Δευτέρα 31 Ιανουαρίου 2022

Varicella post-exposure management for pediatric oncology patients

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Bull Cancer. 2022 Jan 26:S0007-4551(22)00004-2. doi: 10.1016/j.bulcan.2021.11.016. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective was to evaluate health care providers' (HCP) adherence to and efficacy of varicella post-exposure prophylaxis (PEP) recommendations. It was an observational, prospective, multicenter study set in Ile-de-France, France.

METHODS: All children under 18 with a cancer diagnosis, currently or within 3months of receiving cancer treatment, regardless of varicella zoster virus (VZV) serostatus or previous personal history of varicella, were eligible. Study participants with significant exposure were reviewed prospectively for PEP indications. Main outcome measures were the percentage of exposure situations for which HCP were guideline-compliant, the proportion of available VZV serostatuses and the incidence of breakthrough varicella after different PEP approaches.

RESULTS: A total of 51 patie nts from 15 centers were enrolled after 52 exposure episodes. Median age at exposure was 5 years (range, 1-15). Exposure within the household led to 38% of episodes. Prophylactic treatment consisted in specific anti-VZV immunoglobulins (V-ZIG) (n=19) or in oral aciclovir (n=15). No prophylactic treatment was given for 18 patients (in compliance, n=16). In compliance with guidelines, 17 patients received V-ZIG, 11 did not develop varicella (65%, [95% CI, 39-90%]); 15 received aciclovir, 13 did not develop varicella (87%, [95% CI, 67-100%]). Breakthrough varicella occurred in 11 patients, with simple clinical course in all cases; in 8/47 (17%) episodes when PEP was guideline-compliant versus 3/5 (60%) when not.

DISCUSSION: Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.

PMID:35093244 | DOI:10.1016/j.bulcan.2021.11.016

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Computed tomography-assessed variations of the carotid sinus

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Surg Radiol Anat. 2022 Jan 30. doi: 10.1007/s00276-021-02871-x. Online ahead of print.

ABSTRACT

PURPOSE AND BACKGROUND: Previous studies have identified variations regarding the morphology and location of the carotid sinus, a phenomenon still not commonly approached or studied on computed tomography angiography (CTA). Detailed characterization of the carotid sinus was performed on CTAs, determining its position, diameter and length.

METHODS: The study group included 43 patients with disease-free carotid trunks subjected to cervical CTA. We measured the terminal caliber of the common carotid artery (CCA), as well as the calibers of the internal (ICA) and external carotid arteries (ECA) at their origin. The diameters were correlated with the location and the shape of the carotid sinus. We also measured the length of the sinus dilatation (carotid bulb), in regard to its location on the terminal branches of the common carotid artery.

RESULTS: Mean diameters of the studied arteries were 7.39 ± 1.04 mm for the CCA, 6.71 ± 1.49 mm for the ICA and, respectively, 4.27 ± 0.75 mm for the ECA. The classical position of the carotid sinus was seen in 80% of cases, the rest being considered anatomical variants. The length of the carotid bulb on the ICA was 9.99 ± 2.22 mm, showing variability between genders.

CONCLUSIONS: The carotid sinus does not always extend to the ICA, presenting different distribution patterns that might be relevant in sinu s pathology from a clinical point of view, respectively from a surgical point of view during invasive or minimally invasive interventions on the carotid axis.

PMID:35094129 | DOI:10.1007/s00276-021-02871-x

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Relation between auditory difficulties and bortezomib-induced peripheral neuropathy in multiple myeloma: a single-center cross-sectional study

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Eur Arch Otorhinolaryngol. 2022 Jan 31. doi: 10.1007/s00405-021-07234-1. Online ahead of print.

ABSTRACT

PURPOSE: Bortezomib is a neurotoxic drug used in multiple myeloma and responsible for chemotherapy-induced peripheral neuropathy (CIPN). In a previous cross-sectional study, CIPN prevalence was about 26.9% in 67 patients. A second data analysis was performed to explore the relation between CIPN and auditory difficulties.

METHODS: Based on 66 multiple myeloma patients from a single center, auditory difficulties were assessed with a self-questionnaire and compared to sensory CIPN (QLQ-CIPN20 questionnaire), patients' characteristics and anticancer treatments.

