Δευτέρα 31 Ιανουαρίου 2022

Varicella post-exposure management for pediatric oncology patients

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Bull Cancer. 2022 Jan 26:S0007-4551(22)00004-2. doi: 10.1016/j.bulcan.2021.11.016. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective was to evaluate health care providers' (HCP) adherence to and efficacy of varicella post-exposure prophylaxis (PEP) recommendations. It was an observational, prospective, multicenter study set in Ile-de-France, France.

METHODS: All children under 18 with a cancer diagnosis, currently or within 3months of receiving cancer treatment, regardless of varicella zoster virus (VZV) serostatus or previous personal history of varicella, were eligible. Study participants with significant exposure were reviewed prospectively for PEP indications. Main outcome measures were the percentage of exposure situations for which HCP were guideline-compliant, the proportion of available VZV serostatuses and the incidence of breakthrough varicella after different PEP approaches.

RESULTS: A total of 51 patie nts from 15 centers were enrolled after 52 exposure episodes. Median age at exposure was 5 years (range, 1-15). Exposure within the household led to 38% of episodes. Prophylactic treatment consisted in specific anti-VZV immunoglobulins (V-ZIG) (n=19) or in oral aciclovir (n=15). No prophylactic treatment was given for 18 patients (in compliance, n=16). In compliance with guidelines, 17 patients received V-ZIG, 11 did not develop varicella (65%, [95% CI, 39-90%]); 15 received aciclovir, 13 did not develop varicella (87%, [95% CI, 67-100%]). Breakthrough varicella occurred in 11 patients, with simple clinical course in all cases; in 8/47 (17%) episodes when PEP was guideline-compliant versus 3/5 (60%) when not.

DISCUSSION: Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.

PMID:35093244 | DOI:10.1016/j.bulcan.2021.11.016

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Computed tomography-assessed variations of the carotid sinus

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Surg Radiol Anat. 2022 Jan 30. doi: 10.1007/s00276-021-02871-x. Online ahead of print.

ABSTRACT

PURPOSE AND BACKGROUND: Previous studies have identified variations regarding the morphology and location of the carotid sinus, a phenomenon still not commonly approached or studied on computed tomography angiography (CTA). Detailed characterization of the carotid sinus was performed on CTAs, determining its position, diameter and length.

METHODS: The study group included 43 patients with disease-free carotid trunks subjected to cervical CTA. We measured the terminal caliber of the common carotid artery (CCA), as well as the calibers of the internal (ICA) and external carotid arteries (ECA) at their origin. The diameters were correlated with the location and the shape of the carotid sinus. We also measured the length of the sinus dilatation (carotid bulb), in regard to its location on the terminal branches of the common carotid artery.

RESULTS: Mean diameters of the studied arteries were 7.39 ± 1.04 mm for the CCA, 6.71 ± 1.49 mm for the ICA and, respectively, 4.27 ± 0.75 mm for the ECA. The classical position of the carotid sinus was seen in 80% of cases, the rest being considered anatomical variants. The length of the carotid bulb on the ICA was 9.99 ± 2.22 mm, showing variability between genders.

CONCLUSIONS: The carotid sinus does not always extend to the ICA, presenting different distribution patterns that might be relevant in sinu s pathology from a clinical point of view, respectively from a surgical point of view during invasive or minimally invasive interventions on the carotid axis.

PMID:35094129 | DOI:10.1007/s00276-021-02871-x

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High-Resolution CT Imaging of the Temporal Bone: A Cadaveric Specimen Study

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J Neurol Surg B Skull Base
DOI: 10.1055/s-0041-1741006

