Mucopyocele: An Entity Infrequently Reported as a Complication of Functional Endoscopic Sinus Surgery

xlomafota13 shared this article with you from Inoreader Mucopyocele: An Entity Infrequently Reported as a Complication of Functional Endoscopic Sinus Surgery Via Otolaryngology Indian Abstract Paranasal sinus mucocele or mucopyocele development after functional endoscopic sinus surgery is an infrequent phenomenon. The risk of mucocele development after endoscopic surgery for nasal polyposis or for chronic rhinosinusitis with nasal polyposis increases with greater preoperative Lund-Mackay score, with suboptimal post-operative management and with infrequent follow up post-surgery. We are reporting a case of bilateral fronto-ethmoidal mucocele developing secondary to FESS, its management and a brief literature review. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of Blood Investigations in Idiopathic Unilateral Sensorineural Hearing Loss

xlomafota13 shared this article with you from Inoreader Role of Blood Investigations in Idiopathic Unilateral Sensorineural Hearing Loss Via Otolaryngology Indian Abstract Majority of unilateral sensorineural hearing loss are idiopathic. Hence, outcome depends on factors which are associated with nature of disease and its treatment. These can be sudden or progressive. Various studies are done to evaluate the association in sudden variety, however causality still lacks evidence. There are limited studies regarding progressive variety and its outcome. A prospective study of 40 patients with idiopathic unilateral SNHL was carried out which attempts at identifying factors associated with either disease severity or its prognosis. A significant association was seen between distribution of random blood sugar and post treatment improvement in patients with sudden USNHL (p = 0.045). No significant association was seen with other blood parameters to treatment outcome in sudden SNHL, and severity of progressive SNHL to any blood parameters. Elevated blood sugar may affect a negative effect on treatment outcome in unilateral ISSNH L. There is scarcity of evidence in scientific literature related to "Unilateral Idiopathic Progressive Sensorineural Hearing Loss" for any association/correlation with nature of disease. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis.

xlomafota13 shared this article with you from Inoreader Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis. Via radioactive iodine Related Articles Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis. Am J Surg. 2021 Jan 18;: Authors: Limberg J, Stefanova D, Thiesmeyer JW, Ullmann TM, Bains S, Finnerty BM, Zarnegar R, Li J, Fahey Iii TJ, Beninato T Abstract BACKGROUND: The Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage and improved various cancer outcomes. Its impact in papillary thyroid cancer (PTC) remains unclear. METHODS: Non-elderly patients (40-64 years-old) with PTC living in low-income areas either in a 2014 expansion, or a non-expansion state were identified from the National Cancer Database between 2010 and 2016. Insurance coverage, stage at diagnosis, and RAI administration were analyzed using a difference-in-differences analysis. RESULTS: 10,644 patients were included. Compared with non-expansion states, the percentage of uninsured patients (adjusted-DD -2.6% [95%-CI -4.3to-0.8%],p = 0.004) and patients with private insurance decreased, and those with Medicaid coverage increased (adjusted-DD 9.7% [95%-CI 6.9-12.5%],p < 0.001) in expansion states after ACA implementation. The percentage of patients with pT1 did not differ between expansion and non-expansion states; neither did the use of RAI. CONCLUSIONS: Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment. PMID: 33541689 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism.

xlomafota13 shared this article with you from Inoreader Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism. Via radioactive iodine Related Articles Thyroid disease: Long-term management of hyperthyroidism and hypothyroidism. Aust J Gen Pract. 2021 Jan-Feb;50(1-2):36-42 Authors: Hughes K, Eastman C Abstract BACKGROUND: Hypothyroidism and hyperthyroidism are commonly encountered in clinical practice. General practitioners have a central role in the long-term management of these conditions. OBJECTIVE: The aim of this review is to provide an overview of the causes of thyroid function disorders and guidance on management. DISCUSSION: Optimal management of hypothyroidism relies on an understanding of the potential risks and benefits of therapy versus observation. If levothyroxine (LT4) replacement is commenced in a person with subclinical hypothyroidism on the basis of the presence of possibly relevant hypothyroid symptoms, consideration should be given to ceasing LT4 if no symptomatic benefit is observed. Thyroid stimulating hormone levels below the reference range are associated with atrial fibrillation and osteoporosis, and should be avoided. Treatment modalities for hyperthyroidism include antithyroid medications, radioactive iodine therapy and thyroidectomy. Each is satisfactory, but none is ideal. A patient-centred choice of treatment modality should be individualised, taking into consideration the underlying pathology, age, sex, patient preference and availability of expert thyroid surgical care. Long-term management of patients with hyperthyroidism requires careful considerati on of the likely outcomes of treatment including the risk of hypothyroidism. PMID: 33543160 [PubMed - in process] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery

xlomafota13 shared this article with you from Inoreader Role of HRCT Temporal Bone in Predicting Surgical Difficulties Encountered in Fenestral Otosclerosis Surgery Via Otolaryngology Indian Abstract To study spectrum of high resolution computed tomography (HRCT) imaging findings in otosclerosis, to predict approximate length of prosthesis required from pre-operative HRCT measurements and to correlate between oval window niche (OWN) height preoperatively and difficulty in introducing foot plate perforator during surgery. A cross sectional study was conducted on 23 patients with a clinical diagnosis of otosclerosis from September 2018 to July 2020. Sensitivity of HRCT in detecting otosclerosis, correlation between pre-operative incudo-stapedial length (ISL) and intra operative prosthesis length, and correlation between OWN height and difficulty in introducing perforator were sought. The mean age of 23 patients studied was 39.9 years with a female preponderance of 56.5%. 17 out of 19 patients with foci of otosclerosis during surgery had HRCT findings of otosclerosis providing a sensitivity of 89.5%. Mean OWN height obtained was 1.29 mm preoperatively and a cut off value of 1.325 mm found using receiver operating characteristic curve method classifying OWN height as narrow or normal. Mean ISL measured pre operatively was 4.25 mm and mean length of prosthesis used was 4.56 mm with significant positive correlation using intraclass correlation coefficient method with correlation coefficient = 0.879. HRCT is an invaluable modality aiding the surgeon to detect otosclerotic foci with high sensitivity, identify thick obliterative otosclerotic foci requiring additional drilling, to predict the length of prosthesis used and to predict difficulties in approaching footplate when OWN height is below 1.325 mm. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Endonasal Approaches to the Clival Region.

xlomafota13 shared this article with you from Inoreader Endoscopic Endonasal Approaches to the Clival Region. Via leak of cerebrospinal fluid Related Articles Endoscopic Endonasal Approaches to the Clival Region. Acta Med Acad. 2020;49 Suppl 1:45-53 Authors: Ravnik J, Hribernik B, Lanišnik B Abstract OBJECTIVE: Our main objectives were to analyze and determine the safety, risk of post-operative complications, and surgical outcome of the endoscopic endonasal approach to the clival region. METHODS: From May 2011 to May 2019, we operated on 19 patients using the endoscopic endonasal approach to the clival region. Their pathologies were diverse: pituitary macroadenoma, craniopharyngioma, metastasis, and a prepontine neurenteric cyst. The first operations were supervised by an experienced center using telementoring. We explained our surgical technique and analyzed the patients' data, which were included in our study. RESULTS: We managed to achieve complete removal of the pathological process in 14 patients. There were no deaths in the perioperative and early post-operative period. The most common complication was a cerebrospinal fluid leak, which was successfully managed in all of the cases. There were no deaths or significant morbidities in the post-operative period. CONCLUSION: An endoscopic transnasal approach to the clival region is safe and effective. It provides better visualization of that region compared to other transcranial approaches. The risk of post-operative complications is significantly lower with the help of modern reconstructive techniques. CSF leak is the most frequent complication. PMID: 33543630 [PubMed - in process] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms.

xlomafota13 shared this article with you from Inoreader Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms. Via otol rhinol Related Articles Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms. Ann Otol Rhinol Laryngol. 2021 Feb 05;:3489421990156 Authors: Abraham EJ, Bains A, Rubin BR, Cohen MB, Levi JR Abstract OBJECTIVE: To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. STUDY DESIGN: In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018. SETTING: All patients were seen by otolaryngologists at an urban tertiary safety net hospital. SUBJECTS AND METHODS: There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis. RESULTS: Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race (P = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race (P = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category (P = .0004). CONCLUSION: Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making. PMID: 33544624 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