RESULTS: The prevalence of auditory difficulties was about 42.4% (95% CI [30.6-55.2]) of the 66 patients analyzed and was higher in patients with CIPN than without (82.4% vs. 28.6%, p < 0.001). Auditory difficulties were not related to the characteristics of patien ts and treatments. The severity of auditory difficulties were correlated to CIPN severity (spearman's coefficient: 0.49, p = 0.009). Odds-ratio of auditory difficulties (multivariable analysis adjusted for sensory CIPN, recreation or professional noise exposure, gender, age, and treatments) was significantly associated with CIPN (18.7, 95% CI [3.0-117.1], p = 0.002).

CONCLUSION: This relation between CIPN and auditory difficulties raises concerns about hearing safety in multiple myeloma patients treated by bortezomib.

TRIAL REGISTRATION NUMBER: NCT03344328.

PMID:35098333 | DOI:10.1007/s00405-021-07234-1

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Ocular findings from otoneurological examinations in children with and without dyslexia: a systematic review with meta-analysis

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Braz J Otorhinolaryngol. 2021 Nov 25:S1808-8694(21)00190-7. doi: 10.1016/j.bjorl.2021.10.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate ocular movements measures of vectoelectro-nystagmography and video-nystagmography in dyslexic children and compare with measures of typical children.

METHODS: A systematic review of observational studies comparing the ocular movements differences between dyslexic and typical children with no publication date or language restriction. The literature survey included the bibliographic databases MEDLINE, ScienceDirect, Scopus, Web of Science, SciELO, Lilacs and CENTRAL. Gray literature databases were also searched, including: OpenGrey.eu, DissOnline.de, The New York Academy of Medicine and WorldCat. The meta-analysis was performed using software RevMan 5.3 (Cochran Collaboration).

RESULTS: A total of 2375 articles were found of which 113 fell within the inclusion criteria. Among these, 52 were duplicates (found in more than one research source), and 45 articles were selected for reading in full. Thirteen (13) articles were included for analysis and discussion. Meta-analysis showed statistical differences between the two groups for the total number of saccades and duration of fixation.

CONCLUSION: The study revealed that children with dyslexia have longer duration of fixation and fewer saccades during ocular movements on vectoelectro-nystagmography and video-nystagmography when compared to children without dyslexia.

PMID:35094959 | DOI:10.1016/j.bjorl.2021.10.006

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High-Resolution CT Imaging of the Temporal Bone: A Cadaveric Specimen Study

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1741006

Objective Super-high and ultra-high spatial resolution computed tomography (CT) imaging can be advantageous for detecting temporal bone pathology and guiding treatment strategies. Methods Six temporal bone cadaveric specimens were used to evaluate the temporal bone microanatomic structures utilizing the following CT reconstruction modes: normal resolution (NR, 0.5-mm slice thickness, 5122 matrix), high resolution (HR, 0.5-mm slice thickness, 1,0242 matrix), super-high resolution (SHR, 0.25-mm slice thickness, 1,0242 matrix), and ultra-high resolution (UHR, 0.25-mm slice thickness, 2,0482 matrix). Noise and signal-to-noise ratio (SNR) for bone and air were measured at each reconstruction mode. Two observers assessed visualization of seven small anatomic structures using a 4-point scale at each reconstruction mode. Results Noise was significantly higher and SNR significantly lower with increases in spatial resolution (NR, HR, and SHR). There was no statistical difference between SHR and UHR imaging with regard to noise and SNR. There was significantly improved visibility of all temporal bone osseous structures of interest with SHR and UHR imaging relative to NR imaging (p < 0.001) and most of the temporal bone osseous structures relative to HR imaging. There was no statistical difference in the subjective image quality between SHR and UHR imaging of the temporal bone (p ≥ 0.085). Conclusion Super-high-resolution and ultra-high-resolution CT imaging results in significant improvement in image quality compared with normal-resolution and high-resolution CT imaging of the temporal bone. This preliminary study also demonstrates equivalency between super-high and ultra-high spatial resolution temporal bone CT imaging protocols for clinical use.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract   |  Full text

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Thyroid Disease in Pregnancy: A Touch of Clarity

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Thyroid, Ahead of Print.
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Κυριακή 30 Ιανουαρίου 2022

The music-related quality of life: Italian validation of MuRQoL into MUSQUAV questionnaire and preliminary data from a cohort of postlingually deafened cochlear implant users

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Eur Arch Otorhinolaryngol. 2022 Jan 28. doi: 10.1007/s00405-022-07258-1. Online ahead of print.

ABSTRACT

PURPOSE: Cochlear implant (CI) users do not receive much of the auditory information necessary for an accurate perception of music. This usually entails a dissatisfaction with the music they hear, so that their quality of life may potentially be affected. The main aim of this paper was to translate and validate into Italian an instrument to evaluate these aspects-The Music-Related Quality of Life Questionnaire (MuRQoL)-to help the work of clinicians and therapists.

