Changes in the Options for Management of Prolactin Secreting Pituitary Adenomas

xlomafota13 shared this article with you from Inoreader Changes in the Options for Management of Prolactin Secreting Pituitary Adenomas Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722665 Objectives Initial therapy for the management of prolactinomas has long been maintained to be medical, consisting of a dopamine agonist. These therapies may have troublesome side effects, and some prolactinomas are resistant to medical therapy regarding lowering prolactin levels or shrinking the tumor. These issues have revived interest in surgery for prolactin-secreting adenomas as an early therapeutic option. We report our analysis of surgery for prolactin microadenomas in women, using the transsphenoidal endoscopic approach. Design We reviewed a contemporary series of 33 women (mean age = 31.8 years) with microprolactinomas who underwent early surgical intervention, which was a three-dimensional transnasal transsphenoidal endoscopic operation. Setting The study was conducted at a tertiary academic referral center for pituitary tumors. Main Outcome Measures Preoperative and postoperative prolactin. Results Overall, 28 patients had received preoperative dopamine agonists, 24 of these experienced a variety of drug-related side effects, and 4 had tumors that were resistant to lowering prolactin or tumor shrinkage. Preoperative prolactin levels averaged 90.3 ng/mL (range = 30.7–175.8 ng/mL). We observed a 94% normalization rate in postoperative prolactin (mean = 10.08 ng/mL, range = 0.3–63.1 ng/mL). During the follow-up (mean = 33.9 months), five patients had elevated prolactin; four required reinitiation of medical therapy, two had surgical reexploration, and none received radiation therapy. Complications included syndrome of inappropriate antidiuretic hormone secretion (n = 3), transient diabetes insipidus (n = 1), postoperative epistaxis (n = 1), and fat graft site infection (n = 1). Conclusion This review supports the consideration of transsphenoidal surgery as an early intervention for some women with prolactin-secreting microadenoma. Indications include significant side effects of medical therapy and tumors that do not respond to standard medical management. [...] 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.

Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review

xlomafota13 shared this article with you from Inoreader Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1718909 Objectives Given the limitations in the available literature, the precise indications, techniques, and outcomes of anterior skull base free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature and evaluate indications, methods, and complications for anterior skull base free flap reconstruction. Methods A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the anterior skull base. Articles were reviewed for inclusion based on relevance, with the primary outcome being surgical complications. Results After a comprehensive search, 406 articles were obtained and 16 articles were ultimately found to be relevant to this review—79 patients undergoing free flap reconstruction were identified. Overall complication rates were 17.7% (95% confidence interval [CI]: 16.6–33.1%) for major complications and 19.0% (95% CI: 17.8–35.5%) for minor complications. Conclusion Microvascular reconstruction of the anterior skull base is feasible with high reliability reported in the literature. [...] 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.

Vascularized Pericranial Flap for Endonasal Anterior Skull Base Reconstruction

xlomafota13 shared this article with you from Inoreader Vascularized Pericranial Flap for Endonasal Anterior Skull Base Reconstruction Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1721816 Importance As the limits of advanced skull base malignancies that can be managed through an endoscopic endonasal approach continue to be expanded, the resultant anterior skull base defects are of increasing size and complexity. In the absence of nasoseptal or turbinate flaps, the vascularized pericranial flap has been employed at our institution with excellent results. Objective The study aimed to review the outcomes of patients who underwent endonasal anterior craniofacial resection with anterior skull base reconstruction using a vascularized pericranial flap. Design Retrospective chart review of patients treated by the University of California – San Francisco minimally invasive skull base service from the years 2011 to 2017. Average duration of follow-up was 16.4 months. Setting This study was conducted at Academic tertiary referral center. Participants A total of nine patients with advanced anterior cranial base malignancies were identified who were treated with a minimally invasive, endoscopic anterior craniofacial resection from the years 2011 to 2017. Due to the nature of the resection in these patients, nasoseptal flaps and inferior/middle turbinate flaps were unavailable or insufficient for anterior skull base defect repair. Each patient underwent reconstruction of the anterior cranial base defect using an anteriorly based pericranial flap harvested by bicoronal incision, and tunneled anteriorly to the nasal cavity through a frontoethmoidal incision. [...] 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.

As Plain as The Nose on Your Face?

xlomafota13 shared this article with you from Inoreader As Plain as The Nose on Your Face? Via Otolaryngologic Clinics of North America When I was a senior resident, a patient came into the Veterans Administration hospital with a huge fungating squamous cell tumor that had essentially replaced three-fourths of his nose. He was homeless, an alcohol abuser, malnourished and had unfortunately allowed this to grow over time. Resection resulted in significant cosmetic compromise, and reconstructive planning had to take into account the tumor, the defect, and the attendant socioeconomic and nutritional aspects pertaining to this patient. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pre‐clinical evaluation of a novel robotic system for transoral robotic surgery.

