Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis Via leak of cerebrospinal fluid BMC Neurol. 2022 Feb 12;22(1):52. doi: 10.1186/s12883-022-02574-9. ABSTRACT BACKGROUND: Transsphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR). The protocol of extracapsular resection(ER), which considers the pseudocapsule as the PA boundary for surgical removal, has also been introduced gradually. In this study, the clinical efficacies and complications were explored and compared between these two procedures. METHODS: A systematic literature review was performed in the PubMed, EMBASE, Web of Science and Cochrane databases. Articles comparing between IR and ER were included. RESULTS: There were 7 studies containing 1768 cases in accordance with the inclusion criteria. Although the meta-analysis showed no significant difference in complete resection, a sensitivity analysis revealed that ER was more conducive to total PA re section than IR. Moreover, we found a significant difference in favor of ER regarding biochemical remission. Furthermore, there was no significant difference in the incidence rate of certain complications, such as hormone deficiency, diabetes insipidus, intraoperative cerebrospinal fluid(CSF) and postoperative CSF leakage. However, a sensitivity analysis suggested that IR decreased the risk of intraoperative CSF leakage. CONCLUSIONS: This meta-analysis unveiled that ER contributed to biochemical remission. To some extent, our results also showed that ER played a positive role in complete resection, but that IR reduced the incidence of intraoperative CSF leakage. However, the available evidence needs to be further authenticated using well-designed prospective, multicenter, randomized controlled clinical trials. PMID:35151259 | DOI:10.1186/s12883-022-02574-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

PTH in situ measurement in patients with hyperparathyroidism: single-centre experience of 179 patients

xlomafota13 shared this article with you from Inoreader PTH in situ measurement in patients with hyperparathyroidism: single-centre experience of 179 patients Via oto-rhino-laryngologie Eur J Endocrinol. 2022 Feb 1:EJE-21-1249. doi: 10.1530/EJE-21-1249. Online ahead of print. ABSTRACT CONTEXT: The measurement of PTH in situ (PTHis) by fine-needle aspiration (FNA) is proposed as a tool to preoperatively help localize parathyroid glands detected on ultrasound. However, the accuracy of PTHis is highly variable according to the few available studies. We aimed to develop and validate the PTHis procedure. We assessed the performance of PTHis in a large series of patients with hyperparathyroidism. PATIENTS: The technique setup consisted of PTHis measurement in thyroid samples from patients with thyroid nodules and patients with high circulating PTH levels (tertiary hyperparathyroidism). Consecutive patients were recruited and submitted to ultrasound-guided FNA-PTHis determination. RESULTS: During the method setup, we obtained undetectable PTHis levels in all non-parathyroid tissues after sample dilutions. PTHis was high er in patients with hyperparathyroidism (n=145, 1817±3739 ng/L, range <4.6-31,140) than in those with thyroid or undetermined cervical lesions (n=34, <4.6 ng/mL,p<0.0001). When evaluating PTHis performance in histologically proven samples (158 lesions from 121 patients), PTHis was detectable in 85/97 parathyroid lesions (87%, range 22-31,140 ng/L) and undetectable in all non-parathyroid lesions (n=61,p<0.0001). The specificity and positive predictive value were 100%, and the sensitivity was 87.6%. False-negative lesions (n=12) were smaller (9.4±5.9 mm) and more often consisted of hyperplasias (75%) than true-positive lesions (16.1±8.4 mm and 33%, p=0.009 and p=0.0089, respectively). The method was safe and well tolerated. Four educational cases are also provided. CONCLUSIONS: PTHis determination is a safe and well-tolerated procedure that enhances the specificity of ultrasound-detected lesions. If accurately set up, it confirms the parathyroid origin of uncharac terized cervical lesions. PMID:35167489 | DOI:10.1530/EJE-21-1249 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Aggressive paediatric camptodactyly: The evolution of a proposed treatment algorithm

xlomafota13 shared this article with you from Inoreader Aggressive paediatric camptodactyly: The evolution of a proposed treatment algorithm Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2022 Jan 22:S1748-6815(22)00034-1. doi: 10.1016/j.bjps.2022.01.020. Online ahead of print. ABSTRACT INTRODUCTION: It is a long-established teaching to avoid operating on camptodactyly unless there is a failure of non-operative treatment, such as serial splinting and hand therapy, and there is an established proximal interphalangeal joint (PIPJ) contracture of 60°; a recent systematic review reflects this continuing approach, with some papers advocating intervention with a lesser degree of contracture. AIM: To evaluate whether early flexor digitorum superficialis (FDS) release, followed by gentle passive manipulation (GPM), will correct severe 'congenital' camptodactyly, if undertaken at an earlier age than usual, thus avoiding the more aggressive surgical approach required in the established adolescent cases. METHOD: The surgical technique and treatment algorithm are described. A multi-centre case series is presented; data analysis included patient demographics, syndromic association, side/digit affected, ages at onset, progression, referral and at surgery, operation details, pre- and post-operative contracture and range of motion. RESULTS: There were 12 patients (3 males, 9 females) who underwent 15 operations for 24 involved digits. Patients had surgery by 3 months (median) post-referral, and there was a significant improvement in median (range) PIPJ contracture (90°(30°-90°) vs. 0°(0°-45°); p<0.001) and range of motion (0°(0°-60°) vs. 90°(50°-95°); p<0.001), at a median post-operative follow-up of 2.5 years. According to the Siegert grade, 87.5% of digits had excellent/good post-operative outcomes and 12.5% had fair outcomes. CONCLUSION: This paper specifically addresses the problem of aggressive and progressive camptodactyly in the young child. By this, we mean patients who have failed non-operative treatment and have PIPJ contractures ≥60°, and those whose contractures have increased by 30° within 1 year. All cases responded to early FDS release and GPM, hence correcting the PIPJ contracture. However, cases with multiple digital involvement, whether syndromic or not, and failed previous surgery or the older child, required additional procedures to restore a dynamic dorsal apparatus and active extension. PMID:35153164 | DOI:10.1016/j.bjps.2022.01.020 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of Graves' Disease Associated With Severe Neutropenia

