Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: a report of 10 cases

xlomafota13 shared this article with you from Inoreader Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: a report of 10 cases Via Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jul 7;56(7):751-754. doi: 10.3760/cma.j.cn115330-20201015-00805. ABSTRACT Objective: To investigate the feasibility of endoscopic lateral neck dissection via the breast and transoral approaches (ELNDBTOA) for papillary thyroid carcinoma (PTC). Methods: From February 2015 to April 2019, 10 patients with PTC (cN1b) including 1 male and 9 females aged from 22 to 53 years old received ELNDBTOA in the General Surgery Department of Zhongshan Hospital, Xiamen University. Total thyroidectomy, the central lymph node dissection and the selective neck dissection (levels Ⅱ, Ⅲ and Ⅳ) were performed endoscopically via the breast approach, and then the residual lymph nodes were dissected via transoral approach. The medical records, operation time, blood loss, complications and postoperative follow-up outcomes were analyzed retrospectively. SPSS 22.0 software package was used for statistical processing of clinical data of patients. Results: All cases were successfully treated with ELNDBTOA without transfer to open surgery. The average operative time was (362.5±79.7) min, the blood loss was (23.0±14.9) ml, and the postoperative hospital stay was (5.1±1.3) days. The mean number of harvested cervical lymph nodes were (34.2±25.8), and the mean number of positive lymph nodes were (6.5±4.9). Lymph nodes were dissected by the further dissection via oral approach in 6 patients and a total of 9 lateral lymph nodes were havested from 2 of the 6 patients, with 3 positive lymph nodes. Two patients had transient skin numbness in the mandibular area and recovered within two weeks. One patient developed transient hypoparathyroidism and recovered within two months. No secondary bleeding, recurrent laryngeal nerve paralysis, chylous leakage, neck infection, permanent hypoparathyroidism or other complications were observed. The follow-up time was from 16 to 66 mon ths with a median of 42.5 months, no tumor recurrence or metastasis occurred, and also no obvious deformity, abnormal sensation or movement in the chest, neck and mouth was observed. Conclusions: ELNBTOA is safe and feasible, with good cosmetic outcome. PMID:34344103 | DOI:10.3760/cma.j.cn115330-20201015-00805 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Study on changes of voice characteristics after adenotonsillectomy or adenoidectomy in children

xlomafota13 shared this article with you from Inoreader Study on changes of voice characteristics after adenotonsillectomy or adenoidectomy in children Via Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jul 7;56(7):724-729. doi: 10.3760/cma.j.cn115330-20200813-00672. ABSTRACT Objective: To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Methods: Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. More over, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Results: Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(Z=2.18,P=0.041) and F2(t=2.13,P=0.040) increased, B2(Z=2.04,P=0.041) and B4(Z=2.00,P=0.046) decreased. For vowel/i/, F2(t=2.035,P=0.050) and F4( t=4.44,P=0.0001) increased, B2(Z=2.36,P=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(r=-0.392, P =0.032) of vowel/a/and F2(r=-0.279, P=0.048) and F4 (r=-0.401, P =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Conclusions: Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT. PMID:34344099 | DOI:10.3760/cma.j.cn115330-20200813-00672 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Meta‐analysis on continuous nerve monitoring in thyroidectomies

xlomafota13 shared this article with you from Inoreader Meta‐analysis on continuous nerve monitoring in thyroidectomies Via Head & Neck Abstract In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve–recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity usin g the I 2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6–2.9, I 2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08–0.2, I 2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

PD‐L1 is upregulated via BRD2 in head and neck squamous cell carcinoma models of acquired cetuximab resistance

