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Κυριακή 20 Μαρτίου 2022

How I do it: endonasal transcribriform approach for resection of esthesioneuroblastoma

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Acta Neurochir (Wien). 2022 Mar 16. doi: 10.1007/s00701-022-05178-x. Online ahead of print.

ABSTRACT

BACKGROUND: Olfactory neuroblastoma, also known as esthesioneuroblastoma, accounts for only 3-6% of sinonasal malignancies but confers a 40% 5-year overall survival.

METHOD: The authors describe techniques for the endonasal, minimally invasive resection of an esthesioneuroblastoma in a 69-year-old man who presented with headaches and anosmia and describe surgical nuances and their effect on adjuvant therapy planning.

CONCLUSION: This approach, along with microsurgical techniques, helped increase tumor visualization, improved marginal resection, and reduced surgical risk, which may improve patient outcomes. Multilayered reconstruction with a synthetic dural substitute and creation of a nasoseptal flap were performed to reduce postoperative cerebrospinal fluid leak.

PMID:35292841 | DOI:10.1007/s00701-022-05178-x

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Anatomic evaluation of the triceps tendon insertion at the proximal olecranon regarding placement of fracture fixation devices

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Surg Radiol Anat. 2022 Mar 17. doi: 10.1007/s00276-022-02921-y. Online ahead of print.

ABSTRACT

PURPOSE: Olecranon fractures, especially with a small proximal fragment, remain a surgical challenge. Soft tissue irritation and affection of the triceps muscle bear a risk of complications. In order to find an area for a soft-tissue sparing placement of implants in the treatment of olecranon fractures, we aimed to define and measure the segments of the proximal olecranon and eval uate them regarding possible plate placement.

METHODS: We investigated 82 elbow joints. Ethical approval was obtained from the local ethics committee, After positioning in an arm holder and a posterior approach we described the morphology of the triceps footprint, evaluated and measured the surface area of the triceps and posterior capsule and correlated the results to easily measurable anatomical landmarks.

RESULTS: We found a bipartite insertional footprint with a superficial tendinous triceps insertion of 218.2 mm2 (± 41.2, range 124.7-343.2), a capsular insertion of 159.3 mm2 (± 30.2, range 99.0-232.1) and a deep, muscular triceps insertion area of 138.1 mm2 (± 30.2, range 79.9-227.5). Olecranon height was 26.7 mm (± 2.3, range 20.5-32.2), and olecranon width was 25.3 mm (± 2.4, range 20.9-30.4). Average correlation between the size of the deep insertion and ulnar (r = 0.314) and radial length (r = 0.298) was obtained.

CONC LUSIONS: We demonstrated the bipartite morphology of the distal triceps footprint and that the deep muscular triceps insertion area by its measured size could be a possible site for the placement of fracture fixations devices. The size correlates with ulnar and radial length.

PMID:35301578 | DOI:10.1007/s00276-022-02921-y

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Radiological score of computed tomography scans predicts revision surgery for chronic rhinosinusitis

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Acta Otorhinolaryngol Ital. 2022 Feb;42(1):63-74. doi: 10.14639/0392-100X-N1561.

ABSTRACT

OBJECTIVE: Evaluate computed tomography (CT) signs that predict need for revision endoscopic sinus surgery (ESS) of chronic rhinosinusitis (CRS).

METHODS: CRS patients (n = 48) underwent routine sinus CT scans and baseline ESS in 2006-2011. Lund-Mackay (LM) scores and 43 other CT signs were analysed blinded from both sides. Patients filled in a questionnaire during the day of CT s canning. Follow-up data were collected from hospital records until January 2018. Associations were analysed by Fisher's exact, Mann Whitney U, Kaplan-Meier method with logrank test and Cox's proportional hazard model.

RESULTS: Total LM score was not significantly associated with the need for revision ESS. The best predictive model was a sum of CT signs of non-detectable anatomy of inferior/middle turbinates, obstructed frontal recess, and previous sinus surgery. Using these CT findings, we formed a Radiological Score (RS) (min-max, 0-3 points). Having at least one RS point was significantly associated with the need for revision ESS during the average follow-up of 10.7 years (p = 0.008, Logrank test).

