Αρχειοθήκη ιστολογίου

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Κυριακή 21 Νοεμβρίου 2021

Management of cerebrospinal fluid leak in the lateral recess of the sphenoid sinus with transpterygoid approach: A case report

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Int J Surg Case Rep. 2021 Nov 12;89:106594. doi: 10.1016/j.ijscr.2021.106594. Online ahead of print.

ABSTRACT

BACKGROUND: Cerebrospinal fluid (CSF) leak that occurred in the lateral sphenoid sinus is a rare and difficult case. This paper aims to report a case of defect closure in the lateral recess of the sphenoid sinus endoscopically with a transpterygoid approach.

CASE PRESENTATION: A 38-year-old Indonesian woman reported a CSF leak, and identified a defect in the lateral recess of the left sphenoid sinus. CSF leak was repaired with endoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery and no CSF leak was found. The surgical procedure was successful even though it was only performed by an otorhinolaryngologist.

DISCUSSION: Endoscopic transethmoid-pterygoid or transpterygoid endoscopic surgery is effective in repairing defects in the lateral recess of the sphenoid sinus in which surgical procedure is performed by a single otorhinolaryngologist.

CONCLUSION: Endoscopic transpterygoid approach gained access to lateral site of sphenoid sinus was an effective approach in managing CSF leak of lateral sphenoid recess. Closure of the defect using a bone graft and mucosa of the middle turbinate was proven to be effective. It had been carried out successfully in Indonesia.

PMID:34794074 | DOI:10.1016/j.ijscr.2021.106594

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Association of self‐reported financial burden with quality of life and oncologic outcomes in head and neck cancer

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Abstract

Background

There is a paucity of data on financial toxicity among patients with head and neck squamous cell carcinoma (HNSCC).

Materials

This was a retrospective, cross-sectional study of patients with HNSCC surveyed at an outpatient oncology clinic.

Results

The sample included 202 patients with HNSCC with a mean age of 59.6 years (SD 10.0). There were 53 patients (26%) with self-reported financial burden. Education of high school or less was a significant predictor of self-reported financial burden (OR 2.52, 95% CI 1.03–6.14, p = 0.042). Patients reporting financial burden had significantly worse physical (p = 0.003), mental (p = 0.003), and functional (p = 0.036) health-related quality of life (HRQOL). Patients reporting financial burden appeared to have lower 5-year overall survival (74.3% vs. 83.9%, p = 0.165), but this association did not reach statistical significance.

Conclusion

Financial burden or toxicity may affect approximately a quarter of patients with HNSCC and appears to be associated with worse HRQOL outcomes.

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An integrative multi‐omic analysis reveals a major metabolic rewiring between baby foreskin keratinocytes and adult female abdominal keratinocytes.

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Abstract

Even though its development starts early in utero, neonatal skin is still immature at birth relative to adult and undergoes a maturation process extending to the first years of life. It is now established that the stratum corneum is thinner and dryer, and that skin contains less natural moisturizing factors and lipids in newborns compared to children and adults. Moreover, it has been shown that skin surface area expansion is not linear throughout life and is peaking perinatally, suggesting that baby skin has a higher epidermal cellular turnover.

Despite growing resources showing differences between adult and infant skin physiology, molecular and metabolic specificities of baby skin are still poorly understood. To address this critical knowledge gap, we performed an integrative transcriptomic and metabolomic study comparing human primary foreskin and abdominal keratinocytes from male babies and female adults, respectively.

Based on state-of-the-art integrative frameworks, our analyses revealed a major shift in the global energetic metabolism in baby foreskin keratinocytes compared to adult abdominal keratinocytes, highlighting increased amino acid metabolism and mitochondrial oxidative phosphorylation in baby cells to fuel the citric acid cycle, while showing glycolysis as the major cell energy source in adult cells.

