Δευτέρα 28 Νοεμβρίου 2022

Hemostasis in endoscopic sinus and skull base surgery

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Purpose of review Bleeding during endoscopic endonasal procedures can quickly obscure critical anatomic landmarks. This increases both the difficulty of the surgical procedure and the risk of complications faced by the patient. As the indications for surgical management of sinonasal pathology grow, it is important to review techniques to minimize bleeding and facilitate safe surgery. Recent Findings Evidence continues to accumulate for best practices in the surgical management of sinonasal disease. Recently, international guidelines have attempted to summarize this body of evidence, lending further support to several interventions which have been advocated as methods to decrease bleeding during endoscopic endonasal surgery. Additional studies have specifically investigated the safety of certain commonly employed techniques. The utility of preoperative corticosteroid therapy and the use of total intravenous anesthetic techniques in increasingly validated. Further evidence supports the safety of reverse Trendelenburg positioning for surgical management of inflammatory disease. Summary Recent wide scale systematic review of the literature regarding perioperative and intraoperative management of hemostasis has reinforced the utility of certain interventions, while others remain ambiguous.
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Η χρήση του χειρισμού Pringle στις ανατομικές και τμηματικές ηπατεκτομές

Η χρήση του χειρισμού Pringle στις ανατομικές και τμηματικές ηπατεκτομές


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Αλέξανδρος Γ. Σφακιανάκης
Αναπαύσεως 5 Άγιος Νικόλαος Λασιθίου 72100
00302841026182
00306932607174

Κυριακή 27 Νοεμβρίου 2022

Τομογραφία Εκπομπής Ποζιτρονίων (PET) και υβριδικά συστήματα PET-ΜRI

[PDF] Τομογραφία εκπομπής ποζιτρονίων (PET) και υβριδικά συστήματα PET-MRI


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Αλέξανδρος Γ. Σφακιανάκης
Αναπαύσεως 5 Άγιος Νικόλαος Λασιθίου 72100
2841026182
00306932607174

Early warning signals for Omicron outbreaks

alexandrossfakianakis shared this article with you from Inoreader

Abstract

The Omicron variant has become the dominant COVID-19 variant worldwide due to its rapid and cryptic spread; therefore, successful early warning is of great importance to be able to control epidemics in their early phase, before developing into large outbreaks. COVID-19-related Baidu search index, which reflects human behavior to a certain degree, was used to retrospectively detect the warning signs for Omicron variant outbreaks in China in 2022. The characteristics and effects of warning signs were analyzed in detail. We detected the presence of early warning signs (both high and low thresholds) and found that these occurred 4–7 days earlier than traditional epidemiological surveillance and >20 days earlier than the implementation of the local "lockdown" policy. Compared with the "high threshold" warning, the early warning effect of the "low threshold" is also vital because it indicates a complacency about epidemic prevention and control. Ho wever, there is obvious heterogeneity in the optimal threshold for detecting early warning signs and their distribution in different cities. Multi-source and multi-point early warning systems should be established via combining internet-based big data in the future to conduct effective and early real-time warning. This would create precious time for the early control of COVID-19 outbreaks.

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Health‐related quality of life in children and adolescents with pleuropulmonary blastoma: A report from the International PPB/DICER1 Registry

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Abstract

Purpose

Pleuropulmonary blastoma (PPB) is the most common lung cancer of infancy and early childhood and is associated with germline DICER1 variants. Type I and Ir PPB are cystic lesions treated surgically, with a subset of children with type I receiving chemotherapy. Type II and III are more aggressive lesions, treated with surgery, intensive chemotherapy and potentially radiation. We sought to assess health-related quality of life (HRQoL) in children with PPB and known germline DICER1 variants.

Methods

Children with a diagnosis of PPB or germline DICER1 pathogenic variant without history of PPB or other DICER1-related neoplasm (DICER1+ only) were enrolled in the International PPB/DICER1 Registry. Parent reports for participants aged 2–17 years for the PedsQL v.4 and PedsQL Multidimensional Fatigue Scale v.3 were collected. Fatigue, physical, and psychosocial function scores were compared.

Results

Analysis included 84 participants (PPB type Ir = 20, type I = 15, type II/III = 27, DICER1+ only = 22). Total fatigue scores of participants with type I and II/III PPB were lower compared to DICER1+ only, with effect size larger in type II/III (−0.82 vs. −0.40). Total psychosocial and physical functioning scores were lower in participants with type I and type II/III PPB compared to DICER1+ only, with larger effects noted in type II/III. Female sex was suggestive of worse HRQoL for both type I/Ir and type II/III cohorts.

Conclusions

These data demonstrate the importance of regular HRQoL assessment in patients with a history of PPB as well as the importance and feasibility of studying HRQoL in children with rare tumors.

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Salvage treatments for locally recurrent nasopharyngeal cancer: A systematic review and meta‐analysis

alexandrossfakianakis shared this article with you from Inoreader

Abstract

The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2-, 3-, and 5-year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5-year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2-, 3-, and 5-year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment-related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes t o re-irradiation, while offering a better safety profile for selective patients with resectable IrNPC.

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Enteral nutrition support and treatment toxicities in patients with head and neck cancer receiving definitive or adjuvant helical intensity‐modulated radiotherapy with concurrent chemotherapy

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Enteral nutrition (EN) is often required in patients with head and neck cancer (HNSCC); however, initiation criteria is limited or inconsistent. This study aimed to describe the relationship of treatment toxicities and requirement for EN and investigate toxicity and baseline characteristics association with EN duration.

Methods

Acute toxicities and baseline characteristics were collected from patients with HNSCC (n = 110) undergoing H-IMRT. Percentage EN contributing to estimated requirements and EN duration were measured.

Results

The threshold for patients needing ≥50% of estimated requirements via EN increased from week 3 to 4 for grade ≥2 oral/pharyngeal mucositis, dysgeusia, thick saliva and nausea, and for grade 3 dysphagia. Patients with grade 2–3 dysphagia had a reduced risk of ceasing EN compared to those with grade 0–1 dysphagia.

Conclusions

Using acute toxicities in clinical practice may be a useful tool to inform prompt initiation of EN prior to decline in nutritional status and anticipate EN duration.

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