Post-dural puncture headache following lumbar spinal drain: an atypical presentation with cognitive symptoms

xlomafota13 shared this article with you from Inoreader Post-dural puncture headache following lumbar spinal drain: an atypical presentation with cognitive symptoms Via leak of cerebrospinal fluid Anaesth Rep. 2021 Jul 23;9(2):e12127. doi: 10.1002/anr3.12127. eCollection 2021 Jul-Dec. ABSTRACT Post-dural puncture headache is a consequence of cerebrospinal fluid loss, leading to reduced intracranial pressure. Its classical symptoms include a frontal-occipital headache which is worse on standing, neck stiffness, nausea, hearing loss and photophobia. In this report, we describe an atypical presentation of post-dural puncture headache in a 72-year-old woman following an endovascular repair of an aortic aneurysm, before which a lumbar spinal drain was placed to reduce the risk of spinal cord ischemia. Following drain removal, the patient developed hypoactive delirium, challenges with both depth perception and fine motor skills and a mild headache. An epidural blood patch was performed, which resulted in the complete resolution of her symptoms. This case highlights an atypical presentation of post-dural puncture headache in an older patient, in whom the major symptoms were cognitive. Cerebrospinal fluid leakage should be considered as a cause of postoperative delirium in patients who have undergone neuraxial anaesthesia. PMID:34396133 | PMC:PMC8340929 | DOI:10.1002/anr3.12127 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Survival and prognosis of lung large cell neuroendocrine carcinoma

xlomafota13 shared this article with you from Inoreader Survival and prognosis of lung large cell neuroendocrine carcinoma Via Association française pour l'étude du cancer Bull Cancer. 2021 Aug 12:S0007-4551(21)00208-3. doi: 10.1016/j.bulcan.2021.04.010. Online ahead of print. ABSTRACT INTRODUCTION: Only a few large-scale studies have focused on large cell neuroendocrine carcinoma, a rare type of pulmonary malignancy, and uniform diagnostic criteria and standardized treatments are lacking. This study aimed to assess the treatment outcomes and factors influencing patients' prognosis with large cell neuroendocrine carcinoma. METHODS: The data of 55 patients with pathologically confirmed large cell neuroendocrine carcinoma, treated at our hospital from January 2013 to January 2018, were collected. Relationships between clinical characteristics, diagnoses, treatment outcomes, and prognoses were retrospectively analyzed. RESULTS: Patients were followed for a median of 18.5 (0.5-41.0) months. Thirty-four patients died before the final follow-up, resulting in a median overall survival of 17.9 (0.5-3 6.0) months, with 1-, 2-, and 3-year survival rates of 69.1%, 23.6%, and 1.8%, respectively. Single-factor analysis identified gender (P=0.036), smoking history (P=0.008), obstructive atelectasis (P=0.032), regional lymph node metastasis (P=0.020), and treatment selection (P=0.000) as factors influencing overall survival. Multifactor analysis identified treatment selection as an independent survival prognostic factor. Particularly, significant differences were observed between the combination therapies (surgery+chemotherapy, surgery+radiotherapy, surgery+radiotherapy+chemotherapy, and concurrent chemoradiotherapy) and single-therapy approaches (chemotherapy or radiotherapy alone; P<0.001), but not among the combination therapies (P=0.216). DISCUSSION: Male patients with large cell neuroendocrine carcinoma with a history of smoking, obstructive atelectasis, and regional lymph node metastasis have a particularly poor prognosis. Our observation of the treatment approach as an independent survival prognostic factor suggests that combination therapies may yield survival benefits to patients. PMID:34392973 | DOI:10.1016/j.bulcan.2021.04.010 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Patterns of Regional Recurrence and Salvage Treatment in Patients With Oral Cancer

