Morphological features of the chiasma tendinum and its relation with surface landmarks and pulleys: a cadaveric study

xlomafota13 shared this article with you from Inoreader Morphological features of the chiasma tendinum and its relation with surface landmarks and pulleys: a cadaveric study Via radiol anat Surg Radiol Anat. 2021 Jul 1. doi: 10.1007/s00276-021-02783-w. Online ahead of print. ABSTRACT AIM: Chiasma tendinum (Camper's chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures. MATERIALS AND METHODS: Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fi xed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm. RESULTS: Pulley and chiasma tendinum positions were correlated with finger length (p < 0.01). Pulley lengths were significantly less in females. Asymmetrical chiasma tendinum types were found in 45% of the fingers. In most comparisons, values for fifth finger were significantly different than that of other fingers and chiasma tendinum types differed according to fingers and gender. The case of no fiber exchange was observed only in the 5th finger in 15%. CONCLUSION: Findings related to the prediction of location of the pulleys and chiasma tendinum accor ding to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications. PMID:34196774 | DOI:10.1007/s00276-021-02783-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation

xlomafota13 shared this article with you from Inoreader Management and outcome of vagus nerve stimulator implantation: experience of an otolaryngeal/neuropediatric cooperation Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 1. doi: 10.1007/s00405-021-06943-x. Online ahead of print. ABSTRACT OBJECTIVE: Vagus nerve stimulator (VNS) implantation is an established therapy for pharmacoresistant epilepsy that is not amenable to curative epilepsy surgery. Historically, VNS implantation has been performed by neurosurgeons, but otolaryngologist involvement is increasingly common. In this retrospective study, we aimed to evaluate the efficacy and safety of VNS implantation in children and adolescents from the otolaryngologists' perspective. METHODS: This study included children and adolescents who had undergone VNS implantation at the study center between 2014 and 2018. Patient files were analyzed with regards to the durations of device implantation and hospitalization, postoperative complications, and clinical outcome, including seizure frequency, clinical global impression of improvement (CGI-I) score, and quality of life (QoL). RESULTS: A total of 73 children underwent VNS surgery. The median age at implantation was 9.3 ± 4.6 years, and median epilepsy duration before VNS surgery was 6 ± 4 years. Lennox-Gastaut syndrome was the most common syndrome diagnosis (62.3%), and structural abnormalities (49.3%) the most frequent etiology. Operation times ranged from 30 to 200 min, and median postoperative hospitalization length was 2 ± 0.9 days. No complications occurred, except for four revisions and two explantations due to local infections (2.7%). Among our patients, 76.7% were responders (≥ 50% reduction in seizure frequency), 72.1% showed improved CGI-I scores, and 18.6-60.5% exhibited considerable improvements in the QoL categories energy, emotional health, and cognitive functions. CONCLUSION: Our results indicate that VNS implantation is a highly effective and safe treatment option for children and adolescents with AED-refractory epilepsies who are not candidates for curative epilep sy surgery. PMID:34196736 | DOI:10.1007/s00405-021-06943-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Suprameatal-transzygomatic root endoscopic approach to the geniculate ganglion: an anatomical and radiological study

xlomafota13 shared this article with you from Inoreader Suprameatal-transzygomatic root endoscopic approach to the geniculate ganglion: an anatomical and radiological study Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 1. doi: 10.1007/s00405-021-06965-5. Online ahead of print. ABSTRACT PURPOSE: To describe the suprameatal-transzygomatic root endoscopic approach (STEA) to the geniculate ganglion (GG), the labyrinthine facial nerve (FN) and epitympanum. METHODS: The feasibility and limits of the STEA, maintaining the integrity of the ossicular chain, were analysed. Ten human cadaveric ears were dissected. Step-by-step description of the technique and relevant measurements were taken during the approach. The visualization and surgical working field on the anterior and posterior medial epitympanum, GG, greater superficial petrosal nerve, the labyrinthine FN and suprageniculate area were evaluated. The range of motion through the approach and the rate of the decompression of the GG and the labyrinthine portion of the FN were assessed as well. CT-scan measurements were compared with those obtained during the dissec tion. RESULTS: A complete exploration of the epitympanum was possible in every specimen. Decompression of the GG and first portion of the FN was achieved without any trauma to the ossicular chain in nine ears. The endoscope movements were mainly limited by the distance between bony buttress-short process of the incus-tegmen. The working space, during GG and labyrinthine FN decompression, was limited by the distance between malleus head-medial epitympanic wall and malleus head-GG. Radiologic measurements were consistent with those obtained during the dissections. CONCLUSION: The STEA is a promising minimally invasive approach for decompression of the GG and FN's labyrinthine portion. The applications of this corridor include the exploration and surgery of the medial epitympanum, preserving the ossicular chain. PMID:34196734 | DOI:10.1007/s00405-021-06965-5 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study

