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1.
Urol Oncol ; 41(1): 49.e7-49.e12, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441069

RESUMO

BACKGROUND: Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN: This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION: Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION: Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS: To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS: Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS: We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia , Bexiga Urinária , Cistoscopia
2.
Urol Oncol ; 41(1): 48.e11-48.e18, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441068

RESUMO

INTRODUCTION: Ductal adenocarcinoma (DA) and intraductal carcinoma (IDC) of the prostate are associated with higher stage disease at radical prostatectomy (RP). We evaluated diagnostic accuracy of biopsy, MRI-visibility, and outcomes for patients undergoing RP with DA/IDC histology compared to pure acinar adenocarcinoma (AA) of the prostate. MATERIALS AND METHODS: A retrospective cohort study of men receiving RP between 2014 and 2021 revealing AA, DA, or IDC on final pathology was conducted. Multivariable logistic regression and Cox proportional hazards regression models were employed. RESULTS: A total of 609 patients were included with 103 found to have DA/IDC. Patients with DA/IDC were older and had higher PSA, biopsy grade group (GG), RP GG, and other pathologic findings (extraprostatic extension, lymphovascular invasion, perineural invasion, pN stage) compared to AA patients (all P < 0.05). On multivariable analysis, higher age, RP GG, and pT3a were associated with DA/IDC on RP (all P < 0.05). Sensitivity and specificity of biopsy compared to RP for diagnosis of DA/IDC was 29.1% (16.7% DA, 27.8% IDC) and 96.6% (99.3% DA, 96.6% IDC), respectively. In a subset of 281 men receiving MRI, PI-RADS distribution was similar for patients with DA/IDC vs. AA (90.7% vs. 80.7% with PI-RADS 4-5 lesions, P = 0.23) with slightly higher biopsy sensitivity (41.9%). DA/IDC was associated with worse BCR (HR = 1.77, P = 0.02) but not biopsy DA/IDC (P = 0.90). CONCLUSIONS: Sensitivity of prostate biopsy was low for detection of DA/IDC histology at RP. Patients with DA/IDC histology had unfavorable pathologic features at RP and worse BCR. Of patients with DA/IDC at RP, 90.7% were categorized as PI-RADS 4 to 5 on preoperative MRI.


Assuntos
Carcinoma Intraductal não Infiltrante , Neoplasias da Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/cirurgia , Imageamento por Ressonância Magnética , Incidência , Estudos Retrospectivos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia
3.
Urol Oncol ; 41(1): 51.e25-51.e31, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441070

RESUMO

BACKGROUND: Cytoreductive nephrectomy (CN) for the treatment of metastatic renal cell carcinoma (mRCC) was called into question following the publication of the CARMENA trial. While previous retrospective studies have supported CN alongside targeted therapies, there is minimal research establishing its role in conjunction with immune checkpoint inhibitor (ICI) therapy. OBJECTIVE: To evaluate the association between CN and oncological outcomes in patients with mRCC treated with immunotherapy. MATERIALS AND METHODS: A multicenter retrospective cohort study of patients diagnosed with mRCC between 2000 and 2020 who were treated at the Seattle Cancer Care Alliance and The Ohio State University and who were treated with ICI systemic therapy (ST) at any point in their disease course. Overall survival (OS) was estimated using Kaplan Meier analyses. Multivariable Cox proportional hazards models evaluated associations with mortality. RESULTS: The study cohort consisted of 367 patients (CN+ST n = 232, ST alone n = 135). Among patients undergoing CN, 30 were deferred. Median survivor follow-up was 28.4 months. ICI therapy was first-line in 28.1%, second-line in 17.4%, and third or subsequent line (3L+) in 54.5% of patients. Overall, patients who underwent CN+ST had longer median OS (56.3 months IQR 50.2-79.8) compared to the ST alone group (19.1 months IQR 12.8-23.8). Multivariable analyses demonstrated a 67% reduction in risk of all-cause mortality in patients who received CN+ST vs. ST alone (P < 0.0001). Similar results were noted when first-line ICI therapy recipients were examined as a subgroup. Upfront and deferred CN did not demonstrate significant differences in OS. CONCLUSIONS: CN was independently associated with longer OS in patients with mRCC treated with ICI in any line of therapy. Our data support consideration of CN in well selected patients with mRCC undergoing treatment with ICI.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Humanos , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução , Inibidores de Checkpoint Imunológico/farmacologia , Inibidores de Checkpoint Imunológico/uso terapêutico , Estudos Retrospectivos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Nefrectomia
4.
Cornea ; 42(1): 27-31, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35942529

