Migration of Ventriculoperitoneal Shunt to Uterus In A Child: A Case Report

xlomafota13 shared this article with you from Inoreader Migration of Ventriculoperitoneal Shunt to Uterus In A Child: A Case Report Via leak of cerebrospinal fluid J Pediatr Adolesc Gynecol. 2021 Nov 26:S1083-3188(21)00343-0. doi: 10.1016/j.jpag.2021.11.004. Online ahead of print. ABSTRACT BACKGROUND: Ventriculo-peritoneal shunt (VPS) is usually placed inside the peritoneal cavity for cerebrospinal fluid drainage. Rarely, it can migrate to various pelvic visceral organs. Inside the pelvis, the distal end of the shunt can perforate anywhere from the uterus or adnexa to the vulva and migration through the uterus is extremely rare. CASE: A three-and-a-half-year-old girl presented with CSF leak through the vagina following uterine perforation by VPS. The diagnosis was made with an ultrasound. Her symptoms resolved following revision surgery. CONCLUSION: In a patient with a VPS in situ, presenting with a watery fluid leak through vagina, perforation of fornix or uterus must always be kept in mind. Timely diagnosis and intervention can result in the prevention of complications. PMID:34843976 | DOI:10.1016/j.jpag.2021.11.004 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Geographic disparities in head and neck cancer survival

xlomafota13 shared this article with you from Inoreader Geographic disparities in head and neck cancer survival in Upstate New York 2011–2019 Via Head & Neck Abstract Purpose To examine the association between distance to care-center and urban–rural residence on 5-year overall survival (OS) from head and neck cancer (HNC). Materials and methods Five-year OS was retrospectively measured from date of initial diagnosis for patients with HNC treated at a single tertiary care center. Distances were calculated based on ZIP code of patient's residence and care center. Multilevel Weibull regression was used to adjust for confounders and identify disparities in 5-year all-cause mortality. Results A total of 670 patients included in study. Multivariable analysis revealed older age or late-stage cancer at diagnosis, and HPV negative status were associated with poorer OS. Patients residing in isolated small rural town (HR = 2.20, p = 0.015) or small rural town (HR = 2.07, p = 0.015) had lower OS. Distance to care center was not associated with OS (HR = 0.996, p = 0.11). Conclusions Greater rurality was associated with poorer OS among HNC patients in Upstate New York. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Heads up reconstructive microsurgery: Utilisation of the three-dimensional microscope in microvascular procedures

xlomafota13 shared this article with you from Inoreader Heads up reconstructive microsurgery: Utilisation of the three-dimensional microscope in microvascular procedures Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Nov 15:S1748-6815(21)00575-1. doi: 10.1016/j.bjps.2021.11.036. Online ahead of print. ABSTRACT BACKGROUND: Since the earliest use of microscopes in surgery, several modifications have been made to improve the ergonomics of movement and posture, increase the resolution, and expand the visual field. The three-dimensional microscopes are latest innovation in this field. Despite the wider use of 3D microscopes in other specialities, their use in the reconstructive microsurgery in the United Kingdom is still limited. Reconstructive microsurgeons are highly skilled surgeons that are trained to operate utilising the microscope for long hours. This poses an occupational risk with a specific pattern of work-related conditions. AIMS AND METHODS: We aim in this report to demonstrate our experience utilising 3D microscopes in small cohort of patients matched to a control of patients operated utilising the traditional microscopes. Patients were matched by age, comorbidities, oncologic procedures. This was complemented by a survey completed by the operating surgeons. RESULTS: Nine patients were included in each group. There was no significant difference in operative or ischemia time and no significant post-operative complications in both groups. The surgeons reported better ergonomics, improved staff engagement, and a better teaching experience when utilising the 3D microscopes compared to traditional microscopes. CONCLUSION: The utilisation of the 3D microscopes in reconstructive microsurgery has shown to provide comfort, improve ergonomics of movement and posture without significant clinical implications in this series. PMID:34844881 | DOI:10.1016/j.bjps.2021.11.036 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Proximal tibial dimensions in a formalin-fixed neonatal cadaver sample: an intraosseous infusion approach