xlomafota13 shared this article with you from Inoreader Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 1. doi: 10.1007/s00405-021-06962-8. Online ahead of print. ABSTRACT PURPOSE: We aimed to evaluate the effectiveness of different antibiotic regimens for the treatment of parapharyngeal abscess (PPA) and characterize patients, who suffered potentially preventable complications (defined as death, abscess recurrence, spread of infection, or altered antibiotic treatment because of insufficient progress). METHODS: Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments. RESULTS: Surgical treatment included internal incision (100%), external incision (13%), and tonsillectomy (88%). Patients were treated with penicillin G ± metronidazole (n = 39), cefuroxime ± metronidazole (n = 16), or other antibiotics (n = 5). Compared to penicillin-treated patients, cefuroxime-treated patients were hospitalized for longer (4.5 vs 3.0 days, p = 0.007), were more frequently admitted to intensive care (56 vs 15%, p = 0.006), underwent external incision more frequently (31 vs 5%, p = 0.018), and suffered more complications (50 vs 18%, p = 0.022), including re-operation because of abscess recurrence (44 vs 3%, p < 0.001). Nine patients suffered potentially preventable complications. These patients displayed significantly higher C-reactive protein levels, received antibiotics prior to admission more frequently, underwent external incision more commonly, and were admitted to intensive care more frequently compared to other patients. CONCLUSION: The majority of patients with PPA were effectively managed by abscess incision, tonsillectomy, and penicillin G ± metronidazole. Cefuroxime-treated patients were more severely ill at time of admission and had worse outcome compared to penicillin-treated patients. We recommend penicillin G + metronidazole as standard treatment for patients with PPA, but in cases with more risk factors for potentially preventable complications, we recommend aggressive surgical and broadened antibiotic therapy, e.g. piperacillin-tazobactam. PMID:34196735 | DOI:10.1007/s00405-021-06962-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Location, location, location: Melanoma cells “living at the edge”

xlomafota13 shared this article with you from Inoreader Location, location, location: Melanoma cells "living at the edge" Via Experimental Dermatology Abstract Abnormal cell migration and invasion underlie metastatic dissemination, one of the major challenges for cancer treatment. Melanoma is one the deadliest and most aggressive forms of skin cancer due in part to its migratory and metastatic potential. Cancer cells use a variety of migratory strategies regulated by cytoskeletal remodelling. In particular, we discuss the importance of amoeboid invasive melanoma strategies, since they have been identified at the edge of human melanomas. We hypothesize that the presence of amoeboid melanoma cells will favour tumour progression since they are invasive and metastatic; they support immunosuppression; they harbour cancer stem cell properties and they are involved in therapy resistance. The Rho-ROCK-Myosin II pathway is key to maintain amoeboid melanoma invasion but this pathway is further regulated by pro-tumorigenic/pro-metastatic/pro-survival signalling pathways such as JAK-STAT3, TGFβ-SMAD, NF-κB, Wnt11/5-FDZ7 and BRAFV600E-ME K-ERK. These pathways support amoeboid behaviour and are actionable in the clinic. After melanoma wide surgical margin removal, we propose that possible remaining melanoma cells should be eradicated using anti-amoeboid therapies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Screening for Olfactory Dysfunction in COVID-19 Patients Using Quick Smell Identification Test