RESUMO

PURPOSE: The aim of this study was to evaluate the efficacy and safety of the Yogurt technique for Descemet membrane endothelial keratoplasty (DMEK) graft preparation. METHODS: This study included patients who underwent DMEK combined or not with phacoemulsification surgery using donor tissues prepared by a surgeon with the DMEK Tzamalis disposable punch at 2 referral hospitals between October 2019 and June 2021. Primary outcomes were duration of graft preparation, surgeon grading of graft quality, and endothelial cell density measured at 1 and 6 months after surgery. Secondary outcomes were best-corrected visual acuity (BCVA) measured at 1 and 6 months postoperatively and DMEK intraoperative and postoperative complications. RESULTS: Forty-nine patients were included in this study. The mean DMEK graft preparation time was 7.2 ± 1.4 minutes. Donor grafts were rated good in 67.3% of cases (33 of 49), sufficient in 24.5% (12 of 49), and poor in 8.2% (4 of 49). Donor mean endothelial cell density was 2580 ± 155 preoperatively, which were reduced to 2269 ± 191 ( P < 0.000) and 1697 ± 142 ( P < 0.0001) at 1 and 6 months, respectively. No significant difference was found in graft preparation outcome ( P = 0.543). The preoperative BCVA was 0.65 ± 0.44 logMAR, which improved to 0.31 ± 0.43 logMAR ( P < 0.0001) and 0.12 ± 0.14 logMAR ( P < 0.0001) at 1 and 6 months after surgery, respectively. CONCLUSIONS: This study shows that the DMEK Tzamalis punch can be used as an effective and safe method for DMEK graft preparation with a shallow learning curve that allows it to be successfully performed by relatively inexperienced surgeons.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Humanos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Lâmina Limitante Posterior/cirurgia , Endotélio Corneano/transplante , Iogurte , Acuidade Visual , Contagem de Células , Estudos Retrospectivos , Distrofia Endotelial de Fuchs/cirurgia
5.
Cornea ; 42(1): 113-115, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35942525

RESUMO

PURPOSE: The purpose of this study was to report a case of corneal transparency for 7 months after the formation and persistence of a Descemet fluid cleft. METHODS: We report the case of a 64-year-old woman undergoing anterior chamber reformation 2 months after Baerveldt implantation of the right eye. During the procedure, the ophthalmic viscoelastic was inadvertently injected into the posterior stroma, nearly isolating the corneal endothelial cell layer, and creating a Descemet fluid cleft filled with viscoelastic. The patient was managed conservatively and monitored near monthly for corneal decompensation. RESULTS: The cornea remained centrally clear for 207 days after the initial anterior chamber reformation until the collapse of the viscoelastic cleft. When the cleft completely collapsed, the cornea became diffusely edematous, and the patient underwent cataract removal and intraocular lens placement without need for Descemet stripping endothelial keratoplasty to maintain vision. During these 7 months, the patient's best-corrected visual acuity remained stable at 20/25 +2 or better. Intraocular pressure was also stable, averaging 18.2 mm Hg. CONCLUSIONS: We hypothesize that corneal transparency can be maintained in the absence of endothelial cell function provided that aqueous humor cannot reach the cornea and disrupt the arrangement of the interfibrillar space.


Assuntos
Extração de Catarata , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Feminino , Humanos , Pessoa de Meia-Idade , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano/cirurgia , Acuidade Visual , Córnea
6.
Cornea ; 42(1): 105-109, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35965394

RESUMO

PURPOSE: The aim of the current research was to measure the thickness of the residual central corneal bed after performing the manual "Groove and Peel" deep anterior lamellar keratoplasty (GP-DALK) technique on human cadaveric eyes. METHODS: The manual GP-DALK technique was performed on 6 human cadaver eyes by an experienced corneal surgeon. After surgery, the eye globes were fixed in 10% buffered formalin and embedded in paraffin. For each eye, 4-µm-thick hematoxylin and eosin sections involving the pupillary axis were obtained and examined. Using an image-processing software, 2 observers measured the corneal thickness of the residual central corneal bed and the peripheral corneal rims. RESULTS: The overall mean central corneal bed thickness was 35.5 ± 12.9 µm, whereas the mean right and left peripheral rim thicknesses were 993.0 ± 141.1 and 989.3 ± 147.1 µm, respectively ( P = 0.0006 ). In most corneas, the level of dissection reached almost to the pre-Descemetic collagen (Dua) layer. CONCLUSIONS: The GP-DALK technique is effective in removing most of the corneal stroma and may be non-inferior to "big-bubble" deep anterior lamellar keratoplasty in some cases.


