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

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Δευτέρα 31 Ιανουαρίου 2022

Varicella post-exposure management for pediatric oncology patients

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Bull Cancer. 2022 Jan 26:S0007-4551(22)00004-2. doi: 10.1016/j.bulcan.2021.11.016. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective was to evaluate health care providers' (HCP) adherence to and efficacy of varicella post-exposure prophylaxis (PEP) recommendations. It was an observational, prospective, multicenter study set in Ile-de-France, France.

METHODS: All children under 18 with a cancer diagnosis, currently or within 3months of receiving cancer treatment, regardless of varicella zoster virus (VZV) serostatus or previous personal history of varicella, were eligible. Study participants with significant exposure were reviewed prospectively for PEP indications. Main outcome measures were the percentage of exposure situations for which HCP were guideline-compliant, the proportion of available VZV serostatuses and the incidence of breakthrough varicella after different PEP approaches.

RESULTS: A total of 51 patie nts from 15 centers were enrolled after 52 exposure episodes. Median age at exposure was 5 years (range, 1-15). Exposure within the household led to 38% of episodes. Prophylactic treatment consisted in specific anti-VZV immunoglobulins (V-ZIG) (n=19) or in oral aciclovir (n=15). No prophylactic treatment was given for 18 patients (in compliance, n=16). In compliance with guidelines, 17 patients received V-ZIG, 11 did not develop varicella (65%, [95% CI, 39-90%]); 15 received aciclovir, 13 did not develop varicella (87%, [95% CI, 67-100%]). Breakthrough varicella occurred in 11 patients, with simple clinical course in all cases; in 8/47 (17%) episodes when PEP was guideline-compliant versus 3/5 (60%) when not.

DISCUSSION: Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.

PMID:35093244 | DOI:10.1016/j.bulcan.2021.11.016

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Transcapsular access for the excision of primary or recurrent breast tumors in women with implant reconstruction

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J Plast Reconstr Aesthet Surg. 2022 Jan 16:S1748-6815(22)00019-5. doi: 10.1016/j.bjps.2022.01.005. Online ahead of print.

NO ABSTRACT

PMID:35093291 | DOI:10.1016/j.bjps.2022.01.005

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Computed tomography-assessed variations of the carotid sinus

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Surg Radiol Anat. 2022 Jan 30. doi: 10.1007/s00276-021-02871-x. Online ahead of print.

ABSTRACT

PURPOSE AND BACKGROUND: Previous studies have identified variations regarding the morphology and location of the carotid sinus, a phenomenon still not commonly approached or studied on computed tomography angiography (CTA). Detailed characterization of the carotid sinus was performed on CTAs, determining its position, diameter and length.

METHODS: The study group included 43 patients with disease-free carotid trunks subjected to cervical CTA. We measured the terminal caliber of the common carotid artery (CCA), as well as the calibers of the internal (ICA) and external carotid arteries (ECA) at their origin. The diameters were correlated with the location and the shape of the carotid sinus. We also measured the length of the sinus dilatation (carotid bulb), in regard to its location on the terminal branches of the common carotid artery.

RESULTS: Mean diameters of the studied arteries were 7.39 ± 1.04 mm for the CCA, 6.71 ± 1.49 mm for the ICA and, respectively, 4.27 ± 0.75 mm for the ECA. The classical position of the carotid sinus was seen in 80% of cases, the rest being considered anatomical variants. The length of the carotid bulb on the ICA was 9.99 ± 2.22 mm, showing variability between genders.

CONCLUSIONS: The carotid sinus does not always extend to the ICA, presenting different distribution patterns that might be relevant in sinu s pathology from a clinical point of view, respectively from a surgical point of view during invasive or minimally invasive interventions on the carotid axis.

PMID:35094129 | DOI:10.1007/s00276-021-02871-x

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Salted fish and processed foods intake and nasopharyngeal carcinoma risk: a dose-response meta-analysis of observational studies

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Eur Arch Otorhinolaryngol. 2022 Jan 30. doi: 10.1007/s00405-021-07210-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to analyze whether the consumption of salted fish and processed foods increases the risk of nasopharyngeal carcinoma by analyzing the relevant case-control or cohort design.

