Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment

xlomafota13 shared this article with you from Inoreader Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 23:S1748-6815(21)00344-2. doi: 10.1016/j.bjps.2021.06.011. Online ahead of print. ABSTRACT BACKGROUND: Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery. PATIENTS/METHODS: Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variabl e on the decision for surgery were analyzed. RESULTS: The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery. CONCLUSION: Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful cond itions. LEVEL OF EVIDENCE: Level 4, Case-control study. PMID:34275778 | DOI:10.1016/j.bjps.2021.06.011 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sutureless Thyroidectomy With Intraoperative Neuromonitoring and Energy-Based Device Without Sternotomy for Symptomatic Substernal Goiter Harboring Thyroiditis of Gland Parenchyma

xlomafota13 shared this article with you from Inoreader Sutureless Thyroidectomy With Intraoperative Neuromonitoring and Energy-Based Device Without Sternotomy for Symptomatic Substernal Goiter Harboring Thyroiditis of Gland Parenchyma Via radioactive iodine Cureus. 2021 Jul 8;13(7):e16258. doi: 10.7759/cureus.16258. eCollection 2021 Jul. ABSTRACT Since substernal goiter first being described by Haller in 1749, a consensus on the definition of this entity has not been ensured, yet. Despite substernal goiter or retrosternal goiter is delineated as an enlarged thyroid gland with a component extending into the mediastinum, at least 10 definitions have described being able to depict the most accurate definition for substernal goiter. Of no te, no consensus still has been declared on the therapeutic management of asymptomatic substernal goiter. It should be pointed out that, the American Association of Endocrine Surgeons (AAES), Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults reported approximately 9% to 13% of substernal goiters are being harbored thyroid malignancy. The following vignette case describes the clinical features of a symptomatic substernal goiter with chronic lymphocytic thyroiditis, her treatment by sutureless total thyroidectomy with intermittent-intraoperative neural monitoring (I-IONM), and the energy-based device without sternotomy, and the response of an adult who presented with a family history of malignant histopathology, differentiated thyroid carcinoma, which was exposed to the postoperative radioactive iodine ablation. We may recommend dividing the branches of superior thyroid arteries and the superior thyroid veins individually and exploring the fibrous Ligament of Berry, the true Ligament of Berry, with its safe interrelation to the inferior laryngeal nerve, finically, which may be regarded as different peas in a pod in a complete sutureless thyroidectomy for substernal goiter with thyroiditis in thyroidology. PMID:34277302 | PMC:PMC8269993 | DOI:10.7759/cureus.16258 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of patients with Graves' disease in Sweden compared to international surveys of an 'index patient'

xlomafota13 shared this article with you from Inoreader Treatment of patients with Graves' disease in Sweden compared to international surveys of an 'index patient' Via radioactive iodine Endocrinol Diabetes Metab. 2021 Mar 16;4(3):e00244. doi: 10.1002/edm2.244. eCollection 2021 Jul. ABSTRACT INTRODUCTION: The treatment strategies for a 42-year-old female index patient with moderate Graves' disease (GD) vary according to several international surveys. The important question whether surveys of treatment preferences in theoretical patient cases also match how real patients are treated has not yet been addressed. MATERIALS AND METHODS: From a Swedish cohort of 11 86 GD patients (TT-12 cohort), 27 women were identified using the same criteria as from the index patient surveys from the European and American Thyroid Associations. This 'index patient cohort' was age 40-45, otherwise healthy female, with two children and uncomplicated GD. The applied first-line treatment of the patients in the index cohort, together with its variations, was compared with the treatment preferences according to international surveys. A comparison with the TT-12 cohort was also performed. RESULTS: In the 'Index cohort', 77.8% were treated with antithyroid drugs (ATD), and 22.2% were treated with radioiodine (131I). This preference for ATD is in line with most countries/regions, with the exception of USA and the Middle East/North Africa, where 131I was preferred. The distribution of treatment in the TT-12 cohort did not significantly differ from the index cohort. ATD was the preferred treatment in male and young (age 19-22) patients, as wa s RAI in old (age 69-73) patients. The age-related, but not the gender-related, cases differed significantly from the entire TT-12 cohort. CONCLUSION: The treatment choice in an index patient in Sweden seems in line with European practice, where ATD is the preferred first choice. This differs compared to US and North African survey intentions, where 131I is more often used. Age more than gender influences the treatment choice of GD patients. This is, to our best knowledge, the first time an index patient from 'real life' has been presented and compared to treatment preferences of international thyroid association surveys. PMID:34277969 | PMC:PMC8279596 | DOI:10.1002/edm2.244 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Skeletal muscle mass at C3 may not be a strong predictor for skeletal muscle mass at L3 in sarcopenic patients with head and neck cancer

