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Τετάρτη 14 Ιουλίου 2021

Otological and hearing characteristics in children with Turner syndrome

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jun 7;56(6):590-595. doi: 10.3760/cma.j.cn115330-20210305-00111.

ABSTRACT

Objective: To explore the otological and hearing characteristics in children with Turner syndrome (TS), to determine risk factors of hearing loss, and to discuss algorithms for future surveillance. Methods: The clinical data of otolaryngology in children with TS from January 2018 to April 2020 were reviewed retrospectively. A total of 46 female children with TS, aged from 5 to 18 years were enrolled. Karyotypes included 17 cases (37.0%) of monosomy, 16 cases (34.7%) of mosaicism, and 13 cases (28.3%) of abnormal X chromosome structures. The otoscopic characteristics, audiological performance, and otologic diagnoses were evaluated. Multivariate logistic regression and Mann-Whitney U test were used for statistical analysis. Results: The most common otologic comorbidity was otitis media with effusion (OME), including 20 cases (43.5%) with 33 ears (35.9%). 14 cases (30.4%) were diagnosed with hearing loss. The regression analysis revealed that the age (OR=1.345, 95%CI: 1.072-1.760) and comorbidity of OME (OR=9.460, 95%CI: 2.065-60.350) were risk factors associated with hearing loss. In TS with OME, when compared with the mean air conduction threshold, the hearing loss of the group with pars flaccida retractions was significantly higher ((24.3±13.8) dB HL vs. (14.4±4.2) dB HL, U=59.500, P=0.008) than that of the group with none retractions. Conclusion: OME and hearing loss are common in children with TS. As age increases or suffers from OME, the risk of hearing loss increases.

PMID:34256483 | DOI:10.3760/cma.j.cn115330-20210305-00111

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Aberrant internal carotid artery in the middle ear

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jun 7;56(6):685-686. doi: 10.3760/cma.j.cn115330-20210210-00064.

NO ABSTRACT

PMID:34256500 | DOI:10.3760/cma.j.cn115330-20210210-00064

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A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jun 7;56(6):619-625. doi: 10.3760/cma.j.cn115330-20200805-00647.

ABSTRACT

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO2 laser cauterization, and the open-surgery group underwent the following surgery: first, we perform ed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to ( 33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

PMID:34256487 | DOI:10.3760/cma.j.cn115330-2 0200805-00647

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Inverted deltoid posterior cruciate ligament femoral insertion accompanied with medial synovial fold: a case of a complex posterior cruciate ligament anatomical variation recalcitrant to conservative treatment

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Surg Radiol Anat. 2021 Jul 14. doi: 10.1007/s00276-021-02801-x. Online ahead of print.

ABSTRACT

PURPOSE: The present study aims to report a symptomatic rare anatomical variation of the posterior cruciate ligament (PCL) that was encountered during arthroscopy.

CASE PRESENTATION: A 34-year-old female suffered from dull anterior pain in the right knee, along with stiffness and the presence of an audible click and occasionally locking during deep knee flexion. Physical exa mination revealed only slight pain during single-leg squatting and mild knee effusion with painful limitation of the last degrees of flexion. Following unsuccessful conservative treatment, knee arthroscopy was performed in which the PCL was found to be hypertrophic, having a broad femoral insertion that almost completely occupied the intercondylar notch and impinged the anterior cruciate ligament. Moreover, the PCL presented a large medial synovial fold that formed a plica inserting to the medial meniscus's posterior horn. Ligamentoplasty was performed by excising one-third of the PCL lateral portion. The PCL medial synovial fold and the plica attaching to the medial meniscus were resected. The patient was allowed to return to full activity when her symptoms resolved, and the knee function was restored, at 5 weeks post-operatively.

