Transcervical styloidectomy for Eagle syndrome

xlomafota13 shared this article with you from Inoreader Transcervical styloidectomy for Eagle syndrome Via Head & Neck Abstract We demonstrate a safe and effective surgical technique for the operative management of Eagle syndrome, also known as stylohyoid syndrome, via transcervical styloidectomy. Fifteen patients who presented to our institution for surgical management of Eagle syndrome were included. A detailed video shows the operative techniques used to perform styloidectomy via a transcervical approach. The procedure was well tolerated without complications, and all patients were discharged on postoperative day one. Thirteen patients (87%) endorsed significant improvement or complete resolution of their presenting complaint(s), most commonly throat and neck pain/discomfort (53%), otalgia (47%), and/or tinnitus (40%). The transcervical approach for styloidectomy provides an alternative for operative access that overcomes the limitations associated with the transoral approach. It enables better exposure of the operative field, a more efficient procedure, and, in the senior author's experience, results i n decreased postoperative pain, trismus, and length of hospital stay. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of a tongue training program in Parkinson's disease: Analysis of electrical activity and strength of suprahyoid muscles

xlomafota13 shared this article with you from Inoreader Effects of a tongue training program in Parkinson's disease: Analysis of electrical activity and strength of suprahyoid muscles Via swallowing exercises J Electromyogr Kinesiol. 2022 Feb 12;63:102642. doi: 10.1016/j.jelekin.2022.102642. Online ahead of print. ABSTRACT OBJECTIVE: To assess the electrical activity of the suprahyoid muscle and the tongue pressure in a two-wing program of tongue strengthening in individuals with Parkinson's disease (PD). METHODS: A pre-post-detraining design study included sixty PD patients assigned to two groups randomly. The experimental group (EG) performed tongue isometric pressure exercises using the Iowa Oral Performance Instrument with an increasing scheme of 5% load weekly and traditional tongue therapy for 8 weeks. The control group (CG) performed only traditional therapy. The electrical activity of suprahyoids was measured using surface electromyography (sEMG) during tongue-to-palate pressure. Four selected domains of the Swallowing Quality of Life Questionnaire (SWAL-QOL) mostly related to tongue strength were considered. RESULTS: The experimental group showed increased sEMG values of suprahyoid muscles reaching statistically significant difference at the fourth week of tongue training, while the control did it at the eighth week. Experimental group showed significant improvements in tongue strength (d = 2.128; p = 0.000). Only controls showed detraining effect. Statistically significant difference within groups were found in one and three dimensions of the SWAL-QOL in the CG and EG, respectively. CONCLUSION: Analysis of electrical activity on suprahy oids muscles provided a better understanding of the changes underlying the outcomes of tongue strength gains obtained through a combined tongue strengthening exercises protocol in PD. Such protocol led not only to increased tongue strength but also to a better perceived swallowing function in PD subjects. PMID:35189571 | DOI:10.1016/j.jelekin.2022.102642 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Applicability of Transnasal Echography for Identification of Internal Carotid Artery

xlomafota13 shared this article with you from Inoreader Applicability of Transnasal Echography for Identification of Internal Carotid Artery Via The Laryngoscope Objective To study the applicability of transnasal echography for the internal carotid artery (ICA) imaging during endoscopic procedures, primarily nasopharyngectomy. Study Design Non-randomized controlled cohort. Methods The tip of a pediatric transducer for transesophageal echography was inserted into each nostril under endoscopic control and placed in the ipsilateral Rosenmuller's fossa. The ICA's internal diameter and distance between the nasopharyngeal wall and the artery's closest point were measured on each side. Two independent examiners measured the same parameters on the axial plane of the skull base computer tomography (CT). Agreement between CT and echography measurements was estimated by the Bland–Altman approach. Results Twenty-seven ICAs (sides) were available for the echography-CT agreement analysis. Inter method agreement for both parameters was similar to the inter examiner agreement for the CT measurements. Conclusions Our first study on endoscopic echography demonstrated that this method is applicable, potentially allowing safer transnasal surgery in the ICA vicinity. Level of Evidence 3 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes After Oral Cavity and Oropharyngeal Salvage Surgery