Assuntos
Substância Própria , Transplante de Córnea , Humanos , Substância Própria/cirurgia , Cadáver , Córnea , Membrana Celular , Progressão da Doença
7.
BJOG ; 130(1): 99-106, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36043332

RESUMO

OBJECTIVE: To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse. DESIGN: Labelled discrete choice experiment (DCE). SETTING: Eight Dutch hospitals. POPULATION: Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation. METHODS: DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models. MAIN OUTCOME MEASURES: Women's preference for MM or SH. RESULTS: 137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making. CONCLUSIONS: The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.


Assuntos
Dispareunia , Prolapso Uterino , Feminino , Humanos , Prolapso Uterino/cirurgia , Preferência do Paciente , Dispareunia/etiologia , Útero/cirurgia , Inquéritos e Questionários , Resultado do Tratamento , Comportamento de Escolha
8.
BJOG ; 130(1): 107-113, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36053874

RESUMO

OBJECTIVE: Long-term data regarding risks associated with tension-free vaginal tapes (TVT) are sparse, and where available are limited to small numbers. We analyse patient-reported outcomes of TVT after 16-24 years. DESIGN: Prospective observational study. SETTING: Single-centre study in a tertiary referral urogynaecology unit. POPULATION: A cohort of 350 women who had a TVT inserted between 1999 and 2004, in which 96% had urodynamically proven stress incontinence. METHODS: Postal questionnaire survey using the International Consultation on Incontinence Questionnaire, a visual analogue scale and a yes/no question as to whether they would have the procedure again. MAIN OUTCOME MEASURES: The primary outcome was cure of stress urinary incontinence, which was assessed using the ICIQ-FLUTS questionnaire. Secondary outcomes included overactive bladder symptoms, pain, sexual dysfunction, and patient satisfaction with the procedure. RESULTS: A total of 183/350 (52%) responses were received. The median age of women at follow up was 67 years (range 53-93 years) and the median follow up was 20 years (17-24 years). Stress urinary incontinence was denied by 39.3% of women. Urgency was reported by 42.1%. Bladder pain was reported either 'never' or 'occasionally' by 92.3% of women. The median satisfaction rate was 98/100 and 92.4% said they would have the TVT procedure again. CONCLUSIONS: Tension-free vaginal tape has high levels of satisfaction and cure up to 24 years after placement. Pain was uncommon and its impact on quality of life was low. Symptoms of urgency were prevalent but may be related to age. TVT is an effective treatment for SUI more than 20 years after initial placement.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Urológicos/métodos , Resultado do Tratamento , Dor , Seguimentos
9.
BJOG ; 130(1): 42-50, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36054504

RESUMO

OBJECTIVE: To assess whether preoperative ultrasound imaging and intraoperative features predict surgical outcomes in patients at high risk for placenta accreta spectrum (PAS). DESIGN: Cohort study. SETTING: Cairo University Maternity, Egypt. POPULATION OR SAMPLE: Pregnant patients with one or more prior caesarean deliveries presenting with a low-lying/placenta praevia with or without PAS confirmed by histopathology. METHODS: Logistic regression and multivariable analyses. MAIN OUTCOMES MEASURES: Need for primary caesarean hysterectomy, numbers of red blood cell (RBC) units transfused and patients requiring transfusion of >5 units. RESULTS: Ninety consecutive records were reviewed, including 58 (64.4%) PAS cases. Sixty (66.7%, 95% confidence interval (CI) 56-76) required hysterectomy. Odds of hysterectomy were significantly (p = 0.005) increased with complete praevia. Significantly higher odds of hysterectomy were associated with subplacental hypervascularity (7.23, 95% CI 2.72-19.2, p < 0.001), lacunar scores 2+ and 3+ (12.6, 95% CI 4.15-38.5, p < 0.001), lacunar feeder vessels (5.69, 95% CI 1.77-18.3, p = 0.004) or bridging vessels (2.00, 95% CI 1.29-3.10, p = 0.002) on ultrasound, and increased lower segment vascularization at laparotomy (5.42, 95% CI 2.09-14.1, p = 0.001). Transfusion >5 RBC units was associated with number of lacunae (odds ratio [OR] 1.48, 95% CI 1.14-1.93, p = 0.004) and presence of feeder vessels (OR 1.62, 95% CI 1.24-2.11, p = 0.001). The multivariable analysis indicated that parity, placental location and PAS were significantly (p = 0.007; p = 0.01; p < 0.001, respectively) associated with hysterectomy. CONCLUSIONS: Preoperative ultrasound imaging can assist in triaging and counselling patients regarding the odds of PAS, intraoperative blood losses and need for hysterectomy, and intraoperative features can assist the surgeon in evaluating the need for multidisciplinary support.