CONCLUSION: The current study presented a rare and complex anatomical variation of the PCL that was symptomatic and recalcitrant to conservative tr eatment. Magnetic resonance imaging (MRI) can reveal the variant morphology of the PCL, and arthroscopy provides the definite treatment. This case report may be useful for orthopaedic surgeons and radiologists to consider anatomical PCL variations during differential diagnosis in patients with non-specific clinical presentation and findings.

PMID:34259889 | DOI:10.1007/s00276-021-02801-x

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The safety and efficacy of gemcitabine and cisplatin (GP)-based induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: a meta-analysis

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Eur Arch Otorhinolaryngol. 2021 Jul 14. doi: 10.1007/s00405-021-06940-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the safety and efficacy of gemcitabine and cisplatin (GP)-based induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).

METHODS: We systematically searched the PubMed, Web of Science, Embase, and Cochrane Library databases. The endpoints included overall survival (OS), progression-free survival (PFS), distant failure-free survival (DMFS), locoregional failure-free survival (LRFFS) and treatment-related adverse events (AEs).

RESULTS: A total of seven studies were included in this meta-analysis. When GP-based IC was compared with double-drug-based or triple-drug-based IC, there were no significant differences in OS (HR 0.64, P = 0.08), PFS (HR 0.71, P = 0.09), DMFS (HR 0.87, P = 0.49) or LRFFS (HR 0.88, P = 0.66). Furthermore, subgroup analysis revealed that GP IC led to an improvement in OS compared with triple-drug-based IC (P < 0.0001). Regarding safety, compared to triple-drug-based IC, GP-based IC was related to a decreased risk of leucopenia (P = 0.007) and neutropenia (P = 0.02) but was associated with an increased risk of thrombocytopenia (P = 0.01). Compared to double-drug-based IC, the prevalence of grade 3 or above thrombocytopenia was higher in the GP group (P = 0.007). No significant difference in the incidence of other AEs was observed.

CONCLUSION: Based on efficacy and safety, our meta-analysis demonstrated that, compared to double-drug-based or triple-drug-based IC, IC with a GP regimen does not appear to improve OS, PFS, DMFS or LRFFS and mainly led to an increased risk of grade3/4 thrombocytopenia. Notably, our subgroup analysis data show that GP-based IC may bring improved trends in OS as compared to triple-drug-based IC. For the optimal IC regimen has not been es tablished, which IC regimen will benefit most LA-NPC patients should be further explored.

PMID:34259896 | DOI:10.1007/s00405-021-06940-0

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Τρίτη 13 Ιουλίου 2021

Plasma level of prostate related-antigen peptide-reactive IgG is a prognostic factor of patients with breast cancer treated with personalized peptide vaccines

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Exp Ther Med. 2021 Aug;22(2):905. doi: 10.3892/etm.2021.10337. Epub 2021 Jun 25.

ABSTRACT

The present study assessed plasma IgG in patients with metastatic recurrent breast cancer (mrBC) that is reactive to various T-cell epitope peptides of prostate-related antigens (PRAs), such as prostate-specific antigen, prostate-specific membrane antigen and prostate acid phosphatase. Patients were treated with personalized peptide vaccines (PPVs) which were selected and administered from a panel of candidate peptides based on human leukocyte antigen-types and prevaccination IgG levels to each peptide. The peptide panel consisted of 27 cytotoxic T-lymphocyte-epitope peptides derived from tumor-associated antigens, not including PRA. PRA peptides and peptide panels were retrospectively analyzed in 77 PPV-treated patients. The results revealed that PRA reactive IgG levels were increased after vaccination in 31 of the 97 patients included in the pre sent study. Although there was no significant association between anti-PRA peptide levels and progression-free survival (PFS) or overall survival, anti-PRA peptide levels were significantly associated with PFS (P=0.009) in estrogen-receptor positive (ER+) patients with cancer. The results suggested that plasma anti-PRA IgG levels may be a useful prognostic marker for monitoring PPVs, particularly for ER+ patients with mrBC (trial registration no. from the UMIN Clinical Trials Registry, UMIN000001844).

