Blood flow distribution after end-to-side anastomosis with wide arteriotomy in extremity free flap surgery

xlomafota13 shared this article with you from Inoreader Blood flow distribution after end-to-side anastomosis with wide arteriotomy in extremity free flap surgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 28:S1748-6815(21)00112-1. doi: 10.1016/j.bjps.2021.03.022. Online ahead of print. ABSTRACT PURPOSE: Although many studies have investigated the optimal anastomotic procedure for the end-to-side (ETS) procedure with a free flap, no study has focused on the size of the arteriotomy. Some surgeons have recently described the effectiveness of ETS with wide arteriotomy, but the postoperative haemodynamics remains unclear for free flaps created using this technique. The aim of this study was to use ultrasonography to evaluate the postoperative blood flow distribution after ETS with a wide arteriotomy in extremity free flap surgery. METHODS: We evaluated 20 free flaps in 18 consecutive patients who received an ultrasonographic examination after free flap surgery using the ETS technique with wide arteriotomy for arterial anastomosis. All flaps were examined after surgery and blood flow was calculate d for the flap and recipient vessels. RESULTS: All 20 flaps survived, but one flap developed asymptomatic arterial thrombosis and 19 flaps were analysed. For the ETS technique with wide arteriotomy, peripheral circulation was well preserved in all flaps. Comparison of flap types showed that blood flow was significantly higher in myocutaneous flaps than in fasciocutaneous flaps, but there was no significant difference according to the size of the arteriotomy. CONCLUSIONS: Given the range of arteriotomy performed using the ETS with a wide arteriotomy technique, the blood flow volume in the flap depended on the type of flap but not on the size of the arteriotomy. A steal phenomenon related to the creation of a wide window in the receipt artery was not found in the analysed retrospective cohort. PMID:33896743 | DOI:10.1016/j.bjps.2021.03.022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series

xlomafota13 shared this article with you from Inoreader Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 29:S1748-6815(21)00110-8. doi: 10.1016/j.bjps.2021.03.020. Online ahead of print. ABSTRACT BACKGROUND: Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice. METHODS: A retrospective chart review identified patients who underwent microsurgical breast reconstruction from January 2007 through December 2018. Patients with VTE diagnosed within 90 days of surgery were included. Demographics, co-morbidities, signs and symptoms, and characteristics of oncologic, surgical, and post-operative care were analyzed. RESULTS: Seven hundred one patients underwent microsurgical breast reconstruction. Eleven patients with pulmonary embolism (PE) and four with deep vein thrombosis (DVT) were identified, resulting in VTE incidence of 2.1% (0.57% DVT, 1.6% PE). Patients were on average 51 years old and had an average body mass index (BMI) of 31.7 kg/m2. Two had a history of VTE, and none had a known hypercoagulable disorder. Using the 2005 Caprini model, all were high risk and seven were highest risk. Among those with PE, the most common symptom was shortness of breath, and the most common signs were desaturation or supplemental oxygen requirements. VTE was diagnosed on average 14.2 days post-operatively (range 2-52 days). CONCLUSION: VTE is an infrequent complication following abdominally based microsurgical breast reconstruction. We recommend a high index of suspicion in women reporting shortness of breath or having desaturation, especially in those with high BMI, high Caprini scores, post-operative complications, or early return to the operating room. PMID:33896741 | DOI:10.1016/j.bjps.2021.03.020 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Case Report: A New Entity: Multiple Differentiated Variant of Papillary Thyroid Carcinoma With Advanced Clinical Behavior

