Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τρίτη 30 Μαρτίου 2021

Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus

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Ear Nose Throat J. 2021 Mar 30:1455613211003989. doi: 10.1177/01455613211003989. Online ahead of print.

ABSTRACT

Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stal k of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.

PMID:33781124 | DOI:10.1177/01455613211003989

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COVID19 and acute lymphoblastic leukemias of children and adolescents: Updated recommendations (Version 2) of the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE)

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Bull Cancer. 2021 Mar 11:S0007-4551(21)00082-5. doi: 10.1016/j.bulcan.2021.02.004. Online ahead of print.

ABSTRACT

Since the emergence of the SARS-CoV-2 infection, many recommendations have been made. However, the very specific nature of acute lymphoblastic leukemias and their treatment in children and adolescents led the Leukemia Committee of the French Society for the fight against Cancers and leukemias in children and adolescents (SFCE) to propose more specific recommendations. Here is the second version of these recommendations updated according to the evolution of knowledge on COVID19.

PMID:33781551 | DOI:10.1016/j.bulcan.2021.02.004

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Reduction of seroma and improvement of quality of life after early drain removal in immediate breast reconstruction with tissue expander. Preliminary report from a randomized controlled study

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J Plast Reconstr Aesthet Surg. 2021 Mar 9:S1748-6815(21)00074-7. doi: 10.1016/j.bjps.2021.02.005. Online ahead of print.

ABSTRACT

Seroma is the most common complication of breast reconstruction with tissue expander (incidence 0.2-20%) with increased risk of infection and implant loss by 4-6 fold. About 90% of plastic surgeons routinely placed drains for its prevention. We theorized that early drain removal is a safe procedure that improves postoperative quality of life (QoL), reducing pain, length of hospital stay, and limitations on daily activities. We divided 49 patients operated on between September 2016 and March 2018 (follow-up: 9-26 months) into two groups: Group1 (output-based; drains removed when <30 ml/day); and Group2 (early-removal; at 3-4 days postop.). A study-specific questionnaire about the patient's QoL was conducted 3 weeks after surgery. We performed an intention-to-treat analysis. A comparison was performed using a Fisher test and a Mann-Whitney U test with p = 0.05. We observed lower production of wound fluid (641±49 ml vs 231±20 ml; p = 0.004), and a shorter time until wound healing (31.3±4.2 days vs 22±3.9 days; p = 0.031) for Group 2. The difference for infection (p = 0.36), impaired wound healing (p = 0.22), and the seroma formation period (p = 0.11) was not significant. Group 2 experienced less breast pain (8% vs 87.5%; p = 0.001), fewer limitations in daily activities (16% vs 50%; p = 0.002), in mobility (20% vs 83.3%; p = 0.001), and in social life (8% vs 91.7%; p < 0.001), and a better quality of sleep than Group 1 (36% vs 75%; p = 0.002). Group 2 did not require home care after hospital discharge (p < 0.001). The limitations of study are: its small sample size, the wound healing assessment, and the use of a non-validated questionnaire.

PMID:33781704 | DOI:10.1016/j.bjps.2021.02.005

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Δευτέρα 29 Μαρτίου 2021

Oral mucositis. Is it present in the immunotherapy of the immune checkpoint pd1/pd-l1 against oral cancer? A systematic review

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Med Oral Patol Oral Cir Bucal. 2021 Mar 27:24353. doi: 10.4317/medoral.24353. Online ahead of print.

ABSTRACT

BACKGROUND: Oral mucositis (OM) is a painful lesion that takes place in the mucosa of the oral cavity, usually its etiology is associated with drug therapies in cancer patients. It is presented as well-defined ulcers whose painful symptomatology sometimes implies the suspension of oncological treatment or parenteral feeding, being therefore an important adverse effect, marking the evolution of these types of therapies against cancer. The present work aim is to know the prevalence of oral mucositis in oral cancer immunotherapy compared to its prevalence in standard therapy.

MATERIAL AND METHODS: A protocol was developed for a systematic review following PRISMA® guidelines and a focused question (PICO) was constructed. A comprehensive literature search was conducted on electronic databases including PubMed, the SCOPUS data base, the Cochrane library and the Web of Science (WOS).

RESULTS: Six clinical trials were included that met the different inclusion criteria. In these articles, a discrepancy between the prevalence of OM in patients treated with chemotherapy and patients treated with immunotherapy related to the immune checkpoint PD-1/PD-L1 (Nivolumab and Pembrolizumab) was observed.

CONCLUSIONS: The prevalence of oral mucositis is lower in new immunotherapy with monoclonal antibodies against oral cancer than drugs used so far (chemotherapy drugs [methotrexate, cisplatin] as well as cetuximab). However, more studies should be carried out to confirm these data.

PMID:33772569 | DOI:10.4317/medoral.24353

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Cranial fat dissemination following fat grafting for lumbar dural tear: First case report in the literature

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Int J Surg Case Rep. 2021 Mar 22;81:105809. doi: 10.1016/j.ijscr.2021.105809. Online ahead of print.