xlomafota13 shared this article with you from Inoreader Outcomes After Oral Cavity and Oropharyngeal Salvage Surgery Via The Laryngoscope Objectives Investigate outcomes following oral cavity and oropharyngeal salvage surgery. Methods Adult patients who underwent salvage surgery for recurrent squamous cell carcinoma of the oral cavity and oropharynx from 1996 to 2018 were analyzed using multivariable Cox proportional hazards regression. Disease-free survival (DFS), overall survival (OS), associated factors, and basic quality measures were analyzed. Results One hundred and eight patients (72% oral cavity, 28% oropharynx) were followed for a median of 17.9 months. Median DFS and OS were 9.9 and 21 months, respectively. Surgery with adjuvant chemoradiotherapy compared to surgery alone (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.03–0.78) and negative margins (HR = 0.36, 95% CI: 0.14–0.90) were associated with better DFS, while lymphovascular space invasion (LVSI) (HR = 2.66, 95% CI: 1.14–6.19) and higher stage (III vs. I–II, HR = 3.94, 95% CI: 1.22–12.71) were associated with worse DFS. Higher stage was associated with worse OS (HR = 3.79, 95% CI: 1.09–13.19). Patients were hospitalized for a median of 8 days with 24% readmitted within 30 days. A total of 72% and 38% of patients, respectively, underwent placement of a feeding tube or tracheostomy. Conclusions After oral cavity and oropharyngeal salvage surgery, adjuvant chemoradiotherapy, negative margins, negative LVSI, and lower stage were associated with a lower risk of recurrence. Only lower-stage disease was associated with improved survival. The majority of patients had feeding tubes, half underwent free tissue transfer, a third required tracheostomy, and a quarter was readmitted. Level of Evidence 3 Laryngoscope, 2022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effect of extra safety measures on incidence of surgical site infection after alloplastic breast reconstruction

xlomafota13 shared this article with you from Inoreader The effect of extra safety measures on incidence of surgical site infection after alloplastic breast reconstruction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 22:S1748-6815(22)00038-9. doi: 10.1016/j.bjps.2022.01.021. Online ahead of print. ABSTRACT BACKGROUND: This study aimed to evaluate whether the implementation of extra perioperative safety measures and precautions through adopted standard operating procedures (SOPs) to ensure optimal anti-microbial conditions has led to less surgical site infections (SSI) after alloplastic breast reconstruction (BR). METHODS: This retrospective study compared two Cohorts of patients treated before and after the implementation of new SOPs (2009-2014: Cohort 1 versus 2014-2019: Cohort 2). Multivariate logistic regression analyses, adjusting for patient confounders, were implemented to compare SSI incidence between both Cohorts. RESULTS: Overall, SSI incidence was equal in both groups (10%, p = 0.545). The incidence of deep SSI was 9% for Cohort 1 and 5% for Cohort 2 (p = 0.074). Incidence of SSI-related explantation was 8% and 5%, respectively (p = 0.136). After adjusting for patient confounders, no statistically significant difference was seen between both Cohorts in overall SSI, deep SSI incidence, and explantation due to SSI (ORadjusted: -0.31, p = 0.452, ORadjusted: 0.16, p = 0.747 and ORadjusted: 0.18, p = 0.712). Higher BMI, smoking, one-stage BR, and immediate BR were associated with the risk for SSI (p<0.001, p = 0.036, p<0.001, and p = 0.022, respectively). CONCLUSION: Extra safety measures to assure optimal anti-microbial conditions did not contribute to lower SSI incidence or SSI-related explantation after alloplastic BR. Confounders such as BMI, smoking, immediate BR, and one-stage BR were correlated to an increased risk for overall SSI, deep SSI, and SSI-related explantation of TE/implants. PMID:35190280 | DOI:10.1016/j.bjps.2022.01.021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long-Term Voice Outcomes After Type I, Type II, or Type V Cordectomy

