Monday, March 14, 2022

Chemosaturation with percutaneous hepatic perfusion of melphalan for metastatic uveal melanoma

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imageUveal melanoma, the most common primary ocular malignancy in adults, carries a poor prognosis: 50% of patients develop the metastatic disease with a 10–25% 1-year survival and no established standard of care treatment. Prior studies of melphalan percutaneous hepatic perfusion (M-PHP) have shown promise in metastatic uveal melanoma (mUM) patients with liver predominant disease but are limited by small sample sizes. We contribute our findings on the safety and efficacy of the procedure in the largest sample population to date. A retrospective analysis of outcome and safety data for all mUM patients receiving M-PHP was perfor med. Tumour response and treatment toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events v5.03, respectively. 250 M-PHP procedures were performed in 81 patients (median of three per patient). The analysis demonstrated a hepatic disease control rate of 88.9% (72/81), a hepatic response rate of 66.7% (54/81), and an overall response rate of 60.5% (49/81). After a median follow-up of 12.9 months, median overall progression-free (PFS) and median overall survival (OS) were 8.4 and 14.9 months, respectively. There were no fatal treatment-related adverse events (TRAE). Forty-three grade 3 (29) or 4 (14) TRAE occurred in 23 (27.7%) patients with a significant reduction in such events between procedures performed in 2016–2020 vs. 2012–2016 (0.17 vs. 0.90 per patient, P
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Real-world frequency of BRAF testing and utilization of therapies in patients with advanced melanoma

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imageBoth BRAF/MEK targeted agents and immunotherapy are approved for the treatment of advanced melanoma. BRAF testing is recommended at the time of advanced melanoma diagnosis. In addition, little is known regarding the treatment trends for patients with BRAF mutated tumors. This investigation aims to assess the real-world prevalence of molecular testing and treatment trends for patients with BRAF mutated tumors. Using a de-identified database, patients of age ≥18 years with advanced melanoma from 2013 to 2018 were examined. Molecular testing performed within 3 months of advanced diagnosis was considered to have the test pe rformed at the time of diagnosis. Test prevalence was calculated and compared in groups stratified by the patient, tumor and treatment factors. In total 4459 patients were included; 1936 (43.4%) stage III, 1191 (26.7%) stage IV and 1332 (29.9%) recurrent. Totally 50.4% of patients received systemic treatment; 76.4% stage IV, 71% recurrent patients and 26.7% stage III patients. However, 73.5% received first-line immunotherapy. In total 73.8% of patients had molecular testing, and 50.5% had tested at the time of advanced diagnosis. Of those tested 42% had a BRAF mutated tumor. In total 48% of these patients received first-line immunotherapy whereas 43% received a BRAF inhibitor, with increasing immunotherapy use seen over time. The majority of patients with advanced melanoma undergo molecular testing at the time of advanced diagnosis. Immunotherapy is the most commonly prescribed treatment regardless of BRAF mutational status. These results provide real-world data on the frequency of molecular testing and treatment trends for patients with advanced melanoma.
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Proof-of-concept of a new FFP2 mask adapted to Otolaryngological practice in pandemic: a prospective study

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Eur Arch Otorhinolaryngol. 2022 Mar 14. doi: 10.1007/s00405-022-07319-5. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to appreciate the tolerance and convenience of a new FFP2 mask allowed the realization of nasal examination in period of pandemic.

METHODS: Fifty-one patients were prospectively recruited from two European hospitals to test the FFP2 mask prototype. The following outcomes were evaluated in patients after the clinical examination: fear about coronavirus disease 2019 (COVID-19) infection; easiness of mask placement; tolerability; reassurance; and overall satisfaction about the use of this kind of mask in a pandemic context. Seven otolaryngologists evaluated the mask acceptance and usefulness in patients through a standardized physician-reported outcome questionnaire.

RESULTS: Fifty patients completed the evaluation. There were 25 males and 25 females. The mean age of patients was 4 1 years. Ninety percent of patients considered that the use of the mask reduced the risk to be infected during the examination. Seventy percent of patients reported high or very high satisfaction and should recommend mask to other patients in pandemic period. The realization of nasal examination was easier with optic compared with flexible trans-nasal examination (p = 0.001), which significantly impacted the satisfaction level of physician (p = 0.001). The physician difficulty to perform the examination significantly impacted the satisfactory of patient (p = 0.033).