xlomafota13 shared this article with you from Inoreader Patterns of Regional Recurrence and Salvage Treatment in Patients With Oral Cancer Via The Laryngoscope Objectives Regional failure after primary treatment for oral squamous cell carcinoma (OSCC) carries a dismal outcome. Our goal was to investigate the recurrence patterns and salvage treatment in patients with OSCC and regional failure. Study design Retrospective chart review of all patients treated for OSCC in a university-affiliated tertiary care center during 2000-2018. Methods Data collected from patients' medical charts included demographics, clinical and pathological features, staging, treatment modalities and outcomes. Patients with insufficient data or a follow-up of less than 2 years were excluded. Results Out of 266 surgically treated patients, 55 developed regional recurrence and were included in the study cohort. Forty patients received surgical salvage treatment followed by adjuvant chemo-radiotherapy (CRT). Disease specific survival and overall survival were significantly higher in surgically treated patients compared to patients who received non-surgical treatment (46.7% vs. 0%, log-rank P value < .001 and 35.3% vs. 0%, log-rank P value = .001, respectively) and in patients who recurred regionally more than 10 months following initial treatment (40.8% vs 10.7%, log-rank P value = .065). Patients with early recurrence were older (73.6 vs. 61.3 years) and had a deeper invasion of the primary tumor (10.1 vs. 7 mm). Conclusions Salvage neck dissection is feasible in most cases, providing the best outcomes in patients with OSCC who fail regionally. Close follow-up during the first year after initial treatment is paramount as early recurrence carries a dismal prognosis. Specifically, elderly patients and patients with deeper primary tumor invasion should be closely monitored during the first post-operative year. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of Povidone‐Iodine Nasal Irrigation Solution After Sinonasal Surgery: A Randomized Controlled Study

xlomafota13 shared this article with you from Inoreader Efficacy of Povidone‐Iodine Nasal Irrigation Solution After Sinonasal Surgery: A Randomized Controlled Study Via The Laryngoscope Objectives/Hypothesis To evaluate the efficacy of postoperative nasal irrigation with povidone-iodine (PVP-I) solution in patients undergoing sinonasal surgery. Study Design Single-blind, randomized controlled study. Methods This is a prospective, single-blind, randomized controlled study. Patients with chronic rhinosinusitis (CRS) and hypertrophic inferior turbinates who underwent endoscopic sinus surgery (ESS) and inferior turbinate reduction were enrolled in the study. Patients were evaluated using the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22), rhinomanometry, endoscopic examination, and bacterial cultures. One week after the operation, patients were randomly assigned to either a 0.1% PVP-I nasal irrigation group or a control (normal saline) irrigation group. We then compared the two groups' results to illustrate the effects of nasal irrigation with PVP-I solution following sinonasal surgery. Results Of the 55 patients that completed the study, 27 patients were in the PVP-I group and 28 were in the control group. In both groups, the TWSNOT-22 scores, Lund-Kennedy endoscopic scores, and total nasal resistance (TNR) all revealed significant improvements at 3 months postoperatively compared with preoperative measurements (all, P < .05). However, there were no significant differences between the two groups in TWSNOT-22, endoscopic, or TNR scores 3 months after the operation (all, P > .05). Conclusions A dilute 0.1% PVP-I nasal irrigation as a postoperative care modality after sinonasal surgery did not provide additional benefit compared with normal saline irrigation. Level of Evidence 2 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Systematic Review on Vestibular Symptoms in Patients With Enlarged Vestibular Aqueducts

