Impella in cardiogenic shock following acute myocardial infarction: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Cardiogenic shock (CS) conveys a high mortality risk. A cardiac assist device may serve as bridge to patient recovery. We aimed to provide a pooled estimate on mortality and complications from studies evaluating the use of the left ventricular assist device Impella in CS following acute myocardial infarction. In addition, we evaluated whether mortality risk differed with device placement before or after percutaneous coronary intervention (PCI). METHODS: We searched Medline, Embase and Web of Science from 2005 until July 2019 for observational studies or clinical trials on this specific patient group. Studies were required to report on 30-day all-cause mortality and device-related complications. We calculated pooled proportions with 95% confidence intervals (CI) using random effects models and the inverse variance method. RESULTS: Overall, 671 patients from 11 studies (2 randomized and 9 observational) were included. Pooled proportions showed a 30-day mortality of 54.6% (95% CI 47.3-61.8; P = 0.22; I2 = 65.8%). Among complications, major bleeding was found in 19.9% (95% CI 14.2-27.3; P < 0.05; I2 = 69.1%), hemolysis in 10.5% (95% CI 7.2-15.0; P < 0.05; I2 = 52.1%), limb ischemia in 5.0% (95% CI 2.6-9.5; P < 0.05; I2 = 48.3%) and stroke in 3.8% of patients (95% CI 2.4-5.9; P < 0.05; I2 = 0%). Sensitivity analysis demonstrated a statistically significant risk reduction in 30-day mortality when Impella was implanted prior to PCI as compared to after PCI, risk ratio (RR): 0.71, CI 0.58-0.86, P = 0.001, I2 = 0%. CONCLUSION: Pooled estimates of Impella use in myocardial infarction with CS revealed a high 30-day mortality; however, as compared to post-PCI, Impella initiation prior to PCI was associated with a survival benefit.

First-in-man transcatheter mitral valve-in-ring implantation with a repositionable and retrievable aortic valve prosthesis.

AIMS: Transcatheter interventions with balloon-expandable valves have been shown to be efficacious for the treatment of mitral annuloplasty failure but are limited by the fact that there is no opportunity for post-implantation adjustment. The aim of this study was to assess the safety and efficacy of the fully repositionable and retrievable Direct Flow Medical (DFM) valve for the treatment of mitral annuloplasty failure. METHODS AND RESULTS: Patients who underwent transcatheter mitral valve-in-ring (VIR) implantation of a DFM valve for failed mitral annuloplasty deemed high risk for redo surgery were included at four institutions. Eight patients underwent transcatheter mitral VIR procedures with implantation of the DFM valve. The DFM prosthesis was successfully positioned in all patients. Two patients required retrieval of the device due to a suboptimal result, and a further patient required repositioning of the valve with an ultimately successful implantation. During the 30-day follow-up period, two patients died for reasons unrelated to the valve implantation. The four patients with successful implantation had normal valve function associated with a significant improvement in their functional status. CONCLUSIONS: For the first time, we demonstrate the safety, efficacy and advantages of using the DFM prosthesis for the treatment of mitral annuloplasty failure.

Development of a Hodgkin disease tumor in the neck of a patient who previously had undergone complete excision of a hyaline-vascular Castleman disease neck mass.

Castleman disease is an uncommon cause of a neck mass. A benign lymphoproliferative disorder, it may be seen as a self-limited unicentric process or as a fulminant multicentric disease with systemic symptoms. The association between Hodgkin disease and Castleman disease has been debated extensively, but this association is rare. The associated Hodgkin disease frequently has been of the interfollicular subtype and typically has coexisted with the multicentric plasma-cell variant of Castleman disease. We report a case of mixed-cellularity Hodgkin disease of the neck in a patient previously diagnosed with hyaline-vascular-type Castleman disease who had undergone complete excision of a neck mass 2 years earlier.

Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears.