xlomafota13 shared this article with you from Inoreader Long-Term Voice Outcomes After Type I, Type II, or Type V Cordectomy Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 21:34894221081259. doi: 10.1177/00034894221081259. Online ahead of print. ABSTRACT INTRODUCTION: We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. METHODS: A retrospective review of patients treated with Type I, Type II , or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. RESULTS: Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. CONCLUSIONS: Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performe d, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy. PMID:35189725 | DOI:10.1177/00034894221081259 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Case report of unusual insertion of the fibularis brevis muscle

xlomafota13 shared this article with you from Inoreader Case report of unusual insertion of the fibularis brevis muscle Via radiol anat Surg Radiol Anat. 2022 Feb 22. doi: 10.1007/s00276-022-02894-y. Online ahead of print. ABSTRACT The fibularis brevis and fibularis longus muscles belong to the lateral compartment of the leg. The fibularis brevis is morphologically variable, especially in the number of tendons and place of insertion. Its type of insertion is correlated with the presence of a fibularis digiti quinti, which is also anatomically variable. We present a case study based on dissection of a seventy -three-year-old female cadaver with an unusual insertion of the fibularis brevis muscle. The tendon had three bands inserting into the fifth metatarsal bone. There was a coexisting fibularis digiti quinti, which was fused with the fibularis tertius muscle. Awareness of such anatomical variation could be useful during reconstructive surgery and planning rehabilitation protocols. PMID:35192041 | DOI:10.1007/s00276-022-02894-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How to manage Graves' disease in women of childbearing potential

xlomafota13 shared this article with you from Inoreader How to manage Graves' disease in women of childbearing potential Via radioactive iodine Clin Endocrinol (Oxf). 2022 Feb 22. doi: 10.1111/cen.14705. Online ahead of print. ABSTRACT The management of Graves' Disease (GD) in women of childbearing potential has multiple specific complexities. Many factors are involved, which differ at the various stages from preconception, conception, first trimester, later pregnancy, postpartum and lactation, with both maternal and foetal considerations. The incidence and significance of the risks incurred from antithyroid drugs (ATDs) i n pregnancy have been re-evaluated recently and must be balanced against the risks of uncontrolled hyperthyroidism during childbearing years. Contraception is advised until hyperthyroidism is controlled. ATD cessation should be considered in those who are well controlled on low dose therapy before conception and in early pregnancy. Advice on iodine supplementation does not generally differ in those with GD. Radioiodine (RAI) is contraindicated from 6 months preconception until completion of breast feeding. In all women who have a history of GD, monitoring of TSH receptor antibodies (TRAb) is strongly recommended during pregnancy, and if elevated, foetal monitoring, and assessment of thyroid function in the neonate are required. Of note, RAI increases TRAb for up to a year, making this treatment option even less attractive in this patient group. A small amount of ATD is transferred into breast milk but low doses are safe during lactation. Routine periodic thyroid function testing is recommended in remission to detect postpartum GD recurrence. We present our approach to the Clinical Question 'How to manage GD in women of childbearing potential?' This article is protected by copyright. All rights reserved. PMID:35192205 | DOI:10.1111/cen.14705 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma

xlomafota13 shared this article with you from Inoreader Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma Via radioactive iodine Clin Endocrinol (Oxf). 2022 Feb 22. doi: 10.1111/cen.14700. Online ahead of print. ABSTRACT CONTEXT: Lung is the most common site of distant metastases from differentiated thyroid carcinoma (DTC). OBJECTIVE: To investigate the outcomes of a cohort of patients with DTC and lung metastases (LM). METHODS: A retrospective analysis of a cohort of 271 patients with LM was performed. RESULTS: The female-to-male ratio was 1:1 and the median follow-up time was 5.9 (1.1-38. 4) years. Papillary thyroid carcinoma (PTC) was the most frequent type (83.4%), mainly the classic variant, followed by follicular thyroid carcinoma (FTC, 10.3%) and Hürthle cell carcinoma (HTC, 6.3%). The prevalence of PTC, FTC and HCC was different between the micronodular and macronodular LM groups [87.4%, 6.3% and 6.3 % vs 74.6%, 19.0% and 6.3%, respectively (p=0.013)]. Only 5.0% of the patients had LM diagnosed after a period of remission. LM were submitted to radioactive iodine treatment (RAIT) in 84.5% (52.8% showed 131iodine avid metastases). Complete remission was only achieved in 12.2%. Micronodular disease and age <55 years at LM diagnosis were associated with a better prognosis (p<0.05). We found no difference in survival between patients with LM treated or not with RAIT. However, in patients submitted to RAIT, there was a tendency for longer survival in the group of patients with 131I avid lesions. CONCLUSION: The classic variant of PTC was the most frequen t histology found in LM of DTC. LM are rarely diagnosed in the follow-up when complete remission is achieved after surgery and 131I. Younger age at LM diagnosis and a micronodular pattern are associated with a better prognosis. This article is protected by copyright. All rights reserved. PMID:35192239 | DOI:10.1111/cen.14700 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Introduction and expression of PIK3CAE545K in a papillary thyroid cancer BRAFV600E cell line leads to a dedifferentiated aggressive phenotype