xlomafota13 shared this article with you from Inoreader Skeletal muscle mass at C3 may not be a strong predictor for skeletal muscle mass at L3 in sarcopenic patients with head and neck cancer Via Head and neck cancers by Joon-Kee Yoon, Jeon Yeob Jang, Young-Sil An, Su Jin Lee Purpose To evaluate the feasibility of using skeletal muscle mass (SMM) at C3 (C3 SMM) as a diagnostic marker for sarcopenia in head and neck cancer (HNC) patients. Methods We evaluated 165 HNC patients and 42 healthy adults who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography scans. The paravertebral muscle area at C3 and skeletal muscle area at L3 were measured by CT. Pearson's correlation was used to assess the relationship between L3 and C3 SMMs. The prediction model for L3 SMM was developed by multiple linear regression. Then the correlation and the agreement between actual and predicted L3 SMMs were assessed. To evaluate the diagnostic value of C3 SMM for sarcopenia, the receiver operating characteristics (ROC) curves were analyzed. Results Of the 165 HNC patients, 61 (37.0%) were sarcopenic and 104 (63.0%) were non-sarcopenic. A very strong correlation was found between L3 SMM and C3 SMM in both healthy adults (r = 0.864) and non-sarcopenic patients (r = 0.876), while a fair association was found in sarcopenic patients (r = 0.381). Prediction model showed a very strong correlation between actual SMM and predicted L3 SMM in both non-sarcopenic patients and healthy adults (r > 0.9), whereas the relationship was moderate in sarcopenic patients (r = 0.7633). The agreement between two measurements was good for healthy subjects and non-sarcopenic patients, while it was poor for sarcopenic patients. On ROC analysis, predicted L3 SMM showed poor diagnostic accuracy for sarcopenia. Conclusions A correlation between L3 and C3 SMMs was weak in sarcopenic patients. A prediction model also showed a poor diagnostic accuracy. Therefore, C3 SMM may not be a strong predictor for L3 SMM in sarcopenic patients with HNC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Two Cases of Atraumatic Laryngeal Fractures

xlomafota13 shared this article with you from Inoreader Two Cases of Atraumatic Laryngeal Fractures Via Journal of Voice Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion

xlomafota13 shared this article with you from Inoreader The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 19. doi: 10.1007/s00405-021-06995-z. Online ahead of print. ABSTRACT PURPOSE: To investigate the effect of thymic stromal lymphopoietin on the development of chronic otitis media with effusion MATERIALS AND METHODS: This study was conducted on 40 patients who had adenoidectomy operation. The objects were divided into two groups. Group 1; adenoidectomy with chronic serous otitis media, group 2; adenoidectomy without chronic serous otitis media. Serum and tissue thymic stromal lymphopoietin levels were measured by ELISA. Serum and tissue TLSP levels, mast cell count, adenoid size were compared between the groups. RESULTS: Twenty-four (60%) of patients were female and 16 (40%) were male. Twenty patients (55%) had adenoid hypertrophy with chronic serous otitis media, and 18 (45%) had adenoid hypertrophy without chronic serous otitis media. The mean age of the patients was 6.21 ± 2.31 years. The me an mast cell count was significantly higher in group 1 compared with group 2 (p = 0.017). The mean tissue thymic stromal lymphopoietin measurement was also significantly higher in group 1 than group 2 (p = 0.023). However, there was no significant difference in regards to serum levels between the groups (p = 0.480). CONCLUSION: The number of mast cells as well as thymic stromal lymphopoietin levels in the adenoids of children was significantly high in the chronic serous otitis media patients. The release of thymic stromal lymphopoietin from the adenoid tissue plays a role in initiating and maintaining a local inflammatory reaction in the eustachian tube that may lead eventually to middle ear effusion in non-atopic patients. PMID:34279733 | DOI:10.1007/s00405-021-06995-z View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoral and extraoral approach for surgical treatment of Eagle's syndrome: a retrospective study

