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

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Κυριακή 8 Αυγούστου 2021

Vestibular paroxysmia (VP) is a condition with recurrent short bouts of vertigo and is thought to be part of a neurovascular compression syndrome caused by the vascular loop

Vascular Loops: The Innocent Bystander for Vestibular Paroxysmia
2dby Carren Sui-Lin Teh via otol rhinol

Ann Otol Rhinol Laryngol. 2021 Aug 5:34894211037211. doi: 10.1177/00034894211037211. Online ahead of print.

ABSTRACT

INTRODUCTION: Vestibular paroxysmia (VP) is a condition with recurrent short bouts of vertigo and is thought to be part of a neurovascular compression syndrome caused by the vascular loop. However, this is still being debated as vascular loops are considered as normal variants with limited studies involving vertiginous patients.

OBJECTIVES: The aim of this paper is to study the association between audiovestibular symptoms and the presence of vascular loops and to study the association between vestibular paroxysmia and vascular loops.

DESIGN: This is a retrospective analysis of clinical, audiological and MRI findings of patients with and without vascular loops and vestibular paroxysmia from 2000 to 2020.

RESULTS: A total of 470 MRI Internal Auditory Meatus scans were performed during the study period of which, 71 (15.1%) had vascular loops and 162 (34.5%) had normal MRI which were used as controls. From the 233 subjects recruited, there were 37 subjects with VP and 196 non VP subjects were used as controls. There was no association between the vascular loop and control groups in terms of co-morbidity and audiovestibular symptoms. The VP group had a significantly older mean age of 51.8 (SD ± 10.3) as compared to the non VP group with the mean age of 45.6 (SD ± 15.5). The VP group had higher number of patients presenting with hearing loss at 97.3% when compared with those without VP (80.1%) (P = .01). The odds of having a vascular loop giving rise to VP was not statistically significant at 0.82 (95% CI 0.3735-1.7989) P = .62.

CONCLUSION: The vascular loop is a normal variant which may or may not give rise to audiovestibular symptoms or vestibular paroxysmia. Clinical assessment is still most important tool in deriving a diagnosis of VP and MRI may be useful to rule out other central causes.

PMID:34353133 | DOI:10.1177/00034894211037211

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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A New Thyroid Nodule Electronic Algorithmic Tool to Guide Management Decisions

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Clinical Thyroidology, Volume 33, Issue 8, Page 357-360, August 2021.
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Intensity of Thyroid Hormone Treatment in Hypothyroidism Is a Modifiable Risk Factor for Incident Stroke

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Clinical Thyroidology, Volume 33, Issue 8, Page 342-345, August 2021.
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Levothyroxine Is Overprescribed More Than You Realize

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Clinical Thyroidology, Volume 33, Issue 8, Page 339-341, August 2021.
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Safety and Efficacy of Radiofrequency Ablation for Thyroid Nodules

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Clinical Thyroidology, Volume 33, Issue 8, Page 361-363, August 2021.
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Overlapping but Distinct Risk Factors Between Recurrent Follicular and Recurrent Papillary Thyroid Carcinomas

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Clinical Thyroidology, Volume 33, Issue 8, Page 368-371, August 2021.
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A High-Definition 3-Dimensional Exoscope With the ARTip Cruise System as an Effective New Tool for Phonosurgery: A Preliminary Report

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The aim of phonosurgery is to improve voice quality and efficiency by performing precise, minimally invasive, conservative treatment. Magnified visualization of the vocal folds is mandatory to achieve optimal results; operative microscopy has been utilized so far to perform phonosurgery. In recent decades, the use of an exoscope (extracorporeal telescope) has been proposed in several fields of surgery that necessitate magnification. Further technological advancements have enabled 3-dimensional (3D) technology to be added to existing exoscopes.
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A simple qualitative scale for diagnosis of laryngopharyngeal reflux: high correlations with pH measurements and disease severity. The usefulness of the Warsaw Scale in LPR diagnostics compared to other diagnostic tools

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Eur Arch Otorhinolaryngol. 2021 Aug 6. doi: 10.1007/s00405-021-06989-x. Online ahead of print.

ABSTRACT

PURPOSE: Diagnosis and monitoring of laryngopharyngeal reflux (LPR) is a constant challenge in otolaryngological practice, chiefly because there are no specific symptoms characteristic of the disease. In this paper, we present the validation of a simple, 6-level qualitative scale to gauge the clinical findings of LPR. It has been previously published in Polish as the Warsaw Scale.

METHODS: In the study, we enrolled 100 patients with voice problems who had registered in our clinic, and we performed an extended battery of diagnostic tests for LPR, together with 24-h pH monitoring.

RESULTS: The Warsaw Scale significantly outperformed other instruments in both predicting LPR status and correlating with pH measurements. Moreover, the rating provided by the scale showed a strong association with patient-reported symptoms.

CONCLUSION: The data indicate that the Warsaw Scale could be used as an affordable, consistent, and effective diagnostic and monitoring tool for LPR.

PMID:34357461 | DOI:10.1007/s00405-021-06989-x

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T1 glottic laryngeal cancer: the role of routine follow-up visits in detecting local recurrence

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Eur Arch Otorhinolaryngol. 2021 Aug 6. doi: 10.1007/s00405-021-06983-3. Online ahead of print.

ABSTRACT

PURPOSE: We assessed the treatment outcome and the benefits of routine follow-up visits in T1 glottic laryngeal squamous cell carcinoma (LSCC).

