Αρχειοθήκη ιστολογίου

Κυριακή 9 Μαΐου 2021

Studying nerve transfers: Searching for a consensus in nerve axons count

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J Plast Reconstr Aesthet Surg. 2021 Apr 5:S1748-6815(21)00154-6. doi: 10.1016/j.bjps.2021.03.064. Online ahead of print.

ABSTRACT

Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consensus in the fiber count and draw up a protocol that can make future studies from different centers comparable. The search for a standardization of the methodology was aimed to reduce all the factors that are associated with an increase in the variability of the results. All the preferential methods to be used have been suggested. On the other hand, alternative methods and different methods have been identified to achieve the same goal, which in our experience are completely comparable; therefore, they can be used indifferently by the different centers according to their experience and availability.

PMID:33962889 | DOI:10.1016/j.bjps.2021.03.064

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A review of the impact of hearing interventions on social isolation and loneliness in older people with hearing loss

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Eur Arch Otorhinolaryngol. 2021 May 7. doi: 10.1007/s00405-021-06847-w. Online ahead of print.

ABSTRACT

PURPOSE: Hearing loss affects many older people and is associated with social isolation and loneliness. The impact of hearing interventions however has not been established. The objective of this review is to determine the impact of hearing interventions in older people with hearing loss on social isolation and loneliness.

METHODS: A literature review using PubMed, EMBASE and CINAHL databases was performed. Search terms included older people, elderly, aging, ageing, hearing aid, hearing rehabilitation, social isolation, loneliness and social interaction. English-language studies with participants aged over 60 years diagnosed with hearing loss comparing outcomes pre- and post-hearing interventions were included.

RESULTS: A total of 176 articles were identified of which seven met the inclusion criteria. Five studies examine d the impact of traditional hearing aids whilst two articles examined outcomes after cochlear implantation. Several outcome measures were used. Loneliness outcomes were reported in three studies and social isolation outcomes in four. All studies reported improved social isolation and loneliness scores following hearing intervention.

CONCLUSIONS: Small sample sizes, a lack of high-quality evidence, heterogenicity between studies and the presence of confounding factors limits interpretation of the literature. At present, there is inadequate evidence to support the use of hearing interventions in the treatment of social isolation and loneliness in older people. Given the ageing population, the significance of this health burden cannot be underestimated, emphasising the need for further research.

PMID:33963432 | DOI:10.1007/s00405-021-06847-w

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Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

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Eur Arch Otorhinolaryngol. 2021 May 7. doi: 10.1007/s00405-021-06861-y. Online ahead of print.

ABSTRACT

PURPOSE: Patients with advanced laryngeal and hypopharyngeal cancer are often treated with chemo-radiotherapy to avoid total laryngectomy. Subclinical swallowing disorders could be present in these patients even though patients do not complain of any symptoms. We sought to evaluate the impact of chemoradiation on swallowing and quality of life.

METHODS: We studied 21 patients undergoing chemo-radiotherapy for advanced laryngeal and hypopharyngeal cancer. All patients were tumor-free and none reported symptoms related to dysphagia during follow-up or showed altered routine screening tests (EAT-10) to detect it. Swallowing functions were assessed using volume-viscosity swallow test (V-VST) and fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life was assessed with the EORT-H&N35, and SWAL-QOL scales.

RE SULTS: Frequent alterations in swallowing efficacy (100%) and safety (85.5%) were detected with V-VST and FEES. Quality-of-life scales showed a reduction in their scores between 12 and 17%, mainly in the areas of symptoms.

CONCLUSION: Swallowing disorders are common after chemo-radiotherapy, even in patients who do not clinically manifest these disorders, contributing to a decrease in patients' quality of life. FEES and V-VST are useful procedures to detect asymptomatic swallowing disorders.

PMID:33963434 | DOI:10.1007/s00405-021-06861-y

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Quality of life in vestibular schwannoma: a comparison of three surgical techniques

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Eur Arch Otorhinolaryngol. 2021 May 8. doi: 10.1007/s00405-021-06855-w. Online ahead of print.

