestibular schwannoma resection Via leak of cerebrospinal fluid Br J Neurosurg. 2021 Sep 28:1-6. doi: 10.1080/02688697.2021.1981240. Online ahead of print. ABSTRACT BACKGROUND: Cerebrospinal fluid (CSF) leak through petrosal air cells is a known complication after drilling the posterior wall of the internal acoustic canal (IAC) for resection of vestibular schwannoma (VS). Whereas mild pneumocephalus is common after retrosigmoid craniotomy, tension pneumocephalus has been rarely documented. OBJECTIVE: To testify a case of fatal tension pneumocephalus after VS resection in a patient with ventriculo-peritoneal (VP) shunt and to propose possible recommendations to limit the risk of this dramatic complication. METHODS: A case of fatal tension pneumocephalus after VS resection in presence of hidden CSF fistula is illustrated with pre- and post-operative images. RESULTS: In the uneventful situation of concomitant post-operative CSF fistula in presence of VP shunt, tension pneumocephalus may occ ur. The negative pressure created by the shunt system and the presence of osteo-dural defect allow the air to enter and, at the same time, prevent the outflow. CONCLUSION: After VS resection, tension pneumocephalus can occur as a consequence of CSF fistula from petrosal air cells in the presence of functioning VP shunt. Precautions as pre-operative increase to 'virtual-off' the pressure of the valve, subsequences CT scans after surgery and sealing of the petrous air cells are recommended to avoid such as fatal complication. PMID:34579610 | DOI:10.1080/02688697.2021.1981240 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Single Surgeon Experience with 500 Cases of the Robotic Bilateral Axillary Breast Approach (BABA) for Thyroid Surgery Using the Da-Vinci Xi System

xlomafota13 shared this article with you from Inoreader Single Surgeon Experience with 500 Cases of the Robotic Bilateral Axillary Breast Approach (BABA) for Thyroid Surgery Using the Da-Vinci Xi System Via radioactive iodine J Clin Med. 2021 Sep 7;10(18):4048. doi: 10.3390/jcm10184048. ABSTRACT OBJECTIVES: Robotic bilateral axillary breast approach (BABA) thyroid surgery began in 2008 and is now one of the most widely used remote-access thyroid surgeries worldwide. This study aimed to analyze the results of 500 robotic BABA thyroid surgeries performed in a single institution in Korea compared with open thyroid surgery. METHODS: From December 2018 to March 2020, 502 robotic BABA thyroidectomies (R Ts) and 531 conventional open thyroidectomies (OTs) were performed in our institution by a single endocrine surgeon. We retrospectively reviewed patient medical records and performed a comparative analysis of OT and RT. RESULTS: The RT group was younger (43.41 ± 11.41 versus 54.28 ± 13.41 years, p < 0.001) and had a higher proportion of females (84.3% versus 69.3%, p < 0.001), a lower BMI (24.66 ± 3.97 versus 25.83 ± 4.07 kg/m2), a higher proportion of lobectomies (52.6% versus 45.2%) and a lower proportion of lateral neck dissections (3.4% versus 10.0%, p < 0.001). The RT group had a longer operation time (145.33 ± 40.80 versus 93.39 ± 43.55 min, p < 0.001) and higher surgical costs. Although the OT group had a larger tumor size and a higher proportion of extrathyroidal extension, the numbers of retrieved lymph nodes were not significantly different between the two groups. Additionally, there was no difference in the st imulated thyroglobulin level before radioactive iodine therapy (7.01 ± 35.73 versus 8.39 ± 58.77, p = 0.782). The rates of transient vocal cord palsy and transient hypoparathyroidism were significantly lower in the RT group, and those of scar-related complications were higher in the OT group. CONCLUSIONS: Robotic BABA thyroid surgery has advantages not only in better cosmetic outcomes but also in lower rates of vocal cord palsy and hypoparathyroidism, with comparable lymph node retrieval and serum thyroglobulin levels. PMID:34575159 | DOI:10.3390/jcm10184048 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

xlomafota13 shared this article with you from Inoreader Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review Via radioactive iodine J Clin Med. 2021 Sep 15;10(18):4150. doi: 10.3390/jcm10184150. ABSTRACT Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommend ations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted. PMID:34575260 | DOI:10.3390/jcm10184150 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

MicroRNA-Based Risk Score for Predicting Tumor Progression Following Radioactive Iodine Ablation in Well-Differentiated Thyroid Cancer Patients: A Propensity-Score Matched Analysis