CONCLUSION: We identified a radiologic score that was able to predict the need for revision ESS, which is probably useful in predicting CRS outcomes.

PMID:35292788 | DOI:10.14639/0392-100X-N1561

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Immunophenotypic characteristics of T lineage acute lymphoblastic leukemia: absence of immaturity markers-TdT, CD34 and HLADR is not uncommon

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Am J Blood Res. 2022 Feb 15;12(1):1-10. eCollection 2022.

ABSTRACT

INTRODUCTION: T ALL may show variable morphological features and immunophenotypic analysis for characterisation of immature nature of these cells is needed to establish a diagnosis and distinguish from reactive conditions and mature T cell leukemias. Sometimes immaturity markers-CD34, TdT and HLA DR may not be expressed by blasts. The aim of the present study was to analyse immunophenotype of T ALLs especially with respect to absence of immaturity markers.

METHODS: Thirty-eight cases of T ALL diagnosed over a period of two and half years were analysed retrospectively with respect to clinical features, haematological features and flow cytometric immunophenotyping for T, B, Myeloid and immaturity markers. Student's T-test was used for comparing quantitative data and Chi-square test/Fishers exact T-test for qualitative variables. P value less tha n 0.05 was considered significant.

RESULTS: The most common T-lineage marker expressed was cCD3 and CD7 which were expressed in 100% cases followed by CD5 in 86.8% cases. The most common immaturity marker expressed was TdT (39.5% cases) followed by CD34 (34.2% cases). Thirteen cases (34.2%) were negative for all three of the immaturity markers i.e. TdT-/CD34-/HLADR. Absence of CD34 was associated with absence of expression of HLA DR (P<0.05) and aberrant expression of B lineage markers (P<0.05).

CONCLUSION: T-ALL is a rare and aggressive disease. Many cases lack immaturity markers viz, TdT, CD34 and HLADR. In such cases a comprehensive approach taking into account the clinical presentation, cytomorphology and immunophenotyping is diagnostic in experienced hands. Further, molecular studies may be needed to aid diagnosis.

PMID:35291252 | PMC:PMC8918703

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BMI as a risk factor for the development of chronic rhinosinusitis: a prospective population-based study

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Eur Arch Otorhinolaryngol. 2022 Mar 19. doi: 10.1007/s00405-022-07320-y. Online ahead of print.

ABSTRACT

PURPOSE: Obesity is a growing, global health problem and previous cross-sectional studies have demonstrated an association between obesity and chronic rhinosinusitis (CRS). There is, however, a lack of prospective studies regarding the impact of obesity on developing (new-onset) CRS.

METHODS: Questionnaire-based data (n = 5769) relating to new-onset CRS and Body Mass Index (BMI) were collected in 2013 and 2018 from the Telemark population study in Telemark, Norway. Odds ratios for the risk of new-onset CRS in 2018 in relation to BMI in 2013 were calculated, adjusted for smoking habits, asthma, gender and age.

RESULTS: When comparing the group with normal weight (18.5 ≤ BMI < 25) with the obese group (BMI ≥ 30), the odds of new-onset CRS was 53% higher [OR 1.53 (1.11, 2.10)] in the obese group.

CONCLUSION: CR S is a multifactorial disease with different phenotypes and it is important to consider obesity when assessing patients with CRS in a clinical setting.

PMID:35305138 | DOI:10.1007/s00405-022-07320-y

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The effects of Cricothyroid Visor Maneuver (CVM) therapy on the voice characteristics of patients with muscular tension dysphonia: A Case Series Study

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The purpose of this study was to assess the effects of a novel manual therapy, the Cricothyroid visor maneuver (CVM) therapy, on acoustic, auditory perceptual and self-assessment ratings in Muscle tension dysphonia (MTD) patients.
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