xlomafota13 shared this article with you from Inoreader Systematic Review on Vestibular Symptoms in Patients With Enlarged Vestibular Aqueducts Via The Laryngoscope Objective Enlarged vestibular aqueduct (EVA) is a congenital condition that can lead to various outcomes in pediatric patients including hearing loss and vestibular dysfunction. Our goal was to critically appraise the literature on the proportion of patients with EVA who report vestibular dysfunction, determine relevant risk factors for the development of these symptoms, and describe vestibular tests and interventions used to improve outcomes. Methods A systematic review was performed in accordance with the PRISMA guidelines. We queried the EMBASE, Ovid Medline, and Cochrane Library databases for relevant literature. Studies were included if they had n > 10, reported vestibular symptoms or vestibular function testing in patients with EVA, and were published in English. Nonhuman studies, systematic reviews, and review articles were excluded. Results Of 808 identified studies, 20 met inclusion criteria. Subjective vestibular symptoms included dizziness, episodic vertigo, and imbalance. Seventeen studies reported subjective vestibular symptoms, ranging from 2% to 71% of patients between studies. Seventeen studies performed some form of vestibular function test, including physical exam maneuvers (Dix-Hallpike), caloric testing, electronystagmography, and vestibular evoked myogenic potentials. Of those who had vestibular function testing, 7% to 92% had an abnormal result. Two studies identified head trauma as a risk factor. One study successfully treated patients with BPPV using the Epley maneuver, but other vestibular symptoms were not targeted with treatment. Conclusion The degree to which vestibular symptoms impact patients with EVA varies significantly. Performing vestibular function testing may help identify asymptomatic patients with vestibular dysfunction. Future studies should target improving treatment of vestibular symptoms in EVA patients. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence of the fabella and its general characteristics in Turkish population with magnetic resonance imaging

xlomafota13 shared this article with you from Inoreader Prevalence of the fabella and its general characteristics in Turkish population with magnetic resonance imaging Via radiol anat Surg Radiol Anat. 2021 Aug 16. doi: 10.1007/s00276-021-02817-3. Online ahead of print. ABSTRACT INTRODUCTION: The fabella is a fibrocartilaginous or ossified sesamoid bone in the knee, largely located in the lateral tendon of the head of the gastrocnemius muscle. In this study, the prevalence, gender differences, localization and size of the fabella were determined in a Turkish population to make a comparison with other population studies in the literature. MATERIALS A ND METHODS: Thousand patients (500 females, 500 males) who underwent knee magnetic resonance imaging (MRI) with fabella in all three planes, including axial, sagittal and coronal evaluated, retrospectively. All MRI examinations were performed using a 1.5 T unit. Patients with a history of trauma or operation, motion artifacts and patients who could not be evaluated due to image quality were excluded. Anteroposterior diameter in sagittal plan (sAP) of the fabella and the fabella-femur distance was measured. Measurements were evaluated with Pearson's Chi-squared and Mann-Whitney U test for non-homogeneous data in SPSS program, and ANOVA test for homogeneous data. A p value of < 0.05 was considered significant in all analyses. RESULTS: The overall prevalence of fabella was found to be 155 cases. Unilateral fabella was detected in 72.9% of the cases, of which 56.6% were on the right side and 43.4% were on the left side. The median value of AP diameter in sagittal plan was calcu lated as 4.40 ± 1.31 mm. Concerning the gender-related examination the sAP diameter of the fabella was larger in men than in women (p < 0.05). The median value of FFD was calculated as 2.50 ± 0.50 mm. The distribution of FFD between genders was not statistically significant (p = 0.492). CONCLUSION: The fabella is usually a sesamoid bone that can be detected incidentally by imaging techniques. The incidence in the Turkish population is 15.5%, and no gender difference was detected. It is clear that further studies on the basis of populations are needed, especially considering that pathological problems remain in question and there is a lack of scientific data (variations, developmental characteristics, etc.) on sesamoid bones. PMID:34398300 | DOI:10.1007/s00276-021-02817-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Exercise-Induced Hypoalgesia Profile in a Rat Neuropathic Pain Model Predicts Pain Severity Following Infraorbital Nerve Injury and Is Associated with Local Cytokine Levels, Systemic Endocannabinoids, and Endogenous Opioids