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Gene expression profiling of laminin α3 blocked keratinocytes reveals an immune‐independent mechanism of blistering

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Abstract

Laminin-332 pemphigoid is a rare and chronic autoimmune blistering disease which results in subepidermal blisters and erosive lesions predominantly localized to mucous membranes. As histologic inflammation is variable, and non-complement fixing IgG antibodies against laminin-332 are the predominant class of autoantibodies deposited at the epidermal basement membrane zone, we hypothesized that complement-independent pro-inflammatory and blistering pathways existed similarly to that previously shown in BP. As autoantibodies to laminin α3 are most prevalent, we studied the major cellular response to blockade of laminin α3 using a well characterized monoclonal antibody (P3H9-2). RNA-seq revealed upregulation of numerous desmosomal genes (DSG1, DSG3, DSC1, DSC3, DSP) as well as KRT1 and KRT10. Additionally, P3H9-2 treated cells demonstrated downregulation of most hemidesmosomal genes. A pro-inflammatory response was not appreciated. Using pharmacological inhibito rs, we identified both protein kinase C and NOTCH as key regulators of P3H9-2 induced differentiation. We lastly utilized 3D human skin equivalents to determine whether blockade of laminin α3 would lead to delayed blistering, consistent with keratinocyte differentiation. Significant blistering was noted after 72 hours of treatment, with only minimal separation at 24 hours. In summary, blockade of laminin α3 alters keratinocyte differentiation, representing a potential complement-independent mechanism of blistering.

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Misconceptions about paraoxonase-1

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Braz J Otorhinolaryngol. 2021 Oct 26:S1808-8694(21)00171-3. doi: 10.1016/j.bjorl.2021.08.009. Online ahead of print.

NO ABSTRACT

PMID:34794918 | DOI:10.1016/j.bjorl.2021.08.009

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Early outcomes of endoscopic endonasal approach pituitary adenomas resection with minimal nasal injury

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Medicine (Baltimore). 2021 Nov 19;100(46):e27843. doi: 10.1097/MD.0000000000027843.

ABSTRACT

To report the results of a consecutive series of pituitary adenomas resected through endoscopic endonasal approach (EEA) with minimal nasal injury.Retrospectively review tumor characteristics and surgical outcomes of a consecutive series of EEA pituitary adenomas resection performed mainly by a single author between March 2018 and June 2019.A total of 75 endoscopic endonasal approach pituitary adenoma resections were performed by the authors' team. Of the 75 patients, 28 through mononostril EEA, 47 through Binonostril EEA. Hadad-Bassagasteguy vascularized nasoseptal flap was harvested in only 4 (5.3%) patients with a high risk of postoperative cerebrospinal fluid leak, and one side middle turbinate only been resected in 2 (2.7%) patients, other patients preserved bilateral middle turbinate. Of the 75 patients, gross total resection is 74.7%, near-tota l resection is 16.0%. Endocrinological remission was achieved in 76.9% of GH-secreting adenomas, 61.5% of prolactin-secreting adenomas. The postoperative cerebrospinal fluid leak rate was 2.7%. Two patients had suprasellar hemorrhage, 1 patient had perioperative stroke, 2 patients had permanent diabetes insipidus, no cranial nerve deficits, internal carotid artery injury, anosmia, and death. The sino-nasal function was measured with the Sino-Nasal Outcome Test-22 and visual analog scale for olfaction preoperatively and postoperatively, and there was no statistically significant difference.The EEA is an effective approach to resect pituitary adenomas, the gross total resection and near-total resection rate and endocrinological remission rate are satisfactory. The EEA is a safe approach, as the complication rate is acceptable compared with those reported in the previous series of microscopic and endoscopic approaches. These results can be achieved with minimal nasal injury.

PMID :34797319 | DOI:10.1097/MD.0000000000027843

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Petrous Bone Cholesteatoma: Facial and Hearing Preservation

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Ear Nose Throat J. 2021 Nov 19:1455613211056554. doi: 10.1177/01455613211056554. Online ahead of print.

