Πέμπτη 8 Ιουλίου 2021

Fluorescence Imaging to Identify Occult and Ectopic Parathyroid Glands—Revealing the Unseen

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In this issue of JAMA Otolaryngology—Head & Neck Surgery, Kennedy and colleagues describe intraoperative molecular imaging (IMI) using the near-infrared (NIR) agent indocyanine green (ICG) to identify parathyroid glands. One of the most important contributions of this study is that it directly compares 2 methods of fluorescent imaging—use of autofluorescence ("label-free") vs use of ICG as a contrast agent. The use of IMI demonstrated superior signal-to-background ratios (SBRs) compared with autofluorescence. Excitingly, in the 2 patients who underwent reexploration parathyroidectomy, IMI successfully localized the ectopic parathyroid gland, which could not be identified by conventional methods. These results suggest that IMI is an accurate and reproducible method for localizing parathyroid glands and that ICG imaging is supe rior to autofluorescence for parathyroid gland identification.
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Regarding Use of Povidone Iodine to Reduce Nasopharyngeal Viral Load in Patients With COVID-19—Reply

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Reply We thank Singh and colleagues for their great interest in our study. We agree that the strength of our study was to have performed viral cultures to determine whether the virus was still infectious, and therefore potentially transmissible. A decrease in viral titer at day 1 after inclusion was observed in patients receiving povidone iodine nasopharyngeal decolonization (7%; 95% CI, 43%-95% vs 32%; 95% CI, 10%-65%), but the difference was not significant, as reflected by the overlap in 95% CIs. This finding could be attributed to a lack of power of the study. An imbalance in patient characteristics between groups despite randomization, favored by the small sample size, cannot be excluded either. Patients in the intervention group were younger and had fewer comorbidities, although again the difference was not significant. This may ac count in part for the greater decline in viral titer at day 1 in the intervention group. Unfortunately, no adjustment of the results for age was feasible owing to the small sample size.
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Efficacy and Safety of Propranolol vs Atenolol in Infants With Problematic Infantile Hemangiomas

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This randomized clinical trial compares the efficacy and safety of propranolol vs atenolol in Chinese infants with problematic infantile hemangiomas.
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Association Between COVID-19 Vaccination and Sudden Hearing Loss

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This cross-sectional study examines the national incidence of sudden sensorineural hearing loss after COVID-19 vaccination using data from the CDC Vaccine Adverse Events Reporting System.
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Total Thyroidectomy vs Lobectomy for Management of Papillary Thyroid Microcarcinoma

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This survey study assessed surgeons' preference for total thyroidectomy vs lobectomy to treat patients with papillary thyroid cancer.
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Nasal Septal Abscess Resulting From Poorly Fitting Dentures

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This case report describes a woman in her 50s who presented with nasal septal abscess resulting from poorly fitting dentures that resulted in translocation of oral flora into the nasal septum.
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Associations of Baseline Frailty Status and Age With Outcomes After Vestibular Schwannoma Resection

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This cross-sectional study evaluates the independent associations of chronological age and frailty (physiological age) with outcomes following vestibular schwannoma resection.
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COVID-19 caused hearing loss

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Eur Arch Otorhinolaryngol. 2021 Jul 8. doi: 10.1007/s00405-021-06951-x. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this cross-sectional study was to determine if there is a potential link between COVID-19 infection and hearing loss.

METHODS: The prospective study was conducted in the COVID Hospital Clinical Centre Niš, Serbia. We performed tonal audiometry and used a custom questionnaire and medical histories to determine the incidence of hearing loss in COVID-19 positive patients.

RESULTS: There were 74 patients with COVID-19 that met the inclusion criteria of this study and they composed our experimental group. Fifty-four (73%) were men and 20 (27%) women. There were 30 (40.5%) patients with hearing loss. Seventeen patients had unilateral and 13 had bilateral hearing loss. Significant differences between hearing loss groups and control group were found across all age groups, but not at all frequencies. No important differences were found when unilateral hearing loss and bilateral hearing loss groups were compared. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients.

CONCLUSIONS: We found that 30 (40.5%) of the COVID-19 positive patients had sensorineural type of hearing loss. Across all age groups, there were statistically significant differences in frequencies between the COVID-19 positive patients and the control group. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients. Distribution of unilateral and bilateral hearing loss and audiogram types was also not significantly different between the age groups.

PMID:34235578 | DOI:10.1007/s00405-021-06951-x

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Acute Fulminant Mucormycosis Triggered by Covid 19 Infection in a Young Patient

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Abstract

Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was draine d through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.