xlomafota13 shared this article with you from Inoreader Case Report: A New Entity: Multiple Differentiated Variant of Papillary Thyroid Carcinoma With Advanced Clinical Behavior Via radioactive iodine Front Endocrinol (Lausanne). 2021 Apr 7;12:654638. doi: 10.3389/fendo.2021.654638. eCollection 2021. ABSTRACT There are many histological morphological types of papillary thyroid carcinoma (PTC), but the most frequently seen types are conventional. A single PTC commonly has a conventional and/or a variant morphological pattern. PTC with multiple (more than two) well-differentiated morphological patterns are extremely rare. We herein report the rare case of a 48-year-old male with ini tial diaphragmatic, pancreatic, and liver tumors from PTC. Then, the PTC was discovered following resection of these tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a huge mass in the thyroid's left lobe revealed a PTC. After postoperative recovery, physical and ultrasound examinations identified an irregular large nodule in the thyroid's isthmus and left lobe, several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary regions. The US-FNA's pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally in the parotid and salivary glands. An 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., thyroid's isthmus and left lobe, bilateral parotid gland, and subcutaneous tissues). The patient underwent palliative therapy-including total thyroidectomy, bilateral centra l neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary glands. A whole-body scan post-therapeutic radioactive iodine ablation revealed exclusive thyroid bed uptake. The patient subsequently underwent thyroid stimulating hormone (TSH) repression therapy and chemotherapy with lenvatinib, and thereafter achieved stable clinical conditions. Further histopathological analysis of the PTC revealed multiple differentiated morphological patterns in the single tumor located in the isthmus and left lobe of the thyroid, and in some metastatic lesions. Different metastatic lesions also presented different morphological patterns of PTC. In conclusions, we identified a new entity of PTC as a multiple differentiated variant of PTC (MDV-PTC) with an aggressive clinical nature. PMID:33897621 | PMC:PMC8058471 | DOI:10.3389/fendo.2021.654638 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma

xlomafota13 shared this article with you from Inoreader Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma Via radioactive iodine J Contemp Brachytherapy. 2021 Apr;13(2):126-134. doi: 10.5114/jcb.2021.105279. Epub 2021 Apr 14. ABSTRACT PURPOSE: Brachytherapy with iodine-125 (125I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control. MATERIAL AND METHODS: This was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received 125I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques. RESULTS: The study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance b etween the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%). CONCLUSIONS: Intra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position. PMID:33897785 | PMC:PMC8060954 | DOI:10.5114/jcb.2021.105279 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B‐Cell Lymphoma

xlomafota13 shared this article with you from Inoreader Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B‐Cell Lymphoma Via The Laryngoscope Objectives/Hypothesis This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B‐cell lymphoma (SN‐DLBCL) patients. Study Design Retrospective database study. Methods The National Cancer Database was queried for all SN‐DLBCL cases diagnosed from 2004 to 2015. Kaplan–Meier log‐rank test determined differences in OS based on clinical covariates. Cox proportional‐hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality. Results A total of 2,073 SN‐DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early‐stage disease, and 49% had primary tumors in the paranasal sinuses. Early‐stage patients were more likely to receive multi‐agent chemoradiotherapy compared to multi‐agent chemotherapy alone (P < .001). Multivariable Cox proportional‐hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late‐stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post‐2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunothe rapy for late‐stage patients (P = .326). Lastly, for all patients treated post‐2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001). Conclusions Treatment protocol selection differs between early‐ and late‐stage SN‐DLBCL patients. Early‐stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm. Level of Evidence III Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Conventional Naso-Oropharyngeal Sampling Versus Self-Collected Saliva Samples in COVID-19 Testing

xlomafota13 shared this article with you from Inoreader Conventional Naso-Oropharyngeal Sampling Versus Self-Collected Saliva Samples in COVID-19 Testing Via Otolaryngology Indian Abstract Comparing the diagnostic utility of salivary specimen samples with conventional nasopharynx-oropharynx (NP-OP) specimen samples to identify COVID-19 cases by reverse transcription-polymerase chain reaction (RT-PCR). Eighty COVID-19 suspects enrolled for the paired sampling. In addition to conventional sampling, suspects were asked to follow stepwise pictorial instructions for self salivary sampling. Separate nylon swab stick was used for taking the samples from NP-OP and the floor of the oral cavity. The data were analyzed for sensitivity, specificity, concordance of COVID-19 status, and limits of agreement for cycle threshold (ct) values by either method. Forty-nine suspects (61.3%) were males, the mean age was 36.4 years. To determine the diagnostic test performance of the saliva, RT-PCR results of the NP-OP samples were used as the reference standard. Out of 80 suspects, 41 showed positivity by NP-OP swabs and 12 by salivary samples. The salivary samples showed significantly lesser positivity rate. The sensitivity and specificity of salivary samples against conventional reference standards are 24.4%, 94.9% respectively. Concordance of these two types of samples in terms of agreement kappa statistics is estimated as K = 0.252 (0.09–0.42). Median ct values of both the E and ORF1ab gene for the salivary samples were higher compared to the corresponding NP-OP sample. This study showed lesser sensitivity with salivary swab samples as compared to conventional NP-OP sampling for RT-PCR, COVID-19 detection. Hence, we are of opinion that more studies are required to establish the utility of salivary sampling in COVID-19 diagnostics. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Graves' Orbitopathy: Report of 82 cases