Objective Super-high and ultra-high spatial resolution computed tomography (CT) imaging can be advantageous for detecting temporal bone pathology and guiding treatment strategies. Methods Six temporal bone cadaveric specimens were used to evaluate the temporal bone microanatomic structures utilizing the following CT reconstruction modes: normal resolution (NR, 0.5-mm slice thickness, 5122 matrix), high resolution (HR, 0.5-mm slice thickness, 1,0242 matrix), super-high resolution (SHR, 0.25-mm slice thickness, 1,0242 matrix), and ultra-high resolution (UHR, 0.25-mm slice thickness, 2,0482 matrix). Noise and signal-to-noise ratio (SNR) for bone and air were measured at each reconstruction mode. Two observers assessed visualization of seven small anatomic structures using a 4-point scale at each reconstruction mode. Results Noise was significantly higher and SNR significantly lower with increases in spatial resolution (NR, HR, and SHR). There was no statistical difference between SHR and UHR imaging with regard to noise and SNR. There was significantly improved visibility of all temporal bone osseous structures of interest with SHR and UHR imaging relative to NR imaging (p < 0.001) and most of the temporal bone osseous structures relative to HR imaging. There was no statistical difference in the subjective image quality between SHR and UHR imaging of the temporal bone (p ≥ 0.085). Conclusion Super-high-resolution and ultra-high-resolution CT imaging results in significant improvement in image quality compared with normal-resolution and high-resolution CT imaging of the temporal bone. This preliminary study also demonstrates equivalency between super-high and ultra-high spatial resolution temporal bone CT imaging protocols for clinical use.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
Table of contents  |  Abstract   |  Full text

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Thyroid Disease in Pregnancy: A Touch of Clarity

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Thyroid, Ahead of Print.
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Κυριακή 30 Ιανουαρίου 2022

A Tissue Engineered Construct for Laryngeal Regeneration: A Proof‐of‐Concept Device Design Study

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Objectives/Hypothesis

Develop a patient-specific tissue engineered construct for laryngeal reconstruction following a partial laryngectomy.

Study Design

Bench and animal research.

Methods

A construct made from a porous polyethylene scaffold shaped in a canine-specific configuration and seeded with autologous canine adipose-derived stem cells in fibrin glue was implanted in a canine following a partial laryngectomy. After 1 year, the construct was first evaluated in vivo with high-speed imaging and acoustic–aerodynamic measures. It was then explanted and evaluated histologically.

Results

The canine study at 1 year revealed the construct provided voicing (barking) with acoustic and aerodynamic measures within normal ranges. The canine was able to eat and breathe normally without long-term support. The construct was integrated with epithelialization of all areas except the medial portion of the vocal fold structure. No anti-infective agents were needed after the standard perioperative medications were completed.

Conclusion

This study provided a successful first step toward developing a patient-specific composite construct for patients undergoing partial laryngectomies.

Level of Evidence

Not Applicable Laryngoscope, 2022

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The music-related quality of life: Italian validation of MuRQoL into MUSQUAV questionnaire and preliminary data from a cohort of postlingually deafened cochlear implant users

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Eur Arch Otorhinolaryngol. 2022 Jan 28. doi: 10.1007/s00405-022-07258-1. Online ahead of print.

ABSTRACT

PURPOSE: Cochlear implant (CI) users do not receive much of the auditory information necessary for an accurate perception of music. This usually entails a dissatisfaction with the music they hear, so that their quality of life may potentially be affected. The main aim of this paper was to translate and validate into Italian an instrument to evaluate these aspects-The Music-Related Quality of Life Questionnaire (MuRQoL)-to help the work of clinicians and therapists.

METHODS: The translation of the MuRQoL into "Questionario Musica e Qualità della Vita" (MUSQUAV) was done according to the international guidelines. The translated questionnaire was administered to normal hearing (NH) and CI users adults. Exploratory factor analysis, confirmatory factor analysis and known group method were used to confirm construct validity and app licability of MUSQUAV.

RESULTS: We retrieved 225 results. The MUSQUAV questionnaire was acceptable according to the goodness-of-fit indices. The correlation between the items, evaluated using Cronbach's α coefficient, indicates a good internal consistency (> 0.80). The non-parametric Mann-Whitney test showed significant differences in the distinct populations tested.