METHODS: Major databases such as PubMed, ScienceDirect, Embase and Cochrane Library were searched to conduct related studies. In addition, Newcastle-Ottawa scale was employed for assessing the quality of articles. Random-effect model was utilized for meta-analysis. Total relative risk (RR) and 95% confidence interval (95% CI) were calculated.

RESULTS: Dose response showed a consistent linear relationship between the intake of salted fish and processed foods and the risk of nasopharyngeal carcinoma. In salted fish, the summary RR was 1.23 (1.04-1.47) for low intake and 1.45 (1.19-1.76) for high intake. For processed meat, low intake was 1.33 (1.09-1.62) and high intake was 1.65 (1.35-2.02). Low intake of processed vegetables was 1.28 (1.05-1.55) and high intake was 1.45 (1.17 -1.79) for high intake. Significant heterogeneity existed in all data but decreased in some subgroups after subgroup analysis.

CONCLUSION: Salted fish and processed foods are risk factors for increasing nasopharyngeal carcinoma, but they have different risk characteristics due to different intakes, different stages, and different types.

PMID:35094122 | DOI:10.1007/s00405-021-07210-9

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The association between glucocorticoid receptor (NR3C1) gene polymorphism and difficult-to-treat rhinosinusitis

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Eur Arch Otorhinolaryngol. 2022 Jan 30. doi: 10.1007/s00405-021-07228-z. Online ahead of print.

ABSTRACT

BACKGROUND: Difficult-to-treat rhinosinusitis (DTRS) seriously affects the quality of work and life of patients, and the cause is still unclear. We aimed to explore the association between the glucocorticoid receptor (NR3C1) gene polymorphisms and DTRS.

METHODS: A nested case-control study was conducted. The exons of NR3C1 gene were sequenced by an ABI 9700 DNA analyzer in 30 DTRS patients and 70 matched chronic rhinosinusitis (CRS) patient with good outcome (non-DTRS). The genotypic and allele frequencies were calculated and linkage disequilibrium was analyzed.

RESULTS: The three SNPs showed a significant difference between the DTRS and non-DTRS groups. In allelic model analysis, we found that the allele "C" of rs6196, the allele "A" of rs258751, and the allele "T" of rs6194 were associated with increased the risk of DT RS (all p < 0.05). In addition, the haplotype CAT of the 3 SNPs was detected to be significantly associated with DTRS risk (p = 0.001), while the haplotype TGC was associated with the decreased risk of DTRS (p = 0.008).

CONCLUSION: NR3C1 gene polymorphisms are significantly associated with the DTRS.

PMID:35094121 | DOI:10.1007/s00405-021-07228-z

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Prevalence of cardiovascular risk factors in superior vestibular neuritis: A cross-sectional study following STROBE guidelines

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Eur Ann Otorhinolaryngol Head Neck Dis. 2022 Jan 26:S1879-7296(22)00004-7. doi: 10.1016/j.anorl.2022.01.002. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the prevalence of cardiovascular risk factors (CVRF) in patients with superior vestibular neuritis (SVN) versus the general French population, and to examine the possibility of vascular etiology in acute superior vestibular deficit.

MATERIAL AND METHODS: A single-center retrospective study compared the prevalence of hypercholesterolemia, hypertension, diabetes, smoking, cardiovascular disease and atrial fibrillation between patients with SVN and the French general population. Inclusion criteria comprised: rotatory vertigo lasting several days, without hearing impairment or neurological signs, with anterior and lateral semicircular canal involvement on video-Head-Impulse-Test (vHIT). A senior radiologist analyzed superior vestibular nerve and inner ear structure enhancement on cerebellopontine MRI.

RESULTS: One hundred and eighteen cases of SVN were included from May 2016 to February 2020. Statistical analyses concerned 106 cases. The SVN population had significantly less hypercholesterolemia (RR=0.40) than the general French population. There was no significant difference concerning other CVRFs. Superior vestibular nerve enhancement was observed on 84% of MRIs.

CONCLUSION: Prevalence of CVRF was not higher in patients with SVN than in the general population. The present study highlighted involvement of the superior vestibular nerve more than of the anterior vestibular artery in SVN.

PMID:35093295 | DOI:10.1016/j.anorl.2022.01.002

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Anterolateral advancement palatoplasty with tonsillectomy for retropalatal obstruction in selected cases of obstructive sleep apnea

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Eur Arch Otorhinolaryngol. 2022 Jan 31. doi: 10.1007/s00405-021-07235-0. Online ahead of print.