xlomafota13 shared this article with you from Inoreader Exercise-Induced Hypoalgesia Profile in a Rat Neuropathic Pain Model Predicts Pain Severity Following Infraorbital Nerve Injury and Is Associated with Local Cytokine Levels, Systemic Endocannabinoids, and Endogenous Opioids Via pubmed: "j oral facial pain ... J Oral Facial Pain Headache. 2021 Aug 16. doi: 10.11607/ofph.3003. Online ahead of print. ABSTRACT AIMS: To investigate the role of exercise-induced hypoalgesia (EIH) in the development of neuropathic pain (NP) following infraorbital nerve (ION) injury and to explore possible underlying mechanisms defining the differences between rats with high and low EIH. METHODS: EIH was evaluated by measuring the percentage of withdrawal responses to a series of 30 mechanical stimu li applied to the hind paw before and after 180 seconds of exercise on a rotating rod. The rats were assigned to low- and high-EIH groups based on reduction in the percent of withdrawal responses following exercise. NP was induced in high- and low-EIH rats via ION constriction injury. Rats were tested with graded nylon monofilaments to establish the withdrawal threshold. Increasingly stiff monofilaments were applied to the ION territory until there was a clear withdrawal by the rat. This was repeated a total of three times. A decreased withdrawal threshold indicates allodynia. Testing was performed at baseline and at 3, 10, and 17 days following the injury. On day 17 postinjury, IONs were harvested for the assessment of interleukin (IL)-6, IL-1β, and IL-10 levels. Samples from high-EIH and low-EIH surgically naïve rats served as control for the cytokines study. In this second part of the study, the effects of cannabinoid 1 (CB1) and cannabinoid 2 (CB2) antagonists and naltrexone o n EIH profiles and on the withdrawal thresholds to mechanical stimulation were measured. EIH and withdrawal thresholds in high- and low-EIH rats were measured before and after administration of antagonists. RESULTS: Low-EIH rats developed significantly more pronounced allodynia in the ION territory following injury compared to high-EIH rats. At 17 days postinjury, ION IL-1β levels were higher in low-EIH rats, and IL-10 levels were higher in high-EIH rats. CB1 antagonist blocked the analgesic effect induced by exercise in high- but not in low-EIH rats. The CB2 antagonist had no significant effect on high- or low-EIH rats. Naltrexone blocked the effects of EIH in both high- and low-EIH rats. Exercise induced a significant analgesic effect in high-EIH but not in low-EIH rats. CB1 or CB2 antagonist administration had no effect on pre-exercise responses to mechanical stimulation, while naltrexone administration resulted in significant allodynia in both low- and high-EIH rats. < p>CONCLUSION: This study demonstrated substantial differences between rats with high and low EIH. The results suggest that following ION injury, high-EIH rats may have a more prominent or activated endocannabinoids system and that their inflammatory response is moderated, with higher levels of IL-10 and lower levels of IL-1β. PMID:34398938 | DOI:10.11607/ofph.3003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is Fas‐mediated apoptosis of melanocytes indispensable in vitiligo?

xlomafota13 shared this article with you from Inoreader Is Fas‐mediated apoptosis of melanocytes indispensable in vitiligo? Via Experimental Dermatology Abstract With interest, we have read the article by Jimbo et al. in Experimental Dermatology 1. The authors reported that the Fas pathway is involved in CD8+ T-lymphocyte-dependent depigmentation in a vitiligo mouse model. Tumor necrosis factor (TNF)-α and interferon, (IFN)-γ whose expression is elevated in lesional skin of vitiligo patients, synergistically upregulated Fas expression but suppressed Fas-mediated apoptosis of human melanocytes in vitro. While there is no doubt that vitiligo results in cell death of these cells we wondered if patients with mutations of the FAS gene are resistant to develop vitiligo. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes between intensity‐modulated radiation therapy versus 3D‐conformal in early stage glottic cancer