CONCLUSION: The new bioserenity FFP2 mask allows the realization of the trans-nasal endoscopic examination during a pandemic. The use of this mask requires little training period of physician. The use of this mask prototype is well received by patients who reported better perception of self-protection against the virus.

PMID:35286440 | DOI:10.1007/s00405-022-07319-5

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Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions

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Vestn Otorinolaringol. 2022;87(1):4-8. doi: 10.17116/otorino2022870114.

ABSTRACT

To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

PMID:35274885 | DOI:10.17116/otorino2022870114

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The computed tomographic evaluation of bony bridge of C1 as bleeding risk factor at the screw placement

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Surg Radiol Anat. 2022 Mar 14. doi: 10.1007/s00276-022-02919-6. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the prevalence and morphological characteristics of ponticulus posticus (PP) and ponticulus lateralis (PL) using computed tomography (CT) images on a large study sample of the Anatolian population. The presence of the PP and PL bridges can limit gap available for placement procedure through the bony elements of C1. Routine screw techniques are contraindicat ed because of high risk of fatal bleeding of vertebral artery (VA).

METHODS: The CT images of 1000 subjects (500 males, 500 females) were examined for the morphological characteristics and presence of PP and PL. The anteroposterior diameter, superoposterior (transverse) diameter, surface area, and central thickness of the bony bridge of the PP, PL, and transverse foramina (TF).

RESULTS: The prevalence of PP was 14.8%, and bilateral complete PP was the most common PP type at 6.8%. The prevalence of PL was 4.1% and left-side complete PL was the most common PL type at 1.2%. The prevalence of both PP and PL was more common in males and bilateral complete PP were more predominant in males (p = 0.004, p = 0.038, and p = 0.010, respectively). The surface area of PP and PL were determined to be smaller than the surface area of the ipsilateral TF (p < 0.001 and p = 0.042, respectively).

CONCLUSION: PP is not an uncommon anatomic anomaly and PL is even less frequently enc ountered. The prevalence of PP and PL was more common in males and bilateral complete PP was more predominant in males. Detailed information about the prevalence and morphometry of the PP and PL obtained in the present study could guide the clinicians dealing with neurosurgery, physical medicine and rehabilitation, and radiology in their practice.

PMID:35286403 | DOI:10.1007/s00276-022-02919-6

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The issue of auditory neuropathy: from origins to the present

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Vestn Otorinolaringol. 2022;87(1):60-69. doi: 10.17116/otorino20228701160.

ABSTRACT

The issue of auditory neuropathy spectrum disorders (ANSD) has been in a focus of specialists attention for a relatively short time, but during this time a huge amount of scientific and practical knowledge about this hearing disorder has been accumulated. ANSD is a specific auditory deficit caused by dysfunction of periphery part of the auditory system, which may affect the inner hair cells, the spiral ganglion neurons and the auditory nerve, as well as the area of synaptic contact between them, while the outer hair cells, as a rule, remain intact. As a result, a specific condition is formed, in which a patient's otoacoustic emissions and/or cochlear microphonics are present, auditory brainstem responses are abnormal or absent, electrophysiological data may not correlate with hearing level, the discrepancy between pure tone audiometry and speech discrim ination is observed. ANSD prevalence, epidemiology, contemporary views on its etiology, including detailed information on hereditary forms of the disorder and its risk factors are considered in the review. The data on the basic rungs of the ANSD pathogenesis, which underlie the development of various forms of the disorder and mainly determine the rehabilitation approach, are presented. The detailed clinical and audiological characteristics of ANSD are presented; contemporary approach to ANSD diagnosis and rehabilitation, including indications for surgical treatment, are considered.

PMID:35274894 | DOI:10.17116/otori no20228701160

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Hypertrophy of adenoid vegetation in modern treatment conditions

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Vestn Otorinolaringol. 2022;87(1):70-74. doi: 10.17116/otorino20228701170.

ABSTRACT

We present data on the hypertrophy of adenoid vegetation in modern treatment conditions. Actual aspects of the etiology of hypertrophy of adenoid vegetation and chronic adenoiditis are discussed, and mechanisms of the formation of local immunity and the effect of immunomodulating therapy are also described. Data on the morphology of adenoids, immunity condition after exposure to modern drugs and the rationality of treatment in frequently ill children are presented.

PMID:35274895 | DOI:1 0.17116/otorino20228701170

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Effective intranasal GCS application strategy of mono and combines forms in treating patients, suffering from allergic rhinitis. Evidence-based medicine to help a practitioner

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Vestn Otorinolaringol. 2022;87(1):39-45. doi: 10.17116/otorino20228701139.