The purpose of this study was to analyze the anatomic and functional results of cartilage tympanoplasty performed on atelectatic ears using the palisade technique and to assess the long-term efficacy of cartilage palisades in preventing recurrent retractions. The records of 54 patients (56 ears) who underwent surgery for atelectasis with or without mastoidectomy from January 2000 to August 2005 were retrospectively evaluated. A successful outcome was defined as complete and intact healing of the graft without perforation, retraction, or lateralization for at least 36 months after the operation, in addition to improvement of hearing indicated by a pure-tone average air-bone gap (PTA-ABG) of less than 20 dB. The mean follow-up period was 44.5 +/- 8.0 months (range, 36-68 months). Closure of the tympanic membrane was achieved in 91% of ears. Otomicroscopic evaluation revealed nine (16%) mild and five (8%) moderate retractions, but none of the retractions was deep enough to necessitate tube placement. Postoperative PTA-ABG was less than 20 dB in 71% of ears. The average preoperative and postoperative ABG values, including all types of tympanoplasty operations (Type I, II and III), were 28.4 +/- 5.8 and 16.9 +/- 6.7 dB, respectively (p < 0.001). No significant difference in the change in PTA-ABG was found between the groups with or without mastoidectomy (p > 0.05). Palisade cartilage tympanoplasty is an effective technique for tympanic membrane closure and hearing improvement in atelectatic ears. Mastoidectomy does not change the anatomic or audiologic findings in these types of ears. We recommend this technique to other otologic surgeons.

Functional and aesthetic results obtained by modified Bernard reconstruction technique after tumour excision in lower lip cancers.

BACKGROUND: In this study, we investigated the functional and aesthetic results in new lip formation using modified Bernard reconstruction technique after tumour excision in lower lip cancers. MATERIAL AND METHODS: The study included 47 patients. All were operated due to lower labial squamous cell carcinoma and underwent defect reconstruction using modified Bernard technique. The patients were separated into two groups as: 50-70% and 70% total defect occurring after surgical excision. The functional and aesthetic assessments were done after at least 1 year had passed, and the results were compared statistically with a control group. RESULTS: Of the 18 patients with 50-70% defect, sensibility was normal in 16 (89%) and complete competence was determined in all (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in all patients. Nasolabial asymmetry was detected in one patient (6%) and apparent mentolabial scar tissue was detected in two patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Of the 29 patients with 70% total defect, sensibility was normal in 21 (72%) and complete competence was detected in 27 patients (93%). Sialorrhoea on fluid intake was detected in one patient (3.5%) and sialorrhoea at rest in one patient (3.5%). In 22 patients (76%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in 27 (93%) of the 29 patients. Asymmetry in nasolabial fold was detected in one patient (3.5%), apparent scar tissue in nasolabial fold in one patient (3.5%) and commissure asymmetry in one patient (3.5%). In 25 patients (86%), the new vermilion was of equal width to the upper lip vermilion. No statistically significant difference was found (p>0.05) among the two patient groups and the control group in terms of functional and aesthetic results. CONCLUSION: Modified Bernard technique provides a good degree of lip mobility and sensation after excision of lower lip malignant tumour and produces acceptable results.

Giant retropharyngeal abscess in an adult as a complication of acute tonsillitis: case report.

Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.

Investigation of the synergism between alcohol consumption and herpes simplex virus in patients with laryngeal squamous cell cancers.

We investigated the synergism between alcohol consumption and herpes simplex virus (HSV) in the development of laryngeal squamous cell cancer and in the clinical course of this disease. HSV DNA was searched by polymerase chain reaction (PCR) technique in the fresh tumor tissues of 22 patients with laryngeal cancer without alcohol consumption (Group 1) and of 23 patients with chronic alcohol consumption (Group 2), and their HSV prevalences were compared. No statistically significant difference was detected between the two groups in terms of HSV incidence frequency (P > 0.05), but the risk of finding HSV in tumor tissue in patients with alcohol consumption history was 3.4-fold higher than in those without alcohol consumption history (OR = 3.378, 95% CI = 0.762-14.982). There were no statistically significant differences in terms of lymph node metastasis, tumor localization, tumor diameter, tumor stage and tumor differentiation between the patients in Group 1 and Group 2 (P > 0.05). Larger case series will further elucidate the role of HSV in the development of laryngeal cancer, the nature of its interactions with other carcinogens and its effect on the clinical course.

Tinnitus after cochlear implantation.