xlomafota13 shared this article with you from Inoreader Proximal tibial dimensions in a formalin-fixed neonatal cadaver sample: an intraosseous infusion approach Via radiol anat Surg Radiol Anat. 2021 Nov 29. doi: 10.1007/s00276-021-02843-1. Online ahead of print. ABSTRACT PURPOSE: Methods to administer intramedullary medication and fluid infusion in both adults and children date to the early twentieth century. Studies have shown that intraosseous access in the proximal tibia is ideal for resuscitation efforts as fewer critical structures are at risk, and neither is the blood flow to the lower limbs compromised. Insertion of a needle in children you nger than 5 years does have the risk to damage to the epiphyseal growth plate. Therefore, the aim of this study was to determine the ideal intraosseous insertion site distal to the epiphyseal growth plate in neonates. METHODS: The samples consisted of both the left and right sides of 15 formalin-fixed neonatal cadavers. The dimensions were measured on the superior surfaces of each section, anteromedial border, cortical thickness, and medullary space. RESULTS: The most desirable location to gain vascular access is at 10 mm inferior to the tibial tuberosity. CONCLUSION: The smallest cortical thickness (1.32 mm), the largest medullary space (4.50 mm), and the largest anteromedial surface (7.72 mm) were observed at 10 mm inferior to the tibial tuberosity. It is imperative that health care professionals are familiar with the osteological sites that could be safely used for an intraosseous infusion procedure. PMID:34845509 | DOI:10.1007/s00276-021-02843-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The effects of cigarette smoking and nicotine on the therapeutic potential of mesenchymal stem cells

xlomafota13 shared this article with you from Inoreader The effects of cigarette smoking and nicotine on the therapeutic potential of mesenchymal stem cells Via Cellular and Molecular Biology Histol Histopathol. 2021 Nov 30:18400. doi: 10.14670/HH-18-400. Online ahead of print. ABSTRACT Due to their immunoregulatory properties and capacity for multi-lineage differentiation, mesenchymal stem cells (MSCs) have been used as new therapeutic agents in regenerative medicine. Numerous lifestyle habits and behavioral risk factors may modulate metabolic and cell growth signaling pathways in MSCs, affecting their phenotype and function. Accordingly, identification of these factors and minimization of their influence on viability and function of transplanted MSCs may greatly contribute to their better therapeutic efficacy. A large number of experimental and clinical studies have demonstrated the detrimental effects of cigarette smoke and nicotine on proliferation, homing, chondrogenic and osteogenic differentiation of MSCs. Cigarette smoke down-regulates expression of chemokine receptors and modulates activity of anti-oxidative enzyme s in MSCs, while nicotine impairs synthesis of transcriptional factors that regulate the cell cycle, metabolism, migration, chondrogenesis and osteogenesis. In this review article, we summarize current knowledge about molecular mechanisms that are responsible for cigarette smoke and nicotine-dependent modulation of MSCs' therapeutic potential. PMID:34845711 | DOI:10.14670/HH-18-400 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association Between Insurance Type and Outcomes of Reconstructive Head and Neck Cancer Surgery

xlomafota13 shared this article with you from Inoreader Association Between Insurance Type and Outcomes of Reconstructive Head and Neck Cancer Surgery Via The Laryngoscope Objectives/Hypothesis Although the benefits of expanding health insurance coverage are clear, there are limited studies comparing the different types of insurance. This study aims to determine the association between insurance type and outcomes in patients with head and neck cancer undergoing reconstructive surgery in the United States. Methods Population-based cross-sectional study of the 2012–2014 National Inpatient Sample. We identified 1,314 patients with head and neck cancers undergoing tumor ablative surgery followed by pedicled or free flap reconstruction of oncologic defects. Insurance type was classified as private, Medicare, Medicaid, self-pay, or other. The primary outcome was extended length of stay (LOS), defined as greater than 14 days, which represented the 75th percentile of the study sample. Secondary outcomes included acute medical complications, surgical complications, morbidities, and costs. Analyses were adjusted for gender, geographic location, and various medical comorbidities. Results In univariate analysis, insurance type was associated with extended LOS (P = .001), medical complications (P = <.001), and mortalities (P = .020). After controlling for other covariates in the multivariate analysis, compared to private insurance, Medicare and Medicaid were both associated with significantly higher odds of extended LOS (adjusted odds ratio [OR] [95% confidence interval (CI)] = 1.73 [1.09–2.76] and 2.22 [1.38–3.58], respectively). Medicare was associated with significantly higher odds of medical complications, but Medicaid was not (adjusted OR [95% CI] = 1.53 [1.02–2.31] and 1.64 [0.97–2.78], respectively). Conclusions Medicaid and Medicare were independently associated with extended LOS after reconstructive head and neck cancer surgery. Medicare was associated with higher rates of medical complications. Efforts to address LOS should target care planning and coordination. Level of Evidence NA Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post headshake nystagmus: further correlation with other vestibular test results