ABSTRACT

To summarize effective intranasal glucocorticosteroids (GCS) application strategies in treatment of patients, suffering from allergic rhinitis (depending on disease type), based on actual research results. Current study determines the place of fixed intranasal GCS and topic antihistamine medication combination, specifically azelastine and mometasone furoate, as a first line of choice therapy in treatment of patients, suffering from allergic rhinitis. Effective application of stage therapy allows us establish control over allergic inflammation and significantly decrease pharmaceutical load in cases of patients, suffering from allergic rhinitis.

PMID:35274891 | DOI:10.17116/otorino20228701139

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On the tactics of management and treatment of patients with congenital cerebral hernias in their localization in the maxillofacial region

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Vestn Otorinolaringol. 2022;87(1):87-90. doi: 10.17116/otorino20228701187.

ABSTRACT

The analysis of the state of two patients with congenital cerebral hernias was carried out, which made it possible to establish differences in the effect of hernias on the state of the body. In the first case, the hernia is localized in the nasal cavity, and after its removal, the postoperative cerebrospinal fluid (CSF) leakage was stopped by a flap of the mucous membrane from the opposite side of the nasal septum. In the second case clinical analysis and computed tomography made it possible to state that the hernia was in the retromaxillary space and did not affect the patient's condition. Computed tomography shows signs of moderate blood pressure on the adjacent formations, and removal of the hernia and stopping the subsequent CSF leakage were impossible. The presented observations demonstrate an ambiguous approach to resolving the issue of surgical i ntervention in such cases.

PMID:35274898 | DOI:10.17116/otorino20228701187

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Current views on the treatment and prevention of recurrent acute otitis media in children (review of clinical recommendations)

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Vestn Otorinolaringol. 2022;87(1):46-51. doi: 10.17116/otorino20228701146.

ABSTRACT

Recurrent acute otitis media (RAOM) represents at least 3 or more separate episodes of acute otitis media within 6 months or four or more episodes over a 12-month period. The incidence of recurrent otitis media varies from 5 to 30% and does not tend to decrease. Until now, the questions of conservative and surgical treatment of patients remain unsolved. One of the main methods of treatment is antimicrobial therapy. Recently, the treatment of recurrent otitis media is complicated by the increasing acquired resistance of bacteria to antimicrobial drugs. There is also no consensus on the need for and scope of surgical interventions for children with RAOM. The authors in their article cite existing modern approaches to the prevention and treatment of RAOM in children.

PMID:35274892 | DOI:10.17116/otorino20228701146

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Risk factors and clinical features of the course of recurrent acute otitis media in children

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Vestn Otorinolaringol. 2022;87(1):9-13. doi: 10.17116/otorino2022870119.

ABSTRACT

This article discusses the problem of recurrent acute otitis media (RAOM) in children.

OBJECTIVE: To study the risk factors and the clinical course of RAOM in children.

MATERIAL AND METHODS: 148 children (81 boys and 67 girls) from 1 to 14 years old were examined with a diagnosis of recurrent otitis media. The work was carried out in the ENT departments of Pediatric Clinical Hospital No. 13 named after N.F. Filatov, Pediatric Clinical Hospital named after Z.A. Bashlyaeva. The average age of the children was 4.1±1.5 years.

All children underwent a clinical study, a laboratory study on the content of the main metabolite of vitamin D - 25(OH)D3 (25-hydroxyvitamin D, or calcidiol) in blood serum.

RESULTS: Our clinical examination of children with RAOM allows us to identify the main risk factors for this pathology. Thus, the most significant risk factors for the development of RAOM in children included in the study were: early visits by children to preschool institutions (50.6%), allergic history (39.1%), pathology during pregnancy (28.3%), mixed (38.5%) or artificial (27.7%) feeding in the first year of life, frequent upper respiratory tract diseases (41.2%), burdened heredity in close relatives according to RAOM (33.7%), smoking in the family of one of the parents (65.5%) presence in the family of one more child (34.4%).

CONCLUSION: It was shown that the absolute number of children (96%) with RAOM is characterized by a reduced level of 25(OH) vitamin D in the blood serum, which can increase the likelihood of developing episodes of acute otitis media in children and requires therapeutic correction.

PMID:35274886 | DOI:10.17116/otorino2022870119

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