Microsurgical Breast Reconstruction: Maximizing Success

alexandrossfakianakis shared this article with you from Inoreader Microsurgical Breast Reconstruction: Maximizing Success via Seminars in Plastic Surgery Semin Plast Surg 2022; 36: 253-259 DOI: 10.1055/s-0042-1759573 Breast reconstruction is becoming increasingly recognized as a fundamental component in comprehensive breast cancer treatment. The primary goal for any reconstruction is to safely restore a natural appearing breast. When it comes to achieving the elements of size, shape, symmetry, and softness, the use of autologous tissue has many advantages. The approach to autologous breast reconstruction has changed substantia lly over the years as microsurgical free tissue transplants become more routine and accessible. While a variety of flap donor sites exist, careful flap selection based on surgical history and the availability of donor tissue is critical in achieving reliable results. This article reviews the clinical considerations in patient evaluation, donor site selection, and surgical approach taken at the Buncke Clinic. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

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Free Flap Donor-Site Complications and Management

alexandrossfakianakis shared this article with you from Inoreader Free Flap Donor-Site Complications and Management via Seminars in Plastic Surgery Semin Plast Surg DOI: 10.1055/s-0042-1759795 Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fast idious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

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Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux

alexandrossfakianakis shared this article with you from Inoreader Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux via Clinical Otolaryngology Abstract Objective Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. Methods This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. Results In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs 48%) and gaping cardia (69% vs 24%), followed by peptic esophagitis (41% vs 24%). Conclusion The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease. View on Web

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Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials

alexandrossfakianakis shared this article with you from Inoreader Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials via Clinical Otolaryngology Abstract Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=–37.97 ml, 95% CI [–56.97, –18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=–0.97, 95 CI [–1.21, –0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= –3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=–3.73 min, 95% CI [–14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) Conclusion Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. View on Web

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higher female risk for adult glioma associated with variants in the region of CCDC26

alexandrossfakianakis shared this article with you from Inoreader Australian genome-wide association study confirms higher female risk for adult glioma associated with variants in the region of CCDC26 via Neuro-Oncology Advance Access Abstract Background Glioma accounts for approximately 80% of malignant adult brain cancer and its most common subtype, glioblastoma, has one of the lowest 5-year cancer survivals. Fifty risk-associated variants within 34 glioma genetic risk regions have been found by genome-wide association studies (GWAS) with a sex difference reported for 8q24.21 region. We conducted an Australian GWAS by glioma subtype and sex. Methods We analysed genome-wide data from the Australian Genomics and Clinical Outcomes of Glioma (AGOG) consortium for 7,573,692 single nucleotide polymorphisms (SNPs) for 560 glioma cases and 2,237 controls of European ancestry. Cases were classified as glioblastoma, non-glioblastoma, astrocytoma or oligodendroglioma Logistic regression analysis was used to assess the associations of SNPs with glioma risk by subtype and by sex. Results We replicated the previously reported glioma risk associations in the regions of 2 q33.3 C2orf80, 2q37.3 D2HGDH, 5p15.33 TERT, 7p11.2 EGFR, 8q24.21 CCDC26, 9p21.3 CDKN2BAS, 11q21 MAML2, 11q23.3 PHLDB1, 15q24.2 ETFA, 16p13.3 RHBDF1, 16p13.3 LMF1, 17p13.1 TP53, 20q13.33 RTEL and 20q13.33 GMEB2 (P<0.05). We also replicated the previously reported sex difference at 8q24.21 CCDC26 (P=0.0024) with the association being nominally significan t for both sexes (P<0.05). Conclusions Our study supports a stronger female risk association for the region 8q24.21 CCDC26 and highlights the importance of analysing glioma GWAS by sex. A better understanding of sex differences could provide biological insight into the cause of glioma with implications for prevention, risk prediction and treatment. View on Web

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