ABSTRACT

OBJECTIVE: Through years, interest in quality of life (QoL) among patients affected by vestibular schwannoma (VS) has increased. The expansion of the indications for endoscopic ear surgery allowed the development of the transcanal transpromontorial surgery (TTS) for VS removal. The objective of the present study was to assess QoL in a cohort of VS patients operated on by translabyrinthine (TL), retrosigmoid (RS) and TTS approach.

METHODS: The study was conducted on 111 patients who underwent surgery for VS between January 2017 and January 2020 at two different institutions. Patients fulfilled three questionnaires during follow-up: Glasgow Benefit Inventory, Depression Anxiety Stress Scales-21 and Penn Acoustic Neuroma Quality-Of-Life. The association between sex, age, date of surgery, tumor size, post-operative facial nerve (FN ) function and QoL outcomes was assessed.

RESULTS: An overall subjective impairment was demonstrated in all groups. Age, Koos staging and FN functions were associated to distinct QoL outcomes.

CONCLUSIONS: QoL decreases in patients surgically treated for VS. The TTS may allow improved scores in many domains, confirming to be a subjectively well-tolerated technique.

PMID:33963915 | DOI:10.1007/s00405-021-06855-w

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Self-reported smell and taste recovery in coronavirus disease 2019 patients: a one-year prospective study

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Eur Arch Otorhinolaryngol. 2021 May 7. doi: 10.1007/s00405-021-06839-w. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to estimate the 1 year prevalence and recovery rate of self-reported chemosensory dysfunction in a series of subjects with previous mild-to-moderate symptomatic COVID-19.

METHODS: Prospective study based on the SNOT-22, item "sense of smell or taste" and additional outcomes.

RESULTS: 268/315 patients (85.1%) completing the survey at baseline also completed the follow-up interview. The 12 months prevalence of self-reported COVID-19 associated chemosensory dysfunction was 21.3% (95% CI 16.5-26.7%). Of the 187 patients who complained of COVID-19 associated chemosensory dysfunction at baseline, 130 (69.5%; 95% CI 62.4-76.0%) reported complete resolution of smell or taste impairment, 41 (21.9%) reported a decrease in the severity, and 16 (8.6%) reported the symptom was unchanged or wor se 1 year after onset. The risk of persistence was higher for patients reporting a baseline SNOT-22 score ≥ 4 (OR = 3.32; 95% CI 1.32-8.36) as well as for those requiring ≥ 22 days for a negative swab (OR = 2.18; 95% CI 1.12-4.27).

CONCLUSION: A substantial proportion of patients with previous mild-to-moderate symptomatic COVID-19 characterized by new onset of chemosensory dysfunction still complained on altered sense of smell or taste 1 year after the onset.

PMID:33963433 | DOI:10.1007/s00405-021-06839-w

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Intradural extraarachnoid sutureless technique combined with laminoplasty for indirect repair of ventral dural defects in spontaneous intracranial hypotension: technical note and case series

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Acta Neurochir (Wien). 2021 May 8. doi: 10.1007/s00701-021-04868-2. Online ahead of print.

ABSTRACT

BACKGROUND: There is a significant variance in surgical treatment strategies of ventral cerebrospinal fluid (CSF) leaks causing spontaneous intracranial hypotension (SIH). Posterior approaches might represent a preferable alternative to the more invasive anterior and lateral routes, as long as the spinal cord is not exposed to harmful manipulation. The aim of this technical note is to report and illustrate a new surgical technique using an intradural extraarachnoid sutureless technique via laminoplasty for indirect repair of ventral CSF leaks causing intractable SIH symptoms.

METHODS: The surgical technique is described in a step by step fashion. Between May 2018 and May 2020, five patients with ventral spinal CSF leaks were operated on, utilizing this technique. All dural defects were located at the level of the thoracic spine. A retrosp ective review on demographic and radiological findings, symptoms, outcome, and follow-up was performed.

