Τρίτη 15 Φεβρουαρίου 2022

The radial forearm snake flap: An underutilized technique for fasciocutaneous and osteocutaneous forearm flaps with primary closure

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Abstract

Background

The radial forearm free flap (RFFF) is associated with troublesome donor site morbidity related to split thickness skin grafting (STSG). The radial forearm snake flap with primary closure of the donor site may reduce donor site complications.

Methods

Single institution, retrospective cohort study comparing rates of delayed donor site wound healing and tendon exposure in 52 patients undergoing radial forearm snake flap and 95 patients undergoing conventional RFFF with STSG closure of the donor site.

Results

Tendon exposure occurred in zero (0%) patients undergoing snake flap and four (4.2%) patients undergoing conventional RFFF (0/52 vs. 4/95; p = 0.297). Delayed wound healing occurred in zero (0%) patients undergoing snake flap and 19 (20.0%) patients undergoing conventional RFFF (0/52 vs. 19/95; p < 0.001).

Conclusions

The radial forearm snake flap provides an alternative to conventional RFFF harvest, which enables primary donor site closure with reduced rates of delayed donor site healing.

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How to Maximize the Outcomes of Cochlear Implantation in Common Cavity and Cochlear Aplasia With Dilated Vestibule, the Most Severe Inner Ear Anomalies?

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Clin Exp Otorhinolaryngol. 2022 Feb 15. doi: 10.21053/ceo.2022.00164. Online ahead of print.

NO ABSTRACT

PMID:35158419 | DOI:10.21053/ceo.2022.00164

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New AMM: Nivolumab as an adjuvant for oesophageal and gastroesophageal junction cancer

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Bull Cancer. 2022 Feb 11:S0007-4551(22)00009-1. doi: 10.1016/j.bulcan.2021.11.018. Online ahead of print.

NO ABSTRACT

PMID:35164916 | DOI:10.1016/j.bulcan.2021.11.018

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Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

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J Clin Med. 2022 Jan 28;11(3):685. doi: 10.3390/jcm11030685.

ABSTRACT

OBJECTIVE: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia.

METHODS: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), afte r which meta-analyses were performed using a random-effects model.

RESULTS: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training.

CONCLUSIONS: Behavioural interven tions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.

PMID:35160137 | DOI:10.3390/jcm11030685

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Secondary primary malignancy in patients with head and neck squamous cell carcinoma

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by Shih-Wei Wang, Leong-Perng Chan, Ling-Feng Wang, Che-Wei Wu, Sheng-Hsuan Lin, Tzu-Yen Huang, Ka-Wo Lee

Background

The survival rate of head and neck squamous cell carcinoma (HNSCC) patients with secondary primary malignancy (SPM) showed no significant improvement for decades, however, the impact of advances in diagnostic tools is rarely mentioned. This study investigated the clinical characteristic of HNSCC with SPM over a 27-year period especially from the perspective of diagnostic tools.

Methods

This study evaluated 157 HNSCC patients with SPM. The patients were divided into two groups according to the time of SPM diagnosis (Group A:1992–2003; Group B: 2004–2014). Age, gender, stage of first primary malignancy (FPM), SPM interval, overall survival, and disease-free survival were compared between groups.

Results

Group B had significantly more SPM developed rate (p = 0.002), more SPM patients with advanced stage of FPM (p = 0.001), synchronous SPM (p = 0.006), and shorter SPM interval (p Conclusion

Among patients diagnosed with HNSCC recently, more SPMs are diagnosed in a shorter time interval and in a more advanced stage. The overall advances in diagnostic tools cannot significantly improve SPM survival, however, it enables more patients to receive corresponding treatment.

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The Extent of Thyroid Surgery in Differentiated Thyroid Cancer Patients with Low and Intermediate Risks of Recurrence

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Clinical Thyroidology, Volume 34, Issue 2, Page 63-66, February 2022.
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Diagnostic Value of Preoperative Serum Calcitonin Levels in Medullary Thyroid Carcinoma

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Clinical Thyroidology, Volume 34, Issue 2, Page 85-88, February 2022.
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The clinicopathological and prognostic characteristics of mucinous micropapillary carcinoma of the breast

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Histol Histopathol. 2022 Feb 15:18436. doi: 10.14670/HH-18-436. Online ahead of print.

ABSTRACT

BACKGROUND: Mucinous micropapillary carcinoma (MMPC) is a unique subtype of breast cancer, and there is as yet no detailed report on the clinical characteristics of MMPC.

