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Τετάρτη 30 Ιουνίου 2021

A Volumetric Study of the Corpus Callosum

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1731033

Objective The aim of this study is to measure the average corpus callosum (CC) volume of healthy Turkish humans and to analyze the effects of gender and age on volumes, including the genu, truncus, and splenium parts of the CC. Patients and Methods Magnetic resonance imaging brain scans were obtained from 301 healthy male and female subjects, aged 11 to 84 years. The median age was 42 years (min–max: 11–82) in females and 49 years (min–max: 12–84) in males. Corpus callosum and its parts were calculated by using MRICloud. CC volumes of each subject were compared with those of the age and gender groups. Results All volumes of the CC were significantly higher in males than females. All left volumes except BCC were significantly higher than the right volumes in both males and females. The oldest two age groups (50–69 and 70–84 years) were found to have higher bilateral CC volumes, and bilateral BCC volumes were also higher than in the other two age groups (11–29 and 30–49 years). Conclusion The results suggest that compared with females/males, females have a faster decline in the volume of all volumes of the CC. We think that quantitative structural magnetic resonance data of the brain is vital in understanding human brain function and development.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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Decompression of the geniculate ganglion and labyrinthine segments of the facial nerve through a middle cranial fossa approach using an ultrasonic surgical system: an anatomic study

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Eur Arch Otorhinolaryngol. 2021 Jun 30. doi: 10.1007/s00405-021-06966-4. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to evaluate the feasibility and the safety of a novel, alternative method for bone tissue management in facial nerve decompression by a middle cranial fossa approach. Several applications of Piezosurgery technology have been described, and the technique has recently been extended to otologic surgery. The piezoelectric device is a bone dissector which, using micro-vibration, preserves the anatomic integrity of soft tissue thanks to a selective action on mineralized tissue.

METHODS: An anatomic dissection study was conducted on fresh-frozen adult cadaveric heads. Facial nerve decompression was performed by a middle cranial fossa approach in all specimens using the piezoelectric device under a surgical 3D exoscope visualization. After the procedures, the temporal bones were examined for evidence of any injury to the facial nerve or the cochleovestibular organs.

RESULTS: In all cases, it was possible to perform a safe dissection of the greater petrosal superficial nerve, the geniculate ganglion, and the labyrinthine tract of the facial nerve. No cases of semicircular canal, cochlea, or nerve damage were observed. All of the dissections were carried out with the ultrasonic device without the necessity to replace it with an otological drill.

CONCLUSION: From this preliminary study, surgical decompression of the facial nerve via the middle cranial fossa approach using Piezosurgery seems to be a safe and feasible procedure. Further cadaveric training is recommended before intraoperative use, and a wider case series is required to make a comparison with conventional devices.

PMID:34191113 | DOI:10.1007/s00405-021-06966-4

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Predictive Value of a Prognostic Model Based on Lymphocyte-to-Monocyte Ratio Before Radioiodine Therapy for Recurrence of Papillary Thyroid Carcinoma

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Technol Cancer Res Treat. 2021 Jan-Dec;20:15330338211027910. doi: 10.1177/15330338211027910.

ABSTRACT

BACKGROUND: The aim of this study was to investigate the predictive value of a prognostic model based on the lymphocyte-to-monocyte ratio (LMR) before radioiodine treatment for the recurrence of papillary thyroid carcinoma (PTC).

METHODS: Clinicopathological data of 441 patients with papillary thyroid cancer were collected retrospectively. The Receiver operating characteristi c (ROC) was used to determine the optimal cut-off value for predicting PTC recurrence by LMR before radioiodine treatment. Recurrence was the endpoint of the study, and survival was estimated by the Kaplan-Meier method, and any differences in survival were evaluated with a stratified log-rank test. Univariate and multifactorial analyses were performed using Cox proportional-hazards models to identify risk factors associated with PTC recurrence.

RESULTS: The ROC curve showed that the best cut-off value of LMR before radioiodine treatment to predict recurrence in patients with PTC was 6.61, with a sensitivity of 54.1%, a specificity of 73%, and an area under the curve of 0.628. The recurrence rate was significantly higher in the low LMR group (16%) than in the high LMR group (5%) (P = 0.001, χ2 = 12.005). Multifactorial analysis showed that LMR < 6.61 (P = 0.006; HR = 2.508) and risk stratification (high risk) (P = 0.000; HR = 5.076) before ra dioiodine treatment were independent risk factors predicting recurrence in patients with PTC. Patients with preoperative LMR < 6.61 and high risk stratification had the lowest recurrence-free survival rate and the shortest recurrence-free survival time.

CONCLUSIONS: The LMR-based prognostic model before radioactive iodine treatment is valuable for early prediction of PTC recurrence and it can be used in clinical practice as a supplement to risk stratification and applied in combination to help screen out patients with poorer prognosis early.

PMID:34191658 | DOI:10.1177/153303382110 27910

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Metastatic malignant struma ovarii: a case report and review of the literature on the management of malignant struma ovarii

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Acta Clin Belg. 2021 Jun 30:1-5. doi: 10.1080/17843286.2021.1944583. Online ahead of print.

ABSTRACT

OBJECTIVES: To present a case of metastatic struma ovarii, to review the literature on malignant struma ovarii and to discuss the management in locoregional and metastatic disease.

METHODS: We present a case of an 82-year-old patient with a malignant struma ovarii and liver metastasis. The patient was treated with pelvic surgery, total thyroidectomy, radioactive iodine therapy and TSH suppression therapy with levothyroxine. We performed a PubMed search for case reports of metastatic struma ovarii.