xlomafota13 shared this article with you from Inoreader Graves' Orbitopathy: Report of 82 cases Via radioactive iodine Tunis Med. 2021 Feb;99(2):243-251. ABSTRACT INTRODUCTION: Graves' disease (GD) is a common autoimmune disorder. Graves'orbitopathy (GO) is its most common extrathyroidal manifestation. It is rare but may reveal the disease. AIM: To describe the demographic, clinical and therapeutic features of GO. METHODS: We carried out a retrospective and descriptive analysis of 82 patients with GO. This study was conducted in Ophthalmology and Endocrinology departments of Taher Sfar University Hospital in Mahdia, between January 2010 and December 2017. GD patients diagnosed with GO were included. RESULTS: The mean age was 36.17 years ± 12.81. Patients aged 19-40 years had the highest rate of GO. The male-to-female ratio was 0.49. Family history of autoimmune thyroid disease was present in 15% and associated autoimmune disease in 4% of cases. Smoking was seen in 71% of patients. The onset of GO was simultaneous with onset of GD in 45%, before in 21% and after the onset of GD in 34% of cases. GO was bilateral in 76% of patients. The most common ocular symptoms were prominent eyes (55% of patients), ocular pain (11%) and diplopia (41%). Proptosis and upper eyelid retraction were the most common clinical signs (93% and 90% respectively). Dysthyroid optic neuropathy was present in one eye, keratitis in one eye and glaucoma in five eyes. Severe disease was noted in 11% and active disease was present in 7% of patients. CT-scan and magnetic resonance imaging sca n (MRI) were performed in 48% and 42% of cases respectively. Proptosis was the most common radiological sign. Thyroid dysfunction was managed with anti-thyroid medication only (59%), thyroxine replacement (37%), radioactive iodine (35%) and thyroidectomy (6%). 20% of patients received corticosteroids. One patient required immunosuppressive therapy. CONCLUSION: GO is a complex disease, which is associated with impaired quality of life and can potentially result in sight-threatening complications. Appropriate diagnosis, convenient therapy and a regular follow-up are necessary to improve results and avoid the aesthetic and functional sequelae. PMID:33899194 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fundamental Frequency and Jitter Percent in MDVP and PRAAT

xlomafota13 shared this article with you from Inoreader Message: Summary Purpose This study initially investigated the relationship between Fundamental Frequency and Jitter Percent across and within MDVP and PRAAT. Subsequently, it explored if the measured acoustic signal's Length or the analysis temporal segment selection impacts potential correlation across the tools' measures. Methods We collected forty-two Maximum Phonation Time acoustic signals from 10 participants with Healthy Voices in a standardized setting. We excluded from enrollment any potential participants having a history of voice disorders or showing an abnormality in a pre-study assessment. Results There is no correlation between Jitter percent's values and Fundamental Frequency within either Tool in our healthy voice samples. The Length of the acoustic signal and temporal analysis selection impact the correlation between Jitter Percent measurements across the two tools; The correlation between Fundamental Frequency measurements across the devices was not affected. Means of Fundamental Frequency did not differ across the two devices but show a persistent pattern of greater values in MDVP. Jitter Percent measurements were significantly higher in MDVP Conclusions There is a potential for clinicians using PRAAT assessments in the clinic to make inferences from research using MDVP as an analysis tool. Further work is needed in patients with Voice disorders to explore that possibility. Fundamental Frequency and Jitter Percent in MDVP and PRAAT Via Journal of Voice This study initially investigated the relationship between Fundamental Frequency and Jitter Percent across and within MDVP and PRAAT. Subsequently, it explored if the measured acoustic signal's Length or the analysis temporal segment selection impacts potential correlation across the tools' measures. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Consideraciones éticas en la práctica médica