COVID-19 infection rate among tertiary referral center otorhinolaryngology healthcare workers.

xlomafota13 shared this article with you from Inoreader COVID-19 infection rate among tertiary referral center otorhinolaryngology healthcare workers. Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Related Articles COVID-19 infection rate among tertiary referral center otorhinolaryngology healthcare workers. Eur Arch Otorhinolaryngol. 2021 Feb 05;: Authors: Rasmussen KMB, Andersen PA, Channir HI, Aanæs K, Knudsen JD, Kirkeby NS, Klokker M, von Buchwald C, Cayé-Thomasen P, Jensen RG Abstract IMPORTANCE: Otorhinolaryngology is considered one of the medical specialties with a high risk for exposure to corona disease 2019 (COVID-19). Uncontrolled transmission in a hospital department poses a risk to both healthcare workers (HCWs) and patients. OBJECTIVE: To monitor SARS-CoV-2 incidence, transmission, and antibody development among HCWs to identify high risk procedures, pathways, and work areas within the department. METHODS: Prospective cohort study of HCWs using repetitive oro- and nasopharygeal swab samples, antibody tests, and self-reported symptoms questionnaires at a tertiary referral center in Copenhagen, Denmark. RESULTS: 347/361 (96%) HCWs participated. Seven (1.9%) were positive on swab tests and none had symptoms. Fifteen (4.2%) developed antibodies. Only one case of potential transmission between HCWs was identified. Infection rates were low and no procedures or areas within the department were identified as exposing HCWs to a higher risk. CONCLUSIONS AND RELEVANCE: Adherence to the surveillance program was high. The low incidence among HCW during the first wave of the COVID-19 pandemic may reflect local transmission and infection control precautions, as well as a low infectious burden in the Danish society. PMID: 33544196 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diced costal cartilage graft combined with muscle repositioning improves Cleft-Side Alar asymmetry in Asian secondary unilateral cleft rhinoplasty: A three-dimensional evaluation.

xlomafota13 shared this article with you from Inoreader Diced costal cartilage graft combined with muscle repositioning improves Cleft-Side Alar asymmetry in Asian secondary unilateral cleft rhinoplasty: A three-dimensional evaluation. Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS Related Articles Diced costal cartilage graft combined with muscle repositioning improves Cleft-Side Alar asymmetry in Asian secondary unilateral cleft rhinoplasty: A three-dimensional evaluation. J Plast Reconstr Aesthet Surg. 2021 Jan 14;: Authors: An Y, Zhen Y, Ye W, Cui Y, Dang W, Zhao J, Xie L, Li D Abstract OBJECTIVES: Asymmetry in a retrusive cleft-side ala situated posterior, lateral, and/or inferior to the non-cleft ala is aggravated by ipsilateral defect of the pyriform aperture. This study assessed diced costal cartilage graft combined with muscle repositioning in enhancing structural base and alar symmetry in secondary cleft rhinoplasty. METHODS: From 2016 to 2019, 20 consecutive patients who underwent pyriform aperture paranasal augmentation combined with muscle repair secondary unilateral cleft rhinoplasty were reviewed retrospectively. Clinical three-dimensional (3D) photos were analyzed pre- and postoperatively, and the augmentation method and muscle repositioning were described detailedly. RESULTS: Twenty cases aged 22.2 ± 3.9 years were submitted to secondary cleft rhinoplasty with diced costal cartilage graft to the pyriform rim. They were followed up for 6.2-26.2 months, with postsurgical time averaging 10.3 ± 3.4 months. After total lip takedown by anatomic muscle re-approximation, the cleft to non-cleft side showed enhanced alar symmetry (p < 0.001) and heightened vertical lip length (p < 0.001). Additionally, the alar base inclination was improved toward the horizontal plane (p < 0.001). CONCLUSIONS: The cleft-side ala was anatomically ameliorated after muscle repositioning combined with diced costal cartilage graft to the pyriform rim, improving alar symmetry. Complications were minimal, indicating the safety of this method. PMID: 33541823 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates.