xlomafota13 shared this article with you from Inoreader MicroRNA-Based Risk Score for Predicting Tumor Progression Following Radioactive Iodine Ablation in Well-Differentiated Thyroid Cancer Patients: A Propensity-Score Matched Analysis Via radioactive iodine Cancers (Basel). 2021 Sep 16;13(18):4649. doi: 10.3390/cancers13184649. ABSTRACT To identify molecular markers that can accurately predict aggressive tumor behavior at the time of surgery, a propensity-matching score analysis of archived specimens yielded two similar datasets of DTC patients (with and without RAI). Bioinformatically selected microRNAs were quantified by qRT-PCR. The risk score was generated using Cox regression and assessed using ROC, C-statistic, and Brier-score. A predictive Bayesian nomogram was established. External validation was performed, and causal network analysis was generated. Within the eight-year follow-up period, progression was reported in 51.5% of cases; of these, 48.6% had the T1a/b stage. Analysis showed upregulation of miR-221-3p and miR-222-3p and downregulation of miR-204-5p in 68 paired cancer tissues (p < 0.001). These three miRNAs were not differentially expressed in RAI and non-RAI groups. The ATA risk score showed poor discriminative ability (AUC = 0.518, p = 0.80). In contrast, the microRNA-based risk score showed high accuracy in predicting tumor progression in the whole cohorts (median = 1.87 vs. 0.39, AUC = 0.944) and RAI group (2.23 vs. 0.37, AUC = 0.979) at the cutoff >0.86 (92.6% accuracy, 88.6% sensitivity, 97% specificity) in the whole cohorts (C-statistics = 0.943/Brier = 0.083) and RAI subgroup (C-statistic = 0.978/Brier = 0.049). The high-score group had a three-fold increased progress ion risk (hazard ratio = 2.71, 95%CI = 1.86-3.96, p < 0.001) and shorter survival times (17.3 vs. 70.79 months, p < 0.001). Our prognostic microRNA signature and nomogram showed excellent predictive accuracy for progression-free survival in DTC. PMID:34572876 | DOI:10.3390/cancers13184649 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Antalgic effects of socio-aesthetics in cancer patients

xlomafota13 shared this article with you from Inoreader Antalgic effects of socio-aesthetics in cancer patients Via Association française pour l'étude du cancer Bull Cancer. 2021 Sep 24:S0007-4551(21)00306-4. doi: 10.1016/j.bulcan.2021.05.012. Online ahead of print. ABSTRACT INTRODUCTION: Socio-aesthetics is the delivery appropriate beauty care in a population weakened by a physical, psychological and/or social attack. It has found its place in indications in both medical (especially in oncology) and social settings. It offers many types of treatments including facials, foot beauty, make-up, wig tips, body massage, product advice, cosmetic manicure, varnishing… The main purpose of this study was to evaluate pain reduction as a result of socio-aesthetics. METHODS: One hundred and eighty patients were offered a socio-aesthetic session between 12/01/2018 and 11/30/2019. One hundred and fifty-seven (87,2%) accepted the care (56.7% of women/43.3% of men, regardless of the type of cancer) and all agreed to complete a questionnaire on the type of treatment received, the benefits felt and a Li kert pain assessment scale before and after the treatment. RESULTS: No patient experienced an increase in pain after the socio-aesthetic care. In the general population, the mean pain evaluation was rated at 1.31/10 and 0.78/10 before and after the session respectively, p<10-5. By selecting patients experiencing pain before treatment (40 patients, 28.0% of the total population), the mean pain evaluation was 4.27/10 and 2.52/10 before and after the treatment respectively, p<10-5. Pain was significantly reduced by massage. No patient found the socio-aesthetic treatment unnecessary. CONCLUSION: Socio-aesthetics is definitely a supportive care in oncology as it is significantly analgesic. It is easily accepted by men and regardless of the type of cancer. Researchers should conduct more studies on its impact on the quality of life. PMID:34579943 | DOI:10.1016/j.bulcan.2021.05.012 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Accuracy of cancer diagnostic probe (CDP) for intra‐surgical checking of cavity side margins in neoadjuvant breast cancer cases; A human model study

xlomafota13 shared this article with you from Inoreader Accuracy of cancer diagnostic probe (CDP) for intra‐surgical checking of cavity side margins in neoadjuvant breast cancer cases; A human model study Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Recently, a real-time system, named cancer diagnostic probe (CDP), has been developed to diagnose the presence of pre-neoplastic/neoplastic cells in breast cavity side margins. Detecting mechanism is real-time determination of the ROS/H2O2 released from cancer or atypical cells, through reverse Warburg effect and hypoxia glycolysis pathways. Here we designed a human model study based on real-time checking of 387 internal margins from 39 neoadjuvant breast cancer cases by CDP. The permanent pathology results of tested lesions were our gold standard to evaluate CDP scoring. CDP results were compared with permanent pathology of tumor side margins (as a conventional margin evaluation procedure). Results showed that the sensitivity of CDP in scoring the cavity side margins of those cases is 91%. 18 involved internal margins which had been detected by CDP were declared as free margins in pathology section of tumor side samples. Just 5 involve d internal margins were missed by CDP. 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.

Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis

xlomafota13 shared this article with you from Inoreader Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis Via The Laryngoscope Objectives/Hypothesis To investigate the morbidity and mortality of patients undergoing endoscopic sinus surgery (ESS) in the inpatient setting. Study Design Retrospective database review. Methods The Nationwide Inpatient Sample was queried for all ESS between 2008 and 2014. Using All Patients Refined Diagnosis Related Groups (APR-DRG) codes, cases with APR-DRG codes under Major Diagnostic Category 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat) were designated as patients with primary otolaryngology diagnoses undergoing ESS (ORL), and all other codes were designated as patients with non-otolaryngology pathologies as their primary reason for admission but undergoing ESS (non-ORL). A univariate analysis and a logistic regression were used to compare patient demographics, comorbidities, disease severity, and mortality. Results There were 8,305 ORL patients and 6,342 non-ORL patients. ORL patients were more likely to be elective admissions (61.3% vs. 48.5%, P < .001), have a deviated nasal septum (17.9% vs. 12.3%, P < .001), nasal polyps (15.8% vs. 5.0%, P < .001), obstructive sleep apnea (10.7% vs. 5.2%, P < .001), and pulmonary disease (15.9% vs. 10.5%, P < .001). Non-ORL patients had a higher likelihood of in-hospital mortality (odds ratio [OR] 6.22, 95% confidence interval [CI] 3.29–11.78, P < .001), length of stay in the highest quartile (OR 2.43, 95% CI 2.16–2.74, P < .001), and a higher proportion had APR-DRG subclasses indicating extreme severity of illness (19.3% vs. 4.3%, P < .001) or extreme risk of mortality (12.5% vs. 2.0%, P < .001). Conclusion Patients undergoing ESS in the inpatient setting have a higher than expected mortality rate which can be associated with a non-otolaryngology pathology as the primary reason for their admission. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Applications of Artificial Intelligence to Office Laryngoscopy: A Scoping Review

xlomafota13 shared this article with you from Inoreader Applications of Artificial Intelligence to Office Laryngoscopy: A Scoping Review Via The Laryngoscope Objectives/Hypothesis This scoping review aims to provide a broad overview of the applications of artificial intelligence (AI) to office laryngoscopy to identify gaps in knowledge and guide future research. Study Design Scoping Review. Methods Searches for studies on AI and office laryngoscopy were conducted in five databases. Title and abstract and then full-text screening were performed. Primary research studies published in English of any date were included. Studies were summarized by: AI applications, targeted conditions, imaging modalities, author affiliations, and dataset characteristics. Results Studies focused on vocal fold vibration analysis (43%), lesion recognition (24%), and vocal fold movement determination (19%). The most frequently automated tasks were recognition of vocal fold nodules (19%), polyp (14%), paralysis (11%), paresis (8%), and cyst (7%). Imaging modalities included high-speed laryngeal videos (45%), stroboscopy (29%), and narrow band imaging endoscopy (7%). The body of literature was primarily authored by science, technology, engineering, and math (STEM) specialists (76%) with only 30 studies (31%) involving co-authorship by STEM specialists and otolaryngologists. Datasets were mostly from single institution (84%) and most commonly originated from Germany (23%), USA (16%), Spain (9%), Italy (8%), and China (8%). Demographic information was only reported in 39 studies (40%), with age and sex being the most commonly reported, whereas race/ethnicity and gender were not reported in any studies. Conclusion More interdisciplinary collaboration between STEM and otolaryngology research teams improved demographic reporting especially of race and ethnicity to ensure broad representation, and larger and more geographically diverse datasets will be crucial to future research on AI in office laryngoscopy. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Subdorsal Osteotomy and Complete Dorsal Preservation ‐ A New Paradigm in Preservation Rhinoplasty?

xlomafota13 shared this article with you from Inoreader Subdorsal Osteotomy and Complete Dorsal Preservation ‐ A New Paradigm in Preservation Rhinoplasty? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Technique, Pearls, and Pitfalls of the Transaxillary Approach for Robotic Thyroidectomy (With Video)

xlomafota13 shared this article with you from Inoreader Technique, Pearls, and Pitfalls of the Transaxillary Approach for Robotic Thyroidectomy (With Video) Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Micronutrients on Thyroid Parameters

xlomafota13 shared this article with you from Inoreader Effect of Micronutrients on Thyroid Parameters Via Journal of Thyroid Research Micronutrients are involved in various vital cellular metabolic processes including thyroid hormone metabolism. This study aimed to investigate the correlation between serum levels of micronutrients and their effects on thyroid parameters. The correlation of serum levels of micronutrients and thyroid markers was studied in a group of 387 healthy individuals tested for thyroid markers (T4, T3, FT4, FT3, TSH, anti-TPO, RT3, and anti-Tg) and their micronutrient profile at Vibrant America Clinical Laboratory. The subjects were rationalized into three groups (deficient, normal, or excess levels of micronutrients), and the levels of their thyroid markers were compared. According to our results, deficiency of vitamin B2, B12, and B9 and Vit-D25[OH] () significantly affected thyroid functioning. Other el emental micronutrients such as calcium, copper, choline, iron, and zinc () have a significant correlation with serum levels of free T3. Amino acids asparagine (r = 0.1765, ) and serine (r = 0.1186, ) were found to have a strong positive correlation with TSH. Valine, leucine, and arginine () also exhibited a significant positive correlation with serum levels of T4 and FT4. No other significant correlations were observed with other micronutrients. Our study suggests strong evidence for the association of the levels of micronutrients with thyroid markers with a special note on the effect of serum levels of certain amino acids. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.