ABSTRACT

Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and he aring preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.

PMID:34797992 | DOI:10.1177/01455613211056554

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Analysis of the status of treatment of benign thyroid diseases - a public health problem aggravated in the COVID-19 pandemic era

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Braz J Otorhinolaryngol. 2021 Oct 23:S1808-8694(21)00170-1. doi: 10.1016/j.bjorl.2021.08.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Goiters and benign nodules detected in the thyroid are growing lesions and the COVID-19 pandemic have negatively impacted on their surgical treatment. The appropriate selection of patients to treatment will improve the overall health status. This article review will focus on the impact of the COVID-19 pandemic on treatment of benign conditions of the thyroid gland and their implications.

METHODS: This review pointed out the status of the health system in developing country and the problems to treat benign surgical diseases of thyroid. Aspects of epidemiology, incidence, clinical presentation and surgical treatment of goiters, economic and health status impact were cited.

RESULTS: All surgical treatment of goiter and other benign conditions were postponed, forced to redirect, and reschedule all benign surgeries, situation aggravated by poor public management and closure of hospital beds. These conditions have caused deterioration in patients' physical (decompensated thyroid disease) and mental health status, increasing work disabilities and burdening society by increasing the social and health cost. The overall situation could be catastrophic in emergent countries where this increased disease-related social expenditure on surgical treatment may increase the risk of national impoverishment as increase the treatment cost. Brazilian Society Head and Neck Surgery related some recommendations and new suggestions were made to safely treat these high potential hazard surgical conditions.

CONCLUSIONS: Surgeries for goiter and benign thyroid conditions can be performed during the COVID-19 pandemic, following strict safety protocols for the patient and the medical team, reducing the negative economic and on patient health impact.

PMID:34799264 | DOI:10.1016/j.bjorl.2021.08.008

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Is there a change in P300 evoked potential after 6 months in cochlear implant users?

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Braz J Otorhinolaryngol. 2021 Nov 10:S1808-8694(21)00182-8. doi: 10.1016/j.bjorl.2021.10.002. Online ahead of print.

ABSTRACT

OBJECTIVE: There are few studies on long-latency auditory evoked potential (P300) in people with hearing loss who use a cochlear implant. Central auditory system evaluation with behavioral and electrophysiological tests is believed to help understand the neuroplasticity mechanisms involved in auditory functioning after cochlear implant surgery. This study investigated the electrophysiological processing of cortical level acoustic signals in a group of 21 adult individuals with postlingual bilateral severe-to-profound hearing loss who were submitted to cochlear implant surgery.

METHODS: Data were collected in three phases: pre-cochlear implant surgery, at cochlear implant activation, and 6 months after surgery. P300 measures were also registered during all phases. Tone-burst and speech stimuli were used to elicit P300 and were presented in free field.

RESULTS: Mean P3 component latency with tone-burst and speech stimuli were 352.9 and 321.9 ms in the pre-cochlear implant phase, 364.9 and 368.7 ms in the activation phase, 336.2 and 343.6 ms 6 months after the surgery. The P3 component mean latency values using tone-burst at activation were significantly different from those 6 months after cochlear implant. They were also significantly different using speech, between pre-cochlear implant and activation phases. Lower P3 component latency occurred 6 months after cochlear implant activation with tone-burst and pre-cochlear implant with speech stimulus. There was a weak correlation between mean P3 component latency with speech stimulus and time of hearing loss. There was no difference in amplitude between phases or in the comparison with the other variables.

CONCLUSION: There were changes in P3 component latency during the period assessed, for both speech and pure-tone stimuli, with increased latency in the activation phase and similar lower results in the two other phases, Pre-CI and 6 months after CI use. Mean amplitude measures did not vary in the three phases.

