Resection of the internal carotid artery in selected patients affected by cancer of the skull base

xlomafota13 shared this article with you from Inoreader Resection of the internal carotid artery in selected patients affected by cancer of the skull base Via Head & Neck Abstract Invasion of the internal carotid artery (ICA) has been historically considered a criterion of non-resectability of skull base cancer (SBC). Patients affected by SBC who underwent surgery including resection of ICA at two tertiary institutions were included. Demographics, oncologic, and surgical information, complications, and survival outcomes were retrospectively reviewed. Survival outcomes were calculated. Ten patients were included. Three surgical approaches (transnasal endoscopic, transorbital, and transpetrosal) were employed to resect the invaded/abutted tract(s) of the ICA. All patients underwent ICA temporary balloon occlusion test. In two patients, an extracranial-to-intracranial arterial bypass was harvested. Major neuromorbidity was observed in two patients. Perioperative mortality of the series was 10.0%. Mean overall survival was 27.2 months, with 2-year overall and progression-free survival rate of 88.9%. ICA resection is feasible as part of the ablation perform ed for very advanced SBCs. Survival outcomes are acceptable in adequately selected patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan

xlomafota13 shared this article with you from Inoreader Prevalence and Treatment Outcomes of Marine-Lenhart Syndrome in Japan Via radioactive iodine Eur Thyroid J. 2021 Nov;10(6):461-467. doi: 10.1159/000510312. Epub 2020 Sep 30. ABSTRACT INTRODUCTION: Marine-Lenhart syndrome (MLS) is now understood to be a combination of Graves' disease and autonomously functioning thyroid nodule(s) (AFTNs). The prevalence of the syndrome and suitable treatments for those living in iodine-sufficient areas are uncertain. OBJECTIVES: We aimed to investigate the prevalence, treatment, and prognosis of MLS in Japan, an iodine-sufficient area. METHODS: This study involved patients who visited our hospital between February 2005 and August 2019. Among patients with both thyrotoxicosis and thyroid nodule(s) larger than 10 mm, MLS and isolated AFTNs were diagnosed based on serum thyroid-stimulating hormone receptor antibody levels and scintigraphy using radioiodine or technetium-99m and thyroid uptake. RESULTS: Twenty-two patients were found to have MLS, compared to 372 with isolated AFTNs and 8,343 with Graves' disease, during the period. Therefore, the rate of MLS cases was 0.26% among all patients with Graves' disease (22/8,343). Treatments and outcomes were assessed for cases of MLS (n = 18) and isolated AFTNs (n = 269). Antithyroid drugs (ATDs) were withdrawn in 27.8% of cases in the MLS group and 10.3% in the isolated AFTN group. There was no significant difference in the clinical outcome after ATD withdrawal between the 2 groups. However, the rate of hypothyroidism after radioactive iodine (R AI) administration was significantly higher in the MLS group than in the isolated AFTN group (42.9 vs. 9.0%, p = 0.005) despite similar doses of RAI. CONCLUSIONS: The prevalence of MLS among patients with Graves' disease was 0.26% in Japan. RAI therapy induces hypothyroidism more frequently than in those with AFTNs probably because RAI is taken up in the surrounding Graves' tissues. PMID:34950599 | PMC:PMC8647058 | DOI:10.1159/000510312 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma

xlomafota13 shared this article with you from Inoreader Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma Via leak of cerebrospinal fluid Diagnostics (Basel). 2021 Dec 6;11(12):2278. doi: 10.3390/diagnostics11122278. ABSTRACT The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20-82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 yea rs also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group. PMID:34943515 | DOI:10.3390/diagnostics11122278 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report

xlomafota13 shared this article with you from Inoreader Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report Via radioactive iodine Case Rep Oncol. 2021 Nov 8;14(3):1596-1600. doi: 10.1159/000520128. eCollection 2021 Sep-Dec. ABSTRACT Neuropsychiatric symptoms, especially acute psychosis (often referred to as myxedema madness or psychosis), are rare but possible clinical presentations of patients with hypothyroidism. A 42-year-old woman with papillary thyroid carcinoma and recent total thyroidectomy had developed flat affect, paranoid delusion, and visual and auditory hallucination during inpatient admission fo r elective radioactive iodine treatment. On admission, her history and physical exam did not reveal symptoms and signs of significant hypothyroidism. Other medical causes of acute psychosis were excluded, and the patient was immediately treated with thyroid hormone replacement therapy. Subsequently, her thyroid function normalized, and her psychotic symptoms gradually improved. Although there is a lack of classic signs and symptoms of hypothyroidism, myxedema madness should be recognized as one of the potentially treatable causes of acute psychosis. PMID:34950002 | PMC:PMC8647114 | DOI:10.1159/000520128 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sub-brow skin excision Combined with retro-orbicularis fat resection: A Technique for upper eyelid bulkiness and laxity correction