xlomafota13 shared this article with you from Inoreader Post headshake nystagmus: further correlation with other vestibular test results 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 Eur Arch Otorhinolaryngol. 2021 Nov 28. doi: 10.1007/s00405-021-07155-z. Online ahead of print. ABSTRACT BACKGROUND: It is generally accepted that headshake nystagmus (HSN) is generated from an asymmetrical peripheral vestibular input and a correlation exists between HSN and canal paresis. There have been limited reports, however, how HSN correlates with the more recently introduced tests of vestibular function. AIMS/OBJECTIVES: To evaluate the correlation between HSN and unilateral weakness on caloric testing, high-frequency vestibulo-ocular reflex (VOR) function on video head impulse testing (VHIT) and otolith function determined by vestibular evoked myogenic potentials (VEMPs). METHODS: A retrospective study of all patients who underwent complete vestibular function testing at our tertiary referral center from 2016 to 2019 was performed. Demographic data, clinical diagnosis (where available), the results of video-nystagm ography, vHIT, and VEMPs were evaluated. RESULTS: Of the 1499 patients in the study period, 101 (6.7%) had HSN. Vestibular test abnormalities were more common in patients with HSN. The sensitivity of HSN for underlying pathology was low in comparison with vestibular testing. However, HSN demonstrated a high specificity. CONCLUSIONS AND SIGNIFICANCE: HSN generation is likely more complex than caloric-induced nystagmus, probably due to additional variables within the vestibular system. HSN may provide clinicians with additional information concerning high-frequency VOR function involving lateral semicircular and otolith dysfunction. PMID:34839406 | DOI:10.1007/s00405-021-07155-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Omitting axillary lymph node dissection after positive sentinel lymph node in the post-Z0011 era: Compliance with NCCN and ASCO clinical guidelines and Z0011 criteria in a large prospective cohort

xlomafota13 shared this article with you from Inoreader Omitting axillary lymph node dissection after positive sentinel lymph node in the post-Z0011 era: Compliance with NCCN and ASCO clinical guidelines and Z0011 criteria in a large prospective cohort Via Association française pour l'étude du cancer Bull Cancer. 2021 Nov 24:S0007-4551(21)00442-2. doi: 10.1016/j.bulcan.2021.09.018. Online ahead of print. ABSTRACT PURPOSE: In the ACOSOG Z0011 trial, patients with primary breast cancer and 1-2 tumor-involved sentinel lymph nodes (SLNs) undergoing breast-conserving surgery had no oncological outcome benefit after axillary lymph node dissection (ALND), despite a relevant rate of non-SLN metastases of 27%. According to the St Gallen expert consensus, and NCCN and ASCO clinical guidelines, ALND may be avoided in patients who meet all ACOSOG Z0011 inclusion criteria. This recommendation can also be extended to patients undergoing mastectomy, with 1 or 2 positive SLNs and an indication for chest wall radiation, in whom axillary radiotherapy can be proposed as an alternative to completion ALND. The aim of this study was to assess non-compliance with the NCCN and ASCO clinical guidelines and Z0011 criteria, namely the rate of performance of completion ALND when it was not recommended, and the rate of failure to perform completion ALND when recommended. METHODS: Data were prospectively analysed from T1-2 N0 breast cancer patients undergoing an SLN procedure and treated at the Georges-François Leclerc Cancer Center between November 2015 and May 2017. Factors associated with non-compliance treatment decisions were identified using logistic regression. RESULTS: Among 563 patients included, 122 (21.7%) had at least one positive SLN. ALND was not recommended for 76 patients (62.3%), and was recommended in 46 patients (37.7%). The rate of non-compliant treatment was 32% (39/122) overall: ALND was performed despite not being recommended in 16/76 patients (21.1%) and was not performed in 50% of patients in whom it was recommended (23/46). By multivariate analyses, lymphovascular invasion ((Odds Ratio (OR)=6.1; 95% confidence interval (CI): 1.4-26.7; P=0.02)) and only one SLN removed (OR=9.1; 95%CI: 2.2-33.3; P=0.00 2) were associated with performance of completion ALND when not recommended. Conversely, >1 SLN removed (OR=5.1; 95%CI: 1.2-22.2; P=0.03) was associated with the failure to perform completion ALND when recommended. CONCLUSION: Almost one third of patients with invasive breast cancer receive treatment that is not in compliance with recommendations regarding completion ALND. PMID:34838310 | DOI:10.1016/j.bulcan.2021.09.018 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Microsurgical Lymphovenous Anastomosis for Pelvic Lymphoceles after Gynecological Cancer Surgery

