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Κυριακή 3 Οκτωβρίου 2021

Medial patellar plica syndrome

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Clinically young patient with anteromedial knee pain.

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MRI shows a well-defined low signa l intensity band running across medial patellofemoral recess.
However there is no obvious associated bone marrow oedema involving medial articulating facet of patella or medial femoral trochlea. 
Associated joint effusion.
Medial plica mentioned in the report with joint effusion.

Medial plica syndrome

Synonym: synovial plicae of the knee.

Common cause of anterior knee pain typically present with pain on anteromedial aspect of the knee above the joint line associated with crepitation, catching and locking sensations. 
Typically involves young with athletic background. 
There are actually synovial invaginations as a part of remnants of embryological development. They are present in over 70% of individuals and are mostly asymptomatic.
However can become inflamed and symptomatic. They can undergo fibrosis secondary to repeate d inflammation making them non-stretchable.
In symptomatic patients, medial plica seen as low signal intensity band on T1 as well as T2-weighted images with an associated chondral defect involving medial articulating facet of patella.
Treatment is mainly conservative, physiotherapy and steroid injections.

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Morel-Lavallée lesion MRI

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Clinically RTA, run over by tractor.

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This MRI study shows a focal well defined lentiform shaped subcutaneous collection on medial aspect of knee joint superficial to the superficial fascia.
Collection is clear, hypo intense on T1-weighted images without any septation or loculation. No obvious high signal intensity methaemoglobin staining on T1-weighted images to suggest any haematoma.

Morel-Lavallée lesion

These are focal well defined lentiform shaped subcutaneous serous collections commonly encountered during MRI knee joint in the setting of severe trauma. However these lesions are typically described in thigh as well defined collection overlying the greater trochanter of the femur, tensor facia lata. 

These actually localized haemolymphatic collections secondary to closed degloving injuries, where the skin and subcutaneous fatty tissue abruptly separate from the underlying fascia owing to trauma. The potential space thus created superficial to the superficial fascia is filled by serous fluid, some times frank blood.
Similar collection secondary to similar biomechanical forces are described in lumbar region and over the scapula as well. 

The accumulated collection usually needs nothing to be done, resolves spontaneously. However may persist longer if gets organized and encapsulated. The conservative management is with compression bandages. Surgical drainage may be sufficient for larger collection. However, the capsule may need to be resected to prevent re-accumulation if it is long standing and encapsulated collection with thick organized wall. 

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Impact of Depth of Invasion (According to Layer) on Lymph Node Metastasis in Buccal Mucosa Cancers

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Abstract

(1) To study layer of invasion as predictor of cervical lymph node metastasis. (2) To decide a cut off depth according to layer of invasion for neck dissection. It is a prospective study with sample size of 220 patients at tertiary care hospital with previously untreated operable buccal mucosa carcinoma over period of 21 months. The factors considered under the study were Tumor layer of invasion, lymph node metastasis, Ultrasonography doppler neck, CT scan and gender. Wide excision of the lesion and reconstruction was done. Histopathological analysis of resected specimen were recorded as part of data collection for all the cases. Quantitative data represented using Mean ± SD (Standard Deviation) and median and interquartile range compared using Chi square test. Standard principles of univariate analysis was used according to statistical methods. Depth when measured according to layer of invasion, was significantly associated with lymph no de metastasis with 89% of the muscle as layer of invasion being Lymph node positive (p = 0.009). There is 1.39 times chances of lymph nodal metastasis in patients with muscle invasion as compared to submucosal invasion. Tumour layer of invasion plays important role in predicting chances of nodal metastasis in clinically N0 neck in buccal mucosa cancer. According to the study, we should electively proceed with ipsilateral lymph node dissection once the layer of tumour invasion is muscle. This study is limited by sample size and short duration of one year and nine months.

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Πέμπτη 30 Σεπτεμβρίου 2021

The effect of short radiation treatment breaks on chemo‐radiotherapy for oropharyngeal cancers

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Abstract

Background

Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer.

Methods

In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses.

Results

Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks.

