Factors Predictive of Outcome in Inferior Turbinate Surgery.

a.sfakia shared this article with you from Inoreader Factors Predictive of Outcome in Inferior Turbinate Surgery. Via ear nose throat Factors Predictive of Outcome in Inferior Turbinate Surgery. Ear Nose Throat J. 2020 Oct 16;:145561320966066 Authors: Harju T, Numminen J Abstract OBJECTIVES: The purpose of the study was to examine the various preoperative predictive factors of inferior turbinate surgery and to find possible factors that predict an optimal subjective response using 3 common surgical techniques-radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT)-in a randomized, prospective study with a 1-year follow-up. METHODS: The patients filled a visual analogue scale (VAS) questionnaire regarding the severity of nasal obstruction prior to and 1 year after surgery. A VAS score improvement of 3 points or more was chosen as an optimal subjective response. Univariate and multivariate regressions were used to evaluate the effect of the predictive factors. In total, 80 patients attended a 1-year control visit. RESULTS: In the multivariate analysis, patients without anterior septal deviation had a statistically significantly higher odds ratio of a satisfactory subjective response compared to patients with anterior septal deviation (5.6; 95% CI: 1.4-23.1; P = .02). Patients treated with RFA had a statistically significantly higher odds ratio of an optimal subjective response compared to patients treated with MAIT (9.0; 95% CI: 1.5-54.2; P = .02). CONCLUSIONS: Anterior septal deviation seems to decrease the likelihood of an optimal subjective response to inferior turbinate surgery, which supports the consideration of concomitant septoplasty at least in clear cases to optimize the subjective response. Radiofrequency ablation had a significantly higher likelihood of an optimal subjective response compared to MAIT. Further investigations regarding the findings are needed. PMID: 33064011 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Eosinophilic Angiocentric Fibrosis Invading the Nasal Septum: A Case Report and Review of Literature.

a.sfakia shared this article with you from Inoreader Eosinophilic Angiocentric Fibrosis Invading the Nasal Septum: A Case Report and Review of Literature. Via ear nose throat Eosinophilic Angiocentric Fibrosis Invading the Nasal Septum: A Case Report and Review of Literature. Ear Nose Throat J. 2020 Oct 16;:145561320964266 Authors: Han SC, Park JH, Hong SN Abstract Eosinophilic angiocentric fibrosis (EAF) is a rare and slowly progressive disease, which usually involves the sino-nasal structures and upper respiratory tract. It is a fibroinflammatory lesion with an unclear etiology. Recent literature suggests a relation to rheumatic or immunological disorders. Therefore, immunophenotypic workup is critical when suspected. We report a case of a 32-year-old man complaining of nasal obstruction lasting more than 2 years. Nasal endoscopy and computed tomography showed a deviated septum with bilateral soft tissue swelling. During the septoturbinoplasty, a submucosal mass with severe adhesion was observed beneath the septal flap. The mass was completely removed. Dense stromal fibrosis with eosinophil-rich inflammatory cell infiltration was found on histologic examination and the patient was diagnosed with EAF. In addition, we reviewed the pathologic diagnostic criteria, differential diagnosis, and management of EAF. PMID: 33064012 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report.

a.sfakia shared this article with you from Inoreader Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report. Via ear nose throat Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report. Ear Nose Throat J. 2020 Oct 16;:145561320964268 Authors: Takata Y, Anzai T, Matsumoto F, Hara S, Ikeda K Abstract A petrous bone cholesteatoma (PBC) is a rare epidermoid cyst of the petrous portion of the temporal bone. The main treatment is subtotal petrosectomy (SP), which generally involves sacrificing the chorda tympani. We report a case of extensive supralabyrinthine PBC in an elderly patient undergoing hemodialysis that was treated by SP with anatomical preservation of the chorda tympani. To the best of our knowledge, preservation of the chorda tympani during SP has not been previously reported. For maintenance of postoperative taste and appetite, preservation of the chorda tympani is a meaningful maneuver whenever possible. PMID: 33064026 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic prelacrimal approach to lateral recess of sphenoid sinus: feasibility study.

