Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Κυριακή 28 Φεβρουαρίου 2021

Investigating Long-Term Brow Stabilization by Endotine-Assisted Endoscopic Brow Lift with Concomitant Upper Lid Blepharoplasty

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Ann Otol Rhinol Laryngol. 2021 Feb 25:3489421997653. doi: 10.1177/0003489421997653. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether Endotine-assisted endoscopic brow lift with concomitant upper lid blepharoplasty provides long-term brow elevation.

METHODS: Pre- and post-operative photographs from 35 patients who underwent endoscopic brow lift using Endotine Forehead 3 mm implants with concomitant upper lid blepharoplasty were measured to determine chang es in brow height with surgery and up to 55 months post-operatively. Photographs of 20 control subjects who did not undergo periorbital surgery and 11 control subjects who underwent upper blepharoplasty without brow lifting were also measured to provide a basis for comparison. Emotrics software was used to perform automated brow height measurements in order to determine elevation and longevity achieved with endoscopic brow lifting in conjunction with upper lid blepharoplasty.

RESULTS: There was a statistically significant increase in brow height post-operatively, averaging 1.6 mm (P < .0001, 95% confidence interval 0.95-2.18 mm). Fifty-four percent of patients had follow-up beyond 6 months post-operatively and 40% had follow-up beyond 1 year. Elevation remained stable over time with no statistically significant change across all serial post-operative visits. There was no statistically significant difference in brow elevation based on gender or age, or between right a nd left sides.

CONCLUSION: Endotine-assisted endoscopic brow lift in conjunction with upper lid blepharoplasty provides modest brow elevation and long-term brow fixation as demonstrated by stable post-operative brow height measurements for up to 55 months.

PMID:33631951 | DOI:10.1177/0003489421997653

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Preclinical study testing feasibility and technical requirements for successful tele‐robotic long distance peripheral vascular intervention

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Abstract

Background

Robotic‐assisted endovascular surgery enables us to perform interventions from long distances. This study evaluates the workflow and telecommunication requirements of tele‐robotic peripheral vascular interventions.

Methods

Ten superficial femoral artery cases were performed by the operator being 44 miles away from the interventional suite, with an endovascular robotic system, on a high‐fidelity endovascular simulator. Procedural success, technical success, fluoroscopy time, residual stenosis, contrast dose, and network delay were registered. Communication success was assessed after each procedure on a scale from 1(unacceptable) to 5(ideal).

Results

Procedural success and technical success were 100% and 80% respectively. The mean residual stenosis, fluoroscopy time, and contrast dose were 1.7±5.25%, 6.5±1.8 min, and 58.8±14.8 ml. The mean network latency was 38.9±3.5 ms. Median communication success scores were 4.5 (min: 4, max: 5) reported by both the operator and the bedside technician on a scale of 1 (unacceptable) to 5 (ideal).

Conclusion

With a stable network connection and good communication protocol, a high success rate was achieved for remote robotic‐assisted peripheral vascular intervention in an ex‐vivo model.

This article is protected by copyright. All rights reserved.

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Pembrolizumab as first-line therapy in microsatellite instability metastatic colorectal cancers

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Bull Cancer. 2021 Feb 22:S0007-4551(21)00039-4. doi: 10.1016/j.bulcan.2021.01.004. Online ahead of print.

NO ABSTRACT

PMID:33632546 | DOI:10.1016/j.bulcan.2021.01.004

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An Unusual Retained Choanal Foreign Body: A Possible Complication of COVID-19 Testing With Nasopharyngeal Swab

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Ear Nose Throat J. 2021 Feb 26:145561321993933. doi: 10.1177/0145561321993933. Online ahead of print.

ABSTRACT

Testing for coronavirus disease 2019 is critical in controlling the pandemic all over the world. Diagnosis of severe acute respiratory syndrome coronavirus-2 infection is based on real-time polymerase chain reaction performed on nasopharyngeal swab. If not adequately performed, the viral specimen collection can be painful and lead to complications. We present a comp lication occurred during a nasopharyngeal swab collection performed in a noncooperative patient where the plastic shaft of the swab fractured during the procedure, resulting in swab tip retention deep into the nasal cavity. The foreign body was found endoscopically, stuck between the nasal septum and the superior turbinate tail at the upper level of the left choana and removed under general anesthesia in a negative pressure operating room with the health care personnel wearing personal protective equipment. Unpleasant complications like the one described can happen when the swab is collected without the necessary knowledge of nasal anatomy or conducted inappropriately, especially in noncooperative patients. Moreover, the design of currently used viral swabs may expose to accidental rupture, with risk of foreign body retention in the nasal cavities. In such cases, diagnosis and treatment are endoscopy-guided procedures performed in an adequate setting to minimize the risk of spreadin g of the pandemic.

