Free Flap Donor-Site Complications and Management

alexandrossfakianakis shared this article with you from Inoreader Free Flap Donor-Site Complications and Management via Seminars in Plastic Surgery Semin Plast Surg DOI: 10.1055/s-0042-1759795 Free flap harvest will occasionally result in donor-site complications and morbidity. Most of these complications are managed simply without producing lingering effects on activities of daily living. However, some patients will sustain limb weakness, gait issues, chronic pain, and nonhealing wounds. Frank preoperative discussion between surgeon and patient is essential to maximize postoperative outcome and manage expectations. Fast idious surgical technique will help minimize the risks of hematoma, seroma, and infection, while newer techniques can help prevent some issues with wound healing, limb weakness, and sensory changes. In this article, we describe the rates of common and rare complications at free flap donor sites, as well as techniques to prevent and manage them. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

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Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: a two‐center controlled clinical trial

alexandrossfakianakis shared this article with you from Inoreader Oral functioning after open versus closed treatment of unilateral condylar neck or base fractures: a two‐center controlled clinical trial via Journal of Oral Rehabilitation Abstract Background Oral functioning and rehabilitation in patients after condylar trauma can be measured by objective functional outcomes and patient-reported outcomes. The similarities or differences between these outcomes may contribute to the decision if open treatment (OT) or closed treatment (CT) will obtain the most advantageous results. Objectives The aim of this study was to compare OT versus CT for unilateral condylar mandibular neck or base fractures in a two-center controlled clinical trial by objective functional outcomes and patient-reported outcomes measured at six weeks and six months follow-up. Additionally, these outcomes were compared within each group. Methods Patients were enrolled between January 2017 and November 2019. In one center patients received OT by extra-oral open reduction and internal fixation. In another center patients received CT by maxillomandibular fixation. Objective measurements included the mixing ability test (MAT) and mandibular active range of motion (ROM). Patient-reported outcomes included the mandibular function impairment questionnaire (MFIQ) and visual analogue scale (VAS) for pain. Independent t-tests and Mann-Whitney U tests were used to determine differences between the treatment groups at six weeks and six months follow-up. Paired t-tests and Wilcoxon Signed Rank tests were used to determine differences within each group. Results Thirty-three patients were enrolled. No differences were found between the groups treated with OT or CT for MAT, ROM, MFIQ and VAS. Both groups showed functional improvement. Conclusion Good objective functional outcomes and patient-reported outcomes were achieved with both OT and CT in patients with unilateral condylar mandibular neck or base fractures. View on Web

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Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux

alexandrossfakianakis shared this article with you from Inoreader Comparison of Transnasal Esophagoscopy and Sedated Esophagogastroduodenoscopy in the Assessment of Laryngopharyngeal Reflux via Clinical Otolaryngology Abstract Objective Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. Methods This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. Results In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs 48%) and gaping cardia (69% vs 24%), followed by peptic esophagitis (41% vs 24%). Conclusion The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease. View on Web

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The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader The maximum phonation time as marker for voice treatment efficacy: a network meta‐analysis via Clinical Otolaryngology ABSTRACT Purpose There is a diversity in treatment approaches for voice therapy in which aerodynamic treatment effects between the approaches are lacking. The evidence of voice treatments on the maximum phonation time (MPT) was quantified using the statistical approach of a network meta-analysis (NMA). Data sources Three databases and manual search from inception to November 2021 were evaluated. Study selection Studies were considered which were reports of randomized controlled/clinical trials (RCT) evaluating the efficacy of a specific voice therapy treatment using MPT as an outcome measure in adult participants with voice disorders. Studies were excluded if participants had been diagnosed with neurological-motor-speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological, or technical instrumental treatments were used. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension Statement guidelines were followed. Two reviewers independently screened citations, extracted data and assessed risk of bias using PEDro scale. Random effects model was used for meta-analysis. Results We identified finally 12 RCT studies (treatment groups n=285, and control group without an intervention n=62). Eight interventions were evaluated. The only effective intervention with a significant effect was Vocal Function Exercises (VFE) (mean pre-post difference 6.16 sec, 95% confidence interval, 1.18 sec to 11.13 sec). Conclusions and Relevance VFE effectively improved MPT from pre- to post-treatment in comparison with other voice interventions which were identified in the present NMA. Further high-quality intervention studies with large samples sizes, multidimensional measures, and homogeneous groups of dysphonia are needed to support evidence-based practice in laryngology. This article is protected by copyright. All rights reserved. View on Web