RESULTS: 43 cases of metastatic struma ovarii were identified. 53.5% of patients presented with metastatic disease at diagnosis. Mean time to development of metastasis was 6.9 years in the group with initial locoregional disease. First-line treatment was pelvic surgery in all patients. Thyroidectomy was performed in 83.7% of patients, subsequent radioactive iodine therapy in 79.1%, followed by TSH suppression therapy in 46.5% of patients. Mean time of follow-up after diagnosis of metastases was 3.6 years, ranging from 0.5 to 24 years. At the end of the follow-up, 51.1% of patients were free of disease, 34.9% were alive with disease, 7.0% died of disease and 7.0% were lost to follow-up.

CONCLUSION: The majority of patients with metastatic struma ovarii were treated with pelvic surgery, total thyroidectomy and radioactive iodine therapy. Suppression o f TSH with levothyroxine was given in less than half of the patients. In non-metastatic setting, the same approach could be considered depending on the patient profile.

PMID:34191687 | DOI:10.1080/17843286.2021.1944583

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Isolated Traumatic Dislocation of the Malleus into the External Auditory Canal

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Ear Nose Throat J. 2021 Jun 30:1455613211026529. doi: 10.1177/01455613211026529. Online ahead of print.

ABSTRACT

We report a rare case of isolated malleus dislocation into the external auditory canal with lateralized intact tympanic membrane following a head trauma. The patient was a 63-year-old woman who presented at the outpatient department of our institute with hearing loss of 10 years' duration after a bicycle accident. During physical examination of the patient, total d islocation of the malleus-like bony structure into the external auditory canal on the right side was observed. In the computed tomography scan, an isolated malleus dislocation with intact incus-stapes articulation was identified. The patient was successfully treated with endoscopic exploratory tympanotomy and partial ossicular replacement prosthesis. The isolated malleus dislocation can rarely occur after trauma. A careful diagnostic step through history, physical examination, and temporal bone computed tomography scan are needed to confirm this rare condition.

PMID:34191618 | DOI:10.1177/0 1455613211026529

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Endoscopic Endonasal Orbital Apex Decompression for Carotid Cavernous Fistula

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Ear Nose Throat J. 2021 Jun 30:1455613211030347. doi: 10.1177/01455613211030347. Online ahead of print.

ABSTRACT

SIGNIFICANCE STATEMENT: This case report demonstrates a novel approach to treating a rare indirect carotid cavernous fistula (CCF) and associated abducens palsy. Although endovascular treatment is the standard of care in the management of CCFs, it was contraindicated in this patient. Instead, she underwent an endoscopic endonasal approach (EEA) with decompression of the medial orbital apex, including the cavernous sinus and optic nerve, with complete resolution of headache, lateral gaze palsy, and diplopia within 2 months.

PMID:34191645 | DOI:10.1177/01455613211030347

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Τρίτη 29 Ιουνίου 2021

Actualización en carcinoma escamoso orofaríngeo

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Resumen El carcinoma escamoso de orofaringe (CEOF) ha tenido un aumento en su incidencia en las últimas décadas, explicándose por el aumento sustancial de su tipo relacionado con el virus papiloma humano (VPH). Existen diferencias clínicas y pronósticas entre los dos grupos de CEOF según su relación etiológica con VPH. Por un lado, los relacionados con VPH se presentan en una población más joven, con menos prevalencia de tabaquismo y consumo de alcohol; además de presentar un tamaño pequeño del tumor primario, con un compromiso linfonodal temprano. Además, aquellos relacionados con VPH presentan un mejor pronóstico que su contraparte no relacionada con el virus, presentando en algunos estudios hasta un 58% menos riesgo de muerte independiente de la modalidad de tratamiento. Actualmente, el sistema de clasificación TNM en su 8va edición presenta un sistema diferente de clasificación y etapificación para ambos grupos. A pesar de aquello, a la fecha el tratamien to habitual no difiere entre ambos, lo que ha llevado a la realización de estudios que buscan responder si la deintensificación de la terapia en aquellos grupos relacionados con VPH y con bajo riesgo de metástasis a distancia, mantendría los buenos resultados oncológicos, disminuyendo las complicaciones a corto y largo plazo asociadas al tratamiento. Sin embargo, aún no existe evidencia que avale consistentemente esta práctica. Finalmente, la prevención primaria a través de la vacuna contra VPH es un elemento prometedor, sin embargo, no existe evidencia que confirme su utilidad.
Abstract Oropharyngeal squamous cell carcinoma (OPSCC) has suffered an increase in its incidence in recent decades, explained by the increase in its type related to the human papilloma virus (HPV). There are clinical and prognostic differences between the two groups of OPSCC according to their etiological relationship with HPV. On the one hand, those related to HPV appear in a younger population, with a lower prevalence of smoking and alcohol consumption; in addition to presenting a small size of the primary tumor, with early lymph node involvement. Furthermore, those related to HPV have a better prognosis than their non-virus counterpart, presenting in some studies up to 58% less risk of death, independent of treatment used. Currently, the TNM classification system in its 8th edition presents a different classification for both groups. Despite this, the treatment does not differ between the two, which has led to studies that seek to answer whether the de-escalation of therapy in the group associated to HPV and with a low risk of distant metastasis would maintain the reported good oncological results, reducing early and long-term complications associated with treatment, however, there is still no evidence to support its use. Finally, primary prevention through the HPV vaccine is a promising element, however there is no evidence to confirm its usefulness.
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