Τετάρτη 10 Μαρτίου 2021

Molecular Genetic Testing Can Be Performed on Thyroid Cytology Slides Using the ThyroSeq v3 Genomic Classifier

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Clinical Thyroidology, Volume 33, Issue 3, Page 110-113, March 2021.
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Combination Pembrolizumab Plus Lenvatinib May Be Option in Anaplastic and Poorly Differentiated Thyroid Cancers

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Clinical Thyroidology, Volume 33, Issue 3, Page 131-133, March 2021.
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Solute Carrier Proteins and Their Role in Thyroid Hormone Synthesis

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Clinical Thyroidology, Volume 33, Issue 3, Page 107-109, March 2021.
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Preoperative Vitamin D Deficiency Is a Risk Factor for Postsurgical Hypoparathyroidism

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Clinical Thyroidology, Volume 33, Issue 3, Page 137-139, March 2021.
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Who Is Eligible for Thyroid Cancer Active Surveillance in a Population with a Restrictive Diagnostic Protocol?

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Clinical Thyroidology, Volume 33, Issue 3, Page 124-127, March 2021.
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An anatomical investigation of the proximal vertebral arteries (V1, V2)

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Surg Radiol Anat. 2021 Mar 10. doi: 10.1007/s00276-021-02712-x. Online ahead of print.

ABSTRACT

INTRODUCTION: The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addit ion to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population.

MATERIALS AND METHODS: The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019.

RESULTS: The VA exhibited morphological variation in its course. We report the incidence of variant origin of the left VA, all from the aortic arch. Variation in the level of entry into the transverse foramen ranged between C7 and C3. A left dominant pattern was observed; we also report on hypoplasia of the VA. In addition, we report incidence of VA tortuosity at V1, V2 to be 76.6% and 32.1%, respectively.

CONCLUSIONS: The base line data established in this study regarding the diameter, variant origin, and level of entry into the transverse foramen will assist neurosurgeons and interventional radiologists in interpreting, diagnosing, and planning and executing various vascular procedures and treatment of pathology in the vicinity of the VA.

PMID:33689007 | DOI:10.1007/s00276-021-02712-x

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Atypical branching of the musculocutaneous and median nerves with associated unusual innervation of muscles in the anterior compartment of the arm: case report and plea for extension of the current classification system

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Surg Radiol Anat. 2021 Mar 10. doi: 10.1007/s00276-021-02731-8. Online ahead of print.

ABSTRACT

PURPOSE: Variations of the peripheral nervous system in the upper limb, especially of the musculocutaneous and median nerves, are common, but closer attention to the knowledge of the variant anatomy should be paid to avoid iatrogenic injury or to understand the unusual clinical signs.

METHODS: During a routine dissection course, bilateral variations were observed in a Centra l European male cadaver.

RESULTS: Variable branching of the musculocutaneous and median nerves associated with atypical innervation of the muscles in the anterior compartment of the arm and other concomitant variations were found bilaterally. In both cases, the musculocutaneous nerve innervated only the coracobrachialis muscle and terminated inside the muscle belly. Branches to the biceps brachii and brachialis muscles arose either directly from the median nerve or its branches. On the right side, two communicating branches between the roots of the median nerve were noted, and a common medial cutaneous trunk originated from the lateral cord. On the left side, a communicating branch extended from the lateral cord to the medial root of the median nerve and a tributary to the axillary vein passed through a window formed by the roots of the median nerve and the communicating branch.

CONCLUSION: There exist only few cases in the literature describing similar variations, but t he present arrangement has not yet been reported to the best of our knowledge. With the proposed extension to the existing classification system, we aim to provide clearer orientation in the variability of the musculocutaneous and median nerves.

PMID:33689004 | DOI:10.1007/s00276-021-02731-8

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Relationship between the posterior septal artery and the upper edge of the choana

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Surg Radiol Anat. 2021 Mar 10. doi: 10.1007/s00276-021-02732-7. Online ahead of print.

ABSTRACT

BACKGROUND: The pedicled nasoseptal flap has been a key element in advancing the endoscopic transnasal approach (ETA) for the treatment of skull base lesions from the anterior cranial fossa to the occipitocervical junction. To preserve vascular supply, an anatomical knowledge of the location of the posterior septal artery (PSA) is essential. The objective of this work is to establ ish the relationship between PSA and the superior edge of the choana to define a safety margin during the opening of the sphenoidal rostrum preserving PSA.

