Endoscopic tympanoplasty with post-conchal perichondrium in repairing large-sized eardrum perforations.

PURPOSE: This study aimed to compare the outcomes of endoscopic tympanoplasty with post-conchal perichondrium (PCP) and microscopic tympanoplasty with temporalis fascia in repairing large-sized eardrum perforations. METHODS: We performed a retrospective chart review of 43 patients who underwent type 1 tympanoplasty for simple large-sized perforations. The patients were divided into two groups: Group I (endoscopic ear surgery with a PCP graft, 22 patients) and Group II (microscopic ear surgery with temporalis fascia, 21 patients). Graft success rate, demographic data, pre- and postoperative pure-tone average and word-recognition score, closure of the air - bone gap, and postoperative pain scale scores were compared between the two groups. RESULTS: The graft success rates in groups I and II were 86.3% and 85.7%, respectively. The mean operation time in Group I (79.8 ± 16.5 min) was significantly shorter than that in Group II (99.9 ± 26.7 min) (p = 0.006). Both groups showed significant improvements in the pure-tone average and word-recognition scores. Average closure of the air - bone gap (ABG) in groups I and II was 20.7 ± 6.9 dB and 17.6 ± 8.4 dB, respectively. The reduction in ABG in Group I had a significantly higher magnitude than in Group II at 1000 and 2000 Hz, respectively (p = 0.028 and p = 0.017). The two groups showed no significant difference in postoperative pain scores. CONCLUSION: Endoscopic tympanoplasty with PCP showed a reliable, fascia-preserved, and excellent outcome in repairing large-sized perforations.

Impact of kidney size on the outcome of diabetic patients receiving hemodialysis.

INTRODUCTION: Diabetic patients normally have enlarged or normal-sized kidneys throughout their lifetime, but some diabetic uremic patients have small kidneys. It is uncertain if kidney size could have any negative impact on outcome in hemodialysis patients. METHODS: This longitudinal, observational cohort study recruited 301 diabetic hemodialysis patients in 2015, and followed until 2019. Patients were stratified into two subgroups according to their kidney sizes before dialysis, as small (n = 32) or enlarged or normal (n = 269). Baseline demographic, hematological, biochemical, nutritional, inflammatory and dialysis related data were collected for analysis. RESULTS: Patients with small kidney size were not only older (P<0.001) and had lower body mass index (P = 0.016), but had also higher blood uric acid concentration (P<0.001) compared with patients with enlarged or normal kidney size. All patients received adequate doses of hemodialysis since the Kt/V and urea reduction ratio was 1.7±0.3 and 0.7±0.1, respectively. Patients with small size kidneys received higher erythropoietin dose than patients with enlarged or normal kidney size (P = 0.031). At the end of analysis, 92 (30.6%) patients expired. Kaplan-Meier analysis revealed no survival difference between both groups (P = 0.753). In a multivariate logistic regression model, it was demonstrated that age (P<0.001), dialysis duration (P<0.001), as well as blood albumin (P = 0.012) and low-density lipoprotein (P = 0.009) concentrations were significantly correlated with mortality. CONCLUSIONS: Small kidney size on starting hemodialysis was not related with an augmented risk for death in diabetic patients receiving hemodialysis. Further studies are necessary.