xlomafota13 shared this article with you from Inoreader Introduction and expression of PIK3CAE545K in a papillary thyroid cancer BRAFV600E cell line leads to a dedifferentiated aggressive phenotype Via Journal of Otolaryngology - Head & Neck Surgery Anaplastic thyroid cancer (ATC) is a rare, aggressive form of undifferentiated thyroid cancer, which exhibits rapid progression and is almost universally fatal. At least a subset of ATC is thought to arise fro... View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Selumetinib Plus Adjuvant Radioactive Iodine in Patients With High-Risk Differentiated Thyroid Cancer: A Phase III, Randomized, Placebo-Controlled Trial (ASTRA)

xlomafota13 shared this article with you from Inoreader Selumetinib Plus Adjuvant Radioactive Iodine in Patients With High-Risk Differentiated Thyroid Cancer: A Phase III, Randomized, Placebo-Controlled Trial (ASTRA) Via radioactive iodine J Clin Oncol. 2022 Feb 22:JCO2100714. doi: 10.1200/JCO.21.00714. Online ahead of print. ABSTRACT PURPOSE: Selumetinib can increase radioactive iodine (RAI) avidity in RAI-refractory tumors. We investigated whether selumetinib plus adjuvant RAI improves complete remission (CR) rates in patients with differentiated thyroid cancer (DTC) at high risk of primary treatment failure versus RAI alone. METHODS: ASTRA (NCT01843062) is an international, phase III, randomized, placebo-con trolled, double-blind trial. Patients with DTC at high risk of primary treatment failure (primary tumor > 4 cm; gross extrathyroidal extension outside the thyroid gland [T4 disease]; or N1a/N1b disease with ≥ 1 metastatic lymph node(s) ≥ 1 cm or ≥ 5 lymph nodes [any size]) were randomly assigned 2:1 to selumetinib 75 mg orally twice daily or placebo for approximately 5 weeks (no stratification). On treatment days 29-31, recombinant human thyroid-stimulating hormone (0.9 mg)-stimulated RAI (131I; 100 mCi/3.7 GBq) was administered, followed by 5 days of selumetinib/placebo. The primary end point (CR rate 18 months after RAI) was assessed in the intention-to-treat population. RESULTS: Four hundred patients were enrolled (August 27, 2013-March 23, 2016) and 233 randomly assigned (selumetinib, n = 155 [67%]; placebo, n = 78 [33%]). No statistically significant difference in CR rate 18 months after RAI was observed (selumetinib n = 62 [40%]; placebo n = 30 [38%]; odds ratio 1.07 [95% CI, 0.61 to 1.87]; P = .8205). Treatment-related grade ≥ 3 adverse events were reported in 25/154 patients (16%) with selumetinib and none with placebo. The most common adverse event with selumetinib was dermatitis acneiform (n = 11 [7%]). No treatment-related deaths were reported. CONCLUSION: Postoperative pathologic risk stratification identified patients with DTC at high risk of primary treatment failure, although the addition of selumetinib to adjuvant RAI failed to improve the CR rate for these patients. Future strategies should focus on tumor genotype-tailored drug selection and maintaining drug dosing to optimize RAI efficacy. PMID:35192411 | DOI:10.1200/JCO.21.00714 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.