xlomafota13 shared this article with you from Inoreader PD‐L1 is upregulated via BRD2 in head and neck squamous cell carcinoma models of acquired cetuximab resistance Via Head & Neck Abstract Background Tumor models resistant to EGFR tyrosine kinase inhibitors or cisplatin express higher levels of the immune checkpoint molecule PD-L1. We sought to determine whether PD-L1 expression is elevated in head and neck squamous cell carcinoma (HNSCC) models of acquired cetuximab resistance and whether the expression is regulated by bromodomain and extraterminal domain (BET) proteins. Methods Expression of PD-L1 was assessed in HNSCC cell line models of acquired cetuximab resistance. Proteolysis targeting chimera (PROTAC)- and RNAi-mediated targeting were used to assess the role of BET proteins. Results Cetuximab-resistant HNSCC cells expressed elevated PD-L1 compared to cetuximab-sensitive controls. Treatment with the BET inhibitor JQ1, the BET PROTAC MZ1, or RNAi-mediated knockdown of BRD2 decreased PD-L1 expression. Knockdown of BRD2 also reduced the elevated levels of PD-L1 seen in a model of acquired cisplatin resistance. Conclusions PD-L1 is significantly elevated in HNSCC models of acquired cetuximab and cisplatin resistance where BRD2 is the primary regulator. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Suturing of the Arachnoid Membrane for Reconstruction of the Cisterna Magna: Technical Considerations

xlomafota13 shared this article with you from Inoreader Suturing of the Arachnoid Membrane for Reconstruction of the Cisterna Magna: Technical Considerations Via leak of cerebrospinal fluid World Neurosurg. 2021 Jul 31:S1878-8750(21)01138-4. doi: 10.1016/j.wneu.2021.07.129. Online ahead of print. ABSTRACT BACKGROUND: Postoperative cerebrospinal fluid (CSF) fistula following cranial or spinal surgery is associated with increased morbidity and mortality. To prevent CSF fistulas, various techniques have been described. OBJECTIVE: To describe the arachnoid membrane continuous-running-suture technique in cisterna magna reconstruction for preventing postoperative CSF leakage. METHODS: After craniotomy and dural opening, the incision of the arachnoid of the cisterna magna was performed using a diamond blade. To prevent the arachnoid from drying out and shrinking during surgery, it was periodically irrigated with warm saline solution. Posterior fossa surgery was performed. While closing the membranes, the arachnoid membrane was closed with the running-suture technique. After the first surgical knot was made in the cranial en d of the arachnoid opening, continuous suturing with a 2-mm distance between the stitches was performed without stretching them. After every 3 stitches, the free end of the thread was pulled gently along the suturing axis, and the edges of the arachnoid were closed. After the arachnoid edges were approximated, the surgical knot was tied. Watertight closure was checked by performing the valsalva maneuver at the end of the surgery. RESULTS: No CSF leakages were observed after surgery. CONCLUSION: Arachnoid membrane suturing seems to be safe and effective in preventing postoperative CSF leakage and CSF-related complications. Using continuous running suturing alone, without any sealant, might be effective in cases with untraumatized arachnoid membrane. PMID:34343681 | DOI:10.1016/j.wneu.2021.07.129 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Trans-hyoid hyoidthyroidpexy: A modified technique for selected cases of obstructive sleep apnea

xlomafota13 shared this article with you from Inoreader Trans-hyoid hyoidthyroidpexy: A modified technique for selected cases of obstructive sleep apnea Via American Journal of Otolaryngology Publication date: November–December 2021 Source: American Journal of Otolaryngology, Volume 42, Issue 6 Author(s): Sherif Askar, Ali Awad, Tamer Oraby, Alaa Khazbak View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of adjuvant radiation therapy for locoregionally recurrent papillary thyroid carcinoma

xlomafota13 shared this article with you from Inoreader The role of adjuvant radiation therapy for locoregionally recurrent papillary thyroid carcinoma Via radioactive iodine Saudi Med J. 2021 Aug;42(8):832-837. doi: 10.15537/smj.2021.42.8.20210127. ABSTRACT OBJECTIVES: To evaluate the role of adjuvant radiation therapy in patients with locoregionally recurrent (rpT4/N1b) papillary thyroid carcinoma (PTC). METHODS: The medical records of patients with rpT4/N1b PTC who were treated between January 2001 and December 2016 were reviewed. A total of 57 patients were analyzed, of which 24 patients were treated with adjuvant radiation therapy, and 33 pat ients did not receive adjuvant radiation therapy. Survival outcomes were compared between the 2 treatment groups. The primary endpoint was locoregional recurrence-free survival rate. RESULTS: The median follow-up period for all patients was 10.3 years (range, 2.8-19.2 years). The 15-year locoregional recurrence-free survival rate was 80.5% for those who received adjuvant radiation therapy and 28.1% for those who did not (p<0.001). The 15-year distant metastasis-free survival rate was 48.8% for those who received adjuvant radiation therapy and 33.4% for those who did not (p=0.906). The 15-year overall survival rate was 69.7% for those who received adjuvant radiation therapy and 53.1% for those who did not (p=0.921). CONCLUSIONS: Adjuvant radiation therapy ensured favorable locoregional recurrence-free survival in patients with rT4/N1b PTC and might contribute to improving patients' quality of life by reducing the need for additional salvage surgery and the economic burden of other salvage treatments, such as surgery or radioactive iodine therapy. PMID:34344806 | DOI:10.15537/smj.2021.42.8.20210127 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Severe and persistent coronavirus disease 2019 cough resulting in bone flap displacement and pseudomeningocele