xlomafota13 shared this article with you from Inoreader Treatment of Graves' Disease Associated With Severe Neutropenia Via radioactive iodine Cureus. 2022 Jan 7;14(1):e21014. doi: 10.7759/cureus.21014. eCollection 2022 Jan. ABSTRACT Severe neutropenia in newly diagnosed hyperthyroidism is a diagnostic and therapeutic dilemma since antithyroid drugs (ATDs) cannot be started if the absolute neutrophil count (ANC) is <1 x 109/L. We report the case of a patient followed for hyperthyroidism associated with severe neutropenia treated with dexamethasone and ATD. The patient was 51 years old and was hospitalized fo r hyperthyroidism with a thyroid stimulating hormone (TSH) level <0.005 (0.4-4) mUI/L, T4 at 415 (9.3-17.1) ng/L and T3 at 148 (2-4.4) pg/mL on Graves' disease (GD) confirmed by the TSH receptor antibodies at 38 IU/mL and scintigraphy, associated with neutropenia, with ANC at 0.4 x 109/L. He was put on prednisolone 60 mg/day and propranolol 60 mg/day for three weeks without improvement. Faced with the association of hyperthyroidism and severe neutropenia, we could not start the ATD for fear of agranulocytosis; we put the patient on propranolol 60 mg and dexamethasone 6 mg with progressive degression resulting in a spectacular increase of ANC from 0.4 x 109/L to 7.1 x 109/L, which allowed us to start the ATD (carbimazole) at a dose of 30 mg, and then 50 mg, with monitoring of ANC and transaminases every 48 hours. Euthyroidism was achieved after 15 days. A curative treatment with radioactive iodine ablation was administered. Our patient did not resp ond to prednisolone but responded dramatically to dexamethasone; this leads us to consider using dexamethasone for the rapid preparation for radical treatment of patients with GD. PMID:35154986 | PMC:PMC8818315 | DOI:10.7759/cureus.21014 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope

xlomafota13 shared this article with you from Inoreader Message: Bow hunter syndrome (BHS) is an uncommon cause of vertebrobasilar insufficiency that results from occlusion or injury to the vertebral artery (VA) during neck rotation. The cause is often a bony abnormality that may compress the VA compromising distal flow or lead to vessel wall injury resulting in thromboembolism. Thyroid Cartilage Compression Causing Bow Hunter's Syndrome Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 12:34894221077477. doi: 10.1177/00034894221077477. Online ahead of print. ABSTRACT OBJECTIVES AND METHODS: We report a unique case of Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope despite previous decompressive surgery at vertebral levels C5-C6. RESULTS: Re-evaluation with computed tomography-scan during provocation of dizziness by neck rotation revealed compression of the right VA at level C6 from against the ipsilateral posterior border and superior cornu of the thyroid cartilage. Laryngoplasty resulted in complete resolution of symptoms. CONCLUSION: This extremely rare cause of Bow's Hunter's syndrome should be considered, especially in refractory cases after neurosurgical decompression, and surgical management is straightforward and successful. PMID:35152775 | DOI:10.1177/00034894221077477 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sclerotherapy for Hereditary Hemorrhagic Telangiectasia-Related Epistaxis: A Systematic Review

