ὁ δὲ ἡγεμὼν ἔφη· τί γὰρ κακὸν ἐποίησεν; οἱ δὲ περισσῶς ἔκραζον λέγοντες· σταυρωθήτω

Bilateral Posterior Nasoseptal Flap - Double Breasting Technique

xlomafota13 shared this article with you from Inoreader Bilateral Posterior Nasoseptal Flap - Double Breasting Technique Via leak of cerebrospinal fluid Neurol India. 2021 Mar-Apr;69(2):307-310. doi: 10.4103/0028-3886.314538. ABSTRACT BACKGROUND AND INTRODUCTION: The success of endoscopic skull base surgery is largely based on the effective repair of the skull base defect. A pedicled nasoseptal flap (NSF), described by Hadad-Bassagateguy is the workhorse of contemporary endoscopic skull base repair. We describe a modification in the technique, "double breasting technique," using the bilateral posterior NSF for skull base repair. OBJECTIVE: In this video article, we describe the technique of harvesting bilateral posterior nasal septal flaps and overlaying the flaps in a double breasting technique to cover the skull base defect. The posterior NSF can be used to cover medium to large skull base defects effectively. SURGICAL TECHNIQUE: A 40-year-old female patient presented with headache and decreased vision for 2 months. MRI with gadolinium showed a sellar suprasellar lesion with chi asmal compression. Visual field charting showed bitemporal hemianopia. She underwent endoscopic transnasal transsphenoidal surgery (binostril approach) and complete excision of tumor. Intraoperatively, there was evidence of arachnoid breach with high flow cerebrospinal fluid (CSF) leak. Sella was repaired with fat, fascia, fibrin glue, and overlaid with the bilateral posterior NSF in a double breasting technique, as described in the video. RESULTS: The skull base repair was successful, with no CSF leak postoperatively. PMID:33904440 | DOI:10.4103/0028-3886.314538 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Olfactory and Gustatory Dysfunction in Covid-19: An Observational Study in a Tertiary Care Institute of Western Rajasthan

xlomafota13 shared this article with you from Inoreader Olfactory and Gustatory Dysfunction in Covid-19: An Observational Study in a Tertiary Care Institute of Western Rajasthan Via Otolaryngology Indian Abstract Coronavirus causes damage to chemosensory receptors resulting in olfactory and gustatory dysfunction. This study reports our observations on anosmia and ageusia in symptomatic COVID-19 positive patients admitted in the COVID centre of Western Rajasthan. A total of 98 symptomatic, RT-PCR positive COVID-19 patients admitted in the M.G. Hospital during November 2020 were evaluated with detailed history regarding symptoms along with duration and resolution including response to antiviral therapy. Olfactory and Gustatory dysfunction was seen in 53.1% patients. Both anosmia and ageusia coexisted in 61.5% patients followed by isolated anosmia (25%), while isolated ageusia was rare. History of preceding fever was present in 69.2% cases. 100% of the patients with ageusia had loss of salty and sour taste, while 90.1% did not feel sweet taste. Bitter taste sensation was altered only in 63.6%. Symptoms reversed within 7 days in 94.2% cases and after 15 days in 5.8% cases irrespective of antiviral therapy. Chemosensory dysfunction has no racial predominance. It is a self-limiting manifestation and a useful screening symptom. Co-existence of anosmia and ageusia is more common than isolated dysfunction. In ageusia, salty and sour is the most commonly lost taste sensation followed by sweet. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Geographic Variations in Healthcare Utilization and Expenditure for Chronic Rhinosinusitis: A Population‐Based Approach