PMID:33634718 | DOI:10.1177/0145561321993933

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Endoscope-Assisted Multilayered Repair in Oronasal Fistula

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Ear Nose Throat J. 2021 Feb 26:145561321997607. doi: 10.1177/0145561321997607. Online ahead of print.

ABSTRACT

Oronasal fistula following cleft palate repair is a considerable complication with a recurrence rate of 33% to 37% and remains a challenging problem for surgeons. Furthermore, many patients have undergone several operations and experienced scar problems and other forms of morbidity. Therefore, we report a multilayered technique for oronasal fistula closure using an endoscopic nasal inferior turbinate composite graft with a palatal advance flap. This will increase the success rate after closure of small-sized oronasal fistula surgery without complications or recurrence (IRB: 2020-1671-0001).

PMID:33634719 | DOI:10.1177/0145561321997607

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EBV Positive Lymphomatoid Granulomatosis Following Dental Extractions

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Ear Nose Throat J. 2021 Feb 26:145561321997536. doi: 10.1177/0145561321997536. Online ahead of print.

ABSTRACT

Epstein-Barr virus (EBV) associated lymphoproliferative disorders includes a diverse group of diagnoses, encompassing both B-cell and T-cell lineages. With EBV mucocutaneous ulcers becoming a World health Organization diagnosis in 2018, introduction of the disease entity will be beneficial to the practicing otolaryngologist. We are reporting a case of a 69-year-old male with history of rheumatoid arthritis on methotrexate, recently undergoing dental extractions, who then developed multiple oral ulcerations and bony erosions of his palate and alveolar ridge. Associated symptoms included a large 3.0 cm neck mass, splenomegaly, and pulmonary nodules. Histopathology showed EBV+ lymphomatoid granulomatosis. Upon removal of immunosuppressive agent, patient's symptoms improved with resolution of oral lesions, as well as systemic symptoms.

PMID:33634720 | DOI:10.1177/0145561321997536

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The long-term effects of rapamycin-based immunosuppressive protocols on the expression of renal aquaporins 1, 2, 3 and 4 water channels in rats

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Histol Histopathol. 2021 Feb 26:18321. doi: 10.14670/HH-18-321. Online ahead of print.

ABSTRACT

BACKGROUND: To this day, the effect of multi-drug immunosuppressive protocols on renal expression of AQPs is unknown. This study aimed to determine the influence of rapamycin-based multi-drug immunosuppressive regimens on the expression of aquaporins (AQPs) 1, 2, 3, and 4 in the rat kidney.

METHODS: For 6 months, 24 male Wistar rats were administered immunosuppressants, according to the three-drug protocols used in patients after organ transplantation. The rats were divided into four groups: the control group, the TRP group (tacrolimus, rapamycin, prednisone), the CRP group (cyclosporine A, rapamycin, prednisone), and the MRP group (mycophenolate mofetil, rapamycin, prednisone). Selected red cell indices and total calcium were measured in the blood of rats and quantitative analysis of AQP1, AQP2, AQP3 and AQP4 immunoexpression in the k idneys were performed.

RESULTS: In the TRP and CRP groups, a mild increase of mean corpuscular hemoglobin concentration, hematocrit and total calcium were observed. Moreover, decreased expression of AQP1-4 was found in all experimental groups, with the highest decrease in the CRP group.

CONCLUSIONS: The long-term immunosuppressive treatment using multi-drug protocols decreased AQP1-4 expressions in renal tubules, possibly leading to impaired urine-concentrating ability in rat.

PMID:33634832 | DOI:10.14670/HH-18-321

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Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

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Objectives/Hypothesis

To identify any potential barriers for decannulation in children undergoing double‐staged laryngotracheal reconstruction (dsLTR) beyond the severity of disease itself.

Study Design

Case series with chart review.

Methods

We performed a retrospective chart review from 2008 to 2018 of 41 children who had undergone dsLTR as primary treatment for laryngotracheal stenosis at a stand‐alone tertiary children's hospital. We examined the effect of demographic, medical, and surgical factors on successful decannulation and time to decannulation after dsLTR.