xlomafota13 shared this article with you from Inoreader Sub-brow skin excision Combined with retro-orbicularis fat resection: A Technique for upper eyelid bulkiness and laxity correction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 27:S1748-6815(21)00603-3. doi: 10.1016/j.bjps.2021.11.059. Online ahead of print. ABSTRACT BACKGROUND: Many people are characterized by a swollen appearance and loose skin of upper eyelids, especially Asians. Retro-orbicularis oculus fat (ROOF) lying in the lateral canthus area is a critical factor of the bulkiness formation. Although several approaches have been reported, most of them intend to remove orbicularis muscle and preaponeurotic fat through a double-eyelid incision, leaving ROOF untreated. Consequently, an unnatural eyelid fold is formed and the lateral supraorbital region remains bloated . METHODS: Sixty-seven patients underwent sub-brow skin excision combined with ROOF resection. The key point was to excise the loose skin and thick ROOF through an incision along with the lower 1/3 of the eyebrow. Surgical outcomes were evaluated 6 months postoperatively by the heights of the de signed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC). The pinch test, photographs, and complications were also recorded. RESULTS: The preoperative average HPPC, HPMC, and HPLC were 9.68 ± 1.73, 7.68 ± 1.24, and 6.82 ± 1.12 mm, while the postoperative average measurements were 7.25 ± 0.51, 5.99 ± 0.54, and 5.54 ± 0.61 mm, respectively. The result of the pinch test was improved and postoperative scarring was inconspicuous. Two patients had transient numbness in the eyebrow region that subsided within seven days. Two patients had slight asymmetry of eyebrow position but did not need a second operation. CONCLUSIONS: Sub-brow skin excision combined with ROOF resection is an effective technique for improving upper eyelid bulkiness and skin excess with low revision rates. PMID:34949571 | DOI:10.1016/j.bjps.2021.11.059 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of Endolymphatic Sac Surgery for Meniere’s Disease with and without Comorbid Migraine

xlomafota13 shared this article with you from Inoreader Outcomes of Endolymphatic Sac Surgery for Meniere's Disease with and without Comorbid Migraine Via International Journal of Otolaryngology Purpose. To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine. Materials and Methods. A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results. Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, ), shorter duration of vertigo episodes (143 vs. 393 min, ), and younger age (36.6 vs. 50.8 yr, ) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 (). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference (). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions. Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer

xlomafota13 shared this article with you from Inoreader Regulation of nuclear medicine services: Perception of the problems and challenges in Colombia for the approach to cancer Via radioactive iodine Biomedica. 2021 Dec 15;41(4):692-705. doi: 10.7705/biomedica.6123. ABSTRACT Introduction: Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer. Objective: To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia. Materials and methods: We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance. Results: The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors' criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs. Conclusions: Our findings suggest th at nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care. PMID:34936254 | DOI:10.7705/biomedica.6123 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Machine learning can identify patients at risk of hyperparathyroidism without known calcium and intact parathyroid hormone

xlomafota13 shared this article with you from Inoreader Machine learning can identify patients at risk of hyperparathyroidism without known calcium and intact parathyroid hormone Via Head & Neck Abstract Background To prove the concept of diagnosing primary hyperparathyroidism (pHPT) without calcium and parathyroid hormone (PTH) values and identifying potential risk factors for pHPT. Methods Data were extracted from the clinical data warehouse (CDW) at the University of Arkansas for Medical Sciences (UAMS) Epic EHR (2014–2019). Results 1737 patients with over 185 000 rows of clinical data were provided in a relational structure and processed/flattened to facilitate modeling. Phenotype elements were identified for pHPT without advance knowledge of calcium and PTH levels. The area under the curve (AUC) for the prediction of pHPT using our model was 0.86 with sensitivity and specificity of 0.8953 and 0.6686, respectively, using a 0.45 probability threshold. Conclusion Primary hyperparathyroidism was predicted from a dataset excluding calcium and PTH data with 86% accuracy. This approach needs to be validated/refined on larger samples of data and plans are in place to do this with other regional/national datasets. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Proof of Concept Study For Using UR10 Robot To Help Total Hip Replacement

xlomafota13 shared this article with you from Inoreader Proof of Concept Study For Using UR10 Robot To Help Total Hip Replacement Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The demand for total hip replacement (THR) for treating osteoarthritis has grown substantially worldwide. The existing robotic systems used in THR are invasive and costly. This study aims to develop a less-invasive and low-cost robotic system to assist THR surgery. Methods A preliminary robotic reaming system was developed based on a UR10 robot equipped with a reamer to cut acetabulum. A novel approach was proposed to cut through a 5mm hole in femur such that the operation is less invasive to the patients. Results The average error of the cutting hemisphere by the robotic reaming system is 0.118 2 mm which is smaller than the average result reaming by hand (0.130 1 mm) Conclusion The robotic reaming can help make THR procedures less invasive and more accurate. Moreover, the system is expected to be significantly less expensive than the robotic systems available in the market at present. This article is protecte d by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Systematic Review of Robotic Surgery: From Supervised Paradigms To Fully Autonomous Robotic Approaches

xlomafota13 shared this article with you from Inoreader A Systematic Review of Robotic Surgery: From Supervised Paradigms To Fully Autonomous Robotic Approaches Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background From traditional open surgery to laparoscopic surgery and robot-assisted surgery (RAS), advances in robotics, machine learning, and imaging are pushing the surgical approach to-wards better clinical outcomes. Pre-clinical and clinical evidence suggests that automation may standardise techniques, increase efficiency, and reduce clinical complications. Methods A PRISMA-guided search was conducted across PubMed and OVID. Results Of the 89 screened articles, 51 met the inclusion criteria, with 10 included in the final review. Automatic data segmentation, trajectory planning, intra-operative registration, trajectory drilling, and soft tissue robotic surgery were discussed. Conclusion Although automated surgical systems remain conceptual, several research groups have developed supervised autonomous robotic surgical systems with increasing consideration for ethico-legal issues for automation. Automation paves the way for precision surgery and improved safety and opens new possibilities for deploying more robust artificial intelligence models, better imaging modalities and robotics to improve clinical outcomes. 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.

Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

xlomafota13 shared this article with you from Inoreader Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program Via The Laryngoscope Objectives/Hypothesis Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC. Methods Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported. Results Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 ± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75–6.26), fatigue (OR = 2.43, 95% CI = 1.1.7–5.05), anxiety (OR = 1.63, 95% CI = 1.30–2.05), and depression (OR = 1.51, 95% CI = 1.04–2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation. Conclusions Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.