OBJECTIVE: The purpose of this study was to investigate properties of tinnitus which starts after cochlear implantation. Of the 17 adult patients in our cochlear implant group, four (23.5%) who had no pre-implantation tinnitus were eligible for the study. METHODS: Each patient was requested to complete a short questionnaire regarding his or her experience with tinnitus. Tinnitus match test was performed for each patient by using an Interacoustic Clinical Audiometer (model AC40; Assens, Denmark). RESULTS: Tinnitus match test revealed a tinnitus frequency of a 4KHz for three and of a 6KHz for one patient. Mean value of the loudness score was calculated as 17.5dB SL. CONCLUSIONS: The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.

Incidence of fallopian canal dehiscence at surgery for chronic otitis media.

The objectives of this study were to determine the incidence and locations of dehiscence of the fallopian canal (FC) in patients undergoing surgery for different middle ear pathologies and to describe the findings that will aid in pre-operative prediction of dehiscence. Charts and operative details of the 118 ears managed with canal wall-down and 147 ears managed with canal wall-up tympanomastoidectomy performed by a single surgeon were retrospectively reviewed. The distribution of the diagnoses for ears that were operated was as follows: 118 ears cholesteatoma, 42 ears adhesive otitis, 23 ears tympanosclerosis, and 82 ears chronic otitis media. The presence and the location of facial nerve dehiscence after exenteration of the disease as well as the presence of any coexisting inner ear fistula and dural defect were noted. FC dehiscence was observed in 56 of the cases. The incidence of dehiscence was highest among ears with cholesteatoma (n = 44, P < 0.05). Adults and also male patients in the study had significantly higher incidence of dehiscence compared to pediatric (P < 0.05) and female (P < 0.01) patients. The most common location for dehiscence was the tympanic segment which was significantly higher than the other locations (P < 0.01). Among the ears with FC dehiscence, labyrinthine fistula presence was seen in ten ears which was also significant (P < 0.001). Patients with dural exposure were 12.06 times more likely to have FC dehiscence than those without dural exposure. The incidence of FC dehiscence was 1.26 times higher in revision operations, but the difference was not significant (P > 0.05). An otologic surgeon should be more careful while performing operation for cholesteatoma in an adult and male patient because of the high incidence of dehiscence observed in these ears. Presence of lateral semicircular canal fistula and erosion of the bony tegmen should also be considered as a clue for the presence of dehiscence before surgery. Operation of these ears should be performed by experienced surgeons in otology.

[Surgical management of lower lip cancers]. / Alt dudak kanserlerine cerrahi yaklasim.

OBJECTIVES: We evaluated the results of surgical treatment of lower lip cancers. PATIENTS AND METHODS: The study included 47 patients (7 females, 40 males; mean age 53 years; range 34 to 71 years) who underwent surgery for primary lower lip carcinoma. Five patients received postoperative adjuvant radiotherapy. Data were reviewed on clinical features, risk factors, localization of the lesion, regional lymph node status, tumor staging, results of surgical treatment and pathological examination, locoregional recurrence, and prognosis. The mean follow-up period was 60.1 months (range 6 to 110 months). RESULTS: Histopathologic diagnosis was squamous cell carcinoma in all cases. Tumor differentiation was good in 39 patients (83%), moderate in seven patients (15%), and poor in one patient (2%). Stage 1 tumor was seen in 29 patients (61%). T and N staging were as follows: 31 T1, 14 T2, 2 T3; 40 N0, 6 N1, and 1 N2. Histopathologically, three N0 patients (7%), four N1 patients (66%) had lymph node metastasis, and one N2 patient had extracapsular invasion. Three patients (6%) had perineural invasion. Local recurrence developed in one stage 1 patient (9%) and in one stage 2 patient (16%). Neck recurrence was seen in three patients (6%). One stage 4 patient developed distant metastasis two years after the diagnosis. Mortality occurred due to lip cancer in five patients (10%), and to other causes in seven patients (15%). Of 35 patients who survived, 34 (72%) were disease-free. CONCLUSION: Due to its advantages, surgery should be the treatment of choice for cancers of the lower lip of any stage.

A comparison of cartilage palisades and fascia in type 1 tympanoplasty in children: anatomic and functional results.

