Πέμπτη 31 Μαρτίου 2022

Descriptive analysis of recurrences of nasal intestinal‐type adenocarcinomas after radiotherapy

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Abstract

Background

Despite adjuvant radiotherapy, rates of recurrences of endoscopically operated nasal intestinal-type adenocarcinomas (ITAC) have not been improved in successive series. To better understand how to improve local control, we aimed to investigate the site of local recurrences of ITACs.

Methods

Retrospective study in a reference center in sinonasal malignancies. For all patients with a local recurrence, radiotherapy plans were retrieved and compared to the delineation of local recurrences.

Results

Of 63 patients, 54 underwent adjuvant radiotherapy of which 14 (25.9%) had a local recurrence. Eleven of them had their onset in an optimally irradiated area. Difficulty to dissect the cribriform plate and/or the lateral lamina was reported for 11 patients with local recurrences in the operative reports (p <0.0001).

Conclusions

Most of recurrences arose in an optimally irradiated area. A close cooperation between surgeons and radiotherapists is required to define areas at risk and adapt treatment.

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Key Issues in Use of Prophylactic Steroids to Prevent Hypocalcemia and Voice Dysfunction After Thyroidectomy—Reply

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jamanetwork.com

In Reply We thank Ms Kane and colleagues for their feedback on our article.
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Expert consensus on dental caries management

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International Journal of Oral Science, Published online: 31 March 2022; doi:10.1038/s41368-022-00167-3

Expert consensus on dental caries management
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Τετάρτη 30 Μαρτίου 2022

Air polishing or hand and/or power-driven instruments in supportive periodontal therapy

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This review of air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments in supportive periodontal treatment and implant maintenance included 6 RCTs. 4 of the 6 included studies were considered to be at high risk of bias so the findings should be interpreted cautiously.

The post Air polishing or hand and/or power-driven instruments in supportive periodontal therapy appeared first on National Elf Service.

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Subclonal heterogeneity sheds light on the transformation trajectory in IGLV3-21R110 chronic lymphocytic leukemia

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The implicated clinical factors for outcomes in 304 patients with salivary duct carcinoma: Multi‐institutional retrospective analysis in Japan

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Abstract

Background

Salivary duct carcinoma (SDC) is a high-grade salivary malignancy that frequently occurs as the carcinomatous component of carcinoma ex pleomorphic adenoma. We herein examined the clinical factors affecting outcomes in a large cohort of SDC.

Methods

We selected 304 SDC cases and investigated clinical characteristics and the factors affecting outcomes.

Results

The median age of the cases examined was 68 years, the most common primary site was the parotid gland (238 cases), and there was a male predominance (M/F = 5:1). Outcomes were significantly worse when the primary tumor site was the minor salivary glands (SG) than when it was the major SG. Outcomes were also significantly worse in pN(+) cases (161 cases) than in pN0 cases, particularly those with a metastatic lymph node number ≥11. The cumulative incidence of relapse and distant metastases was significantly higher in stage IV cases than in stage 0–III cases.

Conclusions

The absolute number of lymph node metastases, higher stages, and the minor SG as the primary tumor site were identified as factors affecting the outcome of SDC.

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Subclonal heterogeneity sheds light on the transformation trajectory in IGLV3-21R110 chronic lymphocytic leukemia

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Blood Cancer Journal, Published online: 30 March 2022; doi:10.1038/s41408-022-00650-4

Subclonal heterogeneity sheds light on the transformation trajectory in IGLV3-21R110 chronic lymphocytic leukemia
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Advances in Surgical Treatment of Rhinitis

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Abstract

Purpose of Review

Rhinitis is a heterogeneous diagnosis characterized by the presence of several nasal symptoms and it is only when pharmacotherapy fails that surgical treatment is considered. Over the years, multiple surgical techniques and approaches have been proposed to treat these patients. We aim to present a comprehensive literature review of the surgical management of rhinitis, including the most recent techniques and long-term outcome evaluations.

Recent Findings

Endoscopic techniques targeting the inferior turbinates, septum, and the parasympathetic neural supply to the nasal mucosa have evolved over the years to surgically address rhinitis; better understanding of rhinitis physiopathology has prompted the development of less invasive techniques with potentially similar outcomes and decreased morbidity.