METHODS: One hundred and eighty angiotomographies of the brain were assessed. The sphenopalatine artery (SPA) was evaluated in the pterygopalatine fossa and PSA at its entrance into the nasal cavity and on the sphenoidal rostrum.

RESULTS: PSA was found in all 3 tomographic planes (axial, coronal and sagittal) in 100 patients (200 PSAs). Thirty-five were male and 65 were females. Average age was 62 years with a range of 19-90 years. Total average distance between PSA and the superior edge of the choana was 8.5 mm with a range of 2.5-18 (12.45 90th percentile).

CONCLUSION: Although the distance between the choanal edge and PSA is 8.5 mm on average, due to its variability, a distance of at least 12.45 mm for the opening of the sphenoidal sinus in the ETA approach should be considered as a safety margin.

PMID: 33689006 | DOI:10.1007/s00276-021-02732-7

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Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis

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Eur Arch Otorhinolaryngol. 2021 Mar 10. doi: 10.1007/s00405-021-06714-8. Online ahead of print.

ABSTRACT

PURPOSE: In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data.

METHODS: Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrosp ectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters.

RESULTS: LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047-66.81; Sensitivity 0.5; Specificity 0.9355).

CONCLUSION: Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.

PMID:33689023 | DOI:10.1007/s00405-021-06714-8

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One stop neck lump clinic: a boon for quick diagnosis and early management

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Eur Arch Otorhinolaryngol. 2021 Mar 10. doi: 10.1007/s00405-021-06729-1. Online ahead of print.

ABSTRACT

INTRODUCTION: One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience.

OBJECTIVES: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits.

DESIGN: Retrospective observational study SETTING: Regional Head and Neck Cancer Center (Secondary care hospital) PARTICIPANTS: Patients referred by General practitioner with symptoms of a neck lump MAIN OUTCOME MEASURES: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments , one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration.

RESULTS AND CONCLUSIONS: Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic.

PMID:33689020 | DOI:10.1007/s00405-021-06729-1

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Management of tympanic membrane retractions: a systematic review

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Eur Arch Otorhinolaryngol. 2021 Mar 10. doi: 10.1007/s00405-021-06719-3. Online ahead of print.

ABSTRACT

IMPORTANCE: Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances.

OBJECTIVE: To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction.

EVIDENCE REVIEW: The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development.

FINDINGS: In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs.

CONCLUSIONS AND RELEVANCE: This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media).

PMID:33689022 | DOI:10.1007/s00405-021-06719-3

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Intra- and postoperative complications using LigaSure™ Small Jaw in patients undergoing thyroidectomy: a register-based study

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Eur Arch Otorhinolaryngol. 2021 Mar 10. doi: 10.1007/s00405-021-06685-w. Online ahead of print.

ABSTRACT

PURPOSE: LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding postoperative complications and among relevant patients subgroups. In a large cohort of patients including relevant patient subgroups, we evaluated intra- and postoperative complications using LSJ.

METHODS: Single-centre register-based study evaluating 3346 patients undergoing hemi- or total thyroidectomy. We compared differences in intra- and postoperative complications using LSJ compared to conventional technique. Multivariate analyses were conducted to adjust for potential confounders.

RESULTS: Compared to the conventional technique, LSJ was associated with less postoperative drainage (OR 0.4, p = 0.02) and postoperative haemorrhage (OR 0.3, p = 0 .02) among patients undergoing hemi- and total thyroidectomy with benign histology, respectively, but with increased risk of postoperative infection [3 (6.4%) vs. 0 (0.0%) patients, p = 0.04] among patients undergoing total thyroidectomy with malignant histology. LSJ was associated with reduced operation duration (- 12.2 min, p < 0.001, - 7.9 min, p < 0.001 and - 13.2 min, p = 0.002) and intraoperative blood loss (- 52.1 ml, p < 0.001, - 13.6 ml, p < 0.001 and - 12.9 ml, p = 0.02) compared to conventional technique among patients undergoing total and hemithyroidectomy with benign histology and hemithyroidectomy with malignant histology, respectively.

CONCLUSION: LSJ was associated with a reduced risk of postoperative haemorrhage and less postoperative drainage but increased risk of postoperative infection depending on the type of thyroidectomy and histology of the thyroid gland. LSJ was associated with only a small reduction in operation duration and intraoperative blood loss.

TRIAL REGISTRATION: The study was based on data prospectively registered in the Danish national database THYKIR.

PMID:33689021 | DOI:10.1007/s00405-021-06685-w

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