Δευτέρα 15 Μαρτίου 2021

2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction

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Eur Thyroid J. 2021 Feb;9(6):281-295. doi: 10.1159/000512790. Epub 2021 Jan 21.

ABSTRACT

Severe thyroid dysfunction may lead to menstrual disorders and subfertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be a solution. Prior to an ART treatment, ovarian stimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), ne cessitating levothyroxine (LT4) supplements before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic subfertility have a higher prevalence of TAI. Women with hypothyroidism treated with LT4 prior to ART should have a serum TSH level <2.5 mIU/L. Subfertile women with hyperthyroidism planning an ART procedure should be informed of the increased risk of maternal and foetal complications, and euthyroidism should be restored and maintained for several months prior to an ART treatment. Fertilisation rates and embryo quality may be impaired in women with TSH >4.0 mIU/L and improved with LT4 therapy. In meta-analyses that mainly included women with TSH levels >4.0 mIU/L, LT4 treatment increased live birth rates, but that was not the case in 2 recent interventional studies in euthyroid women with TAI. The importance of the increased use of intracytoplasmic sperm injection as a type of ART on pregnancy outcomes in women with TAI deserves more investigatio n. For all of the above reasons, women of subfertile couples should be screened routinely for the presence of thyroid disorders.

PMID:33718252 | PMC:PMC7923920 | DOI:10.1159/000512790

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Update on molecular biomarkers for diagnosis and prediction of prognosis and treatment responses in gastric cancer

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Histol Histopathol. 2021 Mar 9:18326. doi: 10.14670/HH-18-326. Online ahead of print.

ABSTRACT

Gastric cancer (GC) is one of the leading causes of cancer-related deaths worldwide, and its high mortality rate is a serious problem in many regions. To improve prognosis, it is necessary to identify novel biomarkers for the early detection of GC, along with its prognosis, risk of metastatic recurrence, and predicted response to chemotherapy, and to develop individualized treatment strategies. Advances in microarray and sequencing techniques have led to the elucidation of cancer-related gene mutations and aberrant expression levels, which have deepened our knowledge of GC. Further searches for sensitive biomarkers are needed to improve the management of patients with GC. In this review article, we update the current knowledge of GC biomarkers, examine recently published literature, and introduce some representative molecules.

PMID:33719028 | DOI:10.14670/HH-18-326

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The Thermal Damage of Canine Vocal Fold by CO2 Laser Under Different Laser Emission Mode

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Ear Nose Throat J. 2021 Mar 15:145561321999262. doi: 10.1177/0145561321999262. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study is to review the differences between continuous wave (CW) and UltraPulse (UP) on thermal damage of the laser with different power.

METHODS: Four adult beagle dogs underwent transoral laser microsurgery (TLM) using CO2 laser. The laser emission mode and power was CW (3 W, 5 W, and 8 W) and UP (3 W and 5 W), respec tively. The tissue from 4 animals was evaluated histologically on postoperative days 1 and 3. The thermal damage of the laser was measured using slide scan system via SlideViewer version 1.5.5.2 software.

RESULTS: All dogs underwent TLM uneventfully. Under microscope examined, the laser damage area was composed of 2 parts: the vaporized zone (VPZ) and thermal damage area. The thermal damage area can be divided into thermal coagulative necrosis area (TCN) and hydropic degeneration area. The width of VPZ and TCN in UP mode was less than that in CW mode (P < .01). The data indicate that lower laser power created less thermal damage (P < .01). In addition, the width of VPZ on postoperative day 3 was less than that on postoperative day 1 (P < .01).

CONCLUSION: CO2 laser with UP and lower power could decrease the laser thermal damage and may offer more prompt wound healing.

PMID:33719628 | DOI:10.1177/0145561321999262

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Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media

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Ear Nose Throat J. 2021 Mar 15:145561321999263. doi: 10.1177/0145561321999263. Online ahead of print.

ABSTRACT

OBJECTIVES: This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty.

METHODS: This retrospective study was conducted in a tertiary hospital in Shanghai. In t otal, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups.

RESULTS: The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patie nts with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group.

CONCLUSION: Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.

PMID:33719601 | DOI:10.1177/0145561321999263

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An Oropharyngeal Obstructive Lesion in a Neonate

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Ear Nose Throat J. 2021 Mar 15:145561321995014. doi: 10.1177/0145561321995014. Online ahead of print.

ABSTRACT

Neonatal HNT in the pharynx is a rare cause of respiratory distress and poor feeding in the newborn, but must be differentiated from teratoma, encephalocele, and nasal glioma. While surgical resection is the preferred treatment modality, we posit there is a role for sclerosis of the glial heterotopic cyst if complete surgical excision is not possible or carries risk of high morbidity. Here, we present a case of a 7-day-old neonate presenting with acute respiratory distress found to have a nasopharyngeal/oropharyngeal mass ultimately treated with sclerotherapy at 9 months of age.

PMID:33719614 | DOI:10.1177/0145561321995014

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Preoperative Diagnosis and Treatment of Middle Ear Adenoma: A Case Report and Literature Review

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Ear Nose Throat J. 2021 Mar 15:1455613211000295. doi: 10.1177/01455613211000295. Online ahead of print.