xlomafota13 shared this article with you from Inoreader Geographic Variations in Healthcare Utilization and Expenditure for Chronic Rhinosinusitis: A Population‐Based Approach Via The Laryngoscope Objectives/Hypothesis Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. A better understanding of healthcare resource utilization (HCRU) and healthcare expenditure (HCE) pertaining to CRS is required. The objective of this study is to investigate geographic variations in HCRU and HCE for CRS. Study Type/Design Retrospective study of administrative database. Methods Patients meeting pre‐defined diagnostic criteria for CRS with continuous 1‐year pre‐index and 2‐year post‐index data were identified on IBM® Marketscan Research Databases over a 5‐year period (2013–2017). Data pertaining to demographics, HCRU, and HCE were analyzed according to geographic region. Multivariable generalized linear models accounted for age, sex, baseline medication utilization, and co‐morbidities. Results About 237,969 patients were included. Antibiotics were the most commonly prescribed medication (95%). Surgery rate (11%), immunotherapy (9.2%), oral steroid use (66%), and antibiotic utilization (mean 6.3 prescriptions) were highest in the South. However, visits with an otolaryngologist were considerably higher in the Northeast (62%). The Northeast region had the highest mean HCE ($2,449), which was 13% greater than HCE for the North Central region ($2,172). HCRU and HCE were higher in urban areas across all metrics, with 2‐year HCE being 18% greater in urban areas ($2,374 vs. $2,019). Significant geographic variation in HCE was observed even after adjusting for covariates. Conclusion Significant geographic variations in HCRU and HCE exist for CRS even after adjusting for covariates. Future studies are needed to help direct quality improvement and cost‐saving efforts as well as efficient resource allocation in an era of value‐based care. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques

xlomafota13 shared this article with you from Inoreader Very‐Low Energy Monopolar Reduces Post‐Tonsillectomy Hemorrhage Versus Standard Energy Techniques Via The Laryngoscope Objectives/Hypothesis To compare rates of post‐tonsillectomy hemorrhage (PTH) between a very‐low energy transfer monopolar technique (VLET) and standard energy techniques. Study Design Retrospective controlled cohort study. Methods All tonsillectomies performed by practice physicians during the period January 1, 2010 to August 31, 2019 were identified. Three groups were created based on surgeon technique utilization: the study group (VLET) and two control groups (exclusive standard energy monopolar [Standard]; exclusive "hot" technique without exclusive monopolar use [Mixed "Hot"]). Each group's PTH occurrences requiring surgical intervention (PTHRSI) were identified and rates compared. Results During the study period 11,348 tonsillectomies were performed (4,427 Standard, 1,374 VLET, 5,547 Mixed "Hot"), and 167 (1.47%) PTHRSI events identified (14 primary (<24 hours), 153 secondary (>24 hours), 12 repeat (>1PTHRSI/patient). Compared to the Standard group secondary and total PTHRSI rates (1.47%, 1.60%), the Mixed "Hot" group experienced similar rates (1.57%, P = .54; 1.68%, P = .64), but the VLET group experienced significantly lower rates (0.15%, P = .0026, adjusted odds ratio [OR] 0.114 [0.028–0.469]; 0.22%, P = .0016, adjusted OR 0.155 [0.048–0.494]). Age was a significant risk factor for both secondary and total PTHRSI (P = .0025, P = .0024, adjusted OR 1.02/year [1.01–1.03]). No significant difference in rate of primary PTHRSI was seen collectively or in any age group. The <12VLET Group experienced 0 episodes of secondary PTHRSI and a total PTHRSI rate of 0.09% in 1060 tonsillectomies. Conclusions Standard energy techniques had an adjusted odds ratio over 8‐fold higher for secondary PTHRSI and over 6‐fold higher for total PTHRSI compared to the minimized energy transfer VLET technique. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Opening the Palatovaginal Canal to Maximize Anterior Sphenoidotomy in Endoscopic Endonasal Surgery

xlomafota13 shared this article with you from Inoreader Opening the Palatovaginal Canal to Maximize Anterior Sphenoidotomy in Endoscopic Endonasal Surgery Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Colorectal dimensions in the general population: impact of age and gender