xlomafota13 shared this article with you from Inoreader Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates. Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS Related Articles Modified intraoperative distal compression method for lymphaticovenous anastomosis with high success and a low venous reflux rates. J Plast Reconstr Aesthet Surg. 2021 Jan 14;: Authors: Yoshida S, Koshima I, Imai H, Uchiki T, Sasaki A, Fujioka Y, Nagamatsu S, Yokota K, Yamashita S Abstract INTRODUCTION: For successful lymphaticovenous anastomosis (LVA), it is important to create anastomoses with high flow to maintain patency. To ensure that this can be achieved, we compared the efficacy of a modified intraoperative distal compression (IDC) technique with the conventional no compression (NC) method for lower limb lymphedema. PATIENTS AND METHODS: In the IDC group, compression was applied to an area of the foot distal to the first LVA site. After completion of the first LVA, the distal compression was extended over the first LVA site to the distal end of the second LVA site. RESULTS: There was no significant difference between the IDC (n = 25) and NC (n = 25) groups in detection rate. However, significant differences were observed in lymphatic vessel diameter and LVA success rate. No intraoperative anastomotic obstruction was seen at the conclusion of surgery. Intraoperative congestion with blood was detected in lymphatic vessels in 8 of 79 anastomoses (10.1%) in the NC group, but not in any cases in the IDC group (p = 0.002). There was a significant between-group difference in the rate of improvement in lymphedema between the IDC (16.1±3.6) and NC groups (14.0±3.4; p = 0.03). DISCUSSION: IDC during LVA is thought to increase lymph flow in larger caliber lymphatics, leading to a high success rate and a low rate of venous reflux. IDC is beneficial when performing LVA. PMID: 33541824 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Setting up a new microsurgical breast service in a non-tertiary hospital: Is it safe, and do outcomes compare to centres of excellence?

xlomafota13 shared this article with you from Inoreader Setting up a new microsurgical breast service in a non-tertiary hospital: Is it safe, and do outcomes compare to centres of excellence? Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS Related Articles Setting up a new microsurgical breast service in a non-tertiary hospital: Is it safe, and do outcomes compare to centres of excellence? J Plast Reconstr Aesthet Surg. 2021 Jan 10;: Authors: Kiely J, Smith K, Stirrup A, Holmes WJM Abstract AIMS: Access to autologous reconstruction continues to be limited in some areas of the United Kingdom. This is, in part, due to the perceived difficulty offering this service outside of a large tertiary centre. We present our experience setting up a new microsurgical breast reconstruction service in a district hospital and compare our results to the published outcomes of large volume centres. METHODS: Patient data were collected prospectively from the start of the service to date (July 2018- July 2020) with the capture of demographics, management, and outcomes. The BREAST-Q tool was used preoperatively and at a minimum of 3 months. RESULTS: The first 40 patients undergoing DIEP reconstruction were included. Of these, 70% were immediate, mean age was 49 years (27-68) and BMI was 28.1 kg/m2 (22-32.5). In all, 50% had one or more co-morbidities other than breast cancer. Median length of stay was 3 days (2-6) with 75% of patients discharged on day 2 or 3. Ten patients' stay exceeded 3 days - mostly due to social reasons. Flap loss occurred in 1 patient (2.5%). Twenty-one patients developed complications (52%) within 90 days: seven Clavien-Dindo Grade I, two Grade II and ten Grade IIIb. Fat necrosis and mastectomy flap necrosis were the most common complications. Surgical intervention was higher in those needing adjuvant therapy. Patient-reported outcomes showed post-operative improvement across all domains except abdominal physical well-being at median 11.3 months. CONCLUSIONS: We present the shortest published length of stay for unilateral DIEP reconstructions. We are the first paper to publish patient-reported outcomes following a breast microsurgical enhanced recovery protocol. We demonstrate how a new microsurgical service, utilising an enhanced recovery protocol and careful patient selection can immediately achieve outcomes comparable to well-established centres. There is no reason why all patients should not have access to microsurgical breast reconstruction locally. PMID: 33541825 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.