RESULTS: The intra- and postoperative course was uneventful in all patients with no surgery-related complications. Three patients recovered completely at discharge, while neurological symptoms significantly improved in two patients. A postoperative MRI of the spine was obtained for all patients, demonstrating regressive signs of CSF leak.

CONCLUSION: Based on the presented case series, this intradural extraarachnoid sutureless technique combined with laminoplasty seems to be a safe and effective option for indirect repair of ventral dural defects in SIH. In our opinion, it represents a valid alternative to traditional more aggressive approaches.

PMID:33963904 | DOI:10.1007/s00701-021-04868-2

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Incus Autograft Partial Ossicular Reconstruction Prosthesis vs. Titanium Angular Clip Prosthesis in Patients with Incudostapedial Joint Erosion Caused by Chronic Otitis Media; A Randomized Clinical Trial

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Abstract

Chronic otitis media (COM) is a common disease that can cause damage to the middle ear ossicles and thus lead to conductive hearing loss. The purpose of this study was to compare two methods of incus partial ossicular reconstruction prosthesis (PORP) and reconstruction with titanium angular clip prosthesis in patients with incudostapedial joint erosion. In this interventional randomized clinical trial carried out in a tertiary referral hospital, patients with chronic otitis media and incudostapedial joint erosion who were candidates for surgery, were randomly allocated into two groups of incus PORP surgery and reconstruction with a titanium angular clip prosthesis. Audiometry was performed for the patients prior to and six months after surgery. Pre- and post-operative air–bone gap (ABG) and bone conduction (BC) thresholds were calculated and means were compared by analysis of variances (ANOVA). A P value of <0.05 was considered statistically significant. The study consisted of 24 and 14 subjects in the incus PORP and angular clip groups, respectively. There was no statistically significant differ ence between the mean pre- and post-operative ABG, BC thresholds and ABG reduction in the compared groups. Considering issues such as high cost and inaccessibility of titanium angular clips in all centers, incus PORP may be a more acceptable method.

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Πέμπτη 6 Μαΐου 2021

The application of venous nerve conduit trap in the immediate repair and reconstruction of facial nerve in parotid gland tumor: an attempt of a new technique

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Eur Arch Otorhinolaryngol. 2021 May 4. doi: 10.1007/s00405-021-06732-6. Online ahead of print.

ABSTRACT

OBJECTIVE: To introduce the application of venous nerve conduit in the immediate repair and reconstruction of facial nerve in parotid gland tumor.

METHODS: Three patients with parotid gland tumor in Sichuan Provincial Cancer Hospital were reviewed. All patients were found that the tumor encased and invaded the facial nerve which was difficult to be separated during the operation when all patients were treated with facial nerve repair and reconstruction with the venous nerve conduit trapping technique.

RESULTS: After 1-year follow-up, all patients recovered well in facial nerve function.

CONCLUSION: The venous nerve conduit trapping technique is an effective attempt in the immediate repair and reconstruction of facial nerve in parotid gland tumor, but it needs to be further confirmed by multiple studies.

PMID:< a href="https://pubmed.ncbi.nlm.nih.gov/33948682/?utm_source=Inoreader&utm_medium=rss&utm_content=1dKORAZbU5vxmu8AJAeyXPJqUEPUheKpin0OrtWyufEUk4RYqF&ff=20210505215813&v=2.14.4" target="_blank" rel="noopener" class="underlink bluelink" tabindex="-1">33948682 | DOI:10.1007/s00405-021-06732-6

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Intraoperative near‐infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta‐analysis