Assuntos
Placenta Acreta , Placenta Prévia , Humanos , Feminino , Gravidez , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/cirurgia , Placenta Acreta/epidemiologia , Estudos de Coortes , Placenta/patologia , Histerectomia/métodos , Ultrassonografia , Resultado do Tratamento , Estudos Retrospectivos , Placenta Prévia/cirurgia
10.
Am J Otolaryngol ; 44(1): 103649, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36257231

RESUMO

PURPOSE: Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD), intrinsic asthma, eosinophilic granulomatosis with polyangiitis (EGPA) and odontogenic sinusitis may be associated with nasal polyps. The aim of the study was to compare circulating inflammatory cells and structural histopathology of these groups of nasal polyposis. METHODS: We retrospectively evaluated 71 patients with nasal polyps stratified according to the above-mentioned pathogenesis. All patients underwent preoperative laboratory investigations and primary endoscopic sinus surgery. Surgical specimens were submitted to structured histopathological evaluation. RESULTS: The median tissue eosinophil count (cells/HPF) was significantly different between the considered groups of nasal polyposis (p=0.0004). The median of NERD sub-cohort was significantly higher than intrinsic asthma (p=0.0030), odontogenic CRS (p=0.0001) and EGPA ones (p=0.0094). Eosinophilic aggregates positive rate was significantly higher in NERD sub-cohort than in odontogenic CRS (p=0.0072), EGPA (p=0.0497) and asthma (p=0.0188) ones. EGPA sub-cohort had a higher neutrophil infiltrate positive rate than NERD (p=0.0105) and intrinsic asthma ones (p=0.0040). Odontogenic CRS sub-cohort had a higher neutrophil infiltrate positive rate than NERD (p=0.0140) and asthma ones (p=0.0096). EGPA sub-cohort had a higher presence of fibrosis than NERD (p=0.0237) and odontogenic CRS sub-cohort (p=0.0107). Odontogenic sub-cohort had a lower sub-epithelial edema positive rate than NERD (p=0.0028) and asthma (p=0.0149) ones. CONCLUSIONS: Structural histopathology may identify nasal polyps histotypes with different morphological patterns. The identified histopathological features can facilitate the recognition of rational therapeutic and follow-up approaches that consider the tissue modifications associated with the response to drugs and surgery.


Assuntos
Asma , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Pólipos Nasais , Rinite , Humanos , Pólipos Nasais/complicações , Rinite/cirurgia , Síndrome de Churg-Strauss/complicações , Estudos Retrospectivos , Doença Crônica , Asma/complicações
11.
Am J Cardiol ; 186: 163-169, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36273954

RESUMO

Conventional exercise therapy including aerobic and resistance training is desirable for cardiovascular disease, whereas it is generally considered contraindicated for symptomatic severe aortic valve stenosis (AS). This study aimed to evaluate the safety and efficacy of bodyweight resistance exercise training (BRET), which is low-intensity exercise training in symptomatic patients with severe AS. A BRET program consisting of 8 exercises was performed 3 times a week by patients with AS with physical therapists. For the 78 symptomatic patients with severe AS, the median aortic valve area and mean transaortic valve pressure gradient were 0.56 cm2 and 48.9 mm Hg, respectively; none showed any harmful changes in blood pressure or heart rate in 11 sessions of the BRET program. There were no adverse events during hospitalization. Meanwhile, Barthel's Index score significantly improved at the time of hospital discharge. In conclusion, the BRET program in this study did not appear to cause harmful changes in hemodynamics during the program or adverse events during hospitalization, and it improved activities of daily living in symptomatic patients with severe AS, allowing doctors and physical therapists to conduct it safely, with less emotional stress, for cardiac rehabilitation for such patients.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Humanos , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Atividades Cotidianas , Índice de Gravidade de Doença , Resultado do Tratamento , Fatores de Risco , Hemodinâmica , Exercício Físico
12.
Am J Otolaryngol ; 44(1): 103676, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36279829