a.sfakia shared this article with you from Inoreader Endoscopic prelacrimal approach to lateral recess of sphenoid sinus: feasibility study. Via leak of cerebrospinal fluid Related Articles Endoscopic prelacrimal approach to lateral recess of sphenoid sinus: feasibility study. Int Forum Allergy Rhinol. 2020 01;10(1):103-109 Authors: Li L, London NR, Prevedello DM, Carrau RL Abstract BACKGROUND: Various pathologies, including cerebrospinal fluid leaks and meningoencephaloceles, may arise in the lateral recess of the sphenoid sinus (LRSS), which may be accessed via an endonasal transpterygoid approach. The objective of this study was to evaluate the feasibility of accessing the LRSS via an endoscopic prelacrimal approach. Furthermore, we hypothesized that this approach may protect the pterygopalatine ganglion and vidian nerve. METHODS: Five cadaveric heads (9 sides) with a well-pneumatized LRSS were identified and an endonasal prelacrimal approach was performed. The infraorbital nerve, at the orbital floor, served as a critical landmark. After identification of the foramen rotundum at the pterygoid base, the vascular compartment of the pterygopalatine fossa and the pterygopalatine ganglion were displaced inferomedially and superomedially, respectively. Drilling of the bone inferomedial to the foramen rotundum allowed entry into the LRSS. RESULTS: The average distances from the prelacrimal window to the pterygoid base and the posterior wall of the LRSS were 6.22 ± 0.39 cm and 7.16 ± 0.50 cm, respectively. The average areas of the bony prelacrimal window and pterygoid base window were 4.33 ± 0.32 cm2 and 0.73 ± 0.10 cm2 , respectively. The LRSS could be accessed using a 0-degree endoscope, and pterygopalatine neurovascular structures, including the pterygopalatine ganglion and vidian nerve, could be preserved on all 9 sides. CONCLUSION: Our findings suggest that an endonasal prelacrimal approach provides a reasonable alternative to access the LRSS while preserving the vidian nerve and pterygopalatine ganglion. PMID: 31834678 [PubMed - indexed for MEDLINE] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Spontaneous Intracranial Hypotension.

a.sfakia shared this article with you from Inoreader Spontaneous Intracranial Hypotension. Via leak of cerebrospinal fluid Spontaneous Intracranial Hypotension. Dtsch Arztebl Int. 2020 Jul 06;117(27-28): Authors: Urbach H, Fung C, Dovi-Akue P, Lützen N, Beck J Abstract BACKGROUND: Spontaneous intracranial hypotension (SIH) is an underdiagnosed disease. Its incidence is estimated at 5 per 100 000 persons per year. METHODS: This review is based on a selective literature search in PubMed covering the years 2000-2019, as well as on the authors' personal experience. RESULTS: The diagnostic and therapeutic methods discussed here are supported by level 4 evidence. SIH is caused by spinal leakage of cerebrospinal fluid (CSF) out of ventral dural tears or nerve root diverticula, or, in 2-5% of cases, through a fistula leading directly into the periradicular veins (CSF-venous fistula). In half of all patients, no CSF leak is demonstrable. A low CSF opening pressure on lumbar puncture is present in only one-third of patients; imaging studies are thus needed to confirm and localize a spinal CSF leak. Half of all patients in whom myelographic computed tomography (CT) reveals contrast medium reaching the epidural space have ventral dural tears, which tend to be located at upper thoracic spinal levels. Epidural blood patches applied under fluoroscopic or CT guidance can seal the CSF leak in 30-70% of patients, but 90% of patients with ventral dural tears will need operative closure. Some patients who have no visible epidural contrast medium on CT presumably do not have SIH, while others do, in fact, have a CSF leak from a diverticulum or a CSF-venous fistula and will need to have the site of the leak demonstrated with the aid of further studies, such as dynamic (subtraction) myelography in the lateral decubitus position. CONCLUSION: The management of patients with SIH calls for complementary imaging studies to demonstrate the causative spinal CSF leak. Often, successful treatment requires surgical closure of the leak. In view of the sparse evidence available to date, controlled studies should be performed. PMID: 33050997 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Complications Associated with Lumbar Drain Placement for Endovascular Aortic Repair.