xlomafota13 shared this article with you from Inoreader Consideraciones éticas en la práctica médica Via Otorrinolaringología y cirugía de cabeza y cuello Resumen Actualmente la práctica clínica se ve enfrentada a una gran presión en los servicios clínicos públicos, privados, investigación, etc. El avance en ciencia y tecnología, asociado a gran publicidad por diversas redes, habitualmente no científicas, somete al cuerpo médico a una serie de dilemas éticos en forma diaria. Recursos limitados en el servicio público y una población que exige solución a sus problemas de salud, nos hace reflexionar sobre cómo tomar las decisiones más adecuadas, acudiendo a los principios éticos, cultivando valores personales, solicitando consentimiento informado, etc. Este texto pretende poner en contexto los temas de ética clínica con los que nos enfrentamos a diario. Abstract Clinical practice is currently facing a great pressure on the public and private clinical services, research, etc. The progress in science and technology, associated with great publicity through various networks, usually unscientific, subjects the medica l staff to a number of ethical dilemmas on a daily basis. Limited resources in the public service and a population that demands solutions to its health problems, makes us reflect on how to make the most appropriate decisions, turning to ethicalprinciples, cultivating personal values, requesting informed consent, etc. This text aims to put into context the clinical ethics issues that we face on a daily basis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bruxismo y su relación con otorrinolaringología: una revisión de la literatura

xlomafota13 shared this article with you from Inoreader Bruxismo y su relación con otorrinolaringología: una revisión de la literatura Via Otorrinolaringología y cirugía de cabeza y cuello Resumen El bruxismo es una condición que se observa frecuentemente en los pacientes y estos a menudo consultan por sus consecuencias físicas, como pueden ser el desgaste o destrucción dentaria, el dolor orofacial, así como también por el deterioro de la calidad de vida tanto de ellos mismos como de las personas cercanas. En la última década han aumentado en forma importante las investigaciones en torno a esta condición, así como los consensos en cuanto a su definición, clasificación y manejo clínico. Los dentistas son quienes actualmente reconocen esta actividad parafuncional y manejan estos problemas, pero es importante que los profesionales de otras áreas de la salud, como médicos y en especial otorrinolaringólogos, puedan identificar los signos, síntomas y consecuencias del bruxismo, ayudando en la detección de esta condición. Así, el objetivo de esta revisión es establecer un estado del arte sobre bruxismo e incentivar la formación de equipos multidisci plinares que ayuden en el diagnóstico y la terapéutica de esta condición. Abstract Bruxism is a condition that is frequently observed in patients, and they often consult for physical consequences, such as teeth wear or destruction, orofacial pain, as well as for the decrease of the quality of life, of both patients and their loved ones. In the last decade, research on this phenomenon has increased significantly, as well as the consensus in terms of definition, classification and clinical management. Dentists are those who at present recognize this parafunctional activity and manage these problems, but it is important that professionals from other health areas, such as medical doctors, and specially otolaryngologists, can identify signs, symptoms and consequences of bruxism, helping in the detection of this condition. Thus, the objective of this review is to establish a state of the art about bruxism and encourage the formation of multidisciplinary teams that help to in the dia gnosis and better management of this condition. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión

xlomafota13 shared this article with you from Inoreader Síndrome de apnea obstructiva del sueño persistente en niños adenoamigdalectomizados: artículo de revisión Via Otorrinolaringología y cirugía de cabeza y cuello Resumen El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) en niños forma parte del espectro de trastornos respiratorios del sueño en la infancia. Tiene una prevalencia entre un 0,69% y 4,7% en la población infantil con una mayor incidencia entre los 2 y 6 años debido principalmente a la hiperplasia adenoamigdaliana y constituye una importante causa de morbilidad neurocognitiva y conductual en quienes lo padecen. El principal tratamiento quirúrgico del SAHOS infantil lo constituye la adenoamigdalectomía, cirugía que logra la resolución de los síntomas entre un 20% y 75% de los pacientes. Los pacientes con comorbilidades asociadas tales como obesidad, enfermedades neuromusculares y alteraciones craneofaciales, entre otras, tienen mayor riesgo de SAHOS persistente. En la presente revisión de la literatura abordaremos el diagnóstico, enfrentamiento, estudio y tratamiento del SAHOS persistente posadenoamigdalectomía en niños. Abstract Obstructive sleep apnea syndrome (OSA) in children is part of the spectrum of respiratory sleep disorders in childhood. It has a prevalence between 0.69 and 4.7% in pediatric population, with a higher incidence between 2 and 6 years old, mainly due to adenotonsillar hyperpla-sia. OSA constitutes an important cause of neurocognitive and behavioral morbidity. The main surgical treatment for childhood OSA is adenotonsi-llectomy, which resolves symptoms in 20%-75% of patients. Patients with associated comorbidities such as obesity, neuromus-cular diseases, and craniofacial malformations are at higher risk of having persistent OSA. In this literature review, we will discuss the diagnosis, evaluation and treatment of persistent OSA after adenotonsillectomy in children. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.