Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis

xlomafota13 shared this article with you from Inoreader Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis Via radioactive iodine Clin Endocrinol (Oxf). 2021 Mar 4. doi: 10.1111/cen.14455. Online ahead of print. ABSTRACT CONTEXT: Multifocality and bilaterality are common in patients with papillary thyroid microcarcinoma (PTMC). However, their clinical behaviors and prognostic implications remain controversial. OBJECTIVE: To investigate the relationship between multifocality and classically aggressive characteristics and outcomes in patients with PTMC. METHODS: Clinical data of 3005 patients with P TMC were retrospectively reviewed at a tertiary medical center. The role of unilateral and bilateral multifocality in aggressive characteristics and clinical outcomes of PTMC was evaluated using propensity score matching (PSM). RESULTS: A total of 573 patients had bilateral multifocal disease (B-MFD), 272 had unilateral multifocal disease (U-MFD), and 2160 had unifocal disease (UFD). Univariate analysis showed that patients in the multifocal disease (MFD) groups showed significantly different characteristics compared to patients in the UFD group in terms of age, chronic lymphocytic thyroiditis (CLT), follicular variant PTMC, tumor diameter, aggressive growth including extrathyroidal extension (ETE), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM), TNM stage, and underwent radioactive iodine (RAI) therapy. Further stratified analysis revealed that patients in the B-MFD group reflected the differences between the MFD and UFD groups. However, those in the U-MFD group showed slight differences only in sex, CLT, and cell subtypes, compared to the UFD group. In addition, PSM indicated differences in ETE, CLNM, and LLNM between the B-MFD and UFD groups (P<0.001), while only ETE differed between the U-MFD and UFD groups (P<0.001). After a median follow-up period of 60 months, no difference was observed in recurrence-free survival between the UFD and B-MFD (P=0.294) or U-MFD (P=0.603) groups using PSM. CONCLUSION: This propensity score matching analysis provides strong evidence that bilateral multifocality, rather than unilateral multifocality, should be considered as an aggressive marker at presentation, and neither is an independent prognostic factor for clinical outcome in PTMC. PMID:33660317 | DOI:10.1111/cen.14455 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD

xlomafota13 shared this article with you from Inoreader Laryngeal Manifestations of Crohn's Disease in a Toddler with Very Early Onset-IBD Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 4:3489421998214. doi: 10.1177/0003489421998214. Online ahead of print. ABSTRACT OBJECTIVES: We report obstructing laryngeal manifestations of Crohn's disease in a toddler with very early onset-IBD (VEO-IBD) who required tracheotomy tube placement at 27 months of age for relief of recalcitrant airway obstruction unresponsive to maximal medical therapy. We review the literature for the frequency of extra-intestinal laryngeal manifestations of Crohn's disease in adults and children. METHODS: Case report and literature review of laryngeal manifestations of Crohn's disease. RESULTS: Laryngeal involvement of Crohn's disease is very rare with only 14 other cases reported. Most cases appear in adults, with the supraglottis most commonly affected. This case marks the youngest report and only the second report of a patient requiring a tracheotomy for supraglottic obstruction when intensive medical management, including use of steroids and biologics, failed to relieve obstructing laryngeal inflammation. Despite ongoing Crohn's disease, laryngeal manifestations improved permitting decannulation the following year. CONCLUSIONS: Laryngeal manifestations of Crohn's disease are rare and usually affect adults. Most cases are managed with medical therapy, however surgical excision of obstructing lesions or tracheotomy placement is sometimes required for temporary relief of airway obstruction. PMID:33657845 | DOI:10.1177/0003489421998214 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Sinonasal Outcome Test (SNOT-22) Is a Poor Diagnostic Tool for Chronic Rhinosinusitis

xlomafota13 shared this article with you from Inoreader The Sinonasal Outcome Test (SNOT-22) Is a Poor Diagnostic Tool for Chronic Rhinosinusitis Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 4:3489421998213. doi: 10.1177/0003489421998213. Online ahead of print. ABSTRACT BACKGROUND: The SNOT-22 is a validated and widely used outcomes tool in chronic rhinosinusitis (CRS). We hypothesized that SNOT-22 scores and response patterns could be used as a diagnostic tool to differentiate between patients with CRS and those who present with CRS-like symptoms but prove not to have CRS. METHODOLOGY/PRINCIPAL: SNOT-22 measurements were collected from 311 patients who presented with a chief complaint of sinusitis to a tertiary rhinology practice. Following a full diagnostic evaluation, patients were diagnosed with CRS or determined to have non-CRS diagnoses. A response pattern "heatmap" of the SNOT-22 scores for each group was compared. An optimal cutoff point for total SNOT-22 score in predicting CRS was sought using a receiver operating characteristic (ROC) curve. RESULTS: A total of 109 patients were diagnosed with CRS and 202 patients were assigned to non-CRS. The non-CRS SNOT-22 total score histogram had lower overall scores compared to the CRS group, although there was substantial overlap. The CRS SNOT-22 heatmaps had a distinctive pattern compared to the non-CRS group. As individual measures, 3 of the 4 cardinal symptoms of CRS (nasal congestion, loss of smell, and rhinorrhea) were found to be significantly different between the 2 groups (P < .002). However, the ROC analysis showed the total SNOT-22 score to be a poor instrument to differentiate CRS from non-CRS patients. CONCLUSIONS: Our results cause us to reject our hypothesis and conclude that, while an effective outcomes tool, the SNOT-22 (using total score and response pattern) is a poor differentiator between CRS and non-CRS patients. PMID:33657861 | DOI:10.1177/0003489421998213 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series