a.sfakia shared this article with you from Inoreader Complications Associated with Lumbar Drain Placement for Endovascular Aortic Repair. Via leak of cerebrospinal fluid Complications Associated with Lumbar Drain Placement for Endovascular Aortic Repair. J Vasc Surg. 2020 Oct 11;: Authors: Plotkin A, Han SM, Weaver FA, Rowe VL, Ziegler KR, Fleischman F, Mack WJ, Hendrix JA, Magee GA Abstract OBJECTIVES: To review complications associated with perioperative lumbar drain (LD) placement for endovascular aortic repair. METHODS: Patients who had perioperative lumbar drain placement for endovascular repair of thoracic and thoracoabdominal aortic pathologies from 2010-2019 were reviewed. The primary endpoints were major and minor LD-associated complications. Complications that resulted in neurological sequelae, required intervention, or delay in operation were defined as major. These included intracranial hemorrhage, symptomatic spinal hematoma, cerebrospinal fluid (CSF) leak requiring intervention, meningitis, retained catheter tip, arachnoiditis, and bloody tap resulting in delayed operation. Minor complications were defined as bloody tap without delay in operation, asymptomatic epidural hematoma, and CSF leak with no intervention required. Isolated headaches were recorded separately due to minimal clinical impact. RESULTS: There were 309 LD placed in 268 consecutive patients for 222 TEVAR, 85 complex EVAR (F-BEVAR/parallel grafting), and 2 EVAR (65±13 years, 71% male) for aortic pathology including 47% aneurysm, 49% dissection, 3% penetrating aortic ulcer, and 0.6% traumatic injury. A dedicated neurosurgical team performed all LD procedures, the majority performed by the same individual, with a technical success rate of 98%. Radiological guidance was required in 3%. Reasons for unsuccessful placement were body habitus (2) and severe spinal disease (3). Most were placed prophylactically (96%). The overall complication rate was 8.1% (4.2% major, 3.9% minor). Major complications included spinal hematoma with paraplegia (1), intracranial hemorrhage (2), meningitis (2), arachnoiditis (3), CSF leak requiring a blood patch (3), bloody tap delaying operation (1), and a retained catheter tip (1). Patients who had prior LD placement had significantly more major LD-related complications (12.2% v s. 3%, p=.019). The rate of total LD-associated complications did not differ between prophylactic and emergent therapeutic placements (8.1% vs. 7.7%, p=1), and neither did major or minor complications. On multivariate analysis, prior LD placement and an overweight body mass index were the only independent predictors of major LD-related complications. CONCLUSION: Complications associated with LD placement can be severe even when performed by a dedicated team. Prior lumbar drain placement and overweight BMI associated with significantly higher risk of complications, but emergent therapeutic placement is not. While these risks are justified in therapeutic LD placement, the benefit of prophylactic lumbar drain placement to prevent paraplegia should be weighed against these serious complications. PMID: 33053415 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ethmoid Sinus Mucosal and Lacrimal Sac Flap Anastomosing in Patients With Failed Dacryocystorhinostomy.

a.sfakia shared this article with you from Inoreader Ethmoid Sinus Mucosal and Lacrimal Sac Flap Anastomosing in Patients With Failed Dacryocystorhinostomy. Via leak of cerebrospinal fluid Ethmoid Sinus Mucosal and Lacrimal Sac Flap Anastomosing in Patients With Failed Dacryocystorhinostomy. J Craniofac Surg. 2020 Oct 12;: Authors: Yu B, Xia Y, Ji Y, Tu Y, Wu W Abstract PURPOSE: The aim of this work is to demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing in patients with previous failed DCR. METHODS: The clinical data of patients who suffered from recurrent epiphora after failed DCR between September 2014 and March 2018 were reviewed retrospectively. Among them, those who received the second En-DCR procedure were enrolled in this study. During the surgery, anterior ethmoidectomy was performed. Posterior lacrimal sac flap was apposed closely to the mucosal of anterior ethmoid sinus instead of nasal flap at end of the surgery. Patients were followed up more than 12 months were included, the success rate and complications were recorded. RESULTS: Sixty-one eyes of 61 patients were enrolled in the study. The success rate of our modified En-DCR was 83.6% (51/61). Among 10 eyes with postoperative obstruction, 4 eyes caused by granuloma, 2 eyes caused by scar synechia, 2 eyes caused by membranous obstruction, and 2 eyes caused by common canalicular stenosis. No serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis, or visual impairment were occurred in this study. CONCLUSION: Endoscopic approach with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing is a good choice for patients with recurrent epiphora after previous failed DCR. PMID: 33055566 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Regional anesthesia for scapular fracture surgery: an educational review of anatomy and techniques.