xlomafota13 shared this article with you from Inoreader Pre‐clinical evaluation of a novel robotic system for transoral robotic surgery. Via Clinical Otolaryngology Abstract The Versius Surgical System (CMR Surgical, Cambridge, UK) is a new robotic surgical platform that is CE marked and available for clinical use. This is the first pre‐clinical evaluation of the Versius Surgical System in accordance with phase 0 of the IDEAL‐D Framework. Optimal setup of the Versius Surgical System for use in transoral surgery was evaluated and defined. Two experienced TORS surgeons performed 3 index procedures – lateral oropharyngectomy, tongue base mucosectomy and partial supraglottic laryngectomy using three fresh frozen cadavers. Fourteen resections were successfully completed establishing feasibility. Instrument tremor occurred due to suboptimal distal instrument stabilisation. A bespoke transoral stabilisation port is proposed to address this issue. Further preclinical assessment is required prior to phase 1 IDEAL‐D trial evaluation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Standardizing Drug‐Induced Sleep Endoscopy Scoring by an Expert Review Panel: Our Experience in 81 Patients

xlomafota13 shared this article with you from Inoreader Standardizing Drug‐Induced Sleep Endoscopy Scoring by an Expert Review Panel: Our Experience in 81 Patients Via Clinical Otolaryngology Abstract Assessment of pharyngeal collapse patterns by drug‐induced sleep endoscopy (DISE) is often paramount to guide clinical decision‐making in patients with obstructive sleep apnoea. Being a subjective investigation, DISE findings are prone to interindividual variation. The present study introduces the concept of an expert review panel to standardize DISE scoring. Comparing the ratings of the review panel with the original ratings revealed a substantial concordance at the level of the oropharynx and a fair to moderate concordance at the levels of the soft palate, tongue base, hypopharynx, and epiglottis. Several recommendations were made to address the observed discrepancies in DISE ratings. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Using data from over 72,000 individuals to model age‐specific increase in service demand from the 2019 modification to NICE criteria for cochlear implantation.

xlomafota13 shared this article with you from Inoreader Using data from over 72,000 individuals to model age‐specific increase in service demand from the 2019 modification to NICE criteria for cochlear implantation. Via Clinical Otolaryngology Abstract The UK National Institute for Health and Care Excellence has estimated a 70% increase in demand resulting from the 2019 modification to cochlear implant criteria We modelled the projected increase using our large database of pure tone audiometry results, and adjusted for frailty as a marker of risk of general anaesthesia Our results suggest an overall 79% increase in demand, with most of this for adult implantation, and in particular for those over the age of 65 Our findings are important for those planning delivery of cochlear implant services View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reducing the risks of endoscopic sino‐nasal surgery in the Covid‐19 era

xlomafota13 shared this article with you from Inoreader Reducing the risks of endoscopic sino‐nasal surgery in the Covid‐19 era Via Clinical Otolaryngology Abstract Objectives Many powered instruments used in routine sinonasal surgery are regarded as an aerosol generating procedure (AGP). This study aimed to assess assess how different instrument settings may affect detectable droplet spread and the patterns of aerosolised droplet spread during simulated sinonasal surgery with powered instrumentation in order to identify mitigation strategies. Design Simulation series using three‐dimensional (3D) printed sinonasal model. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein‐soaked grapes and bones respectively. Setting University dry lab. Participants 3‐D printed sinonasal model. Main outcome measures Patterns of aerosolised droplet spread. Results and Conclusion There were no observable fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at a specific irrigation rate and suction pressure. Droplet splatter occurred when suction pressure was reduced; simulating a surgical condition where there was excessive fluid in the nasal cavity irrigation. Drilling with either coarse diamond or cutting burr resulted in detectable droplets. Greater droplet spread was observed when drilling within the anterior nasal cavity. The addition of a suction catheter reduces droplet spread when drilling. Activation of the microdebrider when there is fluid excess fluid (reduced or blocked suction pressure, excessive mucosal bleeding or irrigation fluid) accumulating in the nasal cavity resulted in detectable droplet spread. High‐speed drilling is a high‐risk AGP especially when drilling in the anterior nasal cavity, but the addition of suction reduces detectable droplet spread outside the nasal cavity. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Role of 18F-FDG PET/CT in Evaluating the Efficacy of Radiofrequency Ablation in Metastatic and Primary Liver Tumors: Preliminary Results.