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Oro-Antral Fistulas and their Management: Our Experience

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Abstract

Oroantral fistula (OAF) is an epithelized, pathological communication between the maxillary antrum and oral cavity. The most common etiological factor is molar or premolar tooth extraction. The bone between maxillary sinus floor and posterior teeth is thin and occasionally the root apices of the posterior teeth reach the maxillary sinus, predisposing them to the formation of OAF. Other causes are bacterial or fungal infections, osteomyelitis, granulomatous diseases, Paget's disease, malignancy, maxillofacial trauma and iatrogenic. Small OAFs heal spontaneously but larger fistulas, persisting more than three weeks need to be closed. In repairing the persistent OAF, the maxillary sinus must be addressed. Maxillary sinusitis may lead to the failure of closure of the OAF. The basic modus operandi is clearance of disease from the sinus and covering the defect with a suitable graft. Various local and distant flaps are used to repair the OAF. We report three cases of OAF, managed by three different techniques. We also suggest a combined approach for large OAFs, repaired in 3 layers using septal cartilage, fat, and a buccal muco-periosteal advancement flap.

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Endoscopic ultrasound imaging with high flow mode for endonasal transsphenoidal pituitary surgery

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J Clin Neurosci. 2021 Jul;89:329-335. doi: 10.1016/j.jocn.2021.05.024. Epub 2021 May 21.

ABSTRACT

Intraoperative ultrasound during transsphenoidal surgery (TSS) for pituitary tumors has been reported. In reports of endonasal ultrasound (US), Doppler US vessel images were informative and effective in endoscopic TSS. We performed endoscopic US imaging with high flow mode, which is a novel technology, to visualize small vessels during endonasal endoscopic TSS. Six patients (five with pituitary adenomas and one with Rathoke's cleft cyst) underwent endoscopic US-assisted TSS. A small endoscopic US probe (Olympus, BF-UC260FW; diameter, 6.9 mm) was inserted transsphenoidally to the sellar floor and into the sella turcica, and endoscopic US monitoring was performed. By rotating the endoscopic US probe, the internal carotid artery, anterior cerebral artery, middle cerebral artery, various small vessels, optic nerve, and residual tumor were clearly vis ualized on the endoscopic US images. Real-time animated vessel images around the tumor could be generated when needed during TSS. The tumors were removed without leakage of cerebrospinal fluid in the six patients, and their visual acuity was restored. Endoscopic US with high flow mode can visualize not only main cerebral arteries but also intracranial small vessels on B-mode US images. Pituitary tumors were clearly recognized and removed safely and precisely by monitoring the cerebral artery and its small branches as landmarks.

PMID:34119288 | DOI:10.1016/j.jocn.2021.05.024

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Taste impairment after endoscopic stapes surgery: Do anatomic variability of chorda tympani and surgical technique matter? : Post-operative dysgeusia after EStS

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Eur Arch Otorhinolaryngol. 2021 Jul 8. doi: 10.1007/s00405-021-06908-0. Online ahead of print.

ABSTRACT

PURPOSE: To investigate how the anatomical configuration of the oval window region (OWR) influences the management of the chorda tympani (ChT) and the curetting of adjacent bony structures, in a setting of patients undergoing endoscopic stapes surgery (EStS); to assess the incidence of early and late post-operative dysgeusia and to identify anatomical and surgical factors influencing taste function after EStS.

METHODS: Surgical video recordings of 48 patients undergoing EStS for otosclerosis between January 2019 and July 2020 were retrospectively revised, to classify the anatomical variability of selected middle ear structures and the management strategies for the ChT. Clinical records of included patients were reviewed for subjective early and late post-operative taste impairment using a 5-point Likert-scale.

RESULTS: Th e most common configuration of the OWR was type III. The extension of the bony curettage resulted inversely proportional to the exposure of the OWR. The long-term rate of preserved post-operative taste function was 85%. Displacement of the ChT was necessary in 43/48 cases (90%), mostly medially (36/48, 75%).

CONCLUSION: Bone curetting during EStS does not correlate with post-operative taste impairment. Despite 100% ChT preservation rate, dysgeusia may occur in a minority of patients, with no apparent relationship to anatomical variability or intraoperative management of the ChT. The use of CO2 laser could have a role in increasing the risk of post-operative dysgeusia after EStS.

PMID:34236486 | DOI:10.1007/s00405-021-06908-0

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