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.