ABSTRACT

INTRODUCTION AND IMPORTANCE: Dural tear and cerebrospinal fluid (CSF) leak is among the most common complications in lumbar spine surgery. Although primary dural suturing is the preferred method for repair, this is not always achievable specially with ventrolateral tears. Autologous fat grafting is one of the oldest and effective methods for dural repair which can also be used along with other methods of repair. This case report highlights a unique post spinal surgery complication with comment on how to avoid it. To our knowledge, this has not been previously reported in the literature.

CASE PRESENTATION: The authors report a sixty-seven-year-old male with lumbar pseudomeningocele and cranial fat dissemination following fat grafting for non suturable lumbar dural tear. This was demonstrated on magnetic resonance imaging (MRI) af ter her presented with low-pressure headache.

CLINICAL DISCUSSION: Intraoperative dural tear is one of the most common complications in spinal surgery. Methods for optimal dural repair including fat grafting have been described but the choice still heavily dependent on the surgeon's preference and experience. Fat graft can migrate leading to potential undesirable further complications like hydrocephalus and aseptic meningitis.

CONCLUSION: Cranial fat dissemination following fat grafting for lumbar dural tear should be recognized as a post-operative complication in lumbar spine surgery. It should be considered in case of hydrocephalus or aseptic meningitis post dural fat grafting. Surgeons should utilize adjunct methods to minimize its incidence.

PMID:33773369 | DOI:10.1016/j.ijscr.2021.105809

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Lacrimal Sac Anterior Border-Maxillary Line Distance: Effect on Endoscopic Dacryocystorhinostomy (EDCR) Surgery Results and NLDO-SS Questionnaire

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Abstract

This study aimed to investigate the effect of the maxillary line (ML)-lacrimal sac anterior border (LSA) distance on the results of endoscopic dacryocystorhinostomy (EDCR) operation. The study was designed retrospectively. The distance between LSA and ML was measured from preoperative paranasal sinus computed tomography (PNSCT) images. Nasolacrimal duct obstruction symptom score (NLDO-SS) was calculated before and after surgery. The endoscopically proven of the transition of the 2% fluorescein drop instilled into the eye to the nasal passage accepted as a surgical success. 47 patients included in the study and eight of them underwent bilateral EDCR. The average age of the patients was 50.3 ± 14.8. The LSA-ML distance was 4.2 ± 1.0 mm in all patients. The duration of surgery was found as 38.1 ± 6.1 min for each side. The preoperative NLDO-SS mean was 54.9 ± 11.7 and 22.2 ± 12.1 postoperatively (p = 0.000, CI = 28 .9–36.2). Six patients (11%) required revision surgery. A statistically significant high positive correlation was found between duration of surgery and LSA-ML distance (p = 0.000, r = 0.840). There was a significant negative correlation between the duration of surgery and postoperative NLDO-SS (p = 0.041, r = −0.276). The LSA-ML distance calculated in this study was found to be significantly associated with the decrease in the duration of surgery and the NLDO-SS score obtained after surgery. However, more valid results can be obtained if similar studies are carried out in larger samples containing a sufficient number of revision cases.

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Community-acquired Haemophilus influenzae meningitis in adults

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J Infect. 2021 Mar 24:S0163-4453(21)00134-1. doi: 10.1016/j.jinf.2021.03.016. Online ahead of print.

ABSTRACT

BACKGROUND: Haemophilus influenzae is an uncommon cause of meningitis in adults.

METHODS: We analyzed episodes of community-acquired H. influenzae meningitis in adults included in a prospective nationwide cohort study in the Netherlands.

RESULTS: From 2006 to July 2018, 82 of 2272 (4%) bacterial meningitis episodes were caused by H. influenzae (mean annual incidence 0.5 patients per 1,000,000). Median age was 61 years (IQR 46-68), and 48 episodes (59%) occurred in woman. Predisposing factors were otitis and/or sinusitis in 33 of 76 patients (49%), immunocompromising conditions in 19 of 75 patients (25%) and cerebrospinal fluid leak in 13 of 79 patients (17%). Serotyping showed 63 of 80 isolates (79%) were non-typeable (NTHi). Three patients (4%) died and 14 patients (17%) had an unfavorable outcome (Glasgow Outcome Scale s core < 5 at discharge). Pneumonia (odds ratio [OR] 5.8, 95% confidence interval [95%CI] 1.1-30.8), presence of immunocompromising conditions (OR 6.0, 95%CI 1.5-24.4), and seizures on admission (OR 10.7, 95%CI 1.6-72.8) were associated with an unfavorable outcome, while NTHi was associated with a favorable outcome (OR 5.6, 95%CI 1.6-19.5).

CONCLUSION: H. influenzae is an uncommon cause of adult bacterial meningitis patients mainly causing disease in those with predisposing factors, such as CSF leakage, ENT infections, and immunocompromised state. In adult patients the majority of H. influenzae meningitis is caused by non-typeable strains.

PMID:33774020 | DOI:10.1016/j.jinf.2021.03.016

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