Rectal Cancer: Organ preservation and neoadjuvant treatment escalation

xlomafota13 shared this article with you from Inoreader Rectal Cancer: Organ preservation and neoadjuvant treatment escalation Via Association française pour l'étude du cancer Bull Cancer. 2021 Nov 18:S0007-4551(21)00391-X. doi: 10.1016/j.bulcan.2021.09.007. Online ahead of print. ABSTRACT Standard treatment consisting of chemoradiotherapy followed by radical surgery with total mesorectal excision, results in good oncologic local control but high morbidity and poor functional results. Since chemoradiotherapy results in 15% pathological complete response, even reaching up to 30% in case of association with neoadjuvant chemotherapy, radical surgery has been recently debated for good responders. Therefore, a de-escalation strategy, by omitting radical surgery in good responders, has recently been developed with two different options: a watch and wait strategy, requiring an accurate clinical and radiological definition of complete response and a local excision strategy including patients with sub-complete response. Ongoing trials focus on response optimization by chemotherapy intensification or radiotherapy dose escalation. However, many questions are still to be answered regarding definition of complete response, follow-up strategy, morbidity of salvage surgery in case of recurrence as well as long-term oncological and functionnal results. PMID:34802716 | DOI:10.1016/j.bulcan.2021.09.007 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The never-ending battle between proximal row carpectomy and four corner arthrodesis: A systematic review and meta-analysis for the final verdict

xlomafota13 shared this article with you from Inoreader The never-ending battle between proximal row carpectomy and four corner arthrodesis: A systematic review and meta-analysis for the final verdict Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 23:S1748-6815(21)00516-7. doi: 10.1016/j.bjps.2021.09.076. Online ahead of print. ABSTRACT While scaphoid excision combined with Four Corner Arthrodesis (FCA) or Proximal Row Carpectomy (PRC) is a commonly-used salvage procedures to treat type two and type three Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC)-induced degenerative arthritis, controversy remains over which treatment intervention provides superior outcomes. We searched for articles comparing a range of motion, grip strength, complications requiring reoperation, conversion to wrist arthrodesis, pain, and disability of shoulder and arm scores between FCA and PRC-treated patients. The risk of bias was assessed using the National Institutes of Health (NIH) quality assessment tool. We performed a meta-analysis using Random-Effects Models. Fifteen articles (10 retrospective, 2 cross-sectional, 1 prospe ctive, and 2 randomized trials) were included. There was no significant difference between PRC and FCA in any of the different outcome measures. The risk of bias was found consistently high across all studies. Despite the lack of high-quality evidence, based on existing literature, we recommend PRC as the preferred choice of treatment because of the simplicity of the surgical procedure, lack of hardware-related complications, and comparable long-term outcomes. Level of evidence: III - Therapeutic. PMID:34802951 | DOI:10.1016/j.bjps.2021.09.076 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Masseteric nerve transference with sling tendon for symmetry in the restoration of facial paralysis: An effective combination of dynamic and static correction

xlomafota13 shared this article with you from Inoreader Masseteric nerve transference with sling tendon for symmetry in the restoration of facial paralysis: An effective combination of dynamic and static correction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00484-8. doi: 10.1016/j.bjps.2021.09.046. Online ahead of print. ABSTRACT Masseteric nerve transposition has shown to be an effective technique for the treatment of facial paralysis. Due to its low morbidity at the donor site, its consistent anatomy, and one-stage operation, it constitutes a reliable option for both complete and incomplete facial paralysis. Masseteric nerve transference has proven to achieve good commissural excursion and dynamic symmetry. However, some patients with heavy faces and complete facial paralysis recover incompletely after surgery characterized by an asymmetrical smile with asymmetry at rest, affecting the cosmetic appearance. For these patients, we propose a novel combination of masseteric nerve transposition for the dynamic rehabilitation of the smile with a tendon sling suspension to create symmetry at rest. A detailed description of the surgical t echnique is given and results after using it with eight patients show good functional and aesthetic satisfaction. A combination of both dynamic and static techniques for complete facial paralysis rehabilitation may provide adequate symmetry with the contralateral healthy side both at rest and when smiling. PMID:34802952 | DOI:10.1016/j.bjps.2021.09.046 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Feasibility and Accuracy of Orthopedic Surgical Robot Sy stem for Intraoperative Navigation to Locate Bone Tunnel in Anterior Cruciate Ligament Reconstruction