xlomafota13 shared this article with you from Inoreader Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Mar 4:3489421999542. doi: 10.1177/0003489421999542. Online ahead of print. ABSTRACT BACKGROUND: Frey's syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey's syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is la rgely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers. MATERIALS AND METHODS: Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes. RESULTS: Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey's syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site. CONCLUSION: In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey's syndrome and preserved facial cosmesis in most patients. PMID:33657862 | DOI:10.1177/0003489421999542 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Feasibility of robotic‐assisted atrial septal defect repair in a 6‐year‐old patient

xlomafota13 shared this article with you from Inoreader Feasibility of robotic‐assisted atrial septal defect repair in a 6‐year‐old patient Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background The feasibility, safety and advantages of minimally invasive or robotic repair of atrial septal defect (ASD) in adults were reported previously. However, there is limited data for the application of these systems in paediatric patients. Although current robotic systems still have large instruments for surgical repair in children, some appropriate patients may benefit from this technology. Method A 6‐year‐old child with ASD underwent robotic assistant repair via Da‐Vinci Robotic Systems. Venous cannulation was achieved by internal jugular and femoral veins (10F–14F) and arterial cannulation was performed via femoral artery under transesophageal echocardiography (TEE) guidance (10F). A 3 cm incision was made in the right fourth intercostal space, used for working and the camera port in the same time. The ports were placed considering not to damage the potential developing breast tissue. After the port implantation (8F) and cardiac arrest, the ASD repair was completed with primary closure technique. Result The perioperative period was uneventful and the patient was discharged from hospital 5 days after surgery. Conclusion ASD closure with robotic assistant was achieved in a large enough sized paediatric patient. With the development of thinner and shorter robotic arms, it will be possible to use robotic assistance more common during the repair of congenital heart diseases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Novel C‐arm based planning spine surgery robot proved in a porcine model and quantitative accuracy assessment methodology

xlomafota13 shared this article with you from Inoreader Novel C‐arm based planning spine surgery robot proved in a porcine model and quantitative accuracy assessment methodology Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background We assessed pedicle screw accuracy utilizing a novel navigation‐based spine surgery robotic system by comparing planned pathways with placed pathways in a porcine model. Methods We placed three mini screws per vertebra for accuracy evaluation and used a reference frame for registration in four pigs (46 screws in 23 vertebrae). We planned screw paths and performed screw insertion under robot guidance. Using C‐arm and CT images, we evaluated accuracy by comparing the 3D distance of the placed screw head/tip from the planned screw head/tip and 3D angular offset. Results Mean registration deviation between the preoperative 3D space (C‐arm) and postoperative CT scans was 0.475 ± 0.119 mm. The average offset from preoperative plan to final placement was 4.8 ± 2.0 mm from the head (tail), 5.3 ± 2.3 mm from the tip and 3.9 ± 2.4 degrees of angulation. Conclusions Our spine surgery robot showed good accuracy in executing an intended planned trajectory and screw path. This faster and more accurate robotic system will be applied in future studies, first in cadavers and subsequently in the clinical field. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation

xlomafota13 shared this article with you from Inoreader Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Background This study evaluates image quality of a new flat‐panel three‐dimensional (3D) C‐arm to the current generation and to intraoperative and stationary computed tomography (CT) in spinal surgery. Methods Three‐dimensional‐imaging of 44 posterior screws acquired with two generations of 3D C‐arms (Arcadis Orbic, AO and Cios Spin, CS, Siemens, Germany) and CT scans (mobile intraoperative CT Airo, iCT, Brainlab, Germany and stationary CT Aquilion 32, sCT, Toshiba, Japan) were performed. Evaluation regarded assessability and measurements of implant position. Results Assessability score was 0.11 in AO, 0.56 in sCT, 0.91 in iCT and 1.46 in CS (p < 0.0005). AO and CS showed a significant difference in accuracy (p = 0.001) as well as CS and iCT (p < 0.001). Measurements of protrusion over the anterior edge did not show a significant difference (p = 0.341). Conclusions Image quality of the new generation of flat‐panel 3D C‐arms competes with CT imaging and offers significant advantages compared to the former generation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.