xlomafota13 shared this article with you from Inoreader Colorectal dimensions in the general population: impact of age and gender Via radiol anat Surg Radiol Anat. 2021 Apr 26. doi: 10.1007/s00276-021-02756-z. Online ahead of print. ABSTRACT PURPOSE: Constipation is among the most common gastrointestinal disorders, although, there is no generally accepted objective diagnostic criteria thereof. It has been proposed that colorectal dimensions assessed with Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may support the diagnosis, but normative data are lacking. The aim of this study was to describe colorect al dimensions in a sample of the general population and to investigate whether the dimensions were under influence by age and gender. METHODS: The maximum diameters and cross-sectional areas of the ascending colon, descending colon and rectum were determined from 119 CT scans of trauma patients (age groups from 15 to 70 years, 84 men and 35 women). A regression model was applied to explore the impact of age and gender on colorectal dimensions. RESULTS: Overall, great variations were found for all colorectal diameters and cross-sectional areas (median diameter (5% percentiles; 95% percentiles): ascending 46 (26; 63) mm; descending 29 (16; 48) mm; rectum 39 (22; 67) mm. Women had larger rectal cross-sectional areas, reflecting more rectal content, compared to men (p = 0.003). Age did not affect colorectal diameters or cross-sectional areas (all p > 0.10). CONCLUSION: Great variations of colorectal dimensions were found. Larger rectal cross-sectional areas in women could likely reflect the fact that women have increased prevalence of constipation. Future studies should take gender into consideration when evaluating colorectal dimensions. PMID:33903948 | DOI:10.1007/s00276-021-02756-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic administration of pharmacological doses of angiotensin 1-7 and iodoangiotensin 1-7 has minimal effects on blood pressure, heart rate, and cognitive function of spontaneously hypertensive rats

xlomafota13 shared this article with you from Inoreader Chronic administration of pharmacological doses of angiotensin 1-7 and iodoangiotensin 1-7 has minimal effects on blood pressure, heart rate, and cognitive function of spontaneously hypertensive rats Via radioactive iodine Physiol Rep. 2021 Apr;9(7):e14812. doi: 10.14814/phy2.14812. ABSTRACT Cardiovascular diseases are the principal cause of death worldwide, with hypertension being the most common cardiovascular disease risk factor. High blood pressure (BP) is also associated with an increased risk of poor cognitive performance and dementia including Alzheimer's disease. Angiotensin 1-7 (Ang 1-7), a product of the renin-angiotensin system (RAS), exhibits central and peripheral actions to reduce BP. R ecent data from our lab reveals that the addition of a non-radioactive iodine molecule to the tyrosine in position 4 of Ang 1-7 (iodoAng 1-7) makes it ~1000-fold more potent than Ang 1-7 in competing for the 125 I-Ang 1-7 binding site (Stoyell-Conti et al., 2020). Moreover, the addition of the non-radioactive iodine molecule increases (~4-fold) iodoAng 1-7's ability to bind to the AT1 receptor (AT1R), the primary receptor for Ang II. Preliminary data indicates that iodoAng 1-7 can also compete for the 125 I-Ang IV binding site with a low micromolar IC50. Thus, our aims were to compare the effects of chronic treatment of the Spontaneously Hypertensive Rat (SHR) with iodoAng 1-7 (non-radioactive iodine isotope) and Ang 1-7 on arterial pressure, heart rate, and cognitive function. For this study, male SHRs were divided into three groups and treated with Saline, Ang 1-7, or iodoAng 1-7 administrated subcutaneously using a 28-day osmotic mini pump. Systolic BP was m easured non-invasively by the tail-cuff technique. Cognitive function was assessed by Y-Maze test and novel object recognition (NOR) test. We have demonstrated in SHRs that subcutaneous administration of high doses of iodoAng 1-7 prevented the increase in heart rate with age, while Ang 1-7 showed a trend toward preventing the increase in heart rate, possibly by improving baroreflex control of the heart. Conversely, neither Ang 1-7 nor iodoAng 1-7 administered subcutaneously affected BP nor cognitive function. PMID:33904655 | DOI:10.14814/phy2.14812 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Increasing prediction accuracy of pathogenic staging by sample augmentation with a GAN