xlomafota13 shared this article with you from Inoreader The Role of 18F-FDG PET/CT in Evaluating the Efficacy of Radiofrequency Ablation in Metastatic and Primary Liver Tumors: Preliminary Results. Via Mol Imaging Radionucl Ther Related Articles The Role of 18F-FDG PET/CT in Evaluating the Efficacy of Radiofrequency Ablation in Metastatic and Primary Liver Tumors: Preliminary Results. Mol Imaging Radionucl Ther. 2021 Feb 09;30(1):1-7 Authors: Mateva G, Handzhiev S, Kostadinova I Abstract Objectives: The aim of the study was to investigate the role of 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for evaluating the efficacy of radiofrequency ablation (RFA) in primary and metastatic liver tumors compared with contrast-enhanced ultrasound examination (CEUS) and to find its place in overall staging and the follow-up diagnostic algorithm. Methods: PET/CT examinations were performed 2 months after RFA for 20 patients with a total of 34 liver lesions. CEUS was performed within 10 days after PET/CT, and the results were compared. Seven patients were staged with PET/CT and the others with a contrast-enhanced CT. Results: A total of 48 18F-FDG PET/CT examinations were performed. We observed complete response in 8 patients (40%), 2 patients (10%) had stable disease, one (5%) had partial response, and 9 patients (45%) had progression (including 2 cases with extrahepatic involvement). Compared with CEUS, there was a mismatch in 3 cases. Five patients underwent additional RFA for 7 lesions. Conclusion: According to our preliminary data, PET/CT may be a valuable method, with comparable or eventually even better sensitivity than CEUS, for early evaluation of the efficacy of RFA for the treatment of metastatic and primary liver lesions and planning of future treatment. PET/CT might be recommended as a staging method before undergoing RFA of liver lesions for determining the local extent of the disease in the liver in combination with CEUS with an advantage in visualization of extrahepatic involvement. However, more patients need to be investigated in order to demonstrate and confirm the obtained results with certainty. PMID: 33586401 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients.

xlomafota13 shared this article with you from Inoreader The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients. Via Mol Imaging Radionucl Ther Related Articles The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients. Mol Imaging Radionucl Ther. 2021 Feb 09;30(1):8-17 Authors: Soyluoğlu S, Korkmaz Ü, Özdemir B, Durmuş Altun G Abstract Objectives: Gastrointestinal bleeding (GIB) is a life-threatening problem that requires a multidisciplinary approach for successful treatment. This study aims to emphasize the clinical contribution of single photon emission computed tomography/computed tomography (SPECT/CT) for the diagnosis of acute bleeding. Methods: All 14 patients referred to the nuclear medicine department in 3 years with suspicion of acute GIB were evaluated retrospectively. Clinical records were analyzed to assess the scintigraphic findings, emphasizing the correlative contribution of the CT portion on SPECT/CT studies. Results: Five patients were negative on dynamic and static planar images. SPECT/CT was performed in 9 patients who had positive findings on planar imaging. SPECT/CT could identify the same bleeding site originating from the anastomosis in four patients with a history of abdominal surgery. SPECT/CT confirmed bleeding from the cecum in a patient with cervical cancer. SPECT/CT showed the bleeding focus in the bladder neck of a patient with bladder cancer and the bleeding from peritoneal metastases of a patient with gastric cancer. In 1 patient, the right upper quadrant activity accumulation, which may cause false positives, was found to be the gallbladder on SPECT/CT. Delayed images showed the true bleeding focus in the cecum. In 1 patient, suspicious activity accumulation in the midline of the abdomen was found to be due to a previously unknown aortic aneurysm on SPECT/CT. Conclusion: SPECT/CT imaging is a feasible technique to facilitate image interpretation in patients with GIB. SPECT/CT imaging can guide the surgeon through more accurate localization. Therefore, for proper patient management, SPECT/CT should be applied to detect the bleeding focus, if present, especially in patients who had undergone a previous operation. PMID: 33586402 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

18Fluorine-fluorodeoxyglucose PET/CT Imaging in Childhood Malignancies

xlomafota13 shared this article with you from Inoreader 18Fluorine-fluorodeoxyglucose PET/CT Imaging in Childhood Malignancies Via Mol Imaging Radionucl Ther Related Articles 18Fluorine-fluorodeoxyglucose PET/CT Imaging in Childhood Malignancies Mol Imaging Radionucl Ther. 2021 02 09;30(1):18-27 Authors: Bıçakçı N, Elli M Abstract Objectives: The aim of the study was to evaluate the utility of 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the diagnosis, staging, restaging, and treatment response of childhood malignancies. Methods: This study included 52 patients (32 boys, 20 girls) who were referred to our clinic between November 2008 and December 2018 with the diagnosis of malignancy. The patients were evaluated retrospectively. Median age of the patients was 13 years (range 2-17). 18F-FDG was given to the patients intravenously, and time of flight with PET/16 slice CT was performed 1 hour thereafter. The lowest dose was 2 mCi (74 MBq) and the highest dose was 10 mCi (370 MBq). Fasting blood sugars of all patients were found below 200 mg/dL (11.1 mmol/L). Results: 18F-FDG PET/CT was performed to evaluate the response to treatment in 38 of 52 children, staging in 11 patients (staging and evaluation of the response to treatment in nine of them), restaging in 2 patients, restaging, and evaluation of the response to treatment in 1 patient. 18F-FDG PET/CT examination was reported as normal in 13 patients (5 girls, 8 boys). The pathological 18F-FDG uptake was detected in 39 patients (14 girls, 25 boys), which indicated metastasis and/or recurrence of the primary disease. Total number of deaths was 30 (13 girls, 17 boys). Conclusion: 18F-FDG PET/CT has a significant role for staging, restaging, treatment response, and detection of metastatic disease but it is limited for the early diagnosis of childhood cancers. PMID: 33586403 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.