xlomafota13 shared this article with you from Inoreader Feasibility and Accuracy of Orthopedic Surgical Robot Sy stem for Intraoperative Navigation to Locate Bone Tunnel in Anterior Cruciate Ligament Reconstruction Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The combination of navigational system and robotics has the potential to accurately identify and drill bone tunnels in anterior cruciate ligament (ACL) reconstruction. This study explores the feasibility and accuracy of bone tunnel positioning using the TiRobot, an orthopedic surgical robot. Methods The experiment was divided into two groups. In group A, the bone tunnels were positioned using the TiRobot surgical robot (n = 8). In group B, handheld locators were used for positioning (n = 8). Results TiRobot can be used for positioning the ACL bone tunnel. The accuracy of positioning the femoral tunnel in Group A and B was 1.00 ±0.20 mm and 3.10 ±0.59 mm, respectively (t=-9.49, P ＜0.001). As for tibial tunnel, the accuracy was 1.02 ±0.20 mm and 2.64 ±0.14 mm, respectively (t=-18.54, P ＜0.001). Conclusions The bone tunnel drilling precision using TiRobot for ACL reconstruction surgery was more accurate than traditional surgical techniques. 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.

To explore the curative effect of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage primary hepatocellular carcinoma

xlomafota13 shared this article with you from Inoreader To explore the curative effect of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage primary hepatocellular carcinoma Via radioactive iodine J Interv Med. 2021 Feb 27;4(2):82-86. doi: 10.1016/j.jimed.2021.02.009. eCollection 2021 May. ABSTRACT OBJECTIVES: To explore the clinical efficacy and survival of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage Ⅳ primary hepatocellular carcinoma. METHODS: A retrospective study of 62 patients with primary hepatocellular carcinoma in our hospital from January 2017 to December 2018 [60 males, 2 females, age (52.76 ​± ​10.82) years old], All p atients were implanted with Iodine-125 radioactive seeds under CT guidance, followed up regularly after operation to observe the clinical efficacy, including comparison of changes in cancer size before and after treatment, tumor marker AFP, and improvement in complications such as abdominal pain and ascites. Follow-up 3-36 months to assess patient survival. RESULTS: Among the 62 patients, 3 months after Iodine-125 radioactive seed implantation, 5 cases (8.1%) had complete remission of cancer, 33 cases (53.2%) had partial remission, 12 cases (19.4%) had stable lesions, and 12 cases (19.4%) had disease progression. The effective rate was 61.3%. The tumor volume (31.44 ​± ​14.51cm3) was significantly smaller than before (50.96 ​± ​30.13cm3) (t ​= ​5.303, p ​< ​0.05). The tumor marker AFP (69.28 ​± ​50.99) ug/L of 3 months after implantation was significantly lower than that before treatment (90.63 ​± ​68.58) ug/L (t ​= ​3.702, P ​< ​0.05) . The average survival time of Iodine-125 seed implantation for stageⅣhepatocellular carcinoma is 11.47 ​± ​0.85 months, and the median survival time is 9 months. The survival time of the group with better pathological differentiation (gradeⅠ+Ⅱ) was significantly better than that of the group with poor differentiation (grade Ⅲ+Ⅳ) (x2 ​= ​6.869 p ​< ​0.05). Among the 38 patients with different degrees of abdominal pain, 22 patients improved better than before; 15 of 28 patients with different degrees of ascites were better than before. All patients had no serious complications related to treatment. CONCLUSIONS: Iodine-125 radioactive seed implantation therapy can safely and effectively treat hepatocellular carcinoma, and relieve the clinical symptoms of abdominal pain and ascites. PMID:34805953 | PMC:PMC8562200 | DOI:10.1016/j.jimed.2021.02.009 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Do patients with chronic rhinosinusitis exhibit elevated rates of Covid‐19 infection?