xlomafota13 shared this article with you from Inoreader Increasing prediction accuracy of pathogenic staging by sample augmentation with a GAN Via Head and neck cancers by ChangHyuk Kwon, Sangjin Park, Soohyun Ko, Jaegyoon Ahn Accurate prediction of cancer stage is important in that it enables more appropriate treatment for patients with cancer. Many measures or methods have been proposed for more accurate prediction of cancer stage, but recently, machine learning, especially deep learning-based methods have been receiving increasing attention, mostly owing to their good prediction accuracy in many applications. Machine learning methods can be applied to high throughput DNA mutation or RNA expression data to predict cancer stage. However, because the number of genes or markers generally exceeds 10,000, a considerable number of data samples is required to guarantee high prediction accuracy. To solve this problem of a small number of clinical samples, we used a Generative Adversarial Networks (GANs) to augment the samples. Because GANs are not effective with whole genes, we first selected significant genes using DNA mutation data and random forest feature ranking. Next, RNA expression data for selected genes were expanded using GANs. We compared the classification accuracies using original dataset and expanded datasets generated by proposed and existing methods, using random forest, Deep Neural Networks (DNNs), and 1-Dimensional Convolutional Neural Networks (1DCNN). When using the 1DCNN, the F1 score of GAN5 (a 5-fold increase in data) was improved by 39% in relation to the original data. Moreover, the results using only 30% of the data were better than those using all of the data. Our attempt is the first to use GAN for augmentation using numeric data for both DNA and RNA. The augmented datasets obtained using the proposed method demonstrated significantly increased classification accuracy for most cases. By using GAN and 1DCNN in the prediction of cancer stage, we confirmed that good results can be obtained even with small amounts of samples, and it is expected that a great deal of the cost and time required to obtain clinical samples will be reduced. The proposed sample augmentatio n method could also be applied for other purposes, such as prognostic prediction or cancer classification. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Die Behandlung von Schilddrüsenmalignomen aus HNO-ärztlicher Sicht

xlomafota13 shared this article with you from Inoreader Die Behandlung von Schilddrüsenmalignomen aus HNO-ärztlicher Sicht Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1475-4939 Einleitung Die Zahl der Schilddrüsenmalignome zeigt eine deutliche Zunahme. Da die Schilddrüse an der HNO-Klinik Bad Hersfeld im Fokus steht, war dies für uns Anlass, unsere Behandlungsresultate zu untersuchen und Erfahrungen darzustellen. Material und Methoden Es handelt sich um eine Untersuchung beginnend im Jahre 2014 bis zum Juli 2020. Es wurden alle Patienten mit Schilddrüsenmalignomen erfasst und wichtige demografische und medizinische Parameter wie Alter, Geschlecht, Histologie, Calcium, OP-Dauer, Rekurrensparese etc. registriert. Ergebnisse Es wurden insgesamt 63 Patienten mit malignen Schilddrüsenerkrankungen eingeschlossen. Davon waren 42 weiblichen und 21 männlichen Geschlechts. Die Altersspanne reichte von 11 bis zu 95 Jahren. Patienten mit differenzierten Schilddrüsenkarzinomen waren im Schnitt jünger als diejenigen mit anaplastischen Malignomen. Histologisch dominierten die papillären Schilddrüsenkarzinome mit 65 % (n = 41) gegenüber anderen Varianten wie dem follikulären (n = 6), medullären (n = 5) und entdifferenzierten Karzinom (n = 6). Alle Patienten wurden einer operativen Behandlung unterzogen; postoperativ erhielten die Betroffenen mit fortgeschrittenen, differenzierten Karzinomen eine Radiojodtherapie. Von den Patienten mit einem entdifferenzierten Karzinom sind alle ihrem Leiden erlegen, während nach unserer Kenntnis nur eine Betroffene mit einem differenzierten Malignom tumorbedingt verstorben ist. Schlussfolgerung In die Behandlung von malignen Schilddrüsenerkrankungen ist der HNO-Arzt eingebunden. Wie bei den benignen Erkrankungen der endokrinen Halsorgane ist eine interdisziplinäre Zusammenarbeit entscheidend. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Dermatomyositis als paraneoplastisches Syndrom bei Kopf-Hals-Malignomen: Fallserie & Literaturreview

