Cavernous hemangioma: a term to be canceled

Many Authors still refer to “cavernous hemangioma”. To be correct, the term should indicate a tumor. Are cavernous hemangioma tumors? No. In a recent research Rootman et al. have demonstrated that CHs are non-infiltrating, focal venous malformations. They lack hyperplasia, that is, the cell turnover rate is not altered and they grow (when they do it, by an average 10 % per year) owing to phenomena of localized intravascular coagulation (LIC) and subsequent inflammation. Just like other Puig Type I venous malformations, they are (almost) excluded from the general circulation. Since isolated venous malformations of the orbit are not tumors, indications for surgery and, especially, the related informed consent must take this into consideration. Only those malformations presenting clear symptoms, like reduction in visual acuity and/or diplopia should be managed surgically. Another, less agreed on, indication is morphologically significant exophthalmos. Small, asymptomatic malformations, especially those located intraconally, can be just observed over time. Nonsurgical measures such as low molecular weight heparin could be used to stem episodes of LIC. Thus we believe that the term “cavernous hemangioma” should be canceled and replaced by Venous Malformation of the Orbit

Cavernous hemangioma: a term to be canceled

Many Authors still refer to “cavernous hemangioma”. To be correct, the term should indicate a tumor. Are cavernous hemangioma tumors? No. In a recent research Rootman et al. have demonstrated that CHs are non-infiltrating, focal venous malformations. They lack hyperplasia, that is, the cell turnover rate is not altered and they grow (when they do it, by an average 10 % per year) owing to phenomena of localized intravascular coagulation (LIC) and subsequent inflammation. Just like other Puig Type I venous malformations, they are (almost) excluded from the general circulation. Since isolated venous malformations of the orbit are not tumors, indications for surgery and, especially, the related informed consent must take this into consideration. Only those malformations presenting clear symptoms, like reduction in visual acuity and/or diplopia should be managed surgically. Another, less agreed on, indication is morphologically significant exophthalmos. Small, asymptomatic malformations, especially those located intraconally, can be just observed over time. Nonsurgical measures such as low molecular weight heparin could be used to stem episodes of LIC. Thus we believe that the term “cavernous hemangioma” should be canceled and replaced by Venous Malformation of the Orbit

Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities.

The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs

HUBUNGAN BENTUK KOMUNIKASI PERAWAT DENGAN TINGKAT KECEMASAN KELUARGA PASIEN KANKER DI RUANG RAWAT INAP BLUD RUMAH SAKIT UMUM DR. ZAINOEL ABIDIN BANDA ACEH TAHUN 2013

Praktek keperawatan profesional memegang peranan yang sangat penting dalam memberikan asuhan keperawatan pada pasien maupun keluarga. Komunikasi yang efektif dapat mengurangi kecemasan yang dialami keluarga pasien kanker di ruang rawat inap. Jenis penelitian deskriptif korelatif dengan desain cross sectional. Populasi penelitian adalah keluarga pasien kanker di ruang rawat inap yang berjumlah 76 orang dengan cara nonprobability sampling, Uji Chi Square menunjukkan adanya hubungan yang signifikan antara bentuk komunikasi perawat dengan tingkat kecemasan keluarga pasien kanker (p = 0.014> nilai ? 0.05) yang terdiri dari komunikasi verbal (p = 0.016> nilai ? 0.05) dan komunikasi nonverbal (p = 0.005> nilai ? 0.05). Diharapkan kepada perawat agar dapat mempertahankan dan meningkatkan komunikasi terapeutik karena akan mempengaruhi kecemasan keluarga pasien.Banda Ace

SARS-CoV-2 Infection in Health Care Workers: Cross-sectional Analysis of an Otolaryngology Unit

The restart of routine in- and outpatient activity in the COVID-19 postepidemic peak needs to be carefully planned in light of specific patterns of viral diffusion. We evaluated SARS-CoV-2 serology in the entire personnel of a COVID-19-free otolaryngology department in a highly affected area. The aim was to determine the prevalence of SARS-CoV-2 positivity among staff to clarify the impact of different risk factors for infection. The entire staff of the otolaryngology unit was tested for SARS-CoV-2 serology. Symptomatic staff members were tested with nasal/pharyngeal swabs. All answered a survey focused on the number of in- and extrahospital positive contacts and type of activities in the unit. Five (9%) were positive for SARS-CoV-2 infection. The only variable associated with a higher risk of infection was the number of extrahospital contacts without personal protective equipment (P = .008). Our study shows that in non-COVID-19 departments, the use of adequate personal protective equipment leads to low rates of infection among health care workers. The prevalent risk of infection was related to extrahospital contact

Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes

Tonsillectomy and residents: a safe match?

Letter to the Edito

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

OBJECTIVE: To present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication. PATIENT: A 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak. INTERVENTIONS: Bilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets. MAIN OUTCOME MEASURE: CSF leak recurrence, postoperative computed tomographic (CT) scans, intra- and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function. RESULTS: No postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides. CONCLUSIONS: The use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case

Impact of low-thermal-injury devices on margin status in laryngeal cancer. An experimental ex vivo study

We conducted a prospective study on 10 excised larynges from patients affected by advanced laryngeal cancer, to assess the thermal-effect due to surgical incisions made at standard distance by using: scalpel, CO2 Laser, harmonic scalpel and electrocautery. Upon histopathological examination, thermal damage (Surgical Artifact, SA), tissue lost/retraction (Shrinkage, S), and tissue alterations were compared for each instrument