OBJECTIVE: To assess the anatomic and functional results of primary Type1 cartilage tympanoplasty performed with the palisade technique and to compare them with the results of primary Type 1 tympanoplasty performed with temporalis fascia in children. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: The records of 45 children with intact ossicular chain and no history of mastoidectomy or tympanic perforations occupying more than 50% of the membrane area were evaluated. Patients with similar age and middle ear pathologic findings were selected in an effort to make the groups as homogeneous as possible. Of those, 21 children were included in the cartilage study group, and 24 patients were included in the fascia group. INTERVENTIONS: An over-under tympanoplasty technique using either a palisaded tragal cartilage or temporalis muscle fascia. MAIN OUTCOME MEASURES: Successful outcome was defined as full, intact healing of the graft without perforation, retraction, or lateralization for at least 12 months after the operation and with improvement of hearing. Postoperative speech reception thresholds and postoperative air-bone gap were compared with preoperative levels within and between the groups. RESULTS: Tympanoplasty with the palisade cartilage technique resulted in a significantly higher graft acceptance rate (100%) than with the fascia technique (70.2%; p = 0.008). Speech reception threshold levels, pure-tone average, and air-bone gaps improved significantly with surgery in both the palisade and fascia groups (p < 0.001). Comparison of audiologic results between the groups did not reveal any statistically significant difference (p > 0.05). CONCLUSION: Palisade tympanoplasty in children yielded good anatomic and functional results. The anatomic results obtained using this technique were superior to those obtained using temporalis muscle fascia. Children who underwent Type 1 tympanoplasty with palisaded cartilage had equivalent postoperative audiometric results compared with children who underwent Type 1 tympanoplasty with temporalis fascia. Thus, palisade cartilage tympanoplasty is an effective technique for both tympanic membrane closure and hearing improvement in children.

Sarcoma of the pulmonary trunk and the main pulmonary arteries.

We report on a sarcoma of the central pulmonary arteries. Surgical therapy consisted in replacing both main pulmonary arteries and the pulmonary trunk including the pulmonary valve. Six months later a left-sided pneumonectomy had to be performed due to an intravascular tumor. Fifteen months after first resection treatment, recurrent tumors of the right pulmonary artery and the right ventricle were resected. Two years after the first operation the patient has no detectable tumor.

Clinical and angiographic results after implantation of a passive-coated coronary stent in patients with acute myocardial infarction.

BACKGROUND: Key insights into the role of platelets in acute myocardial infarction (AMI) and unstable angina have led to the development of the polymer-coated stent, Camouflage(R). Coating of stents is an elegant method to minimize interactions between platelets and the stent surface and the vascular response following stent implantation. METHODS: This single-center prospective registry was performed to estimate the in-hospital, 30-day and 180-day event rate (death, revascularization, reinfarction and pathological stress test at 180 days) in an everyday patient population with AMI with immediate percutaneous coronary intervention. There were 44 males (65.7%) and 23 females (34.3%); 53 patients (79.1%) had hypertension, 11 (16.4%) were diabetic, and 32 (47.8%) had elevated LDL cholesterol. The mean age was 60.7 +/- 11.6 years. RESULTS: Sixty-seven patients with AMI (STEMI: 56.7%, NSTEMI: 43.3%) were included. Clinical data at the 30-day and 180-day follow up were available for all but 1 of the patients. Overall, there were 3 (4.5%) deaths, 1 (1.5%) death at 30 days and 2 (3.0%) at 180 days (1 cardiogenic shock 3, 1 sudden cardiac death and 1 AMI). Three (4.5%) patients experienced subacute closure of the target vessel. At 180 days, 1 (1.5%) patient had a pathological stress test and 5 patients (7.5%) underwent target vessel revascularization. CONCLUSION: The registry with this passive-coated stent showed good results in patients with AMI, consistent with earlier studies. Data are now available both for the development of hypotheses and for a data-based estimation of the number of cases for a comparative clinical study versus other coronary stents.

Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid.

PURPOSE: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance. MATERIALS AND METHODS: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases. RESULTS: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups. CONCLUSIONS: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function.