RESUMO

PURPOSE: Patients with thyroid goiters and compressive symptoms are treated with surgery. The adequate extent of this surgery for these cases remains unclear. In the current study, we analyze the effect of surgery, total thyroidectomy versus hemithyroidectomy, on the resolution of various compressive symptoms. MATERIALS AND METHODS: This retrospective analysis utilized the TriNetX Research Network to recognize adults with thyroid goiters treated surgically. International Classification of Diseases 10 (ICD10) was used to identify patients. Two groups were created based on surgical treatment, for either a hemithyroidectomy or total thyroidectomy. The primary outcomes were compression symptoms, including dysphagia, choking/globus sensation, dyspnea, cough, and hoarseness/dysphonia. RESULTS: This retrospective review included 45,539 subjects. Of these, 9293 had a partial thyroidectomy, and 36,246 had a total thyroidectomy. After propensity score matching was done for compression symptoms before surgery, there were 8280 patients in each group. There were no differences in symptoms between the matched groups, except for increased hoarseness and dysphonia after total thyroidectomy (RR, 95 % CI) (0.781, 0.67-0.91). Compression symptoms significantly decreased after surgical treatment in both the hemithyroidectomy and total thyroidectomy groups. CONCLUSIONS: Hemithyroidectomy is associated with efficacy similar to total thyroidectomy in reducing compression symptoms postoperatively. Hemithyroidectomy may be able to alleviate compressive symptoms with less surgical risk.


Assuntos
Disfonia , Bócio , Neoplasias da Glândula Tireoide , Adulto , Humanos , Tireoidectomia/efeitos adversos , Estudos Retrospectivos , Rouquidão/etiologia , Rouquidão/cirurgia , Bócio/complicações , Bócio/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações
13.
Am J Otolaryngol ; 44(1): 103672, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36279830

RESUMO

PURPOSE: Clinical examinations following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) are critical for physicians to assess results of the intervention and to early identify recurrences. However, no clear consensus on the frequency and timing of clinical examinations following surgery exists. The aim of this study was to analyze CRSwNP recurrences after FESS with a specific focus on the adherence to follow-up examinations. MATERIALS AND METHODS: Sixty patients who underwent FESS for CRSwNP were enrolled. Clinical parameters were recorded. Adherence to follow-up examinations with nasal fiber optic endoscopy and regular administration of nasal steroids were analyzed. RESULTS: Adherence to periodic clinical examinations and regular treatment with nasal steroids was 25 %. CRSwNP recurrence was observed in 56.7 % of cases at the last follow-up examination. No statistically significant difference concerning nasal symptoms was observed between patients with and without current recurrence (p > 0.05). Subjects who underwent regular examinations and prompt treatment of small recurrences had a lower probability of relapse at their last examination (7.7 % versus 38.2 %, respectively; p < 0.001). Polyp grade > 2 in patients with or without adherence were seen in 15.4 % and 42.9 % of cases, respectively (p < 0.05). CONCLUSIONS: Adherence to follow-up examinations with nasal optic fiber endoscopy is crucial to early identify recurrence after surgery and promptly treat it with medical therapy.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Rinite/complicações , Rinite/diagnóstico , Rinite/cirurgia , Seguimentos , Sinusite/complicações , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Endoscopia/métodos , Doença Crônica , Esteroides/uso terapêutico
14.
Am J Cardiol ; 186: 156-162, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36280473

RESUMO

The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84-13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.


Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Humanos , Albuminúria/epidemiologia , Albuminúria/urina , Creatinina/urina , Estudos Retrospectivos , Prognóstico , Proteinúria/cirurgia , Proteinúria/urina , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Resultado do Tratamento , Fatores de Risco
15.
Am J Otolaryngol ; 44(1): 103671, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36283162

RESUMO

OBJECTIVE: To evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence. DESIGN: Thirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session. RESULTS: Post-operatively, there were significant reduction in AHI (86.03 ± 20.5 vs. 54.65 ± 16.6 p < 0.001), arousal index (71.14 ± 17.7 vs. 35.90 ± 11.8 p < 0.001), and CPAP Pressure (17.13 ± 1.7 vs. 10.97 ± 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 ± 0.2 vs. 75 ± 0.1 p < 0.001), and CPAP using time in hours (1.57 ± 0.56 vs. 3.75 ± 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia. CONCLUSION AND RELEVANCE: Upper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Anestesia Local , Apneia Obstrutiva do Sono/cirurgia , Cooperação do Paciente , Dor
16.
Am J Otolaryngol ; 44(1): 103675, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36302326

RESUMO

OBJECTIVES: To describe the palliative care consultation practices in an academic head and neck surgery practice. METHODS: This is a retrospective review of a palliative care database and the health record for all palliative care consultations of patients suffering from advanced stage head and neck cancer within a 21-month period. RESULTS: Ten head and neck cancer patients received palliative care consults while on the otolaryngology service. One consultation occurred preoperatively; nine occurred postoperatively, on a median of hospital day 9. At the time of referral, seven patients were in the ICU and three were on a surgical floor. Code status de-escalation occurred in six patients and psycho-socio-spiritual suffering was supported in all consultations. Nine patients died within six months, with a median post-consultation survival of 35 days. Of these, two died in an ICU, five were discharged to hospice, one to a SNF, and one to a LTACH. CONCLUSION: Palliative care consultation in this advanced head and neck cancer cohort was commonly late, however, significant suffering was mitigated following most consults. Palliative care specialists are experts at eliciting patient values, determining acceptable tradeoffs and suffering limitations by employing a shared decision-making process that ends with a patient-centered value-congruent treatment recommendation. Oftentimes, this embraces curative-intent or palliative surgery, along with contingency plans for unacceptable value-incongruent postoperative outcomes. Enhanced awareness of the benefits of embracing concordant palliative care in advanced head and neck cancer patients may help overcome the significant barriers to involving palliative care experts earlier.


Assuntos
Neoplasias de Cabeça e Pescoço , Cuidados Paliativos na Terminalidade da Vida , Humanos , Cuidados Paliativos , Neoplasias de Cabeça e Pescoço/cirurgia , Encaminhamento e Consulta , Estudos Retrospectivos
17.
Am J Otolaryngol ; 44(1): 103686, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36306707

RESUMO

OBJECTIVE: The aim of the present article is to describe step by step the endoscopic stapler-assisted Zenker's diverticulotomy (ESD) and to show in details pre- and post-operative management. STUDY DESIGN: Case study with instructional video. SETTING: Department Of Otolaryngology, San Bortolo Hospital of Vicenza. BACKGROUND: Several comparable surgical approaches have been proposed for the treatment of hypopharyngeal Zenker's diverticulum, however determining the best operative facility in terms of safety, outcomes and hospital stay is still a matter of debate. In this scenario the endoscopic treatment of Zenker's diverticulum using the stapler device permits simultaneous sectioning and suturing of the septum between the pouch and esophagus, creating a more functional common cavity. METHODS: We here present a step by step description of an endoscopic treatment of Zenker's diverticulum using the stapler device. Common referral symptoms are persistent hoarseness and globus sensation associated with transient dysphagia. An endoscopic dynamic examination of upper airway may reveal the presence of a hypopharyngeal pouch, which should be confirmed by a fluoroscopic barium esophageal radiography. If a Zenker's diverticulum is diagnosed, an endoscopic single or multiple diverticulotomy with a stapler device is indicated. The patient may be discharged after 24-48 h without any dietary restrictions, once a post-operative esophageal radiography rules out any sort of perforation. CONCLUSION: It is of relevance to precisely know the Endoscopic Stapler-assisted Zenker's Diverticulotomy as it represents a safe and efficient procedure and ensures good outcomes with the benefit of being performed even on a planned 24-hour-stay basis.


