Exclusive surgical treatment for vestibular schwannoma regrowth or recurrence: A meta-analysis of the literature

Vestibular schwannomas can be treated in different ways, but for symptomatic or growing tumors, the gold standard is surgical removal of the lesion. In order to preserve neurovascular structures, partial removal is often performed, leaving a residual that may grow in subsequent years. To date, there is no consensus with regard to surgical treatment of vestibular schwannoma residuals, and so this review focuses on this topic. A structured search was performed on PubMed searching for all articles discussing vestibular schwannoma residuals and recurrences. Only articles discussing surgical treatment were included, focusing on studies which also examined facial nerve outcomes. A total of 51 articles were eligible for review and these included 375 patients. Statistical analysis was performed by correlating the following parameters: patients' gender and age at first surgery, surgical approach adopted at first and subsequent surgeries, tumor and residual size, and extent of resection (gross total, near total, subtotal or others) at first and subsequent surgical procedures. Facial nerve function was also analyzed focusing on its performance when correlated with the different surgical approaches. The data were analyzed by linear regression but there were no correlations between any of the parameters chosen. There was a statistically significant difference between the first approach used (mainly the retrosigmoid route) compared with subsequent approaches (mainly the translabyrinthine route). In total, 8.5 % of patients needed further treatment due to residual regrowth. Facial nerve outcome was independent of the parameters chosen. Exclusive surgical treatment for vestibular schwannoma residuals had a very low failure rate in terms of requiring further treatment. The approach usually chosen for second surgery was the translabyrinthine technique, and this may be explained by the location of the residual, rather than its size. The choice of a particular surgical approach rather than another had no influence on facial nerve function. Complications rates are comparable to Gamma Knife Radiosurgery's as reported in the literature

Le lesioni esofago-gastriche da caustici

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En «nasjonal skandale»?: En multimodal kritisk diskursanalyse av alternative mediers dekning av «pistolklubbsaken»

Denne masteravhandlingen er en studie av «pistolklubbsaken,» en nyhetssak som oppsto 01. februar 2019, da det ble kjent at Kvinesdal pistolklubb hadde medlemmer med flyktningbakgrunn, og at medlemskontingenten til ei 16 år gammel jente fra Syria hadde blitt betalt av NAV som et «folkehelse- og integreringstiltak.» Lokalavisa Agder Flekkefjords Tidende, NRK og NTB publiserte artikler om saken, men den mest omfattende og kritiske dekningen av saken sto de såkalt «alternative mediene» Resett, Human Rights Service, og til dels Document, for. Prosjektet utgjør en multimodal kritisk diskursanalyse av de alternative medienes dekning av saken. Datamaterialet består av 13 nyhetsartikler, samt 15 tilknyttede Facebook innlegg forfattet av mediene selv, eller deres redaktører. Gjennom en nærlesing av tekst, bilde og retoriske virkemidler, utforsker jeg hvilken alternativ virkelighet disse mediene ønsker å overbevise sitt publikum om. Oppgavens hovedfunn er at Resett, Human Rights Service og til dels Document har konstruert saken som en «nasjonal skandale» i sin dekning, og utnyttet pistolklubbsaken for å fremme mothegemoniske narrativer om innvandring- og integreringspolitikk, og kontekstualisert saken gjennom avmakt-, frykt- og trusseldiskurser.This master's thesis is a study of the «gun club case,» a current events controversy which arose on 1 February 2019, when it became known that Kvinesdal Gun Club had members with a refugee background and that a 16-year-old Syrian girl’s membership fee had been paid by NAV as a "public health and integration initiative." The local newspaper Agder Flekkefjords Tidende, as well as NRK and NTB, all published articles about the case, though the most comprehensive and critical coverage was provided by the so-called “alternative media” Resett, Human Rights Service, and to some extent Document. This master’s project entails a multimodal critical discourse analysis of the alternative media's coverage of the case. The data consists of 13 articles, as well as 15 associated Facebook posts published by the media themselves, or their editors. Through a close reading of text, images, and rhetorical devices, I explore which alternative reality the alternative media want to convince us of. The main findings of the thesis are that Resett, Human Rights Service and to some extent Document, have constructed “a national scandal” in their coverage, used the gun club case to promote counter-hegemonic narratives about immigration and integration, and sought to contextualize the case through discourses of powerlessness, fear and threat.publishedVersio

Non-vascular interventional procedures: effective dose to patient and equivalent dose to abdominal organs by means of dicom images and Monte Carlo simulation

This study evaluates X-ray exposure in patient undergoing abdominal extra-vascular interventional procedures by means of Digital Imaging and COmmunications in Medicine (DICOM) image headers and Monte Carlo simulation. The main aim was to assess the effective and equivalent doses, under the hypothesis of their correlation with the dose area product (DAP) measured during each examination. This allows to collect dosimetric information about each patient and to evaluate associated risks without resorting to in vivo dosimetry. The dose calculation was performed in 79 procedures through the Monte Carlo simulator PCXMC (A PC-based Monte Carlo program for calculating patient doses in medical X-ray examinations), by using the real geometrical and dosimetric irradiation conditions, automatically extracted from DICOM headers. The DAP measurements were also validated by using thermoluminescent dosimeters on an anthropomorphic phantom. The expected linear correlation between effective doses and DAP was confirmed with an R(2) of 0.974. Moreover, in order to easily calculate patient doses, conversion coefficients that relate equivalent doses to measurable quantities, such as DAP, were obtained