xlomafota13 shared this article with you from Inoreader Severe and persistent coronavirus disease 2019 cough resulting in bone flap displacement and pseudomeningocele Via leak of cerebrospinal fluid Surg Neurol Int. 2021 Jul 12;12:348. doi: 10.25259/SNI_405_2021. eCollection 2021. ABSTRACT BACKGROUND: Cough is one of the most common symptoms of coronavirus disease 2019 (COVID-19) infection. This relatively benign symptom may lead to serious sequelae, especially in postoperative neurosurgical patients. CASE DESCRIPTION: Here, we report a case of bone flap displacement, pseudomeningocele formation, and consequent cerebrospinal fluid leak in a patient with COVID-19 infection who recently underwent craniotomy for excision of cerebral metastasis. We highlight the pathophysiologic mechanisms of cough that may cause increased intracranial pressure (ICP), leading to the postoperative morbidity. CONCLUSION: Aside from additional risks to the patient's health and increased treatment costs, these complications also lead to subsequent delays in the management of the underlying disease. Symptomatic treatment of cough is advised to prevent complications resulting from increased ICP. PMID:34345488 | PMC:PMC8326096 | DOI:10.25259/SNI_405_2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intradural disc herniation at the L1-2 level

xlomafota13 shared this article with you from Inoreader Intradural disc herniation at the L1-2 level Via leak of cerebrospinal fluid Surg Neurol Int. 2021 Jul 12;12:351. doi: 10.25259/SNI_561_2021. eCollection 2021. ABSTRACT BACKGROUND: Intradural disc herniations (IDHs) are rare, are difficult to diagnose on preoperative MR/CT imaging, and typically, are most readily confirmed at the time of surgery. However, one of the greatest challenges posed by these lesions, is the repair of the ventral dural rent. CASE DESCRIPTION: A 55-year-old male with a 20-year history of lumbago presented with low back pain and right lower extremity sciatica of 3 months' duration. The MR and CT studies showed a compressive lesion at the L1-2 level. There was no original suspicion that this was an IDH. At surgery, performed under the operating microscope, a subtotal L1-L2 laminectomy was performed (i.e. while lysing severe adhesions between the posterior longitudinal ligament and the ventral dura, a traumatic durotomy occurred. White, spongious, friable, soft tissue, and free-floating disc fragments extruded through the durotomy site. Notably, it was initially considered to be a tumor rather than a disc. Once all fragments had been delivered, unsuccessful attempts were made to repair the ventral dura. Further efforts were curtailed due to concern that they would result in damage to multiple ventral nerve rootlets. Despite the lack of primary dural repair, the secondary measures resulted in no postoperative recurrent cerebrospinal fluid leakage (CSF) and a smooth postoperative surgical course. CONCLUSION: IDH at the L1-2 level is rare, and preoperative MR/CT studies may not always document their intradural location. Ideally, ventral dural tears attributed to these lesions should be directly repaired and/or managed with additional adjunctive CSF leak repair techniques (i.e. muscle patch grafts, microfibrillar collagen, and fibrin sealants). PMID:34345491 | PMC:PMC8326135 | DOI:10.25259/SNI_561_2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Rare incidence of tension pneumocephalus 2 months after repeat microvascular decompression