Assuntos
Divertículo de Zenker , Humanos , Divertículo de Zenker/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Endoscopia , Esôfago , Esofagoscopia
18.
Am J Cardiol ; 186: 176-180, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36319504

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiovascular events. Although the association between NAFLD and aortic valve sclerosis has been described, the prevalence and prognostic implications of NAFLD among patients with severe aortic stenosis (AS) have not been described. In addition, the effect of the presence of severe tricuspid regurgitation (TR) on the prevalence of NAFLD remains unexplored. Accordingly, we investigated the prognostic implications of NAFLD among patients with severe AS with and without concomitant significant TR. A total of 538 patients (aged 80 ± 7 y, 49.6% men) who underwent noncontrast computed tomography before transcatheter aortic valve implantation (TAVI) between 2007 and 2019 were included. NAFLD was defined as a liver-to-spleen attenuation ratio <1.0 on noncontrast computed tomography. NAFLD was present in 118 patients (21.9%). There were no significant differences in pulmonary arterial pressure, right atrial pressure, or the prevalence of significant TR between patients with and without NAFLD. During a median follow-up of 47 months (interquartile range 20 to 70 months), 224 patients (41.6%) died. Univariate Cox regression analysis demonstrated that NAFLD was not significantly associated with all-cause death among patients treated with TAVI (hazard ratio 1.32, 95% confidential interval 0.97 to 1.79, p = 0.07). In conclusion, among patients with severe AS who underwent TAVI, the prevalence of significant TR and the clinical outcomes were similar in patients with and without NAFLD.


Assuntos
Estenose da Valva Aórtica , Hepatopatia Gordurosa não Alcoólica , Substituição da Valva Aórtica Transcateter , Insuficiência da Valva Tricúspide , Masculino , Humanos , Feminino , Substituição da Valva Aórtica Transcateter/métodos , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Prognóstico , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Fatores de Risco
19.
Am J Otolaryngol ; 44(1): 103668, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36323158

RESUMO

AIM: To report the experience of an image-guided and navigation-based robot arm as an assistive surgical tool for cochlear implantation in a case with a labyrinthitis ossificans. PATIENT: A 55-years-old man with a history of childhood meningitis whose hearing deteriorated progressively to bilateral profound sensorineural hearing loss. INTERVENTION: Robotic Assisted Cochlear Implant Surgery (RACIS) with a straight flexible lateral wall electrode. PRIMARY OUTCOME MEASURES: Electrode cochlear insertion depth with RACIS with facial recess approach and autonomous inner ear access with full electrode insertion of a flexible straight cochlear implant array. CONCLUSIONS: Intra cochlear ossifications pose a challenge for entering the cochlea and full-length insertion of a cochlear implant. RACIS has shown that computations of radiological images combined with navigation-assisted robot arm drilling can provide efficient access to the inner ear.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva Neurossensorial , Meningite , Procedimentos Cirúrgicos Robóticos , Robótica , Masculino , Humanos , Pessoa de Meia-Idade , Implante Coclear/métodos , Osteogênese , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/cirurgia , Perda Auditiva Bilateral/cirurgia , Meningite/cirurgia
20.
Am J Otolaryngol ; 44(1): 103677, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36323159

RESUMO

OBJECTIVE: Maxillomandibular advancement (MMA) surgery is considered a highly successful treatment for obstructive sleep apnea (OSA). Various modifications to the technique have been described. We aim to study the long-term results in Asian patients who underwent a modified MMA procedure intended to avoid bimaxillary protrusion and which involved four-quadrant bicuspid extractions with posterior maxillary alveolar setback. METHOD: A review of operative logs from 2000 to 2003 was conducted to identify Asian patients who underwent modified MMA during that period, for treatment of moderate and severe OSA. Sleep indices and psychometric performances were prospectively analyzed. RESULTS: Eight Asian patients were included. The mean length of follow-up was 14.4 years (range: 13.0-16.5). Mean preoperative apnea-hypopnea index (AHI) was 48.9 (range: 19.0 to 84.8). Mean post-operative AHI was 31.6 (range: 6.2 to 79.5). This reduction was statistically significant (p<0.05). Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire (FOSQ) revealed that majority of the patients (75%) did not have excessive daytime somnolence and all patients had high FOSQ totalled scores (mean 17.7, range 11.8 to 20), indicating good functional performance. CONCLUSION: This series is the longest follow-up of an Asian cohort who underwent modified MMA. With a mean follow-up of 14.4 years, improvement in AHI is still observed but not at a degree as large as prior studies with shorter lengths of follow-up. The purported efficacy of MMA for Caucasian patients may not be reproducible in Asian patients and long-term sustainability of this treatment's efficacy requires rigorous evaluation.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Humanos , Avanço Mandibular/métodos , Resultado do Tratamento , Apneia Obstrutiva do Sono/cirurgia , Maxila/cirurgia , Sono
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