Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

BACKGROUND: Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established. METHODS: Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. RESULTS: Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]). CONCLUSIONS: ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.

Injection Laryngoplasty Using Autologous Fat Enriched with Adipose-Derived Regenerative Stem Cells: A Safe Therapeutic Option for the Functional Reconstruction of the Glottal Gap after Unilateral Vocal Fold Paralysis.

BACKGROUND: Paralysis of one vocal fold leads to glottal gap and vocal fold insufficiency that has significant impact upon a patient's quality of life. Fillers have been tested to perform intracordal injections, but they do not provide perdurable results. Early data suggest that enriching fat grafts with adipose-derived regenerative cells (ADRCs) promote angiogenesis and modulate the immune response, improving graft survival. The aim of this study is to propose ADRC-enriched adipose tissue grafts as effective filler for the paralyzed vocal fold to use it for functional reconstruction of the glottal gap. METHOD: This is the first phase I-IIA clinical trial (phase I/IIA clinical trial, unicentric, randomized, controlled, and two parallel groups), to evaluate the safety of a new therapy with ADRC-enriched fat grafting (ADRC: group I) for laryngoplasty after unilateral vocal fold paralysis. Control group patients received centrifuged autologous fat (CAF: group II) grafts. Overall mean age is 52.49 ± 16.60 years. Group I (ADRC): 7 patients (3 males and 4 females), 52.28 ± 20.95 year. Group II (CAF): 7 patients (3 males and 4 females), 52.71 ± 12.59 year. RESULTS: VHI-10 test showed that preoperative mean score was 24.21 ± 8.28. Postoperative mean score was 6.71 ± 6.75. Preoperative result in group I was 21.14 ± 3.58 and postoperative result was 3.14 ± 3.53. Preoperative result for group II was 27.29 ± 10.66. Postoperative score in group II was 10.29 ± 7.52. Wilcoxon and the Student t-tests showed that the patient's self-perception of posttreatment improvement is larger when ADRCs are used. Comparing pre- and posttreatment voice quality analysis, group I showed a p = 0.053. Group II showed a p = 0.007. There would be no significant differentiation between pre- and posttreatment results. This is true for group II and limited for group I. CONCLUSIONS: This prospective trial demonstrates the safety and efficacy of the treatment of glottal gap defects utilizing ADRC-enriched fat grafts. This trial is registered with NCT02904824.

Expanded Endoscopic Transclival Approach for Resection of a Chordoid Meningioma without Dural Attachment (MWODA) Located in the Prepontine Cistern.

BACKGROUND: Meningiomas without dural attachment (MWODA) located in the posterior fossa are an unfrequent entity. They are usually located in the fourth ventricle, and their occurrence outside of this anatomic structure is an even more uncommon finding. Chordoid meningiomas are a rare subtype of meningioma, and they have been reported to account for 0.5%-1% of all meningiomas. CASE DESCRIPTION: We report the unusual case of a 36-year-old female patient, with unremarkable past medical history, who presented at our institution complaining of acute binocular diplopia. Right cranial nerve VI paresis was observed on physical examination. Imaging studies revealed an intradural retroclival solid mass that enhanced homogeneously after contrast administration. Interestingly, no dural tail was present. Expanded endonasal endoscopic resection of her retroclival lesion was performed. We used a 4-hand technique with 0 and 30 degrees endoscopes, with intradural pituitary transposition. Gross total resection was achieved and the pathology report described findings consistent with chordoid meningioma. The patient is recurrence-free and in good condition at 1-year follow-up. CONCLUSIONS: We performed a thorough review of the literature, and we found 10 reported cases describing extraventricular MWODA in the posterior fossa. To our knowledge, this is the first reported case of retroclival MWODA with pathologic findings consistent with chordoid meningioma.

Coincidental pituitary adenoma and planum sphenoidale meningioma mimicking a single tumor / Adenoma hipofisario y meningioma de planum coincidentes simulando un tumor único

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