METHODS: MMPC, pure mucinous breast carcinoma (PMBC), and invasive micropapillary carcinoma (IMPC) samples were enrolled simultaneously, and immunohistochemistry analysis was performed to explore the clinicopathological attributes of MMPC. Moreover, survival analyses of MMPC were performed among the MMPC, PMBC, and IMPC groups and within the MMPC group.

RESULTS: The results showed that MMPC demonstrated distinct pathological features and that vascular invasion and lymph node metastasis were two significant clinical attributes of MMPC. MMPC leads to a shorter survival time than PMBC but an increased survival time compared to IMPC, while the tumor-node-metastasis stage and lymph node metastasis were identified as two independent prognostic elements for disease-free survival in discerning the MMPC prognosis.

CONCLUSIONS: The gathered data implied that further understanding and classification of MMPC may provide better individualized therapeutic strategies for MMPC treatment.

PMID:35166367 | DOI:10.14670/HH-18-436

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Comparison of outcomes between intracapsular resection and pseudocapsule-based extracapsular resection for pituitary adenoma: a systematic review and meta-analysis

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BMC Neurol. 2022 Feb 12;22(1):52. doi: 10.1186/s12883-022-02574-9.

ABSTRACT

BACKGROUND: Transsphenoidal surgery is the preferred first-line therapy for most pituitary adenoma(PA), and the conventional strategy of treatment is intracapsular resection(IR). The protocol of extracapsular resection(ER), which considers the pseudocapsule as the PA boundary for surgical removal, has also been introduced gradually. In this study, the clinical efficacies and complications were explored and compared between these two procedures.

METHODS: A systematic literature review was performed in the PubMed, EMBASE, Web of Science and Cochrane databases. Articles comparing between IR and ER were included.

RESULTS: There were 7 studies containing 1768 cases in accordance with the inclusion criteria. Although the meta-analysis showed no significant difference in complete resection, a sensitivity analysis revealed that ER was more conducive to total PA re section than IR. Moreover, we found a significant difference in favor of ER regarding biochemical remission. Furthermore, there was no significant difference in the incidence rate of certain complications, such as hormone deficiency, diabetes insipidus, intraoperative cerebrospinal fluid(CSF) and postoperative CSF leakage. However, a sensitivity analysis suggested that IR decreased the risk of intraoperative CSF leakage.

CONCLUSIONS: This meta-analysis unveiled that ER contributed to biochemical remission. To some extent, our results also showed that ER played a positive role in complete resection, but that IR reduced the incidence of intraoperative CSF leakage. However, the available evidence needs to be further authenticated using well-designed prospective, multicenter, randomized controlled clinical trials.

PMID:35151259 | DOI:10.1186/s12883-022-02574-9

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PTH in situ measurement in patients with hyperparathyroidism: single-centre experience of 179 patients

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Eur J Endocrinol. 2022 Feb 1:EJE-21-1249. doi: 10.1530/EJE-21-1249. Online ahead of print.

ABSTRACT

CONTEXT: The measurement of PTH in situ (PTHis) by fine-needle aspiration (FNA) is proposed as a tool to preoperatively help localize parathyroid glands detected on ultrasound. However, the accuracy of PTHis is highly variable according to the few available studies. We aimed to develop and validate the PTHis procedure. We assessed the performance of PTHis in a large series of patients with hyperparathyroidism.

PATIENTS: The technique setup consisted of PTHis measurement in thyroid samples from patients with thyroid nodules and patients with high circulating PTH levels (tertiary hyperparathyroidism). Consecutive patients were recruited and submitted to ultrasound-guided FNA-PTHis determination.

RESULTS: During the method setup, we obtained undetectable PTHis levels in all non-parathyroid tissues after sample dilutions. PTHis was high er in patients with hyperparathyroidism (n=145, 1817±3739 ng/L, range <4.6-31,140) than in those with thyroid or undetermined cervical lesions (n=34, <4.6 ng/mL,p<0.0001). When evaluating PTHis performance in histologically proven samples (158 lesions from 121 patients), PTHis was detectable in 85/97 parathyroid lesions (87%, range 22-31,140 ng/L) and undetectable in all non-parathyroid lesions (n=61,p<0.0001). The specificity and positive predictive value were 100%, and the sensitivity was 87.6%. False-negative lesions (n=12) were smaller (9.4±5.9 mm) and more often consisted of hyperplasias (75%) than true-positive lesions (16.1±8.4 mm and 33%, p=0.009 and p=0.0089, respectively). The method was safe and well tolerated. Four educational cases are also provided.

CONCLUSIONS: PTHis determination is a safe and well-tolerated procedure that enhances the specificity of ultrasound-detected lesions. If accurately set up, it confirms the parathyroid origin of uncharac terized cervical lesions.

PMID:35167489 | DOI:10.1530/EJE-21-1249

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