Summary

For the management of allergic rhinitis, isolated outfracture of the inferior turbinate remains the least invasive technique and classical submucosal resection remains very much in favor among practitioners. A variety of methods to achieve adequate submucosal reduction of the inferior turbinate are also discussed, including the microdebrider, radiofrequency ablation, and coblation techniques. Regarding non allergic rhinitis, we assess both endoscopic vidian neurectomy and posterior nasal nerve neurectomy, two broadly effective, but elaborate, options necessitating general anesthesia and a visit to the operating room. We also discuss cryoablation of the posterior nasal nerve, which presents as a minimally invasive technique that can be performed as an in-office procedure.

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Anatomical variations in the relationship between the spinal accessory nerve and internal jugular vein: a systematic review and meta-analysis

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The relationship between the spinal accessory nerve and internal jugular vein is important for modified neck dissection surgery. Therefore, the aim of this review was to investigate variations in this relationship. Through a search of the PubMed, Scopus, Web of Science, LILACS, and SciELO databases, the review authors collected anatomical data for inclusion in a meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four relationship patterns were identified and classified: type 1, the nerve lies superficial to the vein; type 2, the nerve lies deep to the vein; type 3, the nerve crosses the branches of the vein; type 4, the nerve splits and its branches pass around the vein.
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Τρίτη 29 Μαρτίου 2022

Fibrin immobilization vestibular extension (FIVE): A case series

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Abstract

Aims

The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri-implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)".

Material and Methods

The protocol utilized entailed apical positioning and stabilization of peri-implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet-rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap.

Results

A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri-implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5–5.2 mm) of peri-implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5–4.5 mm) at 3 years post-FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8–6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6–5.6 mm). The mean of maxilla was si gnificantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri-implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri-implantitis patients were removed due to advanced peri-implantitis.

Discussion

The present case series provides proof-of-principle data for efficacy of FIVE for peri-implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft.

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Management of Benign Salivary Gland Conditions

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Surg Clin North Am. 2022 Apr;102(2):209-231. doi: 10.1016/j.suc.2022.01.001. Epub 2022 Mar 8.

ABSTRACT

In this section, we discuss the management of benign salivary gland disease. Pathologies vary from sialolithiasis, salivary duct stenosis, sialadenitis, infectious glandular disease, autoimmune glandular disease, and radioactive iodine-induced disease. We discuss both novel techniques in the diagnosis and management of these diseases, including ultrasound, sialendoscopy, minor salivary gland biopsy, and botulinum toxin injection, which allow for both the alleviation of symptoms and gland preservation.

PMID:35344693 | DOI:10.1016/j.suc.2022.01.001

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Migration of a Fish Bone From the Esophagus to the Thyroid Gland

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Ear Nose Throat J. 2022 Mar 29:1455613221086032. doi: 10.1177/01455613221086032. Online ahead of print.

ABSTRACT

Accidental swallowing of fish bone is one of the most common emergencies in the otolaryngology department. The impacted fish bones are usually found in the palatine tonsil, base of the tongue, valleculae, pyriform sinus, and esophagus, which can be successfully removed after a thorough examination. However, in some cases, the fish bone may penetrate into the neck soft tissue and migrate to extraluminal organs, causing infection, abscess formation, or rupture of vessels. In such cases, prompt recognition and immediate removal of the impacted fish bone are necessary. Herein, we report a rare case of a 60-year-old woman who had accidently swallowed a fish bone 10 days prior to visiting the outpatient department. The fiberoptic scope and head and neck computed tomography scans were obtained from the outpatient department. The fish bone was found to migrate from the upper esophagus to the left thyroid gland. First, a rigid esophageal endoscopy was performed in the operating room, but no obvious fish bone was noted over the esophagus. Finally, the fish bone was removed via exploratory cervicotomy with left-sided total lobectomy of the thyroid. The patient recovered after the operation, and there were no further complications during the 3 years of follow-up.

PMID:35348022 | DOI:10.1177/01455613221086032

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