xlomafota13 shared this article with you from Inoreader Dermatomyositis als paraneoplastisches Syndrom bei Kopf-Hals-Malignomen: Fallserie & Literaturreview Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1408-6551 Einleitung/Ziel Die Dermatomyositis (DM) ist eine seltene Erkrankung, die sich klinisch durch Schwäche und Schmerzen proximaler Muskeln sowie fliederfarbene Hautveränderungen manifestiert. In fast einem Fünftel der Fälle ist die DM mit dem Auftreten von Tumorerkrankungen assoziiert. Ziel dieser Untersuchung ist die Bewertung der Bedeutung der DM als paraneoplastisches Syndrom bei Malignomen im Kopf-Hals-Bereich unter Berücksichtigung der aktuellen Literatur. Material/Methoden Nach retrospektiver Krankenaktenanalyse der Jahre 2008–2018 von Patienten mit Kopf-Hals-Malignomen fanden sich 8 Patienten mit einer Dermatomyositis: 4 Patienten mit Tonsillenkarzinom, 1 Patient mit Nasopharynxkarzinom, 1 Patient mit Parotiskarzinom und 2 Patienten mit Lymphomen. Es wurden die Diagnostik, Therapie und Behandlungsergebnisse der Fälle beschrieben. Zudem erfolgte eine selektive Analyse der Literatur (PubMed) zur DM bei HNO-Tumoren. Bei dieser fanden sich insgesamt 290 Fälle: die Malignome waren in 283 Fällen im Nasopharynx, in 5 Fällen in der Tonsille und in 2 Fällen im Hypopharynx lokalisiert. Ergebnisse/Schlussfolgerung Eine DM als paraneoplastisches Syndrom bei Kopf-Hals-Malignomen ist selten. Sie tritt häufiger in Assoziation mit Nasopharynxkarzinomen und selten bei Tonsillenkarzinomen auf.Das gehäufte Auftreten der DM bei Kopf-Hals-Malignomen in Abhängigkeit von der ethnischen Verteilung (Nasopharynxkarzinome – asiatische Abstammung, Tonsillenkarzinom – kaukasische Abstammung) ist möglicherweise auch auf regionale Inzidenzunterschiede der genannten Tumorentitäten zurückzuführen.Bei Patienten mit einer DM sollte ein Tumorausschluss auch im Kopf-Hals-Bereich erfolgen, insbesondere bei Vorliegen einer zervikalen Lymphadenopathie. Der Verlauf einer tumorassoziierten DM wird durch die Tumortherapie positiv beeinflusst. Therapeutisch ist aber auch eine konsequente Behandlung der DM die Grundlage für eine erfolgreiche Tumortherapie. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques

xlomafota13 shared this article with you from Inoreader Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques 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 Apr 27. doi: 10.1007/s00405-021-06829-y. Online ahead of print. ABSTRACT OBJECTIVE: This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. METHODS: A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n = 22), combined (n = 35) and microscope exclusive (n = 46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected a nd persistence or recurrence of the disease assessed. RESULTS: The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of - 6.02 dB HL (95% CI - 8.87 to - 3.16, p < 0.001) between pre-operative and postoperative ABG, without significant effect of surgical technique. During follow-up, no significant differences regarding disease or otorrhea control were observed. Duration of surgery and hospitalization was shorter in the endoscopic cohort without statistical significance. Intra- and postoperative complications were lower in the endoscopic group. CONCLUSION: Revision CWD surgery can take advantage of the endoscope as a minimally invasive exclusive or adjunct tool to traditional microscopic procedures. Outcome measures of endoscopic revision CWD surgery showed anatomic and functional results comparable to those of the microscopic group. The complication rate, the duration of su rgery and hospitalization were favorable in the endoscopic group. PMID:33904981 | DOI:10.1007/s00405-021-06829-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.