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Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials

alexandrossfakianakis shared this article with you from Inoreader Efficacy of prophylactic preoperative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: a systematic review and meta‐analysis of randomized placebo‐controlled trials via Clinical Otolaryngology Abstract Aim To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18-March-2022. The included studies were evaluated for risk of bias. The efficacy endpoints were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Five RCTs comprising 380 patients (desmopressin=191 patients and placebo=189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n=5 RCTs, MD=–37.97 ml, 95% CI [–56.97, –18.96], p<0.001), 5-point Boezaart scores (n=2 RCTs, MD=–0.97, 95 CI [–1.21, –0.74], p<0.001), and 10-point Boezaart scores (n=2 RCTs, MD= –3.00, 95% CI [-3.61, -2.40], p<0.001) were significantly reduced in favor of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n=5 RCTs, MD=–3.73 min, 95% CI [–14.65, 7.18], p=0.50). No patient in both groups developed symptomatic hyponatremia (n=3 RCTs, 194 patients) or thromboembolic events (n=2 RCTs, 150 patients) Conclusion Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS. View on Web

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higher female risk for adult glioma associated with variants in the region of CCDC26

alexandrossfakianakis shared this article with you from Inoreader Australian genome-wide association study confirms higher female risk for adult glioma associated with variants in the region of CCDC26 via Neuro-Oncology Advance Access Abstract Background Glioma accounts for approximately 80% of malignant adult brain cancer and its most common subtype, glioblastoma, has one of the lowest 5-year cancer survivals. Fifty risk-associated variants within 34 glioma genetic risk regions have been found by genome-wide association studies (GWAS) with a sex difference reported for 8q24.21 region. We conducted an Australian GWAS by glioma subtype and sex. Methods We analysed genome-wide data from the Australian Genomics and Clinical Outcomes of Glioma (AGOG) consortium for 7,573,692 single nucleotide polymorphisms (SNPs) for 560 glioma cases and 2,237 controls of European ancestry. Cases were classified as glioblastoma, non-glioblastoma, astrocytoma or oligodendroglioma Logistic regression analysis was used to assess the associations of SNPs with glioma risk by subtype and by sex. Results We replicated the previously reported glioma risk associations in the regions of 2 q33.3 C2orf80, 2q37.3 D2HGDH, 5p15.33 TERT, 7p11.2 EGFR, 8q24.21 CCDC26, 9p21.3 CDKN2BAS, 11q21 MAML2, 11q23.3 PHLDB1, 15q24.2 ETFA, 16p13.3 RHBDF1, 16p13.3 LMF1, 17p13.1 TP53, 20q13.33 RTEL and 20q13.33 GMEB2 (P<0.05). We also replicated the previously reported sex difference at 8q24.21 CCDC26 (P=0.0024) with the association being nominally significan t for both sexes (P<0.05). Conclusions Our study supports a stronger female risk association for the region 8q24.21 CCDC26 and highlights the importance of analysing glioma GWAS by sex. A better understanding of sex differences could provide biological insight into the cause of glioma with implications for prevention, risk prediction and treatment. View on Web

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ALT in Pediatric High-Grade Gliomas Can Occur without ATRX Mutation and is Enriched in Patients with Pathogenic Germline MMR Variants

alexandrossfakianakis shared this article with you from Inoreader ALT in Pediatric High-Grade Gliomas Can Occur without ATRX Mutation and is Enriched in Patients with Pathogenic Germline MMR Variants via Neuro-Oncology Advance Access Abstract Background To achieve replicative immortality, most cancers develop a telomere maintenance mechanism, such as reactivation of telomerase or alternative lengthening of telomeres (ALT). There are limited data on the prevalence and clinical significance of ALT in pediatric brain tumors, and ALT-directed therapy is not available. Methods We performed C-circle analysis (CCA) on 579 pediatric brain tumors that had corresponding tumor/normal whole genome sequencing through the Open Pediatric Brain Tumor Atlas (OpenPBTA). We detected ALT in 6.9% (n=40/579) of these tumors and completed additional validation by ultrabright telomeric foci in situ on a subset of these tumors. We used CCA to validate TelomereHunter for computational prediction of ALT status and focus subsequent analyses on pediatric high-grade glioma (pHGG) Finally, we examined whether ALT is a ssociated with recurrent somatic or germline alterations. Results ALT is common in pHGG (n=24/63, 38.1%), but occurs infrequently in other pediatric brain tumors (<3%). Somatic ATRX mutations occur in 50% of ALT+ pHGG and in 30% of ALT- pHGG. Rare pathogenic germline variants in mismatch repair (MMR) genes are significantly associated with an increased occurrence of ALT. Conclusions We demonstrate that ATRX is mutated in only a subset of ALT+ pHGG, suggesting other mechanisms of ATRX loss of function or alterations in other genes may be associated with the development of ALT in these patients. We show that germline variants in MMR are associated with development of ALT in patients with pHGG. View on Web

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