xlomafota13 shared this article with you from Inoreader Microsurgical Lymphovenous Anastomosis for Pelvic Lymphoceles after Gynecological Cancer Surgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 22:S1748-6815(21)00497-6. doi: 10.1016/j.bjps.2021.09.056. Online ahead of print. ABSTRACT BACKGROUND: Pelvic lymphoceles are the most common complications after pelvic lymphadenectomy. Microsurgical procedures have attracted attention as an alternative treatment for lymphoceles. Here, we report six cases of refractory lymphoceles that were successfully treated using lymphovenous anastomosis (LVA). METHODS: Six patients underwent surgery for gynecological cancers and developed pelvic lymphoceles, which did not respond to conventional treatment. We mainly performed LVA on the ipsilateral lower limbs, although some procedures were also performed on the contralateral limbs. The change in the lymphocele volume after LVA was examined using computed tomography and compared using the Wilcoxon test. RESULTS: Five of the six refractory lymphocele cases were successfully treated using LVA, and the remaining case exhibited an 87% reduction in lymphocele volume. The average numbers of anastomoses were 6.7 on the ipsilateral side and 2.8 on the contralateral side (the median numbers: 6 [range: 5-9] vs. 3 [range: 1-4], P = 0.034). The average lymphocele volume decreased significantly from 414.0 mL preoperatively to 8.0 mL postoperatively (the median lymphocele volume: 255.8 [range: 61.5-1,329.2] vs. 0 [range: 0-47.7], P = 0.0313). CONCLUSION: We found that microsurgical treatment was potentially effective for lymphoceles that did not respond to conventional treatment. PMID:34840117 | DOI:10.1016/j.bjps.2 021.09.056 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis

xlomafota13 shared this article with you from Inoreader Using RSI and RFS scores to differentiate between reflux-related and other causes of chronic laryngitis Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Oct 17:S1808-8694(21)00155-5. doi: 10.1016/j.bjorl.2021.08.003. Online ahead of print. ABSTRACT OBJECTIVE: To establish if the Reflux Symptom Index (RFI) and the Reflux Finding Score (RFC) can help establish the differential diagnosis in patients with distinct causes of chronic laryngopharyngitis. METHODS: A group of 102 adult patients with chronic laryngopharyngitis (Group A - 37 patients with allergic rhinitis; Group B - 22 patients with Obstructive Sleep Apnea (OSA); Group C - 43 patients with Laryngopharyngeal Reflux (LPR)) were prospectively studied. Chronic laryngitis was diagnosed based on suggestive symptoms and videolaryngoscopic signs (RSI ≥ 13 and RFS ≥ 7). Allergies were confirmed by a positive serum RAST, OSA was diagnosed with a positive polysomnography, and LPR with a positive impedance-PH study. Discriminant function analysis was used to determine if the combination of RSI and RFS scores could differentiate between groups. RESULTS: Patients with respiratory allergies and those with LPR showed similar and significantly higher RSI scores when compared to that of patients with OSA (p < 0.001); Patients with OSA and those with LPR showed similar and significantly higher RFS scores when compared to that of patients with Respiratory Allergies (OSA vs. Allergies p < 0.001; LPR vs. Allergies p < 0.002). The combination of both scores held a higher probability of diagnosing OSA (72.73%) and Allergies (64.86%) than diagnosing LPR (51.16%). CONCLUSIONS: RSI and RFS are not specific for reflux laryngitis and are more likely to induce a false diagnosis if not used with diligence. PMID:34840124 | DOI:10.1016/j.bjorl.2021.08.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ectopic thymic tissue in subglottis of children: evaluation and management

xlomafota13 shared this article with you from Inoreader Ectopic thymic tissue in subglottis of children: evaluation and management Via Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial Braz J Otorhinolaryngol. 2021 Nov 5:S1808-8694(21)00179-8. doi: 10.1016/j.bjorl.2021.10.001. Online ahead of print. ABSTRACT OBJECTIVES: Ectopic thymic tissue in the subglottis is an extremely rare disease that causes airway obstruction. Few cases reported were accurately diagnosed before surgery. METHODS: A case of a 2-year-old boy with airway obstruction caused by a left subglottic mass was reported. The presentation of radiological imaging, direct laryngoscopy and bronchoscopy, pathology, and surgical management were reviewed. An extensive search in PubMed, EMBASE, Web of Science, Google Scholar, and EBSCO of English literature was performed without a limit of time. RESULTS: Besides our case, only six cases were reported since 1987. The definitive diagnosis on these patients were made with the findings of pathology, of which, five were ectopic thymus and two were ectopic thymic cysts. Our case was the only one with a cor rect suspicion preoperatively. Four cases underwent open surgical resection, and two cases underwent microlaryngeal surgery, while one deceased after emergency tracheostomy. No recurrences were found by six patients during the follow-up after successful treatments. CONCLUSION: Ectopic thymus is a rare condition, infrequently considered in the differential diagnosis of subglottic masses. Modified laryngofissure may be an effective approach to removing the subglottic ectopic thymus and reconstructing the intact subglottic mucosa. PMID:34840123 | DOI:10.1016/j.bjorl.2021.10.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.