xlomafota13 shared this article with you from Inoreader Screening for Olfactory Dysfunction in COVID-19 Patients Using Quick Smell Identification Test Via Otolaryngology Indian Abstract Objective: To determine the prevalence of OD in the confirmed case with COVID-19 among our population using quick smell identification test (Q-SIT) as screening tool. Methods: Cross- sectional study carried out in Qatif area—Saudi Arabia among adult hospitalized patient with confirm COVID-19 during the period between May and July, 2020. All adults confirmed COVID-19 patients were interviewed for history of current disease and associated symptoms as well as performing Q-SIT. Participants who had history of olfactory dysfunction, and critical cases required ICU admission were excluded. Results: The prevalence of OD among COVID-19 cases was (16.3%) in our population using Q-SIT compared to (27.4%) for self-reported symptom. Females were having higher prevalence in compare to males (30.5% and 11.1%) respectively; which was statistically significant (P < 0.001). The patients reported higher prevalence of ageusia (31.9%) with significant association w ith OD (P < 0.001). Q-SIT showed high positive and negative predictive value in detecting OD among patients with COVID-19 (84% and 93% respectively). Conclusion: Q-SIT is a useful, validated and easy to apply tool for screening OD among patients with COVID-19. Some patients presented solely with this symptom which can occurs unnoticed in COVID-19 patients, and there for required objective test for detection. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Correlation Between Video-Otoendoscopy and Tympanograms of Patients with Acute Middle Ear Infections

xlomafota13 shared this article with you from Inoreader Correlation Between Video-Otoendoscopy and Tympanograms of Patients with Acute Middle Ear Infections Via Otolaryngology Indian Abstract The tympanic membrane (TM) undergoes a number of pathological changes in middle ear disease which can be detected by a video-otoendoscope. Middle ear disease is also accompanied by changes in middle ear pressure which can be assessed by tympanometry. The objectives of this study were to find the correlation between video-otoendoscopy and tympanometry in acute middle ear infections and to deduce which of the two is more efficient and reliable for early diagnosis. 75 patients with AOM or OME were included over 1 year where each patient was followed for 21 days. Detailed history and clinical examination with videootoendoscope and tympanometry was done on each visit. Each TM was graded using OMGRADE scale. Symptoms and clinical findings consistent with acute otitis media were given a clinical score (CO Score). The results were collected and correlation between video-otoendoscopy and tympanometry was determined and their individual sensitivity, specificity a nd diagnostic accuracy was calculated. The sensitivity, specificity and diagnostic accuracy for tympanometry and video-otoendoscopy was calculated individually for each of the 4 visits and positive correlation between the 2 was found. Our study showed that tympanometry had a higher overall sensitivity than video-otoendoscopy. While, video-otoendoscopy showed a higher specificity than Tympanometry. Otoendoscopy is good for ruling out AOM/OME but cannot rule out persisting Middle Ear Effusion and Tympanometry is a better tool for detecting MEE but cannot differentiate well between AOM and OME. We found that tympanometry plus otoendoscopy together greatly increase the chances of detecting AOM and OME thus improving diagnostic accuracy, reducing financial costs associated with over or mis-diagnosis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population

xlomafota13 shared this article with you from Inoreader Objectifying growth of vascularized bone transfers after mandibular reconstruction in the pediatric population Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 11:S1748-6815(21)00262-X. doi: 10.1016/j.bjps.2021.05.010. Online ahead of print. ABSTRACT BACKGROUND: Autologous vascularized bone transfer is the preferred strategy for the reconstruction of mandibular defects in a pediatric population. The principal argument is the theoretical postoperative growth potential of the neomandible, which uses vascularized donor tissues. OBJECTIVES: The purpose of this study was to objectify the veritable growth potential of vascularized bone transfers in children. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, revealing 57 patients younger than or equal to 18 years who had undergone a mandibular reconstruction with a vascularized free flap. Only studies using postoperative imaging were included. Outcomes regarding growth and postoperative corrections and complica tions were analyzed. RESULTS: Neomandibular growth was observed in 63.2% of all included patients. The proportion of growth was higher in patients with condylar preservation (95.7%) than that of patients with condylar involvement (41.2%). Reconstruction of the condyle by a free flap, which includes an epiphyseal growth plate or cartilage increased postoperative growth potential (77.8%) but did not reduce the need for later orthognathic surgery. CONCLUSION: After mandibular reconstruction with a vascularized bone transfer, the majority of pediatric patients shows neomandibular growth. Condylar preservation, the inclusion of epiphyseal growth plates or cartilage, and the patients age at the time of reconstruction are essential defining parameters. PMID:34187765 | DOI:10.1016/j.bjps.2021.05.010 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Composition, Quoracy and Cost of Specialist Skin Cancer Multidisciplinary Team Meetings in the United Kingdom

