Αρχειοθήκη ιστολογίου

Τρίτη 12 Οκτωβρίου 2021

Prepectoral implant-based breast reconstruction with TiLOOP® Bra Pocket - a single-centre retrospective study

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J Plast Reconstr Aesthet Surg. 2021 Sep 17:S1748-6815(21)00413-7. doi: 10.1016/j.bjps.2021.08.027. Online ahead of print.

ABSTRACT

BACKGROUND: Prepectoral implant-based reconstruction using synthetic meshes is feasible with good outcomes. We present our data using TiLOOP® Bra Pocket, a novel ready-to-use mesh pocket which acts as an internal bra and prevents the implant from dislocating or twisting.

MATERIALS AND METHODS: A single-centre retrospective cohort study was performed to assess short-term complication rates and cosmetic outcomes in patients with prepectoral implant-based reconstruction using the TiLOOP® Bra Pocket. The primary endpoint was complication rates during the first 6 months. The secondary endpoint was the cosmetic outcome after 6 to 12 months, which was judged by two breast surgeons using the Harvard score.

RESULTS: A total of 63 breasts (43 patients) were reconstructed using the TiLOOP® Bra Pocket be tween 2018 and 2020, 57 were immediate reconstructions. The overall complication rate was 30,2% (n = 19/63). Major complications occurred in seven breasts (n = 7/63; 11,1%) and minor complications occurred in 12 breasts (12/63; 19,0%). The unplanned revision rate was 12,7%. The cosmetic outcome was good (Harvard score: mean 3, range 1-4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0%) and six cosmetic revision surgeries were performed (6/63; 9,5%).

CONCLUSION: The use of the TiLOOP® Bra Pocket is convenient and standardized because the pocket is preformed and does not require to be sewn first. Cosmetic outcome is good; however, the surgical morbidity needs to be addressed in future reconstructions. Careful patient selection and preparation techniques are vital in order to achieve acceptable complication rates and satisfying cosmetic results.

PMID:34635454 | DOI:10.1016/j.bjps.2021.08.027

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A silent, trapped guest in the maxillary sinus: Oestrus ovis myiasis with unusual presentation (with CARE guideline)

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Publication date: Available online 11 October 2021

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): A. İşlek, S. Şimşek

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Study protocol: the ear-nose-throat (ENT) prospective international cohort of patients with primary ciliary dyskinesia (EPIC-PCD)

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BMJ Open. 2021 Oct 11;11(10):e051433. doi: 10.1136/bmjopen-2021-051433.

ABSTRACT

INTRODUCTION: Primary ciliary dyskinesia (PCD) is a rare, genetic, multiorgan disease with an estimated prevalence of 1 in 10 000. It affects mainly the upper and lower airways due to impaired mucociliary clearance. Almost all patients have sinonasal or otologic (ear-nose-throat, ENT) problems, although the ENT clinical phenotype may present great variability. Despite that, data on PCD ENT manifestations are scarce and based on small single-centre studies. To date, we know little about the spectrum and severity of PCD ENT disease, its association with lung disease, its course over life and its determinants of prognosis.This study protocol describes the aims and methods of the first prospective, observational, multinational cohort study focusing on ENT disease in patients with PCD.

METHODS AND ANALYSIS: The ENT prospective international cohort of patients wi th PCD (EPIC-PCD) is a prospective standardised observational clinical cohort set up as a multinational multicentre study, embedded into routine patient care. It aims to longitudinally characterise ENT disease in patients with PCD and its association with lung disease, and to identify determinants of its prognosis. Patients of all ages, diagnosed with PCD who undergo an ENT clinical assessment at least once a year at one of the participating centres will be invited to participate. Collected data include diagnostic test results, results of ENT examinations, lung function measurements, information on management of ENT disease and patient-reported data on clinical symptoms and health-related quality of life (QoL). Data are collected using the standardised PCD-specific FOLLOW-PCD form and the validated QoL-PCD questionnaire.

ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Human Research Ethics Committees at all participating centres, based on local legisl ation. The results of the study will be published in scientific journals, presented at scientific conferences and disseminated to participants and national patient organisations.

TRIAL REGISTRATION: NCT04611516.