PMID:34249152 | PMC:PMC8264823 | DOI:10.3892/etm.2021.10337

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Solitary Extramedullary Plasmacytoma of the Oropharynx: A Case Report

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Abstract

Plasma cell neoplasms rarely manifest as a solitary extramedullary plasmacytoma. Oropharyngeal involvement had been already reported in the literature. The most common malignancy of the oropharynx is squamous cell carcinoma, while soft tissue malignancy is extremely rare. In our present case report, the patient presented with a huge oropharyngeal mass which developed in a short duration. His family's concerns were mostly about his survival and quality of life. After complete checkup, a diagnosis for solitary extramedullary plasmacytoma of the oropharynx was concluded. The patient received neo-adjuvant chemotherapy and radiotherapy. The mass markedly decreased in size with complete regression as seen both clinically and radiologically. Our main aim for reporting this present case of pathology in oropharyngeal malignant masses is to increase the awareness and draw attention of Otolaryngology, the Head and Neck surgeons.

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Oral Malignant Melanoma

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Abstract

To present a case of malignant melanoma. A 55-year old female presented with swelling over left upper gingiva which bled on brushing. She was diagnosed with left oral malignant melanoma on histopathology of punch biopsy specimen, which was then followed by C.T. P.N.S and Neck to know the lesion's extent and Ultrasonography of Abdomen and Pelvis to rule out any metastatic deposits. Patient was managed by left lower partial maxillectomy with left radical neck dissection. No intra-operative or post-operative complications seen. Patient was then sent for chemoradiotherapy. No any complications seen at fifteen months follow-up. Oral malignant melanoma is amenable to surgery and chemoradiotherapy with excellent results if detected at an early stage.

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Study of Hearing Status in COVID-19 Patients: A Multicentered Review

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Abstract

To evaluate the hearing status of COVID-19 patients and compare with control group. Prospective study carried out in 9 institutes. The pure tone audiogram and impedance audiometry of COVID-19 patients performed initially and at 3 months follow up. The control group consisted COVID-19 negative individuals with no history of ear related diseases. The average of air and bone conduction threshold (AC and BC) were compared between the COVID-19 patients and control group using independent t-test with a p value of less than 0.05 considered significant. Total of 331 patients, age 32 ± 4.3 years, 66.7% males and 33.3% females were included in the study. There were 80 individuals in the control group. Aural symptoms were, tinnitus in 1.8%, aural fullness in 1.4%, hearing loss in 3. 9%, and ear ache in 1.8% were present initially, resolved at 3 months follow up. The impedance audiometry demonstrated type B and type C curve in 5.1% and 1.15% ears , and out of these 64.7% and 40% improved at 3 months follow up respectively. No significant difference observed between the average AC and BC of the COVID-19 patients and control group. The COVID-19 infection may present with aural symptoms; however, it was concluded that there was no significant difference in the hearing status of the COVID-19 positive patients in comparison to the control group. The presence of some changes in the normal functioning of the eustachian tube and middle ear in the COVID-19 infection was also highlighted.

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Lingual-Artery Thromboembolism

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An 83-year-old woman presented with swelling and discoloration of the right side of the tongue. An electrocardiogram revealed atrial fibrillation. CT angiography was performed, and a diagnosis of right lingual-artery thromboembolism was made.

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Long-term results of a balloon-assisted endoscopic approach in failed dacryocystorhinostomies

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Eur Arch Otorhinolaryngol. 2021 Jul 12. doi: 10.1007/s00405-021-06975-3. Online ahead of print.

ABSTRACT

PURPOSE: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction.

METHODS: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the pr imary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test.

RESULTS: Among 14 patients included and after a mean follow-up of 19.5 months (range 13-51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported.

CONCLUSION: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure.

PMID:34251520 | DOI:10.1007/s00405-021-06975-3

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