Αρχειοθήκη ιστολογίου

Τρίτη 16 Μαρτίου 2021

Aufbau und Entwicklung eines interdisziplinären Zentrums für hereditäre hämorrhagische Teleangiektasie

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Laryngorhinootologie
DOI: 10.1055/a-1402-0543

Hintergrund Die hereditäre hämorrhagische Teleangiektasie (HHT) ist eine seltene, systemische Erbkrankheit, die durch mukokutane und viszerale Gefäßmalformationen gekennzeichnet ist. Ein interdisziplinäres Behandlungskonzept in HHT-Zentren wird empfohlen. Material und Methoden In einer retrospektiven Studie wurden Strukturen, Prozesse und die Daten aller Patienten analysiert, die von April 2014 bis August 2019 in unserem neu gegründeten HHT-Zentrum behandelt wurden. Ergebnisse Innerhalb des Universitätsklinikums Essen wurde zunächst ein Netzwerk von über 20 verschiedenen Fachabteilungen zur Behandlung von Patienten mit HHT aufgebaut. Von den 282 Patienten, die sich seit der Zentrumsgründung mit möglicher HHT im Westdeutschen Morbus-Osler-Zentrum vorstellten, wurde bei 261 Patienten (93 %) die Diagnose als möglich angesehen. Die meisten Patienten wiesen multiple Symptome auf (Epistaxis und/oder Teleangiektasien: je > 80 %, viszerale Beteiligung: 65 %), welche häufiger eine Behandlung im interdisziplinären Rahmen erforderten. Über 900 E-Mails fielen jährlich für die direkte Behandlung der Patienten mit HHT, deren Koordination, Kooperationen und Öffentlichkeitsarbeit an. Durch den internationalen Austausch innerhalb des Europäischen Referenznetzwerks für multisystemische vaskuläre Erkrankungen (VASCERN) ist eine Behandlung auf aktuellem Stand auch bei komplexen Fragestellungen gewährleistet. Schlussfolgerungen Ein HHT-Zentrum beinhaltet ein interdisziplinäres Netzwerk von medizinischen Fachrichtungen, bei denen die Abläufe durch Prozesse definiert und durch eine wirksame Öffentlichkeitsarbeit, Schulungs- und Veröffentlichungstätigkeit gekennzeichnet sind.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

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10-1055-s-0041-1725037_200268-1.jpg

J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1725037

Objectives The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers. Design present study is a retrospective chart review from August 2016 until August 2019. Setting The study was conducted at a tertiary care center. Participants Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope. Main Outcome Measures Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study. Results Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% (n = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, n = 23) or T4 (55%, n = 30) and of cutaneous (62%, n = 34) and parotid (27%, n = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, n = 48), auriculectomies (47%, n = 26), mandibulectomies (53%, n = 29), and parotidectomies (96%, n = 53). On final pathology, 24% (n = 13) had microscopically positive margins. Over the study period, 20% (n = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2–30 months). Conclusion In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract&n bsp; |  Full text

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Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review

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Braz J Otorhinolaryngol. 2021 Mar 6:S1808-8694(21)00024-0. doi: 10.1016/j.bjorl.2021.02.003. Online ahead of print.

ABSTRACT

INTRODUCTION: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis.

OBJECTIVE: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome.

METHODS: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated gr oup and only antibiotics treated group.

RESULTS: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I2=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I2=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group.

CONCLUSION: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

PMID:33722520 | DOI:10.1016/j.bjorl.2021.02.003

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The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study

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Braz J Otorhinolaryngol. 2021 Mar 7:S1808-8694(21)00026-4. doi: 10.1016/j.bjorl.2021.02.005. Online ahead of print.

ABSTRACT

INTRODUCTION: Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages.

OBJECTIVE: To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients.

METHODS: Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B- group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migrain e attack frequencies in the last three months were also evaluated.

RESULTS: There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B- group patients (p<0.001 for all). The mean Migraine Disability Assessment Scale score gains (p<0.001) and vertigo attack frequency gains (p= 0.003) were significantly higher in the B+ patients than B- patients.

CONCLUSIONS: Both B+ and B- group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application shoul d be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.

PMID:33722518 | DOI:10.1016/j.bjorl.2021.02.005

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Diagnostic evolution of vestibular neuritis after long-term monitoring

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Braz J Otorhinolaryngol. 2021 Mar 5:S1808-8694(21)00025-2. doi: 10.1016/j.bjorl.2021.02.004. Online ahead of print.

ABSTRACT

INTRODUCTION: The diagnosis of vestibular neuritis is based on clinical and laboratory findings after exclusion of other disease. There are occasional discrepancies between clinical impressions and laboratory results. It could be the first vertigo episode caused by other recurrent vestibular disease, other than vestibular neuritis.

OBJECTIVE: This study aimed to analyze the clinical features and identify the diagnostic evolution of patients with clinically suspected vestibular neuritis.

METHODS: A total of 201 patients clinically diagnosed with vestibular neuritis were included in this study. Clinical data on the symptoms and signs of vertigo along with the results of vestibular function test were analyzed retrospectively. Patients were categorized in terms of the results of caloric testing (CP - cana l paresis) group; canal paresis ≥25%; (MCP -minimal canal paresis) group; canal paresis <25%). Clinical features were compared between the two groups and the final diagnosis was reviewed after long-term follow up of both groups.

