Tips and Tricks in Endoscopic Frontal Sinus

Endoscopic sinus surgery (ESS) failure and frontal ostium (FO) stenosis are commonly due to inadequate or incomplete removal of ethmoid cells. Residual cells may be found in 10-96% of cases of revision sinus surgery. Furthermore, the frontal sinus outflow tract is the region where disease recurrence is most likely to occur. Frontal sinusotomy represents a risk to residual or newly created disease due to scarring, osteoneogenesis, middle turbinate or amputated superoanterior stump lateralization. Intraorbital or intracranial violation and anterior ethmoid artery injury are possible complications in this region. Exposure is crucial and it may be obtained by the punch-out procedure (Metson). The first step is the identification of the uppermost attachment of the uncinate process (the “vertical bar” of Stamm). Removing the dome of the terminal recess, the agger nasi cell, in most cases, provides surgeons with a clear view of the frontal ostium and, therefore, according to Wormald, it plays the key role in endoscopic frontal sinusotomy. The frontal cells, type 1, 2 and 3, according to Kuhn, or SAC, SAFC, SBC, SBFC according to the new terminology, are less commonly encountered. The intact bulla technique allows following the natural sinus outflow tract and, at the same time, it reduces the risk of injuring the anterior ethmoid artery (AEA). Pneumatized ethmoid bulla or SBFC, when contacted, anteriorly, the dome of the terminal recess, can extremely narrow the outflow tract and obstacle dissection. In these cases, the ethmoid bulla should be partially resected while leaving the superior attachment to the skull base before identifying the frontal ostium. The AEA is mostly located between the second and third lamella, posterior to the superior attachment of the bulla lamella and constitutes an optimal landmark. The evidence guiding the selection of patients who may benefit from more aggressive surgery is lacking. A type I-II drainage procedure (Draf) is recommended in the frontal sinuses with a large A–P diameter. The correct interpretation of the CT and preop rebuilding the 3D anatomy are mandatory in frontal sinusotomy, allowing to identify step by step the anatomic landmarks. It is important to use cutting instruments and not to grasp and pull out, and the anatomy must be followed, the anatomical route predesigned by nature (Stammberger)

Breakthrough Cancer Pain in Patients With Abdominal Visceral Cancer Pain

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Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.

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Orphan symptoms in advanced cancer patients followed at home.

Abstract Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected. Myoclonus, hiccup, sweating, pruritus, and tenesmus, either rectal or vesical, were assessed, according to a preliminary definition, at time of home care program admission. Three hundred sixty-two patients were surveyed at the three home care programs. Globally, 48 patients presented one or more orphan symptoms in the period taken into consideration, and 7 patients presented more than 1 symptom. One patient presented occasional and diffuse myoclonus. Nineteen patients presented sweating, 13 patients presented pruritus, and 14 patients presented hiccup. Finally, nine patients presented rectal or vesical tenesmus. There was a significant correlation between sweating and transdermal fentanyl use (P = 0.044), fever (P = 0.001), hiccup (P < 0.0005), and vesical tenesmus (P = 0.028). Pruritus was not associated to any factor. Hiccup was associated with gender (males, P = 0.006) and sweating (P < 0.0005). Vesical tenesmus was associated with fever (P = 0.019) and sweating (P = 0.028). Although the symptoms examined have a low prevalence in advanced cancer patients admitted to home care, the distress for patients may be high and deserve further analyses. Given the low prevalence of these symptoms, large studies are needed to find possible associated factors

Physical Exercise and Quality of Life in Breast Cancer Survivors

An important goal for cancer patients is to improve the quality of life (QOL) by maximising functions affected by the disease and its therapy. Preliminary research suggests that exercise may be an effective intervention for enhancing QOL in cancer survivors. Research has provided preliminary evidence for the safety, feasibility, and efficacy of exercise training in breast cancer survivors. The aim of this study was to assess the association between physical exercise and quality of life in a population of female breast cancer survivors, followed up from diagnosis to the off-treatment time period, and investigated about their exercise habits in pre-diagnosis

Personalized Pain Goals and Responses in Advanced Cancer Patients

To assess the personalized pain intensity goal (PPIG), the achievement of a personalized pain goal response (PPGR), and patients' global impression (PGI) in advanced cancer patients after a comprehensive pain and symptom management

The effects of low doses of pregabalin on morphine analgesia in advanced cancer patients

Abstract OBJECTIVES: The aim of this study was to evaluate the opioid response in patients receiving morphine and pregabalin, independently from the presumed pain mechanisms, in comparison with patients receiving morphine treatment only. METHODS: A multicenter prospective randomized controlled study was carried out in a sample of 70 advanced cancer patients with pain requiring strong opioids. Thirty-five patients (group MO) were randomized to receive sustained-release morphine using initial doses of 60 mg/day. Thirty-five patients (group MO-PR) were randomized to start the same morphine doses and pregabalin in increasing doses, starting with 25 mg/day up to 150 mg/day in one week. The following data were also recorded before starting the treatments (T0) and then at week intervals for four weeks (W1-4): age, gender, primary cancer and known metastases, pain causes and mechanisms, symptoms associated with opioid therapy, pain intensity, Brief Pain Inventory (BPI), morphine doses and escalation indexes (OEIs), and quality of life. RESULTS: Forty-eight patients completed the study, twenty-eight and sixteen patients in group MO and MO-PR, respectively. Twenty patients were females, the mean age was 65.5 (± 10.3), and the mean Karnofsky status was 66.0 (± 18.9). No differences between groups were found in age (P = 0.839), Karnofsky status (P = 0.741), opioid doses as well as escalation indexes (OEI mg, P = 0.260, and OEI%, P = 0.270). No differences between the two groups were found in quality of life and all BPI items. CONCLUSION: The use of low doses of pregabalin added to morphine therapy in advanced cancer patients does not seem to provide advantageous analgesic effects, despite limitations of the present study due to the number of drop-outs

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements