Αρχειοθήκη ιστολογίου

Τρίτη 29 Μαρτίου 2022

Fibrin immobilization vestibular extension (FIVE): A case series

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Abstract

Aims

The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri-implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)".

Material and Methods

The protocol utilized entailed apical positioning and stabilization of peri-implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet-rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap.

Results

A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri-implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5–5.2 mm) of peri-implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5–4.5 mm) at 3 years post-FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8–6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6–5.6 mm). The mean of maxilla was si gnificantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri-implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri-implantitis patients were removed due to advanced peri-implantitis.

Discussion

The present case series provides proof-of-principle data for efficacy of FIVE for peri-implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft.

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Management of Benign Salivary Gland Conditions

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Surg Clin North Am. 2022 Apr;102(2):209-231. doi: 10.1016/j.suc.2022.01.001. Epub 2022 Mar 8.

ABSTRACT

In this section, we discuss the management of benign salivary gland disease. Pathologies vary from sialolithiasis, salivary duct stenosis, sialadenitis, infectious glandular disease, autoimmune glandular disease, and radioactive iodine-induced disease. We discuss both novel techniques in the diagnosis and management of these diseases, including ultrasound, sialendoscopy, minor salivary gland biopsy, and botulinum toxin injection, which allow for both the alleviation of symptoms and gland preservation.

PMID:35344693 | DOI:10.1016/j.suc.2022.01.001

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Natural history, predictive factors of apparent disease (structural or biochemical) and spontaneous excellent response in patients with papillary thyroid carcinoma and indeterminate response to initial therapy with radioiodine

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Endocrine. 2022 Mar 28. doi: 10.1007/s12020-022-03040-9. Online ahead of print.

ABSTRACT

BACKGROUND: About 20% of patients with papillary thyroid carcinoma (PTC) submitted to total thyroidectomy followed by radioactive iodine (RAI) exhibit an indeterminate response to therapy. The aim was to evaluate the natural history, predictive factors of apparent disease (structural or biochemical), and spontaneous excellent response in patients with PTC and an initial indeterminate response to RAI therapy defined based on unstimulated Tg (u-Tg).

METHODS: We evaluated 164 patients who were initially treated with total thyroidectomy and RAI and who had an indeterminate response to therapy (u-Tg between 0.2 and 1 ng/ml, undetectable anti-Tg antibodies [TgAb], and neck ultrasonography [US] without anomalies). None of the patients received empirical therapy with RAI. The patients were followed up for 24 to 144 months (median 72 months).

RESULTS: Apparent disease occurred in 16 patients (9.7%), including 13 with structural disease and 3 with u-Tg elevation > 1 ng/ml, but no tumor was detected by the imaging methods (biochemical disease). A higher frequency of disease was observed in patients with >3 lymph node metastases (LNM) and initial u-Tg >0.35 ng/ml. The frequency was only 2% among patients with ≤3 LNM and u-Tg ≤0.35 ng/ml and 9.7% among patients with > 3 LNM or u-Tg >0.35 ng/ml, while the frequency was 27% in patients with >3 LNM and u-Tg >0.35 ng/ml. In the absence of any additional therapy, u-Tg was <0.2 ng/ml (excellent response) in the last assessment in 70 patients (42.7%). Only initial u-Tg was associated with a higher probability of spontaneously achieving an excellent response: 40/72 patients (55.5%) with u-Tg ≤0.35 ng/ml versus 30/92 patients (32.6%) with u-Tg >0.35 ng/ml.

CONCLUSIONS: A minority of patients with PTC and an initial indeterminate response to RAI defined based on u-Tg develop apparent disease (structural or biochemical) and many spontaneously achieve an excellent response. The risk of disease can be refined based on parameters such as the extent of lymph node involvement and initial Tg concentration.

PMID:35347578 | DOI:10.1007/s12020-022-03040-9

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Migration of a Fish Bone From the Esophagus to the Thyroid Gland

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Ear Nose Throat J. 2022 Mar 29:1455613221086032. doi: 10.1177/01455613221086032. Online ahead of print.

ABSTRACT

Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up.

PMID:35348022 | DOI:10.1177/01455613221086032

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A comparison between sniffing and blowing for olfactory testing before and after laryngectomy

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Eur Arch Otorhinolaryngol. 2022 Mar 29. doi: 10.1007/s00405-022-07343-5. Online ahead of print.

ABSTRACT

PURPOSE: Olfactory dysfunction occurs after laryngectomy due to the loss of nasal airflow and inability to sniff. However, the reason for the loss of olfactory function after laryngectomy is unclear on evaluation with sniffing type tests performed individually. It is expected that the sensorineural olfaction remains, and the results of the sniffing test would be negative, while that of the odour-blowing test would be positive. Therefore, the aim of this study was to investigate both tests and prove normal olfaction in the patients.

METHODS: Patients who had undergone laryngectomy were evaluated using the T&T olfactometer for odour-sniffing tests, Jet Stream Olfactometer (JSO) for odour-blowing tests, and visual analogue scale (VAS). Evaluations were performed pre-operatively, and 1 month, 6 months, and 1-year post-laryngec tomy.

RESULTS: Thirty-two patients were included in the study. The median recognition thresholds using the T&T and JSO were 1.4 and 2.2 before surgery, 5.8 and 5.4 at 1 month, 5.8 and 5.2 at 6 months, and 5.8 and 5.0 at 1 year after surgery, respectively. Results of the olfactory threshold test in both T&T and JSO and VAS score were significantly worse after surgery compared to that before laryngectomy (p < 0.05). The degree of increase was significantly smaller with JSO than with T&T (p < 0.05).

CONCLUSION: While we could not prove normal olfaction in patients after laryngectomy, the odour-blowing test was superior to the odour-sniffing test in detecting patients with residual olfaction. Simply blowing a scent is insufficient to obtain good olfaction; active airflow is crucial for recognizing odours.

PMID:35348858 | DOI:10.1007/s00405-022-07343-5

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Acromegaly

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Acromegaly results from excessive secretion of insulinlike growth factor-1 and growth hormone, which most commonly occurs because of pituitary somatotrophinoma. Diagnostic features of acromegaly include elevated insulinlike growth factor-1 and growth hormone; lesion on brain MRI; and clinically dysmorphic features, such as soft tissue swelling, jaw prognathism, and acral overgrowth. Transsphenoidal resection is the primary therapy for individuals with acromegaly, even in the cases where gross total resection is not possible because of parasellar extension and cavernous sinus involvement. For recurrent or persistent disease after resection, systemic medications and stereotactic radiosurgery are used.
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Cushing Disease

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Cushing disease is a disorder of hypercortisolemia caused by hypersecretion of adrenocorticotropic hormone by a pituitary adenoma and is a rare diagnosis. Cushing disease presents with characteristic clinical signs and symptoms associated with excess cortisol, but diagnosis is difficult and often relies on repeated and varied endocrinologic assays and neuroradiologic investigations. Gold standard treatment is surgical resection of adrenocorticotropic hormone–secreting pituitary adenoma, which is curative. Patients require close endocrinologic follow-up for maintenance of associated neuroendocrine deficiencies and surveillance for potential recurrence. Medications, radiation therapy, and bilateral adrenalectomy are alternative treatments for residual or recurrent disease.
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Bladder Cancer Need Not Always Require Radical Cystectomy Bladder Cancer Need Not Always Require Radical Cystectomy

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Researchers involved in a large cohort study from three major institutions are calling for broader use of trimodal therapy for muscle-invasive bladder cancer.Medscape Medical News (Source: Medscape Hematology-Oncology Headlines)
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Surgical treatment trends and identification of primary breast tumors after surgery in occult breast cancer: a study based on the Japanese National Clinical Database-Breast Cancer Registry

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CONCLUSIONS: Breast surgery for cT0N+ decreased between 2010 and 2018. Despite the high identification rate of primary tumors, most tumors were small, and there was no significant change in the identification rate or invasive diameter of the identified tumors after 2010.PMID:35316446 | DOI:10.1007/s12282-022-01348-y (Source: Breast Cancer)
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Improvement of performance and function in respiratory protection equipment using nanomaterials

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Abstract

Nanotechnology has become one of key areas for the current development and research. Nanotechnology focuses on matter at the nanoscale and is capable of using different approaches to produce nanomaterials, structures, devices, and systems. One of the concerns that have to be addressed is the adverse effects of exposure to pathogens and pollutants in different workplaces and environments. Respiratory protective equipment (RPE) is one of the personal protective equipment (PPE) utilized to reduce the risk of exposure to environmental or occupational respiratory hazards. Thus, various studies have been conducted for improving the functional properties of sorbents or filters in different kinds of RPE. Different categories of nanomaterials have been reported as effective agents for achieving this goal. The application of these nanomaterials in mask layers or respirators' cartridge could significantly increase the filtration efficiency, breathing comfort, and antiba cterial/antiviral properties of the masks and respirators. The present study aimed to comprehensively review the nanomaterials used in different types of face RPE with emphasis on various properties of the utilized nanomaterials. The study also aimed to show an applied perspective for future research on this important subject.

Graphical abstract

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Stereotactic radiosurgery for the treatment of hypoglossal schwannoma: a multi-institutional retrospective study

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Abstract

Background

Surgical removal has been performed as the first line treatment for symptomatic or enlarging hypoglossal schwannomas (HS). Stereotactic radiosurgery (SRS) offers a minimally invasive approach that may afford long-term tumor control for patients with HS particularly those who refuse or are unfit for surgery. This study evaluates outcomes after SRS performed for both newly diagnosed and residual tumors after incomplete resection.

Methods

This retrospective, multi-institutional study involved patients treated with adjuvant or primary SRS for HS. The study end-points included local tumor response, clinical outcomes, and procedure-related complications. All the patients had Gamma Knife SRS.

Results

The cohort included 12 patients (five females), median age at SRS 49.5 years (range, 37–76)]. The median tumor target volume was 5.9 cm3 (range, 0.7–27.23). At median imaging follow-up of 37 months (range, 6–153), tumor control was achieved in 11 patients. Tumor enlargement that was managed with surgical resection was noted at the 6-month follow-up in one patient. At median clinical follow-up of 30.5 months (range, 6–157), stability, or improvement of all pre-SRS signs and symptoms was noted in nine patients. Two patients experienced worsening of at least one pre-existing symptoms or sign. New-onset trapezius weakness was noted in one patient and tongue atrophy in two patients.

Conclusion

Single-fraction SRS appears to be a safe and effective upfront and adjuvant treatment option for HS. SRS may be recommended as an alternative to surgery for patients presenting with HS or as an adjuvant treatment following subtotal resection and at HS recurrence.

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How I do it: management of M2 tear injury caused by drilling during intradural anterior clinoidectomy for microsurgical clipping of intracranial aneurysms

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Abstract

Background

High-speed drilling is associated with potential injury to neurovascular structures, particularly during intradural drilling of the anterior clinoid process.

Method

During an anterior clinoidectomy, a cotton patty and middle cerebral artery branches became inadvertently wrapped around the bit, causing a tear on the inferior M2 trunk. Following temporary clipping of the internal carotid artery, the tear was identified. Temporary clips were placed proximally and distally. The tear was then repaired with interrupted microsutures.

Conclusion

Extreme care should be exercised during clinoidectomy. Should small vascular injury occur, direct microsuturing can be a good alternative to sacrificing or implantation anastomosis repair.

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