xlomafota13 shared this article with you from Inoreader Do patients with chronic rhinosinusitis exhibit elevated rates of Covid‐19 infection? Via The Laryngoscope Abstract Patients with chronic rhinosinusitis (CRS) may have concerns regarding their potential for an increased likelihood of contracting Covid-19, given baseline inflammatory disease and utilization of topical or oral immunosuppressive therapies for disease treatment. In the present study, we utilize matched cohort sampling of over 12,000 CRS patients and 12,000 controls seen between June of 2020 and January of 2021, examining rates of Covid-19 testing and positivity during that time period. We found no difference in Covid-19 contraction between CRS patients and matched non-CRS patients, despite an almost two-fold significant increase in testing among those with CRS. This suggests that CRS patients are likely not inherently more vulnerable to Covid-19 infection at a rate above that of the general population. 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.

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

xlomafota13 shared this article with you from Inoreader Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy Via Head & Neck Abstract Background The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration-related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well-studied. Method Patient- and clinician-reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Results Ninety-three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Conclusion Radiation dose to DARS is associated with post-treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta‐analysis Via Head & Neck Abstract To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10–1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63–0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70–1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OS CC ≤40 years old. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear implantation in LEOPARD syndrome: our experience with three patients

xlomafota13 shared this article with you from Inoreader Cochlear implantation in LEOPARD syndrome: our experience with three patients Via Clinical Otolaryngology Abstract LEOPARD syndrome is a rare hereditary disease characterized by several congenital defects in multiple organs, including sensorineural hearing impairment. LEOPARD syndrome is caused by mutations in the PTPN11 gene, and different PTPN11 mutations are associated with different clinical features. Cochlear implantation (CI) can potentially benefit LEOPARD syndrome patients with profound sensorineural hearing impairment. The CI outcomes in LEOPARD syndrome patients are influenced by the PTPN11 genotypes, because different PTPN11 mutations confer different pathogenicity on neurocognitive development. Genetic testing is of prognostic value in the management of LEOPARD syndrome. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Assessment of swallow function pre and post‐endoscopic CO2 laser medial arytenoidectomy: a case series

xlomafota13 shared this article with you from Inoreader Assessment of swallow function pre and post‐endoscopic CO2 laser medial arytenoidectomy: a case series Via Clinical Otolaryngology Abstract Endoscopic CO2 laser medial arytenoidectomy is performed for glottic stenosis however post-operative aspiration remains a risk Pre-operative and post-operative objective and subjective assessments of swallow function were evaluated There was no statistically significant difference when comparing pre- and post-operative penetration-aspiration scores or subjective swallow function If baseline swallow is impaired, this should not preclude the patient from arytenoidectomy; baseline FEES is essential to aid surgical planning and inform patient consent 'Staged arytenoidectomy' should be performed as a swallow-preserving procedure View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Honesty and Transparency, Indispensable to the Clinical Mission—Part I

xlomafota13 shared this article with you from Inoreader Honesty and Transparency, Indispensable to the Clinical Mission—Part I Via Otolaryngologic Clinics of North America At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing—and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Value of Diversity, Equity, and Inclusion in Otolaryngology

xlomafota13 shared this article with you from Inoreader The Value of Diversity, Equity, and Inclusion in Otolaryngology Via Otolaryngologic Clinics of North America Diversity impacts performance of our teams, fosters innovation, and improves outcomes of our patients in otolaryngology head and neck surgery. In addition to the moral imperative, increasing the otolaryngology diversity workforce will decrease health care disparities while equity and justice can increase the culture humility to take care of an increasingly diverse patient population. To move toward justice, otolaryngology departments need to end biases in faculty hiring, development, research evaluations, and publication practices. The more intentional our efforts, the more benefit to our patients, providers, staff, learners, and society. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.