ABSTRACT

Most reported cases of middle ear adenoma (MEA) have focused on histopathology because MEA is usually diagnosed postoperatively, which is considered as a major setback. We focused on the surgical aspect of the disease to facilitate a preoperative diagnosis, resulting in prompt and proper treatment, without requiring a second stage of surgical treatment. In this re port, we present the differential diagnoses in a 40-year-old man with MEA requiring surgical treatment. Preoperatively, the patient was suspected to have an MEA. An analysis of the surgical procedures in similar misdiagnosed tumors has enabled us to assess surgical procedures in cases wherein the preoperative diagnosis does not coincide with the postoperative histopathological results.

PMID:33719615 | DOI:10.1177/01455613211000295

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Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

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Ear Nose Throat J. 2021 Mar 15:145561321994995. doi: 10.1177/0145561321994995. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy.

METHODS: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic R eviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis.

RESULTS: Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = -0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue.

CONCLUSIONS: There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.

PMID:33719616 | DOI:10.1177/0145561321994995

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Factors Related to Ventilation Tube Extrusion Time in Children and Adults

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Ear Nose Throat J. 2021 Mar 15:145561321999204. doi: 10.1177/0145561321999204. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the factors affecting extrusion time in both children and adults with ventilation tube (VT) insertion, providing useful information for clinicians for better decision-making, follow strategy, and potentially improve clinical outcomes for these patients.

METHODS: Data from patients receiving myr ingotomy with VT insertion from January 1, 2007, to June 30, 2012, were retrospectively collected and analyzed by the end of 2018. Various factors, including age, gender, history of VT insertion, tympanogram, size of VT used, local finding of tympanic membrane, hypertension, diabetes mellitus, hyperlipidemia, and postoperative ear infection, were included and analyzed to examine the effects of these factors on extrusion time.

RESULTS: A total of 447 patients were included in this study (Child group-Adult group = 237:210). The overall average extrusion time was 225.85 days. In the subgroup analysis, the average time was 221.3 days and 231.0 days for children and adults, respectively. The results showed that the VT extrusion time was significantly longer in participants without a history of VT insertion and in those where larger sized VTs were inserted in both age-groups. Male gender had an influence on extrusion time in children. In addition, a history of VT insertion and VT si ze were determined to be factors related to extrusion before 12 months in children.

CONCLUSION: History of VT insertion and VT size were significantly related to VT extrusion time in both children and adults and defined as factors associated with extrusion before 12 months in children. The findings suggest avoiding VT with a diameter < 1 mm and considering an appropriately larger size in patients with a history of VT insertion to optimize VT retention.

PMID:33720800 | DOI:10.1177/0145561321999204

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Germ Line Mutations in the Thyroid Hormone Receptor Alpha Gene Predispose to Cutaneous Tags and Melanocytic Nevi

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Thyroid, Ahead of Print.
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Retrobulbar hematoma in endoscopic endonasal dacryocystorhinostomy

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Vestn Otorinolaringol. 2021;86(1):112-116. doi: 10.17116/otorino202186011112.

ABSTRACT

Recently, an increase in the number of operations on the lacrimal ducts performed by otorhinolaryngologists has been noted throughout the world. During these operations, intra- and postoperative complications may develop, which require the intervention of an ophthalmologist. A rare complication of endoscopic dacryocystorhinostomy is the development of retrobulbar hemorrhage. This article presents a clinical case of the development of retrobulbar hemorrhage in endoscopic dacryocystorhinostomy. The patient with dacryocystitis underwent endoscopic dacryocystorhinostomy. Preoperative computed tomography revealed a lack of bone tissue in the lacrimal sac fossa. Severe bleeding was noted during the operation. Against the background of tamponade of the formed anastomosis, a growing exophthalmos, conjunctival chemosis, subconjunctival hemorrhage were noted. After removing the tampon, a positive trend was noted. Dexamethasone solution was intraoperatively intravenously administered, in the postoperative period - methylprednisolone solution. According to computed tomography data, exophthalmos persisted on the first day after the operation, hematoma was localized. Visual functions are unchanged. Six months after the operation, the patient had no complaints. According to the computed tomography data, a functioning dacryorhinostomy anastomosis was determined. Often, an interdisciplinary approach to such complications is required, since it can provide full orbital decompression, as well as adequate postoperative management of the patient, which contributes to the most complete ophthalmic rehabilitation. The interaction of otorhinolaryngologists and ophthalmologists in such cases is an indispensable condition for the safety of the operation.

PMID:33720663 | DOI:10.17116/otorino202186011112

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The experience in surgical treatment of hearing loss in Van der Hoeve patients

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Vestn Otorinolaringol. 2021;86(1):6-10. doi: 10.17116/otorino2021860116.

ABSTRACT

Despite the rare incidence of Van der Hoeve syndrome in the population, the problem of treating patients with this type of disease is important for modern science and practical medicine. One of the most difficult tasks in treatment is to improve the quality of hearing. The world scientific community lacks a unified coordinated approach to the methods of auditory rehabilitation of patients with Van der Hoeve syndrome. In recent years, there have been tendencies in the scientific literature to increase the frequency of non-surgical approach due to the low incidence of satisfactory results of surgical treatment. In this regard, we present our experience of complex treatment of patients with Van der Hove syndrome, based on the use of modern surgical technologies and conservative pathogenetically substantiated treatment.

PMID:33720643 | DOI:10.17116/otorino2021860116

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