xlomafota13 shared this article with you from Inoreader Sclerotherapy for Hereditary Hemorrhagic Telangiectasia-Related Epistaxis: A Systematic Review Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 12:34894221078075. doi: 10.1177/00034894221078075. Online ahead of print. ABSTRACT OBJECTIVES: Hereditary hemorrhagic telangiectasia (HHT) is a common inherited condition characterized by mucosal telangiectasias, recurrent epistaxis, and arteriovenous malformations. HHT results in detriment to quality of life. Morbidity and mortality result from severe anemia. Conventional interventions for HHT-related epistaxis include nasal packing, diath ermy, lasers, coblation, microdebridement, bevacizumab (topical and systemic), as well as septodermoplasty and nasal closure. Sclerotherapy has been recently described in the literature as a novel approach to HHT-related epistaxis. We hypothesize that sclerotherapy is an effective treatment for HHT-related epistaxis and improves upon the current standard of care for this disease. METHODS: A systematic review was conducted to study sclerotherapy for treating HHT-related epistaxis. Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science were searched. Articles were evaluated and excluded according to PRISMA guidelines and reviewed by 2 authors. Reported variables included number of injections, months of follow up, changes in Epistaxis Severity Score, previous treatments used to control epistaxis, and post-injection side effects. RESULTS: Seven studies with a total of 196 patients met inclusion criteria. Three studies reported significant improvement as measured by the Epista xis Severity Score scale. One reported improvement through subjective patient surveys and others used the Bergler-Sadick scale to measure frequency and intensity of epistaxis. All studies reported improvement in HHT-related epistaxis. The lack of uniform reporting measures however precluded formal meta-analysis. CONCLUSIONS: Based on limited data, sclerotherapy appears to be effective for treating HHT-related epistaxis and offers promise for treating this recalcitrant condition. However, larger, prospective, multi-centered studies using universally validated instruments for epistaxis are needed to definitively evaluate outcomes from sclerotherapy. PMID:35152768 | DOI:10.1177/00034894221078075 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thyroid Cartilage Compression Causing Bow Hunter's Syndrome

xlomafota13 shared this article with you from Inoreader Thyroid Cartilage Compression Causing Bow Hunter's Syndrome Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 12:34894221077477. doi: 10.1177/00034894221077477. Online ahead of print. ABSTRACT OBJECTIVES AND METHODS: We report a unique case of Bow Hunter's syndrome with a dominant aberrantly coursing right vertebral artery (VA), presenting with persistent dizziness and syncope despite previous decompressive surgery at vertebral levels C5-C6. RESULTS: Re-evaluation with computed tomography-scan during provocation of dizziness by neck rotation revealed compression of the right VA at level C6 from against the ipsilateral posterior border and superior cornu of the thyroid cartilage. Laryngoplasty resulted in complete resolution of symptoms. CONCLUSION: This extremely rare cause of Bow's Hunter's syndrome should be considered, especially in refractory cases after neurosurgical decompression, and surgical management is straightforward and successful. PMID:35152775 | DOI:10.1177/00034894221077477 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Low MICA Gene Expression Confers an Increased Risk of Graves' Disease: A Mendelian Randomization Study

xlomafota13 shared this article with you from Inoreader Low MICA Gene Expression Confers an Increased Risk of Graves' Disease: A Mendelian Randomization Study Via liebertpub1 Thyroid, Volume 32, Issue 2, Page 188-195, February 2022. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Serratus Anterior-Rib Composite Flap as a Novel Approach for Tracheal Reconstruction

xlomafota13 shared this article with you from Inoreader Serratus Anterior-Rib Composite Flap as a Novel Approach for Tracheal Reconstruction Via otol rhinol Ann Otol Rhinol Laryngol. 2022 Feb 13:34894211067608. doi: 10.1177/00034894211067608. Online ahead of print. ABSTRACT OBJECTIVE: To report a novel case of tracheal reconstruction using a serratus anterior-rib composite flap. METHODS: Case report and literature review. RESULTS: A 46-year-old male with a 4 cm anterior tracheal wall defect underwent reconstruction with a serratus anterior-rib composite flap. The patient experienced excellent results regarding phonati on, swallowing, and cosmesis. CONCLUSION: The serratus anterior-rib composite flap appears to be a suitable candidate for tracheal reconstruction and merits further analysis in this context. The flap's intrinsic incorporation of a perfused rib segment allows for reliable reconstruction of the neotrachea and maintenance of proximal dynamic airway support. PMID:35156399 | DOI:10.1177/00034894211067608 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: Systematic review

xlomafota13 shared this article with you from Inoreader Long‐term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: Systematic review Via Head & Neck Abstract Long-term survival and recurrence patterns of squamous cell carcinoma arising from inverted papilloma (IP-SCC) have not been thoroughly investigated. Four electronic databases were searched and primary studies describing overall survival (OS), recurrence, and mean time to recurrence of patients with IP-SCC were included for review. Our search yielded 662 studies. The 28 studies selected for inclusion identified 663 patients with IP-SCC. In 596 patients with reported T classification, 439 (73.7%) were T3/T4 on presentation. Of the 650 participants with recurrence data (local, regional, and distant), 155 (23.8%) experienced a recurrence, with an aggregate mean time-to-recurrence of 24.3 months. In 565 patients with 5-year OS rates, the aggregate 5-year OS was 62%. Based on the literature to date, IP-SCC is associated with a 5-year OS rate of 62%. 23.8% of patients experienced recurrence at a mean time of 24.3 months, suggesting the need for long-term surveillance. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

xlomafota13 shared this article with you from Inoreader Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review Via Head & Neck Abstract We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty-six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty-one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures . Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.