METHODS: Medical records of patients diagnosed with stage T1 glottic LSCC (N = 303) in five Finnish university hospitals between 2003 and 2015 were reviewed. Moreover, data from the Finnish Cancer Registry and the Population Register Center were collected.

RESULTS: Of all 38 recurrences, 26 (68%) were detected during a routine follow-up visit, and over half (21 of 38, 55%) presented without new symptoms. Primary treatment method (surgery vs. radiotherapy) was not connected with 5-year disease-specific survival (DSS) or laryngeal preservation rate.

CONCLUSION: The majority of recurrences were detected on a routine follow-up visit, and local recurrences often presented without new symptoms. Routine post-treatment follow-up of T1 glottic LSCC seems beneficial.

TRIAL REGISTRATION: Trial registration number and date of registration HUS/356/2017 11.12.2017.

PMID:34357460 | DOI:10.1007/s00405-021-06983-3

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Predictors of Response and Survival to Multikinase Inhibitors in Radioiodine Resistant Differentiated Thyroid Cancer

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J Pers Med. 2021 Jul 18;11(7):674. doi: 10.3390/jpm11070674.

ABSTRACT

Sorafenib and lenvatinib are the only multikinase inhibitors (MKIs) approved for the treatment of radioactive iodine refractory differentiated thyroid cancer (RR-DTC). Although they have been demonstrated to improve progression free survival and overall response rate, the risk of toxicities is very high, worsening patients' quality of life. Therefore, predicting MKI treatment outcomes in the setting of RR-DTC is very challenging for optimizing patients' management. The current review provides an overview of the predictive factors for the response and survival of sorafenib and lenvatinib in RR-DTC. In this setting, a systemic therapy should be considered after conducting a multidisciplinary discussion aimed at evaluating the risk-benefit ratio of the treatment and taking into account several clinical, biochemical, and molecular factors. Age, performance status, and cancer-related symptoms are the most important clinical markers to be considered prior to starting MKI treatment, together with tumor burden. Some tissue and circulating biomarkers have been investigated, those involved in the angiogenic pathways being the most promising. Finally, prospective clinical trials aimed at evaluating predictive markers for therapeutic response are needed for tailoring patient management and allowing more appropriate treatment choices.

PMID:34357141 | DOI:10.3390/jpm11070674

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Efficacy of a Graphene Oxide/Chitosan Sponge for Removal of Radioactive Iodine-131 from Aqueous Solutions

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Life (Basel). 2021 Jul 20;11(7):721. doi: 10.3390/life11070721.

ABSTRACT

Iodine-131 is increasingly used for diagnostic and therapeutic applications. The excretion of radioactive iodine is primarily through the urine. The safe disposal of radioactive waste is an important component of overall hospital waste management. This study investigated the feasibility of using graphene oxide/chitosan (GO/CS) sponges as an adsorbent for the removal of iodine-131 from aqueous solutions. The ad sorption efficiency was investigated using iodine-131 radioisotopes to confirm the results in conjunction with stable isotopes. The results revealed that the synthetic structure consists of randomly connected GO sheets without overlapping layers. The equilibrium adsorption data fitted well with the Langmuir model. The separation factor (RL) value was in the range of 0-1, confirming the favorable uptake of the iodide on the GO/CS sponge. The maximum adsorption capacity of iodine-131 by GO/CS sponges was 0.263 MBq/mg. The highest removal efficiency was 92.6% at pH 7.2 ± 0.2. Due to its attractive characteristics, including its low cost, the ease of obtaining it, and its eco-friendly properties, the developed GO/CS sponge could be used as an alternative adsorbent for removing radioiodine from wastewater.

PMID:34357093 | DOI:10.3390/life11070721

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Treatment outcomes of neoadjuvant chemotherapy and transoral robotic surgery in locoregionally advanced laryngopharyngeal carcinoma

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Abstract

Background

We aimed to identify the optimal indications of neoadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) in patients with locoregionally advanced (T3-4 or N2-3) head and neck cancer (HNC).

Methods

A total of 50 patients were included in the study.

Results

T1 was identified in seven cases, T2 in 19, T3 in 22, and T4 in 2. N0 was identified in nine cases, N1 in 18, N2 in 22, and N3 in 1. There were 25 patients (50%) with complete remission of the primary lesion and 25 patients (50%) with partial remission. On pathologic examination of surgical specimens after neoadjuvant chemotherapy and TORS, 2 patients (4%) had a positive surgical margin, and 48 patients (96%) had a negative margin. Pathologic metastatic lymph nodes (LNs) were not observed in 39 cases (78%), and one metastatic LN was observed in 11 cases (22%). The 3-year recurrence-free survival (RFS) of all patients was 85.4%. On multivariate analysis, lymphovascular invasion showed a significant correlation with RFS.

Conclusions

In patients with locoregionally advanced HNC, NACT and TORS achieved favorable oncologic and functional outcomes.

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Vascularized Prelaminated Thermoplastic Bioabsorbable Scaffold in Tracheal Reconstruction

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Abstract

Successful tracheal reconstruction remains a challenging task for the reconstructive surgeon. A variety of techniques have been previously employed, using both autografts and allografts. The authors present a novel method for tracheal reconstruction utilizing a prelaminated fascial flap in conjunction with a bioabsorbable scaffold. Laryngoscope, 2021

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