xlomafota13 shared this article with you from Inoreader Composition, Quoracy and Cost of Specialist Skin Cancer Multidisciplinary Team Meetings in the United Kingdom Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00271-0. doi: 10.1016/j.bjps.2021.05.019. Online ahead of print. ABSTRACT BACKGROUND: Multidisciplinary team (MDT) meetings are an integral component of skin cancer service provision, enabling the implementation of evidence-based decisions and standardised patient outcomes. OBJECTIVES: We sought to evaluate the composition, quoracy and cost of Specialist Skin Cancer Multidisciplinary Teams (SSMDTs) in the United Kingdom (UK) to establish the functionality and financial impact of these meetings. METHODS: Cross-sectional design with a national freedom of information request made to 65 NHS trusts in the UK hosting an SSMDT. Detailed information with regard to attendance frequency and core membership from attendance registers was requested. Quoracy was measured against the 2006 National Institute for Health and Care Excellence Cancer Services standard 'Improving outcomes f or people with skin tumours including melanoma'. We costed the SSMDT utilising the running time, core membership salaries derived from national pay scales and overhead values provided by trusts. RESULTS: Out of 58 respondents (89% response rate), only 15 SSMDTs (26%) were quorate by membership. Forty SSMDTs (69%) were quorate by meeting frequency. The main reasons for membership noncompliance was lack of clinical oncology presence. There was a large variation in the cost per patient (µ = £132.68, range: £31.67-£313.10). There was no geographical variation in quoracy or cost between England, Wales, Scotland and Northern Ireland. PMID:34187763 | DOI:10.1016/j.bjps.2021.05.019 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery

xlomafota13 shared this article with you from Inoreader Bracketing with Multiple Radioactive Seeds to Achieve Negative Margins in Breast Conservation Surgery: Multiple Seeds in Breast Surgery Via radioactive iodine Clin Breast Cancer. 2021 Jun 3:S1526-8209(21)00141-5. doi: 10.1016/j.clbc.2021.05.013. Online ahead of print. ABSTRACT INTRODUCTION: Breast conservation surgery (BCS) is the treatment of choice for unifocal, early-stage breast cancer. The ability to offer BCS to a wider subset of patients, including those with multifocal/multicentric cancer as well as extensive ductal carcinoma in situ, has emerged over time, especially in those undergoing joint oncoplastic reconstruction and those treated with neoadjuvant therapy. However, localization techniques using multiple radioactive seeds for bracketing in this patient subset have not been validated. MATERIALS AND METHODS: A single-institution retrospective review was conducted of all patients with breast cancer who underwent BCS, guided by multiple bracketed iodine I 125 radioactive seeds between January 2014 and April 2017. RESULTS: Bracketing of breast cancer using 2 or more radioactive seeds was performed in 157 breasts in 156 patients. Negative margins were achieved in 124 of 157 (79%) breasts, including 33 cases (21%) that underwent targeted margin reexcision at the time of surgery after intraoperative, multidisciplinary margin assessment. Thirty-three cases (21%) resulted in close or positive margins, of which 11 (7%) and 10 (6.4%) underwent completion mastectomy or repeat lumpectomy, respectively. Twelve patients (7.6%) did not undergo reexcision. En bloc resection was successful in 134 of 157 (85. 4%) lumpectomies. Eighty-nine percent of the procedures were coupled with oncoplastic reconstruction. CONCLUSION: Bracketing techniques using multiple radioactive seeds expands the indications for breast conservation therapy in patients who would have traditionally required mastectomy. Intraoperative margin assessment improves surgical and pathologic success. Larger defects created by multifocal resection are optimally managed in concert with oncoplastic reconstruction to minimize asymmetries and aesthetic defects. PMID:34187752 | DOI:10.1016/j.clbc.2021.05.013 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reliability and toxicity of bevacizumab for neurofibromatosis type 2-related vestibular schwannomas: A systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Reliability and toxicity of bevacizumab for neurofibromatosis type 2-related vestibular schwannomas: A systematic review and meta-analysis Via American Journal of Otolaryngology Publication date: November–December 2021 Source: American Journal of Otolaryngology, Volume 42, Issue 6 Author(s): Jianwei Shi, Dafeng Lu, Ruxin Gu, Huaping Sun, Li Yu, Ruihan Pan, Yansong Zhang View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.