a.sfakia shared this article with you from Inoreader Regional anesthesia for scapular fracture surgery: an educational review of anatomy and techniques. Via anesth pain med Regional anesthesia for scapular fracture surgery: an educational review of anatomy and techniques. Reg Anesth Pain Med. 2020 Oct 13;: Authors: Sonawane K, Balavenkatasubramanian J, Dixit H, Tayi H, Goel VK Abstract Scapular fractures are very rare, and those requiring surgical interventions are even rarer. Most scapula surgeries are done under general anesthesia with or without the regional anesthesia (RA) technique as an adjunct. Since scapular innervation is complicated, a thorough review of the relevant anatomy is warranted. In this RAPM educational article, we aimed to summarize the target nerves and blocks needed to optimize analgesia or even to provide surgical anesthesia for scapula surgeries. In this review, we are describing an algorithmic "identify-select-combine" approach, which enables the anesthesiologist to understand detailed innervation of the scapula and to obtain a procedure-specific RA technique. Procedure-specific RA would probably be the way forward for defining future RA practices. PMID: 33051238 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis.

a.sfakia shared this article with you from Inoreader Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis. Via anesth pain med Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis. Reg Anesth Pain Med. 2020 Oct 14;: Authors: Park SK, Yoon S, Kim BR, Choe SH, Bahk JH, Seo JH Abstract BACKGROUND AND OBJECTIVES: Epidural analgesia is the gold standard for post-thoracotomy pain management and can be started before or after surgical incision. This systematic review and meta-analysis investigated whether pre-emptive epidural analgesia before thoracotomy incision reduces acute and chronic post-thoracotomy pain in adults compared with epidural analgesia after incision. METHODS: We searched databases including MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing epidural analgesia initiated before (pre-emptive group) and after (control group) thoracotomy incision in adults. The primary outcomes were the pain intensity during rest and coughing within 72 hours after surgery and the incidence of pain 1 to 6 months after surgery. Data were combined with random-effects meta-analyses. We rated the quality of evidence as high, moderate, low, and very low using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. RESULTS: We included 19 trials with 1062 participants involving 529 in the pre-emptive group and 533 in the control group. The pain intensity was significantly lower at rest within 72 hours after surgery (19 studies, n=1062) and during coughing within 48 hours after surgery (11 studies, n=638), and the incidence of pain was significantly lower 1 to 6 months after surgery (6 studies, n=276) in the pre-emptive group than in the control group. The quality of evidence was moderate or low in the primary outcomes. CONCLUSIONS: Our review provides low-quality evidence that pre-emptive epidural analgesia reduces the intensity of acute pain and the incidence of chronic pain after thoracotomy in adults. PROTOCOL REGISTRATION NUMBER: CRD42019131620. PMID: 33055105 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

lnc‐HOTAIR predicts hepatocellular carcinoma in chronic hepatitis C genotype 4 following direct‐acting antivirals therapy