xlomafota13 shared this article with you from Inoreader Outcomes between intensity‐modulated radiation therapy versus 3D‐conformal in early stage glottic cancer Via Head & Neck Abstract Background The purpose of this study is to evaluate practice patterns and outcomes between intensity-modulated radiation therapy (IMRT) and 3D-conformal radiation (3D-CRT) in early stage glottic cancer. Methods The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify and compare patient and disease profiles, mortality, and toxicity in patients with T1-2 larynx cancer undergoing definitive radiation (RT). Results A total of 1520 patients underwent definitive radiation with 3D-CRT (n = 1309) or IMRT (n = 211). Non-white race, those with a Charlson Comorbidity Index ≥2, T2 disease, and those treated at community practices were more likely to undergo IMRT. Rates of IMRT increased from 2006 to 2015, while relative rates of 3D-CRT decreased. Two-year CSS was superior with 3D-CRT (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.22–0.65; p < 0.001). There was no difference in OS between 3D-CRT and IMRT (p = 0.119). Conclusions Patients receiving 3D-CRT had improved CSS compared to IMRT with no difference in OS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients

xlomafota13 shared this article with you from Inoreader Transoral endoscopic thyroidectomy vestibular approach: Experience from a multicenter national group with 412 patients Via Head & Neck Abstract Background Well-established conventional thyroidectomy has satisfactory outcomes; however, robotic and endoscopic thyroid surgery can avoid visible anterior neck scars. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recent of these techniques. Methods This was a retrospective review of 412 patients who underwent TOETVA from 2017 to 2020 in 13 Brazilian centers. Results The study included 359 (87.1%) females and 53 (12.9%) males, with a mean age of 40 years. There were 231 (56.1%) total thyroidectomies. The conversion rate was 0.7%. The transient vocal cord palsy rate was 7.6% (30 patients). Temporary and persistent hypocalcemia rates were 4.0% and 0.8%, respectively. There were two cases of infection (0.5%). Discussion This is a large multi-institute TOETVA study, with one of the largest cohorts published to date that; despite its retrospective nature and selection bias, reached outcomes comparable to previously reported series, this study reinforced safeness, feasibility, and nationwide reproducibility for this technique. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Sarcopenia in Older Patients Undergoing Head and Neck Cancer Surgery

xlomafota13 shared this article with you from Inoreader Evaluation of Sarcopenia in Older Patients Undergoing Head and Neck Cancer Surgery Via The Laryngoscope Objectives/Hypothesis Sarcopenia is a hallmark of aging and its identification may help predict adverse postoperative events in patients undergoing head and neck surgery. The study objective was to assess the relationship between sarcopenia and postoperative complications and length of stay in patients undergoing major head and neck cancer surgery. Study Design Prospective cohort study. Methods A prospective cohort study was performed of patients 50 years and older undergoing major head and neck surgery. Sarcopenia was defined as low muscle mass (determined by neck muscle cross-sectional imaging) with either low muscle strength (grip strength) or low muscle performance (timed walk test). Logistic regression was applied on binary outcomes, and linear regression was used for log-transformed length of hospital stay (LOS). Univariate and multivariate analyses were performed. Results Of the 251 patients enrolled, pre-sarcopenia was present in 34.9% (n = 87) and sarcopenia in 15.6% (n = 39) of patients. Patients with sarcopenia were more likely to be older (P = .001), female (P = .001), have a lower body mass index (P = .001), and lower preoperative hemoglobin (P < .001). On univariate analysis, the presence and severity of sarcopenia was associated with the development of medical complications (P = .029), higher grade of complications (P = .032), LOS (P = .015), and overall survival (P = .001). On multivariate analysis, sarcopenia was associated with a longer LOS (β = 0.32 [95% CI: 0.19–0.45], P < .001) and worse overall survival (HR = 2.21 [95% CI: 1.01–4.23], P = .017). Conclusions Sarcopenia may aid in the prediction of prolonged hospital stay and death in patients who are candidates for major head and neck surgery. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.