xlomafota13 shared this article with you from Inoreader Intraoral and extraoral approach for surgical treatment of Eagle's syndrome: a retrospective study Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 19. doi: 10.1007/s00405-021-06914-2. Online ahead of print. ABSTRACT BACKGROUND AND PURPOSE: Eagle's syndrome is not uncommon in clinical work. Because of its atypical symptoms, it is easy to be misdiagnosed as other diseases, further leading to misdiagnosis and mistreatment. At present, there is no expert consensus or treatment guidelines for the disease. We evaluated the clinical characteristics and postoperative efficacy of 103 patients with Eagle's syndrome based on their clinical symptoms, radiological studies, and physical examination. Through the multicenter clinical study of Tongji Medical College and Dalian Medical University, we found some characteristics of Eagle's syndrome in operation and imaging. METHODS: In total, 103 patients with Eagle's syndrome (treated from January 2010 to January 2020) were retrospectively enrolled. The postoperative curative effect was analyzed by three su rgical methods: styloid process resection through the external cervical approach (styloid process could not be touched through the mouth or could be touched under the jaw or when the CT scan showed that the inclination angle was not large), tonsillectomy + styloidectomy, and preservation of the tonsil for styloidectomy (the styloid process bone could be touched directly during intraoral palpation or in whom the distal part of the styloid process could not be directly touched, but the CT scan showed that the bone inclined toward the oropharynx and its distal part was relatively close to the oropharynx cavity; whether tonsillectomy was performed depended on whether the patient's tonsil was too large to affect the surgical incision). According to the Quality of Well-Being Scale (QWB), we calculated the W value of the scale before operation and 30 days, 3 months, 6 months and 12 months after operation, and compared the W value of each group. RESULTS: The average length of the styl oid process was 33 mm (range 25-61 mm). The patients were followed up for 12-36 months (average 15 months). Of the 103 patients, 21 underwent styloid process resection through the external cervical approach, 49 underwent tonsillectomy and styloidectomy, and 33 underwent styloidectomy with preservation of the tonsil. The treatment cured 48 (46%) cases, was effective in 35 (34%) and was ineffective in 20 (20%). The R language 3.6.3 software was used to perform the nonparametric rank sum test, differences in characteristics between groups were analyzed using the Kruskal-Wallis test with Dunn post hoc tests ( R package FSA) for categorical variables, and there was no significant difference between the three types of operations (H = 0.491, P = 0.782). QWB showed that the quality of life after operation was improved compared with that before operation. CONCLUSIONS: Operation is an effective method for treating Eagle's syndrome. There were no significant differences between the effec ts of the intraoral and external cervical approaches. Imaging examination-especially CT scanning and 3D reconstruction of the styloid process-is very helpful for diagnosis, but not an absolute criterion for the selection of surgery protocol. PMID:34279732 | DOI:10.1007/s00405-021-06914-2 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Paroxysmal Atrial Fibrillation Induced by Ice-Cold Water Ingestion in a Triathlete: A Case Report

xlomafota13 shared this article with you from Inoreader Paroxysmal Atrial Fibrillation Induced by Ice-Cold Water Ingestion in a Triathlete: A Case Report Via swallowing exercises Am J Case Rep. 2021 Jul 19;22:e931460. doi: 10.12659/AJCR.931460. ABSTRACT BACKGROUND Swallowing-induced tachyarrhythmias are rare, and their possible mechanisms are still not completely elucidated. Even though a mechanical stimulation has been suggested, involvement of the autonomic nervous system has not been completely excluded. Moreover, tachyarrhythmias are not so frequent in athletes. CASE REPORT We present a case of a 35-year-old male triathlete who reported palpitations aft er swallowing ice-cold water following physical activity. His physical examination and basal electrocardiogram were essentially normal. The 24-h Holter monitoring showed a sinus rhythm with sporadic isolated supraventricular ectopic beat and a 2-h run of atrial fibrillation (160-200 beats/min). This episode of paroxysmal atrial fibrillation was related to and occurred after the ingestion of ice-cold water following physical exercise. We were able to reproduce this event. Notably, the tachyarrhythmia was only triggered by swallowing ice-cold water; nothing happened with room-temperature water. No therapy was given to the triathlete to avoid influencing his physical performance in any way. CONCLUSIONS This case suggests that both an esophageal mechanical stimulation and autonomic nervous system involvement were at the base of this tachyarrhythmia. The influence of water temperature on the esophageal thermoceptors has to be considered. PMID:34280178 | DOI:10.12659/AJCR.931460 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Functionalized Ionic Porous Organic Polymers Exhibiting High Iodine Uptake from Both the Vapor and Aqueous Medium