[Transpalatal approach in juvenile nasopharyngeal angiofibroma]. / Juvenil nazofarenks anjiyofibromunda transpalatal yaklasim.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) cases treated with transpalatal approach were evaluated with respect to localization, complications, intraoperative blood loss, recurrence, and prognosis. PATIENTS AND METHODS: The study included 15 male patients (mean age 13 years; range 10 to 16 years) treated for JNA. The patients were classified according to the Chandler staging system. Transpalatal surgical excision was performed in 14 patients. Preoperative embolization of the maxillary arteries was performed in three patients. One patient with intracranial extension was treated with radiotherapy. The mean follow-up was 3 years and 7 months (range 7 months to 7 years). RESULTS: Three patients (20%) had Chandler stage II, 11 patients (73%) had stage III, and one patient (7%) had stage IV disease. The mean intraoperative blood loss was 575 ml in three patients with preoperative embolization, and 1,079 ml in those without embolization. The average intraoperative transfusion requirement was 2.3 units. Recurrences developed in three patients (20%), two of whom were treated by surgery and one by radiotherapy. CONCLUSION: Transpalatal surgical approach is effective in the treatment of JNAs localized in the nasopharynx, nasal cavity, and sphenoid sinuses, with minimal mortality and morbidity.

Peritonsillar abscess: a comparison of outpatient i.m. clindamycin and inpatient i.v. ampicillin/sulbactam following needle aspiration.

In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we compared the clinical efficacy of empiric intramuscular clindamycin and intravenous ampicillin/sulbactam (following needle aspiration of the abscess) in a prospective, randomized study of 58 patients. Patients in the clindamycin group were treated on an outpatient basis, whereas those in the ampicillin/sulbactam group were hospitalized for the duration of their treatment (minimum: 7 days). Comparison of clinical outcomes with respect to the posttherapeutic duration of fever and throat pain and the time to resumption of eating revealed no statistically significant difference between the two groups. These results suggest that intramuscular clindamycin is an excellent choice and can be safely prescribed on an outpatient basis following needle aspiration, thereby reducing both antibiotic and hospital costs.

Use of steroids in the treatment of peritonsillar abscess.

Peritonsillar abscess is the most common deep infection of the head and neck that occurs in adults; the treatment of the disease remains controversial. A prospective study using a single high dose steroid treatment for peritonsillar abscess, was undertaken in 62 patients to determine the treatment's effectiveness in relieving symptoms such as fever, throat pain, dysphagia and trismus. All patients were randomly assigned to two groups: 28 patients received intravenous antibiotic therapy and a single dose placebo and 34 patients were treated with single use of high dose steroid in addition to intravenous antibiotic. Patients were hospitalized after needle aspiration and therefore their clinical courses and responses to therapy could be rigorously assessed. Comparison of clinical outcomes with respect to hours hospitalized, throat pain, fever, trismus were assessed between the two groups. Clinical outcomes revealed a statistically significant difference between the two groups (p < 0.01), indicating that single use of high dose steroid prior to antibiotic therapy is more effective than the use of an antibiotic alone. These results suggest that single intravenous use of steroid in addition to antibiotic therapy is an excellent choice for the management of peritonsillar abscess.

[Reconstruction of nasal cutaneous defects with the use of supratrochlear artery-based paramedian forehead flap]. / Nazal kutanöz defektlerin rekonstrüksiyonunda supratroklear arter bazli paramedyan alin flebi uygulamasi.

OBJECTIVES: We evaluated oncologic and functional results of paramedian forehead flap in the reconstruction of nasal cutaneous defects. PATIENTS AND METHODS: Supratrochlear artery-based paramedian forehead flap was employed in 14 patients (13 men, 1 woman; mean age 57 years; range 46 to 63 years) for the reconstruction of nasal cutaneous defects resulting from excision of squamous or basal cell carcinoma. No other treatment modalities were performed other than removal of the primary lesion. The mean follow-up was 42.4 months (range 8 to 83 months). RESULTS: None of the patients developed flap necrosis, local recurrences, or distant metastasis. Airway problems of varying extent were observed in 10 patients (71.4%), the severity of which became attenuated in time as the flap gained proper contraction. CONCLUSION: Acceptable functional and successful oncologic results can be obtained in the reconstruction with the use of paramedian forehead flap.