xlomafota13 shared this article with you from Inoreader Rare incidence of tension pneumocephalus 2 months after repeat microvascular decompression Via leak of cerebrospinal fluid Surg Neurol Int. 2021 Jun 28;12:311. doi: 10.25259/SNI_917_2020. eCollection 2021. ABSTRACT BACKGROUND: Tension pneumocephalus is a rare complication after intracranial procedures and craniotomy. We report a rare case of intraventricular and subdural tension pneumocephalus occurring 2 months after repeat right-sided microvascular decompression (MVD) for recurrent trigeminal neuralgia. CASE DESCRIPTION: The patient in this case was a 79-year-old woman who presented with acute-onset confusion, headaches, nausea, and vomiting. On computed tomography, substantial volumes of pneumocephalus in the fourth ventricle and subdural space at the site of the retrosigmoid exposure for the previous MVD were seen. She underwent emergent wound exploration, and no obvious dural defect or exposed mastoid air cells were identified. The dura was reopened, and the surgical site was copiously irrigated. Mastoid air cells were covered with ample amounts of bon e wax, and the wound was closed. The patient recovered well postoperatively with complete resolution of the pneumocephalus by her 3-month follow-up evaluation. CONCLUSION: It is important to assess for cerebrospinal fluid leakage and that air cells are sealed off before wound closure to prevent a pathway for air to egress into the surgical cavity and corridor. PMID:34345452 | PMC:PMC8326134 | DOI:10.25259/SNI_917_2020 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Protective effect of propofol via the regulation of ovarian granulosa cell proliferation and apoptosis

xlomafota13 shared this article with you from Inoreader Protective effect of propofol via the regulation of ovarian granulosa cell proliferation and apoptosis Via Experimental and therapeutic medicine Exp Ther Med. 2021 Sep;22(3):988. doi: 10.3892/etm.2021.10420. Epub 2021 Jul 13. ABSTRACT Propofol is an anesthetic frequently used in surgery. Accumulating evidence suggests that propofol exhibits an effect on cell viability, apoptosis and invasion in several types of cancer cells. MicroRNAs (miRNAs) have been reported to play pivotal roles in the development of polycystic ovary syndrome (PCOS). However, the diagnostic applications of miR-451a in PCOS remain unknown. The present study aimed to elucidate the effects of propofol on ovarian granulosa cell proliferation and apoptosis and illustrate the specific mechanisms associated with this process. Human ovarian granulosa cell-like KGN cells, which were used as a representative of granulosa cells in the present study, were treated with different concentrations (0, 1, 5 and 10 µg/ml) of propofol for 48 h and cell proliferation and apoptosis were assessed using MTT and flow cytometry as says, respectively. Propofol treatment resulted in significant inhibition of cell viability and induction of apoptosis in KGN cells, which was accompanied with increased cleaved caspase 3 and suppressed pro-caspase 3 expression levels. Furthermore, propofol reduced Wnt3a and β-catenin protein and mRNA expression levels. miR-451a expression in KGN cells was evaluated by reverse transcription-quantitative PCR (RT-qPCR). miR-451a expression was upregulated in propofol-stimulated KGN cells. The data further demonstrated that miR-451a mimics suppressed cell proliferation and increased apoptosis of KGN cells compared with cells transfected with control mimics. Furthermore, the association between miR-451a and propofol was investigated. Rescue experiments were performed to investigate the anti-proliferative mechanism of propofol in ovarian granulosa cells. KGN cells were transfected with miR-451a inhibitor or inhibitor control sequences for 6 h and treated with 10 µg/ml propofol for an a dditional 48 h. The results from the MTT, RT-qPCR and western blot assays indicated that 10 µg/ml propofol inhibited cell viability, induced apoptosis, enhanced cleaved caspase 3 expression, reduced pro-caspase 3 levels and inhibited the protein and mRNA expression of Wnt3a and β-catenin. However, inhibition of miR-451a demonstrated the opposite effects. In conclusion, the results of the present study revealed that propofol exerted an anti-proliferative and apoptosis-inducing role in ovarian granulosa cells through mediation of miR-451a expression. In addition, the data indicated that miR-451a may be used as an effective therapeutic target for PCOS treatment. PMID:34345270 | PMC:PMC8311282 | DOI:10.3892/etm.2021.10420 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.