METHODS: The translation of the MuRQoL into "Questionario Musica e Qualità della Vita" (MUSQUAV) was done according to the international guidelines. The translated questionnaire was administered to normal hearing (NH) and CI users adults. Exploratory factor analysis, confirmatory factor analysis and known group method were used to confirm construct validity and app licability of MUSQUAV.

RESULTS: We retrieved 225 results. The MUSQUAV questionnaire was acceptable according to the goodness-of-fit indices. The correlation between the items, evaluated using Cronbach's α coefficient, indicates a good internal consistency (> 0.80). The non-parametric Mann-Whitney test showed significant differences in the distinct populations tested.

CONCLUSIONS: The MUSQUAV questionnaire is a valid, low-cost and rapid instrument for professional workers in the audiological field, especially useful in the assessment of the patients' perception and musical engagement.

PMID:35089391 | DOI:10.1007/s00405-022-07258-1

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Intraoral Approach for Parapharyngeal Branchial Cleft Cysts

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Ear Nose Throat J. 2022 Jan 28:1455613211067846. doi: 10.1177/01455613211067846. Online ahead of print.

ABSTRACT

Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of para pharyngeal BCC misdiagnosed as peritonsillar abscess.

PMID:35088618 | DOI:10.1177/01455613211067846

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Bereavement Practices Among Head and Neck Cancer Surgeons

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Objectives

Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons.

Methods

A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up.

Results

There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients.

Conclusion

There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement.

Level of Evidence

NA Laryngoscope, 2022

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Diagnostic accuracy of conventional oral examination for detecting oral cavity cancer and potentially malignant disorders in patients with clinically evident oral lesions: Systematic review and meta‐analysis

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Abstract

This systematic review evaluates the diagnostic accuracy of conventional oral examination (COE) versus incisional or excisional biopsy for the diagnosis of malignant and/or dysplastic lesions in patients with clinically evident lesions. Searches were conducted across five electronic databases from inception to January 2020. Meta-analyses were undertaken, where appropriate. Among 18 included studies, 14 studies were included in the meta-analysis, giving summary estimates for COE of 71% sensitivity and 85% specificity for the diagnosis of dysplastic and/or malignant lesions. The pooled diagnostic accuracy of identifying malignant-only lesions was reported in seven studies, giving a pooled estimate of 88% sensitivity and 81% specificity. Diagnostic accuracy of different types of dental/medical professionals in identifying dysplastic or malignant lesions gave varying estimates of sensitivity and specificity across three studies. Further research is needed to improve the diagnostic acc uracy of COE for early detection of dysplastic and malignant oral lesions.

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Πέμπτη 27 Ιανουαρίου 2022

Birth of the Beta-knife Thyroidectomy: The Radiance of Saul Hertz

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Am Surg. 2022 Jan 26:31348211060463. doi: 10.1177/00031348211060463. Online ahead of print.

ABSTRACT

This is the story of how one man's life's work allowed for Iodine-131 (I-131) to become a therapy for hyperthyroidism and thyroid cancer. What is now a standard in our times arose from Saul Hertz's rather challenging and humble beginnings. Thyroid lobectomy and total thyroidectomy were therapeutic mainstays for thyroid disease until Hertz treated his first patient with radioactive i odine (RAI) ablation therapy at Massachusetts General Hospital (MGH) on March 31, 1941. His concepts for using beta particle emission from RAI to ablate thyroid tissue were revolutionary. Hertz's RAI therapy translated to research with thyroid cancer by the mid-1940s. The high-energy beta particles produced cytolethal effects on remnant thyroid tissue left behind by total thyroidectomy, thereby accomplishing completion thyroidectomy in some patients. Progressive surgeons from the Hertz era incorporated RAI into their practice. MGH surgery resident Francis Moore took sabbatical from clinical training to do translational research with RAI and other radioisotopes. Irving Ariel of New York became known as a nuclear surgeon in the wake of Hertz's work. George Crile Jr of Cleveland became an RAI advocate for the surgical community, implementing several paradigm-changing concepts in thyroid disease along the way. Hertz was a visionary who sparked this movement, predicting many of the molec ular dilemmas with RAI-tumor avidity that clinical researchers continue to navigate today. This timely history for surgical oncologists and endocrine surgeons traces the development of RAI therapy through the life of Saul Hertz, a biographical window influenced by social stigma, political controversy, and mainstream media.

PMID:35081787 | DOI:10.1177/00031348211060463

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