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Abstract

This meta‐analysis evaluates whether near‐infrared autofluorescence (NIRAF) imaging reduces the risk of hypocalcemia after total thyroidectomy. A systematic literature search in PubMed, EMBASE, Web of Science, and Cochrane Library for studies from June 2011 to January 2021 comparing total thyroidectomy with NIRAF and conventional surgery (naked eye). Six eligible studies involving 2180 patients were included. The prevalence of transient hypocalcemia was 8.11% (40/493) and 25.19% (425/1687) in the NIRAF and naked eye groups (p < 0.0001), respectively. The prevalence of permanent hypocalcemia was 0% (0/493) and 2.19% (37/1687) in the NIRAF and naked eye groups (p = 0.05), respectively. NIRAF reduces the risk of transient hypocalcemia and may possibly lower the rate of permanent hypocalcemia. Nonetheless, further studies are needed to verify our results and evaluate the cost‐effectiveness of NIRAF in real‐world clinical practice.

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Intact Parathyroid Hormone Levels in Predicting Postoperative Hypocalcaemia After Total Thyroidectomy in South Indian Population: Cross Sectional Study

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Abstract

Hypocalcaemia being one of the most common complications after total thyroidectomy may not be avoidable in all cases. This study evaluated the effectiveness of intact Parathyroid hormone (iPTH) measured at 1-h after total thyroidectomy in predicting postoperative hypocalcaemia in early postoperative period in South Indian population. Patients who underwent total thyroidectomy in our institute from 2016 to 2018 were included. Preoperative calcium and iPTH levels were measured. Patients' iPTH level was measured 1 h after surgery and serum calcium level was measured at 24 h after surgery. Patients were also monitored clinically for any symptoms and signs of hypocalcaemia. A total of 57 patients were studied. The malignant causes accounted for 75.4% with papillary carcinoma thyroid being the most common cause. 65.7% of patients who underwent total thyroidectomy and 100% of patients who underwent total thyroidectomy with neck dissection developed hypocalca emia. 70% of patients with low iPTH developed hypocalcaemia and none of the patients who had normal iPTH developed hypocalcaemia. This relation was statistically significant with p value of 0.018 (< 0.05). The positive predictive value is 70% and negative predictive value is 100%. Though our study supports the hypothesis that iPTH is effective in predicting hypocalcaemia after total thyroidectomy in the early postoperative period, a larger sample study is needed to further support this. It can be used to consider patients for early discharge or to prophylactically start oral calcium and Vitamin D supplementation based on iPTH levels at 1 h after surgery.

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Bacterial Biofilms on Tracheostomy Tubes

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Abstract

Tracheostomy is a commonly performed airway surgery for critically ill patients. Tracheostomy tube is an indwelling prosthesis, providing potential surface for growth of bacteria. Biofilm formation by bacteria as a self-protective mechanism, has led to worrisome antibacterial resistance and thus higher rate of nosocomial infections. A prospective observational study was conducted with a purpose of knowing most common organisms capable of forming biofilm on tracheostomy tube and their antibiotic sensitivity in our setting. Fifty seven percent of the isolates were found to be capable of biofilm production. Acinetobacter baumannii (45%) was the commonest biofilm producer isolated and the commonest multidrug resistant organism (35.7%), followed by Klebsiella pneumoniae (28.5%). Both biofilm producers and non-biofilm producers were found most susceptible to Amikacin (43%), followed by Gentamicin (30%) and Ciprofloxacin (18.5%). No significant associa tion was found between biofilms and ventilators (p value = 0.558) or pre-existing infection (p value = 0.66) using Chi square test. Potentially biofilm producing bacteria were isolated from tracheostomy tube inner surfaces just after a week of their insertion, in majority of patients. Acinetobacter baumannii and Klebsiella pneumoniae were the commonest biofilm forming organisms and Amikacin, Gentamicin and Ciprofloxacin were most sensitive drugs. Multi drug resistant organisms were also commonly found, stressing the need for sensitivity-based antibiotics. Ventilator usage had no strong association with biofilm formation. Patients with non-infectious conditions also harboured bacteria capable of biofilms in tracheostomy tubes demanding the need for stringent tube hygiene measures and prophylactic antibiotics.

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