La correzione chirurgica delle malformazioni congenite della parete toracica anteriore

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Leiomyosarcoma of the Larynx: A Complex Diagnosis

An 84-year-old man was referred to our institution for dysphonia present for 2 months. Fiberoptic laryngoscopy demonstrated a polypoid lesion of the right true vocal fold with normal motility. Excisional biopsy of a submucosal thickening of the right vocal fold with vocal ligament calcification was performed. Histology revealed squamous cell epithelium without malignancy. Postoperative endoscopic follow-up was regular. Six months after surgery, dysphonia and dyspnea occurred. Flexible laryngoscopy demonstrated right hemilaryngeal paralysis, edema, and partial airway obstruction. Necrotic tissue and purulent secretions were visible at the anterior commissure, right vocal fold, and ipsilateral vestibule. A second microlaryngoscopic surgery included multiple biopsies and debridement of the necrotic tissue. Histological report was negative for malignancy, and purulent chondritis was diagnosed. Intravenous antibiotic therapy was administered with improvement of infection, inflammation, dysphonia, and dyspnea. The patient was discharged

Proposal of a timing strategy for cholesteatoma surgery during the COVID-19 pandemic.

The COVID-19 infection is an aggressive viral illness with high risk of transmission during otolaryngology examination and surgery. Cholesteatoma is known for its potential to cause complications and scheduling of surgery during the pandemic must be done carefully. The majority of otological surgeries may be classified as elective and postponed at this time (e.g., stapedotomy, tympanoplasty); whereas, others are emergencies (e.g., complicated acute otitis media, complicated cholesteatoma with cerebral or Bezold's abscess, meningitis, sinus thrombosis) and require immediate intervention. What is the ideal time for the surgical management of Cholesteatoma during the COVID-19 pandemic? Senior otologic surgeons from six teaching hospitals from various countries affected by the COVID-19 from around the world met remotely to make recommendations on reorganizing schedules for the treatment of cholesteatoma which has a risk of severe morbidity and mortality. The recommendations are based on their experiences and on available literature. Due to the high risk of infecting the surgical staff it is prudent to stop all elective ear surgeries and plan cholesteatoma surgery after careful selection of patients, based on the extent of the disease and available resources. Specific precautions including use of appropriate personal protection equipment should be followed when operating on all patients during the pandemic. To facilitate the decision-making in the management of cholesteatoma, timing for surgery can be divided into two categories with 3 and 2 sub-groups based on disease severity. Evidence on the timing of surgery of patients with cholesteatoma during the COVID-19 pandemic is lacking. This manuscript contains practical tips on how cholesteatoma surgery can be reorganized during this pandemic

A drug safety evaluation of abiraterone acetate in the treatment of prostate cancer

Introduction: To evaluate the safety profile characteristics of abiraterone acetate (AA) in the treatment of metastatic prostate cancer (mPCa). Areas covered: In this literature review the authors evaluate safety data from phase III trials investigating the combination of abiraterone acetate plus prednisone (AAP) in patients with metastatic prostate cancer. In particular, the aim was to clarify its toxicity profile, long-term exposure impact, and the correlation with general health-related quality of life (HRQoL). Expert opinion: Based on the studies reviewed, it appears that abiraterone acetate has favourable outcomes, is effective and well tolerated, mostly in asymptomatic or slightly symptomatic patients, and has recognised toxicity profile characteristics. Incidence of adverse events (AEs), such as mineralocorticoid- and corticosteroid-releated AEs, and hepatotoxicity is well known and widely described. Understanding the toxicity profile of AA could assist decision-making in clinical practice

The use of skin traction in the adult patients with proximal femur fracture. What are the effects, advantages and disadvantages? A scoping review

Background: Hip surgery is normally the chosen therapy for proximal femur fractures. Surgery within 24–48 h after hip fracture is recommended, but surgery may not always be performed promptly. Consequently, skin-traction is applied to reduce complications. The purpose of this review is to assess both advantages and disadvantages of skin traction. Methods: A scoping review was conducted. The research question was: which are the effects of skin traction, its advantages and disadvantages in adult patients with proximal femur fractures hospitalised in orthopaedic wards? The search was done in the databases PubMed, CINAHL, Cochrane, Embase, DOAJ, ClinicalTrials.gov and OpenDissertation. Results: 9 records were included, skin traction effects were summarised in 7 categories: pain, pressure sores, comfort and relaxation, thromboembolism, damage from adhesive, complications and quality of care. The possible advantage is pain reduction between 24 and 60 h, the possible disadvantage is skin damage. Discussion and conclusion: The routine use of skin traction does not appear recommended, but more consistent evidence is necessary to make clinic decisions. Future RCTs could focus on the effects of skin traction 24–60 h after hospitalisation and before surgery