Results

Of the 41 children meeting inclusion criteria who underwent dsLTR, 34 (82%) were decannulated. Age, gender, race, insurance status, medical comorbidity, and multilevel stenosis did not predict overall decannulation. Insurance status did not impact time to decannulation (P = .13, Log‐rank). Factors that increased length of time to decannulation were the use of anterior and posterior cartilage grafts (P = .001, Log‐rank), history of pulmonary disease (P = .05, Log rank), history of cardiac disease (P = .017, Log‐rank), and race/ethnicity (P = .001 Log‐rank).

Conclusion

In a cohort with a similar decannulation rates to previous dsLTR cohorts, we identified no demographic or medical factors that influenced overall decannulation. We did observe that pulmonary comorbidity, cardiac comorbidity, and race/ethnicity lengthens time to decannulation.

Level of Evidence

4 Laryngoscope, 2021

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Usefulness of Exam Questions and Vital Signs for Predicting the Outcome of Objective Vestibular Tests

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Objectives/Hypothesis

To determine the value of standard clinic screening questions and vital signs in predicting abnormal vestibular function, indicated by standard objective diagnostic tests.

Study Design

Retrospective records review.

Methods

We reviewed electronic medical records of 150 patients seen by the neurotologists or the physician assistant they supervised, in an out‐patient tertiary care clinic, between June 2018 and March 2020, and subsequently referred for the complete objective vestibular test battery (VB).

Results

Of standard questions asked during the initial exam about vertigo, disequilibrium, lightheadedness and oscillopsia, only vertigo predicted an abnormal response on the VB. More males than females had abnormal VB responses, P < .05. Pulse was not related to VB score. Significantly more subjects with blood pressure in the range for stage 2 hypertension (blood pressure [BP] stage 2) had abnormal than normal results on the VB, P < .00001. Subjects with BP stage 2 had high rates of diabetes (34.2%) and hypertension (68.4%) as diagnosed by their primary care physicians or cardiologists.

Conclusion

Complaints of subjective vertigo and BP in the range of hypertension stage 2 are most likely to predict abnormal findings on the VB. Therefore, during an examination of a patient who comes in complaining of dizziness, two measures may be the most useful for screening: BP in the range of hypertension type 2, when BP is taken by a nurse, and a question to determine whether or not the patient has true vertigo.

Level of Evidence

3. Laryngoscope, 2021

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Arachnoid granulations bulging into the transverse sinus, sigmoid sinus, straight sinus, and confluens sinuum: a magnetic resonance imaging study

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Surg Radiol Anat. 2021 Feb 26. doi: 10.1007/s00276-021-02719-4. Online ahead of print.

ABSTRACT

PURPOSE: Few studies have explored arachnoid granulations (AGs) bulging into the cranial dural sinuses using contrast-enhanced magnetic resonance imaging (MRI). This study aimed to explore such AGs in the transverse (TS), sigmoid (SigS), and straight (StS) sinuses, and confluens sinuum (ConfS) using thin-sliced, contrast MRI.

METHODS: A total of 102 patients with intact dura l sinuses underwent thin-sliced, contrast MRI in the axial, coronal, and sagittal planes.

RESULTS: In 88.2%, more than one AG was identified in the TS and SigS, StS, and ConfS. In the TS, AGs were identified in 40.2% on the right side and 37.3% on the left and were frequently located in the middle and lateral thirds. In the SigS, AGs were identified on the right in 17.6% and on the left in 18.6% in the distal region. In the StS, AGs were identified in 35.3% of cases, most frequently located in the proximal third, followed by the distal third. In the ConfS, AGs were identified in 20.6% of cases. Furthermore, in 23.5%, a collection of multiple AGs of varying sizes was found in the TS. A statistical difference was not shown between the mean age of 90 patients with AGs and that of 12 patients without identifiable AGs.

CONCLUSIONS: Bulging AGs may more frequently found in the TS. Thin-sliced, contrast MRI is useful for delineating AGs.

PMID:33635406 | DOI:10.1007/s00276-021-02719-4

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Blutstillung im Bereich der A. sphenopalatina und A. ethmoidalis anterior

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Laryngorhinootologie 2021; 100: 236-239
DOI: 10.1055/a-1331-1772



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