CONCLUSIONS: The MUSQUAV questionnaire is a valid, low-cost and rapid instrument for professional workers in the audiological field, especially useful in the assessment of the patients' perception and musical engagement.

PMID:35089391 | DOI:10.1007/s00405-022-07258-1

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Intraoral Approach for Parapharyngeal Branchial Cleft Cysts

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Ear Nose Throat J. 2022 Jan 28:1455613211067846. doi: 10.1177/01455613211067846. Online ahead of print.

ABSTRACT

Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of para pharyngeal BCC misdiagnosed as peritonsillar abscess.

PMID:35088618 | DOI:10.1177/01455613211067846

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Spindle cell carcinoma of larynx: a report of 3 cases

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Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jan 7;57(1):59-61. doi: 10.3760/cma.j.cn115330-20210304-00106.

NO ABSTRACT

PMID:35090213 | DOI:10.3760/cma.j.cn115330-20210304-00106

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Place of Linacs in extracranial stereotactic radiotherapy: Are they now equivalent to Cyberknife®?

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Bull Cancer. 2022 Jan 25:S0007-4551(22)00003-0. doi: 10.1016/j.bulcan.2021.10.008. Online ahead of print.

ABSTRACT

Extracranial stereotactic radiotherapy has developed recently, since the years 1990-2000. Devices specifically dedicated to this type of treatment were then developed and shared the favors of radiation oncologists: Tomotherapy® and especially Cyberknife®, which offered the advantage of "tracking" with the possibility of real time motion correction, allowing an increase in the precision of targeting volumes. Recently, the latest generations of linear accelerators (Linac) have been developed, integrating much higher dose rates, an improved ballistic precision with a very short treatment duration time and the possibility of real time motion management (with notably the possibility of adaptive radiotherapy in real time with the development of "MLC tracking"). So are Linacs able to perform equivalent (not inferior) extracrani al stereotactic radiotherapy treatments to those with Cyberknife®, the historical gold standard in this field? This article presents a comparison of these two treatment devices, by successively considering dose distributions in the irradiated volume, distant received doses from this volume (including the "integral dose"), problems linked to the duration of the sessions and those linked to motion management.

PMID:35090720 | DOI:10.1016/j.bulcan.2021.10.008

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The importance of systemic immune-inflammation index in obstructive sleep apnea syndrome

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Eur Arch Otorhinolaryngol. 2022 Jan 29. doi: 10.1007/s00405-021-07227-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to explore the importance of systemic immune-inflammation index (SII) in patients diagnosed with obstructive sleep apnea (OSA).

MATERIALS AND METHOD: In this study planned as a retrospective cohort, the files of the patients who presented with sleep apnea/snoring complaint between 10.01.2017 and 10.01.2021 and underwent polysomnography (PSG) and complete blood count analyses were reviewed. PSG findings (age, sex, body mass index (BMI), apnea-hypopnea index (AHI), mean oxygen saturation) were compared with SII in 194 patients meeting study eligibility criteria.

RESULTS: Patients included in this study were divided into 4 groups by AHI value. Statistical difference was detected between the groups in terms of age, sex, body mass index (BMI), and mean oxygen saturation (p < 0.05). There is an ap proximately 30% positive statistically significant correlation between the severity of OSA and SII (p < 0.001). As for the mean SII values of the AHI groups, it was observed that the more severe AHI is, the higher the mean SII value is. The correlation between SII and the severity of OSA was found to be more significant than the correlation with neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR).

CONCLUSION: There is a significant correlation between SII and the severity of OSA. This correlation is stronger compared to NLR and PLR. SII can be used to demonstrate the chronic systemic inflammation observed in OSA patients, and can be utilized as a simple and inexpensive biomarker as it can be easily calculated from the parameters present in routine blood analyses.

PMID:35091830 | DOI:10.1007/s00405-021-07227-0

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Bereavement Practices Among Head and Neck Cancer Surgeons

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Objectives

Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons.

Methods

A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up.

Results

There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients.

Conclusion

There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement.

Level of Evidence

NA Laryngoscope, 2022

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