a.sfakia shared this article with you from Inoreader lnc‐HOTAIR predicts hepatocellular carcinoma in chronic hepatitis C genotype 4 following direct‐acting antivirals therapy Via Molecular Carcinogenesis Abstract Emerging hepatocellular carcinoma (HCC) has been sequentially reported in chronic hepatitis C virus (HCV) treated with direct‐acting antivirals (DAAs). Homeobox transcript antisense RNA (HOTAIR), an oncogene, has been reported to be associated with cancer. We investigated the predictive value of lnc‐HOTAIR for HCC surveillance in chronic HCV patients following DAAs therapy. The expression levels of lnc‐HOTAIR and ATG‐7 genes were measured in 220 with chronic HCV, following a DAAs based therapy for 12 weeks, the patients were followed‐up for attentive surveillance of HCC for 12 months after starting DAAs. In terms of lnc‐HOTAIR, patients with HCC and high viral load had significantly higher median expression levels of HOTAIR of (68 vs. 24; p = .001) and (94 vs. 52; p = .001), respectively. Moreover, the median expression level of ATG‐7 was higher in those who developed HCC (114 vs. 51; p =  .001). The expression of lnc‐HOTAIR and ATG‐7 are significant predictors of the development of HCC in HCV‐4 infected patients treated with DAAs, with a cut‐off value of 37 and 86, respectively. The increased expression levels of lnc‐HOTAIR more than 68 in HCC patients following DAAs were correlated with poorer disease outcomes compared to those with lower expression levels; however, ATG‐7 expression levels more than 114 were correlated with worse overall survival but not the progression‐free one. We suggest that high expression levels of lnc‐HOTAIR could serve as a risk assessment biomarker for HCC before and during DAAs course therapy in Chronic HCV‐4 patients, and should be rigorously taken into consideration before DAAs. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of the Electroglottographic Signal Variability in Organic and Functional Dysphonia.

a.sfakia shared this article with you from Inoreader Evaluation of the Electroglottographic Signal Variability in Organic and Functional Dysphonia. Via Vocal Fold Polyps Evaluation of the Electroglottographic Signal Variability in Organic and Functional Dysphonia. J Voice. 2020 Oct 12;: Authors: Nacci A, Macerata A, Bastiani L, Paludetti G, Galli J, Marchese MR, Barillari MR, Barillari U, Laschi C, Cianchetti M, Manti M, Berrettini S, Fattori B, Ursino F Abstract OBJECTIVES: To confirm the data reported in our previous studies on the analysis of the variability of the electroglottographic signal in the pathological voice; to evaluate possible differences in variability between organic and functional pathologies; to identify any distinctive/typical EGG patterns for these pathologies. METHODS: One hundred twenty-five subjects were enrolled (36 euphonic and 89 pathological: 24 functional dysphonia, 21 bilateral vocal nodules, 23 unilateral polyps and 21 unilateral cysts). All subjects were studied with videolaryngostroboscopy, spectrographic analysis of voice and electroglottography (EGG). The EGG signal variability was then investigated using amplitude-speed combined analysis, by means of a proprietary software algorithm. Amplitude and Speed variation were expressed as a new parameter, the Variability Index (VI), calculated both for the whole EGG signal recorded (VI-tot) and in each phase of the glottic cycle (VI-Q, absolute value; VI-Q%, percentage value). RESULTS: In the comparison of VI values between pathological and normal groups, VI-tot and VI-Q2% (which corresponds to the final phase of vocal fold contact) were significantly greater in pathological subjects (P= 0.002). The comparison of VI values among subgroups of the various pathologies showed a difference for VI-tot (P< 0.0001) and VI-Q2% (P= 0.001); this difference was more marked in the cysts than in the functional dysphonia. The cut-off values of VI-tot and VI-Q2% were 0.191 and 18.17%, respectively (sensitivity and specificity 65.2% and 66.7% for VI-tot and 84.3% and 77.8% for VI-Q2%). CONCLUSIONS: The variability of the EGG signal investigated through the combined analysis of the amplitude and the speed of vibration using a proprietary algorithm software has proved useful not only to distinguish the normal voice from the pathological voice, but also to characterize which phases are more altered in the various voice pathologies studied, both functional and organic. Furthermore, the analysis of the VI parameter allowed to propose cut-off values characterized by a good sensitivity and specificity to discriminate dysphonia from the euphonic voice. Larger groups of patients will be needed to confirm these results. PMID: 33060006 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.