xlomafota13 shared this article with you from Inoreader Functionalized Ionic Porous Organic Polymers Exhibiting High Iodine Uptake from Both the Vapor and Aqueous Medium Via radioactive iodine ACS Appl Mater Interfaces. 2021 Jul 19. doi: 10.1021/acsami.1c07178. Online ahead of print. ABSTRACT Large-scale generation of radioactive iodine (129I, 131I) in nuclear power plants pose a critical threat in the event of fallout, thus rendering the development of iodine sequestering materials (from both the vapor and aqueous medium) highly pivotal. Herein, we report two chemically stable ionic polymers containing multiple binding sites, including phenyl rings , imidazolium cations, and bromide anions, which in synergy promote adsorption of iodine/triiodide anions. In brief, exceptional iodine uptake (from the vapor phase) was observed at nuclear fuel reprocessing conditions. Furthermore, the ionic nature propelled removal of >99% of I3- from water within 30 min. Additionally, benchmark uptake capacities, as well as unprecedented selectivity, were observed for I3-anions. The excellent affinity (distribution coefficient, ∼105 mL/g) enabled iodine capture from seawater-spiked samples. Moreover, iodine-loaded compounds showed conductivity (10-4 S/cm, 10-6 S/cm), placing them among the best known conducting porous organic polymers. Lastly, DFT studies unveiled key insights in coherence with the experimental findings. PMID:34279084 | DOI:10.1021/acsami.1c07178 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Epley Maneuver Versus Gans Repositioning Maneuver in Treating Posterior Canal BPPV and Familial Incidence of BPPV: Protocol for A Randomized Controlled Trial

xlomafota13 shared this article with you from Inoreader Epley Maneuver Versus Gans Repositioning Maneuver in Treating Posterior Canal BPPV and Familial Incidence of BPPV: Protocol for A Randomized Controlled Trial Via Otolaryngology Indian Abstract Benign paroxysmal positional vertigo (BPPV) is a widely recognized vestibular disorder which occurs with short periods of paroxysmal vertigo produced in specific positions. This investigation targets contrasting the adequacy of two unique moves utilized in the management of posterior canal BPPV (PC-BPPV). One is traditional procedure, Epley repositioning maneuver (ERM) and another is Gans Repositioning maneuver (GRM). To compare the efficacy of maneuvers on vertigo and dizziness for people with posterior canal BPPV using Dix hallpike test, Vertigo Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI), 100 people will be recruited confirming to eligibility criteria for this two group (ERM group and GRM group) participant and assessor blinded randomized control study. After Participants will be randomly assigned to either group, the respective maneuver will be performed one or two times until the symptoms resolve. Post maneuver instructions will be demon strated to each subject nicely. Then, family history will be taken using a questionnaire. Outcomes will be taken once after giving maneuver and then, once after 1 month of treatment. Main outcome variables include VAS, DHI, and Dix hallpike test negativity. If the results indicate that Gans Manoeuvre is equivalent to Epley manoeuvre, then in older and postural compromised BPPV patients who has cervical related neck stiffness and pain or any other disorder, where Epley manoeuvre can not be given as it involves neck extension and rotation, Gans manoeuvre can be given. Trial registration: Clinical Trials Registry (CTRI/2019/10/021681). October 16, 2019. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Optimal Diagnostic Criteria and a Staging System for Otogenic Skull Base Osteomyelitis

xlomafota13 shared this article with you from Inoreader Optimal Diagnostic Criteria and a Staging System for Otogenic Skull Base Osteomyelitis Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1732308 Objective Diagnostic criteria for otogenic skull base osteomyelitis (SBO) have been conflicting among researchers. We aimed to propose clinically useful diagnostic criteria and a staging system for otogenic SBO that is associated with infection control and mortality. Design The present study is designed as a retrospective one. Setting This study was conducted at the University Hospital. Participants Thirteen patients with otogenic SBO who met the novel rigorous diagnostic criteria consisted of symptomatic and radiological signs on high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI). Simple refractory external otitis was not included. A staging system according to disease extent revealed by HRCT and MRI is proposed: lesions limited to the temporal bone (stage 1), extending to less than half (stage 2), exceeding the midline (stage 3), and extending to the whole of the clivus (stage 4). All patients received long-term antibiotic therapy. Patients were divided into infection-uncontrolled or -controlled groups based on symptoms, otoscopic findings, and C-reactive protein level at the last follow-up. The mean follow-up period was 27.7 months. Main Outcome Measures Possible prognostic factors, such as immunocompromised status and symptoms, including cranial nerve palsy, pretreatment laboratory data, and treatments, were compared between the infection-uncontrolled and -controlled groups. Disease stages were correlated with infection control and mortality. Results The infection-uncontrolled rate and mortality rate were 38.5 and 23.1%, respectively. There were no significant differences in possible prognostic factors between the infection-uncontrolled and -controlled groups. HRCT-based stages significantly correlated with infection control and mortality. Conclusion We proposed here the clinically useful diagnostic criteria and staging systems that can predict infection control and prognosis of otogenic SBO. [...] 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.