Conclusions

In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks.

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Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma

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Ear Nose Throat J. 2021 Sep 29:1455613211048966. doi: 10.1177/01455613211048966. Online ahead of print.

ABSTRACT

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surg ically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.

PMID:34587824 | DOI:10.1177/01455613211048966

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Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma

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Ear Nose Throat J. 2021 Sep 29:1455613211048966. doi: 10.1177/01455613211048966. Online ahead of print.

ABSTRACT

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petr ous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.

PMID:34587824 | DOI:10.1177/01455613211048966

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A Case of Nasal Rhinosporidiosis in the United States

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Ear Nose Throat J. 2021 Sep 29:1455613211049004. doi: 10.1177/01455613211049004. Online ahead of print.

ABSTRACT

Rhinosporidiosis, an infectious granulomatous disease, is seldom encountered in the United States. We present a case of rhinosporidiosis in a 26-year-old man, who presented with an unusual mass in his nasal cavity. Suspicion for rhinosporidiosis was high due to the patient's travel and activity history. After imaging and proper diagnosis, surgery was performed to excise the lesion. As international travel resumes during the COVID-19 pandemic, the potential for encountering this rare organism is heightened.

PMID:34587820 | DOI:10.1177/01455613211049004

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COVID-19 and anosmia: The story so far

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Ear Nose Throat J. 2021 Sep 29:1455613211048998. doi: 10.1177/01455613211048998. Online ahead of print.

ABSTRACT

OBJECTIVES: The pandemic has affected over 182 million coronavirus disease 2019 (COVID-19) cases worldwide. Accumulated evidence indicates that anosmia is one of the significant characteristics of COVID-19 with a high prevalence. However, many aspects of COVID-19-induced anosmia are still far from being fully understood. The purpose of this review is to summarize recent developments in COVID-19-induced anosmia to increase awareness of the condition.

METHODS: A literature search was carried out using the PubMed, Embase, Web of Science, and Scopus. We reviewed the latest literature on COVID-19-induced anosmia, including mechanisms of pathogenesis, olfactory testing, anosmia as predictive tool, pathological examinations, imaging findings, affected factors, co-existing diseases, treatments, prognosis, hypothesis theories, and future directions.

RESULTS: The possible pathogenesis of COVID-19-induced anosmia may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The D614G spike variant may also play a role in the increased number of anosmia patients. Anosmia may also be an essential indicator of COVID-19 spread and an early indicator of the effectiveness of political decisions. The occurrence and develop ment of COVID-19-induced anosmia may be influenced by smoking behaviors and underlying diseases such as type 2 diabetes, gastroesophageal disorders, and rhinitis. Most patients with COVID-19-induced anosmia can fully or partially recover their olfactory function for varying durations. COVID-19-induced anosmia can be treated with various approaches such as glucocorticoids and olfactory training.

CONCLUSION: Anosmia is one of the main features of COVID-19 and the underlying disease of the patient may also influence its occurrence and development. The possible pathogenesis of COVID-19-induced anosmia is very complicated, which may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system.

PMID:34587819 | DOI:10.1177/01455613211048998

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Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula After Laryngectomy

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This multicenter cohort study of adult patients with laryngeal cancer uses data from a national database to identify nonclinical risks associated with the formation of pharyngocutaneous fistula after total laryngectomy.
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An Unusual Case of Bilateral Chylothorax After Neck Dissection

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This case report describes a woman in her 30s who underwent to tal thyroidectomy with modified radical neck dissection due to papillary thyroid cancer and was subsequently diagnosed with bilateral chylothorax secondary to cervical thoracic duct injury.
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Addressing the safety of hyaluronic acid dermal filler injections during the SARS CoV-2 pandemic worldwide vaccination

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J Plast Reconstr Aesthet Surg. 2021 Sep 20:S1748-6815(21)00420-4. doi: 10.1016/j.bjps.2021.08.037. Online ahead of print.

NO ABSTRACT

PMID:34588152 | DOI:10.1016/j.bjps.2021.08.037

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