PMID:34635525 | DOI:10.1136/bmjopen-2021-051433

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Extramedullary Solitary Plasmacytoma of Larynx: A Rare Entity and Therapeutic Challenge

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Abstract

Solitary extramedullary plasmacytoma is a rare entity. The diagnosis is established by clinical evaluation, detailed radiological workup and histopathology with immunohistochemistry markers. There is no clear standard of care for a solitary laryngeal plasmacytoma. A case of solitary laryngeal plasmacytoma is being reported here with the rationale for the chosen treatment modality.

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Migrated Foreign Body of Upper Digestive Tract—A Ten-Year Institutional Experience

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Abstract

The ingested foreign body is one of the commonest emergencies encountered by otolaryngologists Depending on the shape and duration of impaction, a small number of foreign bodies (1–2%) can perforate the wall of the gastrointestinal Tract. A migrated foreign body may remain quiescent or cause life-threatening suppurative and vascular complications. Data were collected retrospectively from the hospital records in a tertiary care hospital in South India from 2010 to 2020. Fifteen patients diagnosed with migrated foreign body and who underwent neck exploration were included in the study. Demographic details, mode of presentation, clinical and radiological findings, rigid esophagoscopy findings, neck exploration techniques employed were noted. The mean age of the patients was 37.66 years. All patients had a history of dysphagia, odynophagia, and point tenderness. All the patients underwent a lateral neck radiograph, and it was positive in 12 patients (80%), whi le in 3 patients (20%), it was negative. All the patients had a positive finding in Contrast-Enhanced Computed Tomography. Esophagoscopy was done prior to neck exploration to identify the site of injury and the probable site of migration. All the patients underwent lateral neck exploration, and foreign body was removed. Migrated foreign body can cause significant morbidity and mortality if not diagnosed and managed early. Strong suspicion and a systematic approach are needed for the diagnosis and management.

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An Unusual Tumor in an Uncommon Site-Orbital Rosai–Dorfman Disease: A Case Report

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Abstract

Rosai–Dorfman disease (RDD) is also known as Sinus Histiocytosis with Massive Lymphadenopathy. It is a rare, benign, self-limiting disease of phagocytic histiocytes presenting with massive painless cervical lymphadenopathy. RDD can present as a nodal disease and also extra-nodal involvement with episodes of exacerbation and remissions and relapses after treatment. Its etiology remains poorly understood and is highly variable in its clinical presentation and response to treatment. Its treatment is poorly defined but the prognosis is usually fair. Here we are reporting a rare, unusual clinical presentation of infraorbital soft tissue mass diagnosed as RDD with cyto-histopathological correlation. Only a few such cases have been reported in the literature.

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Gait and Age‐Related Hearing Loss Interactions on Global Cognition and Falls

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Objectives

Age-related hearing loss (ARHL) is considered a risk factor for cognitive impairment and falls. The association may be modulated by gait performance because ARHL is related to mobility decline, which strongly contributes to cognitive impairment and falls. We investigated the interactive effects of gait and ARHL on global cognition and falls among older adults.

Study Design

Retrospective cohort study.

Methods

The auditory acuity of 810 community-dwelling older adults was measured using a pure-tone average of hearing thresholds at 1,000 and 4,000 Hz in the better-hearing ear. Participants were then stratified as follows: normal hearing, ≤25 dB; mild hearing loss (HL), >25 and ≤40 dB; and moderate to severe HL, >40 dB. Gait speed was assessed as an indicator of gait performance and fall occurrence within the previous year. Global cognition was determined using the Montreal Cognitive Assessment (MoCA) test.

Results

A total of 320 (39.5%) and 233 (28.8%) participants had mild and moderate to severe HL, respectively. Hierarchical multiple and logistic regression analyses showed interactions between gait performance and moderate hearing loss on both global cognition and the occurrence of falls. Specifically, older adults with moderate hearing loss who walked slowly showed lower MoCA scores and a higher incidence of falls, whereas those with decent gait speed did not show such a tendency.

Conclusion

Our results suggest that poor gait performance might modulate the effects of ARHL, leading to cognitive decline and falls. Poor cognitive performance and falls may be prevalent in older adults with ARHL, especially in those with slower gait and moderate hearing loss.

Level of Evidence

3 Laryngoscope, 2021

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Impact of Hospital Volume on Outcomes Following Head and Neck Cancer Surgery and Flap Reconstruction

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Objective/Hypothesis

Utilization of flaps for reconstruction of large head and neck cancer (HNCA) defects has become more prevalent. The present study aimed to assess the impact of center experience as measured by annual hospital caseload on mortality, major complications, resource utilization, and 90-day readmissions following HNCA resection with flap reconstruction.