PMID:34799269 | DOI:10.1016/j.bjorl.2021.10.002

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Effects of vestibular rehabilitation in the management of patients with and without vestibular migraine

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Braz J Otorhinolaryngol. 2021 Oct 25:S1808-8694(21)00161-0. doi: 10.1016/j.bjorl.2021.07.011. Online ahead of print.

ABSTRACT

OBJECTIVE: Vestibular Migraine (VM) is the second most common cause in patients with vertigo. Patients with VM complain about vestibular symptoms during a headache attack or during the period between attacks. Vestibular Rehabilitation (VR), an exercised based therapy to treat dizziness and balance dysfunction has been shown to be effective in vestibular diseases. In this study, we aimed to assess the effect of VR for vestibular symptoms and quality of life in VM patients, and to compare the results with patients with vestibular disorders without migraine.

METHODS: Sixty (60) patients who received VR treatment were divided into two groups: vestibular migraine group (30 patients) and non-migraine vestibular dysfunction group (30 patients). All patients received VR for 18 sessions and the program was complete d in 1.5 months. Pre- and post-treatment Dizziness Handicap Inventory (DHI) scores, Vestibular Disorders Activities of Daily Living Scale (VADL) scores, the frequency of dizziness and headache, and Computerized Dynamic Posturography (CDP) scores were assessed and compared retrospectively.

RESULTS: With VR in both the vestibular migraine group and vestibular dysfunction group, DHI score, VADL score, the frequency of dizziness and headache scores significantly impaired. Post-treatment CDP results were higher than pre- treatment results for both patient groups.

CONCLUSION: With VR, a significant improvement was observed in subjective and objective balance assessment measurement. Vestibular Rehabilitation must be considered in patients who do not benefit from medical therapy or have limited benefit.

LEVEL OF EVIDENCE: Level III (evidence obtained from well-designed controlled trials without randomization).

PMID:34799267 | DOI:10.1016/j.bjorl.2021.07.011

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Is there a change in P300 evoked potential after 6 months in cochlear implant users?

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Braz J Otorhinolaryngol. 2021 Nov 10:S1808-8694(21)00182-8. doi: 10.1016/j.bjorl.2021.10.002. Online ahead of print.

ABSTRACT

OBJECTIVE: There are few studies on long-latency auditory evoked potential (P300) in people with hearing loss who use a cochlear implant. Central auditory system evaluation with behavioral and electrophysiological tests is believed to help understand the neuroplasticity mechanisms involved in auditory functioning after cochlear implant surgery. This study investigated the electrophysiological processing of cortical level acoustic signals in a group of 21 adult individuals with postlingual bilateral severe-to-profound hearing loss who were submitted to cochlear implant surgery.

METHODS: Data were collected in three phases: pre-cochlear implant surgery, at cochlear implant activation, and 6 months after surgery. P300 measures were also registered during all phases. Tone-burst and speech stimuli were used to elicit P300 and were presented in free field.

RESULTS: Mean P3 component latency with tone-burst and speech stimuli were 352.9 and 321.9 ms in the pre-cochlear implant phase, 364.9 and 368.7 ms in the activation phase, 336.2 and 343.6 ms 6 months after the surgery. The P3 component mean latency values using tone-burst at activation were significantly different from those 6 months after cochlear implant. They were also significantly different using speech, between pre-cochlear implant and activation phases. Lower P3 component latency occurred 6 months after cochlear implant activation with tone-burst and pre-cochlear implant with speech stimulus. There was a weak correlation between mean P3 component latency with speech stimulus and time of hearing loss. There was no difference in amplitude between phases or in the comparison with the other variables.

CONCLUSION: There were changes in P3 component latency during the period assessed, for both speech and pure-tone stimuli, with in creased latency in the activation phase and similar lower results in the two other phases, Pre-CI and 6 months after CI use. Mean amplitude measures did not vary in the three phases.

PMID:34799269 | DOI:10.1016/j.bjorl.2021.10.002

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