RESULTS: Out of 201 patients, 57 showed minimal canal paresis (CP<25%) and 144 showed definite canal paresis (CP≥25%). A total of 48 patients (23.8%) experienced another vertigo episode and were re-diagnosed. Recurring vestibular symptoms were seen more frequently in patients with minimal canal paresis (p=0.027). Repeated symptoms were observed on the same affected side more frequently in the CP group. The proportion of final diagnosis were not different between two groups.

CONCLUSIONS: Patients with minimal CP are more likely to have recurrent vertigo than patients with definite CP. There was no significant difference in the distribution of the final diagnoses between two groups when the vertigo recurs.

PMID:33722519 | DOI:10.1016/j.bjorl.2021.02.004

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The PROfound study or the arrival of personalised medicine in the treatment of prostate cancer

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Bull Cancer. 2021 Mar 12:S0007-4551(21)00042-4. doi: 10.1016/j.bulcan.2020.11.016. Online ahead of print.

NO ABSTRACT

PMID:33722378 | DOI:10.1016/j.bulcan.2020.11.016

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Adult non-Hodgkin bone lymphomas

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Bull Cancer. 2021 Mar 12:S0007-4551(21)00070-9. doi: 10.1016/j.bulcan.2020.12.010. Online ahead of print.

ABSTRACT

Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associate d with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.

PMID:33722379 | DOI:10.1016/j.bulcan.2020.12.010

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Delayed facial palsy after cochlear implantation caused by reactivation of Herpesvirus: A case report and review of the literature

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Publication date: Available online 15 March 2021

Source: Auris Nasus Larynx

Author(s): Yui Ishikawa, Makoto Hosoya, Sho Kanzaki, Kaoru Ogawa

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The effects of residual parotid volume on symptom-specific quality of life and complications in patients undergoing parotid surgery

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Eur Arch Otorhinolaryngol. 2021 Mar 15. doi: 10.1007/s00405-021-06742-4. Online ahead of print.

ABSTRACT

PURPOSE: To measure postoperative residual parotid volumes in parotidectomy patients and to measure the effect of residual parotid volumes on the symptom-specific quality of life (SSQOL) and complications.

METHODS: Between January 2010 and December 2016, 148 parotid gland surgeries were performed, and 74 patients were included in the study. Bilateral parotid gland volumes were measured by Magnetic Resonance Imaging (MRI). Parotidectomy Outcome Inventory-8 and aesthetic scale questionnaire were applied to the patients. The volumetric averages obtained were compared with the questions in the SSQOL scale, the aesthetic scale data, and complications.

RESULTS: In the volumetric examination performed with MRI, the mean residual volumes of the operated parotid glands were 9.5 cm3, while the non-operated side was 28.8 cm3. The width of the surgery and the residual parotid tissue volume was inversely correlated. There was a statistically significant difference between the residual parotid gland volume and the pain related to the surgical area, depression in the surgical site, Frey's syndrome, incision scar, and numbness. As the residual parotid gland volumes decreased, the patients' cosmetic problems related to the surgical field increased significantly, and their SSQOL decreased.

CONCLUSION: Postoperative residual parotid tissue volume could be an objective parameter to measure patients' SSQOL and complications. After parotidectomy, the maximum amount of disease-free tissue of the parotid gland should be left in place to increase patients' quality of life and minimize complications.

PMID:33723622 | DOI:10.1007/s00405-021-06742-4

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Ring finger protein 126: a potential biomarker for colorectal cancer

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Histol Histopathol. 2021 Mar 16:18328. doi: 10.14670/HH-18-328. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) is the most common cancer of the digestive system. However, effective therapeutic targets against CRC have not been found yet. Further, the relationship between the expression of ring finger protein 126 (RNF126) and CRC is not clear.

MATERIAL AND METHODS: The expression level of RNF126 in CRC tissues and cell lines was detected by immunohistochemical staining and western blot. Subsequently, endogenous RNF126 expression was inhibited in a CRC cell line using a short hairpin RNA. Next, the effect of RNF126 on the properties of CRC cells was studied through different experimental methods.

RESULTS: We found that the RNF126 protein was mainly localized in the cytoplasm. High RNF126 expression was observed to be an independent risk factor for poor prognosis in CRC patients. In vitro studies showed th at RNF126 was able to promote the proliferation, migration, and invasion ability of CRC cells.

CONCLUSION: RNF126 acts as an oncogene during CRC development, and may serve as a novel target for CRC treatment.

PMID:33724438 | DOI:10.14670/HH-18-328

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Differences between cancer patients and others who use medicinal Cannabis

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by Matthew M. Cousins, Mary Jannausch, Reshma Jagsi, Mark Ilgen

Background

Cancer patients have been at the forefront of policy discussions leading to legalization of medical Cannabis (marijuana). Unfortunately, Cannabis use among those with cancer is poorly understood.

Methods

A diverse group of patients seeking certification for medical Cannabis in the state of Michigan were surveyed at the time of their presentation to medical dispensaries. The survey assessed demographics, employment/disability, pain, physical functioning, mental health, mode of Cannabis use, and frequency/amount of Cannabis use. Chi-square and t-tests were performed to compare those who did and did not endorse cancer diagnosis.

Results

Analysis of data from 1485 adults pursuing medical Cannabis certification, including 72 (4.8%) reporting a cancer diagnosis, indicated that those with cancer were older [mean age 53.4 years (SD = 10.5) vs. 44.7 years (SD = 13.0); p Conclusions

Patients with cancer who are seeking medical Cannabis are different from thos e seeking medical Cannabis without cancer, and they report using Cannabis differently. Further research to characterize the patterns and consequences of Cannabis use in cancer patients is needed.

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