Study Design

Non-Randomized Controlled Cohort Study.

Methods

All adult patients undergoing elective HNCA resection with flap reconstruction were identified utilizing the 2010 to 2018 Nationwide Readmissions Database. Hospitals were subsequently classified as low-, medium-, or high-volume based on annual institutional surgical caseload tertiles. Multivariable regression models were implemented to assess the independent association of hospital volume with the outcomes of interest.

Results

Over the nine-year study period, the proportion of HNCA resection with flap reconstruction gradually increased (12.8% in 2010 vs. 17.3% in 2018, P < .001). Although increasing hospital volume did not alter the odds of mortality, patients treated at high-volume centers were less likely to experience both surgical (adjusted odds ratio [AOR] 0.81, 95% confidence interval [CI] 0.67–0.97, P = .025) and medical complications (AOR 0.70, 95% CI 0.57–0.85, P < .001). Furthermore, these patients had shorter hospitalizations (−2.1 days, 95% CI −2.7 to −1.4 days, P < .001) and decreased costs (−$8,100, 95% CI −11,400 to −4,700, P < .001) compared to counterparts at low-volume centers. However, hospital volume did not impact 90-day readmissions.

Conclusion

Patients undergoing HNCA resection with flap reconstruction at high-volume centers were less likely to experience surgical and medical complications while incurring shorter hospitalizations and lower costs. Implementation of volume standards may be appropriate to improve outcomes in this surgical population.

Level of Evidence

3 Laryngoscope, 2021

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Sentinel Lymph Node Biopsy Versus Elective Node Dissection in Stage cT1‐2N0 Oral Cavity Cancer

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Objective

To compare overall survival (OS) and disease-free survival (DFS) between sentinel lymph node biopsy (SNB) and elective neck dissection (END) in the surgical management of cT1-2N0 oral cavity squamous cell carcinoma (OCSCC).

Methods

English full-text articles were searched in PubMed and Embase on May 9, 2021. Articles had to compare SNB with END in cT1-T2N0 OCSCC patients; report hazard ratios (HRs), Kaplan–Meier curves, or P-values with total number of events for survival outcomes; be from a clinical trial, cohort, or case–control study. Two reviewers reviewed articles and a third settled disagreements. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Risk of Bias in Non-randomized Studies of Interventions tool and revised Cochrane risk-of-bias tool for randomized trials were used. The generic inverse variance method with a random-effect model was used for meta-analysis.

Results

Ten studies, five retrospective, three prospective, and two randomized controlled trials, were included (total number of patients [n] = 10,498, END n = 9102, SNB n = 1396). No significant differences were found in OS (HR = 0.92; 95% confidence interval [CI]: 0.65–1.31) or DFS (HR = 0.70; 95% CI: 0.41–1.20). Heterogeneity was not detected in pooled OS analysis (P = .18; I 2 = 30%), but was in pooled DFS analysis (P = .003; I 2 = 66%).

Conclusions

No statistically significant differences in OS or DFS were observed between SNB and END in cT1-2N0 OCSCC, suggesting that SNB might be an alternative to END in the management of early-stage, clinically node-negative OCSCC. Laryngoscope, 2021

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Perioperative Complication Profile of Skull Base Meningioma Resection in Older versus Younger Adult Patients