ABSTRACT

PURPOSE: This study tried to assess the surgical outcome of anterolateral advancement palatoplasty (ALP) with simultaneous tonsillectomy for the treatment of retropalatal obstruction in selected cases of obstructive sleep apnea (OSA).

METHODS: In this clinical trial, 22 adult OSA patients having predominant retropalatal collapse were managed by ALP and tonsillectomy.Thirteen patients had positional OSA (PP) and 9 patients had non-positional (NPP). ALP entailed the stripping of a horizontal trapezoid area of mucosa/submucosa of the soft palate and suturing with one central simple suture and two paramedian sutures made as an anterolateral parallelogram. Uvula was not jeopardized and no lateral mucosal cuts were made.

RESULTS: Postoperative data of the study group showed high significant improvement (p < 0.001) as regard s apnea-hypopnea index (AHI), mean lowest oxygen saturation level (LO2), Epworth sleepiness scale (ESS) and snoring visual analog scale (VAS-s). The overall percentage of improvement as regards the AHI was 60%.On comparison of postoperative data of PP and NPP, significant difference was reported as regards AHI (p = 0.009), while non-significant differences were reported (p > 0.05) as regards LO2, ESS and VAS-s. Postoperative means of AHI in supine position showed a significant difference (p = 0.03). Upon comparison of means of ODI and T90% of PP and NPP, a highly significant difference was reported in both pre- and postoperative comparison (< 0.001).

CONCLUSION: Anterolateral advancement palatoplasty seems to be an easy, effective and low-cost procedure. More favorable outcomes were reported among positional-dependent subjects. The procedure could be employed in multilevel, single-stage surgery for patients with OSA.

PMID:35098334 | DOI:10.1007/s00405-021-07235-0

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Relation between auditory difficulties and bortezomib-induced peripheral neuropathy in multiple myeloma: a single-center cross-sectional study

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Eur Arch Otorhinolaryngol. 2022 Jan 31. doi: 10.1007/s00405-021-07234-1. Online ahead of print.

ABSTRACT

PURPOSE: Bortezomib is a neurotoxic drug used in multiple myeloma and responsible for chemotherapy-induced peripheral neuropathy (CIPN). In a previous cross-sectional study, CIPN prevalence was about 26.9% in 67 patients. A second data analysis was performed to explore the relation between CIPN and auditory difficulties.

METHODS: Based on 66 multiple myeloma patients from a single center, auditory difficulties were assessed with a self-questionnaire and compared to sensory CIPN (QLQ-CIPN20 questionnaire), patients' characteristics and anticancer treatments.

RESULTS: The prevalence of auditory difficulties was about 42.4% (95% CI [30.6-55.2]) of the 66 patients analyzed and was higher in patients with CIPN than without (82.4% vs. 28.6%, p < 0.001). Auditory difficulties were not related to the characteristics of patien ts and treatments. The severity of auditory difficulties were correlated to CIPN severity (spearman's coefficient: 0.49, p = 0.009). Odds-ratio of auditory difficulties (multivariable analysis adjusted for sensory CIPN, recreation or professional noise exposure, gender, age, and treatments) was significantly associated with CIPN (18.7, 95% CI [3.0-117.1], p = 0.002).

CONCLUSION: This relation between CIPN and auditory difficulties raises concerns about hearing safety in multiple myeloma patients treated by bortezomib.

TRIAL REGISTRATION NUMBER: NCT03344328.

PMID:35098333 | DOI:10.1007/s00405-021-07234-1

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Aggressive Papillary Thyroid Carcinoma Presenting with Metastasis to the Pancreas

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Case Rep Endocrinol. 2022 Jan 20;2022:5355419. doi: 10.1155/2022/5355419. eCollection 2022.