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1736408

Objectives To better understand the risk-benefit profile of skull base meningioma resection in older patients, we compared perioperative complications among older and younger patients. Design Present study is based on retrospective outcomes comparison. Setting The study was conducted at a single neurosurgery institute at a quaternary center. Participants All older (age ≥ 65 years) and younger (<65 years) adult patients treated with World Health Organization grade 1 skull base meningiomas (2008–2017). Main Outcome Measures Perioperative complications and patient functional status are the primary outcomes of this study. Results The analysis included 287 patients, 102 older and 185 younger, with a mean (standard deviation [SD]) age of 72 (5) years and 51 (9) years (p < 0.01). Older patients were more likely to have hypertension (p < 0.01) and type 2 diabetes mellitus (p = 0.01) but other patient and tumor factors did not differ (p ≥ 0.14). Postoperative medical complications were not significantly different in older versus younger patients (10.8 [11/102] vs. 4.3% [8/185]; p = 0.06) nor were postoperative surgical complications (13.7 [14/102] vs. 10.8% [20/185]; p = 0.46). Following anterior skull base meningioma resection, diabetes insipidus (DI) was more common in older versus younger patients (14 [5/37] vs. 2% [1/64]; p = 0.01). Among older patients, a decreasing preoperative Karnofsky performance status score independently predicted perioperative complications by logistic regression analysis (p = 0.02). Permanent neurologic deficits were not signific antly different in older versus younger patients (12.7 [13/102] vs. 10.3% [19/185]; p = 0.52). Conclusion The overall perioperative complication profile of older and younger patients was similar after skull base meningioma resection. Older patients were more likely to experience DI after anterior skull base meningioma resection. Decreasing functional status in older patients predicted perioperative complications.
[...]

Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Identifying distinct risks of treatment failure in nasopharyngeal carcinoma: A study based on the dynamic changes in peripheral blood lymphocytes, monocytes, N classification, and plasma Epstein‐Barr virus DNA

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Abstract

Background

To evaluate the prognostic value of the dynamic change in absolute lymphocyte counts (ALCs) and absolute monocyte counts (AMCs) and identify patients with N stage and plasma Epstein-Barr virus (EBV) DNA levels in nasopharyngeal carcinoma (NPC) who are at risk of treatment failure.

Methods

A total of 1124 eligible patients with Stage II–IVb NPC treated with concurrent chemoradiotherapy (CCRT) were enrolled. Percentage changes in the ALC (ΔALC%) and AMC (ΔAMC%) were calculated.

Results

Patients with high ΔALC% were correlated with poorer 5-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) rates than those with low ΔALC%. Likewise, high ΔAMC% was significantly associated with worse outcome than low ΔAMC% (OS, p = 0.001; PFS, p = 0.001; DMFS, p = 0.034). Multivariate analyses revealed that ΔALC% (p = 0.046), ΔAMC% (p = 0.019), and EBV DNA level (p < 0.001) were independent prognostic factors for OS. With respect to PFS, ΔALC% (p = 0.036), ΔAMC% (p = 0.011), N classification (p = 0.016), and EBV DNA level (p < 0.001) were also independent prognosticators. Based on the aforementioned independent risk factors (ΔALC% ≥ 83.33%, ΔAMC% ≥ 40.00%, Stage N2–3, EBV DNA ≥ 4000 copies/ml), patients were divided into three differen t risk groups (low-risk group [with <1 risk factor], intermediate risk group [with 1–3 risk factors], and high-risk group [with 4 risk factors]) that correlated with disparate risks of death (p < 0.001), disease progression (p < 0.001), and distant metastasis (p < 0.001).

Conclusions

High ΔALC% and ΔAMC% were correlated with poor prognosis in patients with NPC. Risk stratification based on ΔALC%, ΔAMC%, N classification, and plasma EBV DNA levels could provide potential utility for risk-adapted therapeutic strategies for NPC.

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miR‐29a‐3p promotes migration and invasion in ameloblastoma via Wnt/β‐catenin signaling by targeting catenin beta interacting protein 1

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Abstract

Background

Ameloblastoma (AB) is a common epithelial odontogenic tumor. The Wnt/β-catenin pathway has been found to be related to AB invasion.

Methods

The alteration expression of microRNAs (miRNAs) and messenger RNAs (mRNAs) was performed by miRNA and mRNA microarray analysis and validated by quantitative real-time polymerase chain reaction (RT-PCR). The effects of miR-29a-3p on migration and invasion in AB cells were evaluated by a transwell assay. Bioinformatic prediction was conducted using the miRSystem and validated by quantitative RT-PCR, western blot, and a luciferase reporter assay.

Results

miR-29a-3p was overexpressed in AB tissues, which promoted the migration and invasion of AB cells in vitro. Catenin beta interacting protein 1 (CTNNBIP1), a negative regulator of the Wnt/β-catenin pathway, was predicted to be a target of miR-29a-3p. miR-29a-3p inhibited the expression of CTNNBIP1 and promoted the expression of the downstream molecules of the Wnt/β-catenin pathway.

Conclusions

miR-29a-3p promoted migration and invasion in AB via Wnt/β-catenin signaling by targeting CTNNBIP1.

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