ABSTRACT

Papillary thyroid cancer is the most common type of thyroid cancer. Aggressive forms tend to metastasize to the lungs and bones, but the abdomen is a rare site of metastasis. We present a 46-year-old male patient who presented with a neck mass associated with shortness of breath and hemoptysis. He was found to have a large thyroid mass on imaging. He underwent a total thyroidectomy with bilateral neck dissection, with pathology showing a multifocal tall cell variant of papillary thyroid carcinoma with lymphovascular invasion in both thyroid lobes. Due to recurrent findings of residual thyroid tissue on whole-body scan imaging, the patient underwent radioactive iodine ablation therapy twice, with poor response to therapy, suggested by persistently elevated thyroglobulin levels. However, the residual tissue responded to external beam radiation. After the initial response to radiation, thyroglobulin was noted to have increased again, prompting a PET-CT after administration of recombinant TSH. PET showed a focal area of increased uptake in the head of the pancreas. The patient underwent the Whipple procedure for resection of the metastasis. Pathology showed papillary thyroid carcinoma with strong and diffuse staining for TTF-1 and thyroglobulin. The patient was started on lenvatinib in the postoperative period and is currently tolerating treatment well with eviden ce of decreasing thyroglobulin levels. Intra-abdominal metastasis from a thyroid malignancy source is quite rare and can be challenging as far as diagnosis and treatment. Surgical resection can be curative and can be followed by radioactive iodine ablation therapy if cancer cells show avidity. Tyrosine kinase inhibitors can be used in refractory disease. New research is being conducted on new agents that can reverse the resistance to radioactive iodine therapy.

PMID:35096430 | PMC:PMC8794687 | DOI:10.1155/2022/5355419

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Ocular findings from otoneurological examinations in children with and without dyslexia: a systematic review with meta-analysis

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Braz J Otorhinolaryngol. 2021 Nov 25:S1808-8694(21)00190-7. doi: 10.1016/j.bjorl.2021.10.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate ocular movements measures of vectoelectro-nystagmography and video-nystagmography in dyslexic children and compare with measures of typical children.

METHODS: A systematic review of observational studies comparing the ocular movements differences between dyslexic and typical children with no publication date or language restriction. The literature survey included the bibliographic databases MEDLINE, ScienceDirect, Scopus, Web of Science, SciELO, Lilacs and CENTRAL. Gray literature databases were also searched, including: OpenGrey.eu, DissOnline.de, The New York Academy of Medicine and WorldCat. The meta-analysis was performed using software RevMan 5.3 (Cochran Collaboration).

RESULTS: A total of 2375 articles were found of which 113 fell within the inclusion criteria. Among these, 52 were duplicates (found in more than one research source), and 45 articles were selected for reading in full. Thirteen (13) articles were included for analysis and discussion. Meta-analysis showed statistical differences between the two groups for the total number of saccades and duration of fixation.

CONCLUSION: The study revealed that children with dyslexia have longer duration of fixation and fewer saccades during ocular movements on vectoelectro-nystagmography and video-nystagmography when compared to children without dyslexia.

PMID:35094959 | DOI:10.1016/j.bjorl.2021.10.006

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Management of neurotoxicity following CAR-T cell therapy: Recommendations of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

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Bull Cancer. 2022 Jan 27:S0007-4551(22)00013-3. doi: 10.1016/j.bulcan.2021.12.013. Online ahead of print.

ABSTRACT

The immune effector cell-associated syndrome (ICANS) has been described as the second most frequent specific complication following CAR-T cell therapy. The median time to the onset of neurological symptoms is five days after CAR-T infusion. ICANS can be concomitant to cytokine release syndrome but often follows the resolution of the latter. However, 10 % of patients experience delayed onset after 3 weeks of CAR-T cell infusion. The duration of symptoms is usually short, around five days if an early appropriate treatment is given. Symptoms are heterogeneous, ranging from mild symptoms quickly reversible (alterations of consciousness, deterioration in handwriting) to more serious forms with seizures or even a coma. The ICANS severity is currently based on the ASTCT score. The diagnosis of ICANS is clinical but EEG, MRI and l umbar punction can help ruling out alternative diagnoses. The first line treatment consists of high-dose corticosteroids. During the twelfth edition of practice harmonization workshops of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), a working group focused its work on updating the SFGM-TC recommendations on the management of ICANS. In this review we discuss the management of ICANS and other neurological toxicities in patients undergoing of CAR-T cell therapy. These recommendations apply to commercial CAR-T cells, in order to guide strategies for the management neurological complications associated with this new therapeutic approach.

PMID:35094839 | DOI:10.1016/j.bulcan.2021.12.013

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