Cholesteatoma surgery in children: 10-year retrospective review

2012 ◽  
Vol 126 (5) ◽  
pp. 450-453 ◽  
Author(s):  
V Visvanathan ◽  
H Kubba ◽  
M S C Morrissey
Keyword(s):  
Recurrent Disease ◽  
Ossicular Chain ◽  
Disease Recurrence ◽  
Retrospective Case ◽  
Disease Extent ◽  
Primary Surgery ◽  
Time To Recurrence ◽  
Cent Time ◽  
Spontaneous Improvement ◽  
Cholesteatoma Surgery

AbstractObjective:To review outcomes following paediatric cholesteatoma surgery performed between 1999 and 2009 in a tertiary paediatric ENT unit.Study design:Retrospective case note review.Results:A total of 137 mastoid procedures were recorded. Fifty-four per cent of children were observed to have disease involving the entire middle-ear cleft and mastoid complex. The revision rate was 25 per cent. Time to recurrence was one to three years in 17 patients, three to six years in five patients, and six to nine years in three cases. Eight of 25 revision cases demonstrated spontaneous improvement in air conduction thresholds following primary surgery. A high facial ridge and inadequate meatoplasty correlated highly with disease recurrence.Conclusion:Children tend to present with aggressive disease. Disease extent and ossicular chain involvement are associated with a higher risk of recurrent disease. Spontaneous improvement in hearing thresholds following cholesteatoma surgery should alert the clinician to recurrent disease.

Hearing Outcomes after Ossicular Reconstruction with Removal of the Malleus

2017 ◽  
Vol 158 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Rex S. Haberman ◽  
Anna M. Salapatas
Keyword(s):  
Chart Review ◽  
Health Care Organization ◽  
Case Series ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Care Organization ◽  
Retrospective Case ◽  
Disease Extent ◽  
Ossicular Chain Reconstruction ◽  
Hearing Outcomes

Objectives (1) Evaluate hearing outcomes of patients after planned malleus removal during ossicular chain reconstruction. (2) Analyze hearing results for titanium (Ti) and hydroxyapatite (HA) total ossicular prostheses (TOPs) and partial ossicular prostheses (POPs). (3) Compare Ti and HA partial prostheses. Study Design Retrospective case series with chart review. Setting Tertiary health care organization. Subjects and Methods A chart review was conducted of 139 consecutive patients who presented with chronic otitis media with perforation (with or without cholesteatoma) and were treated with initial-stage tympanoplasty (with or without mastoidectomy) and managed with TOP (n = 22) or POP (n = 117) between July 2010 and July 2015. The malleus was completely removed in all cases. Hearing was assessed via bone and air conduction pretone averages (0.5, 1, 2 kHz) pre- and postoperatively. Air-bone gap (ABG) and change in ABG (ΔABG) were analyzed. Pre- and postoperative values were compared. Results The overall mean ABG decreased from 29.4 ± 12.3 dB to 18.2 ± 11.4 dB postoperatively ( P < .001) with a mean ΔABG of 14.5 dB (95% CI, 12.793-16.203). Overall success was achieved by 69.1%. The POP group achieved higher success (70.9%) than the TOP group (59.1%; P = .0001). Mean ABG decreased significantly within surgical groups (TOP and POP) and prosthesis material groups (Ti and HA; all P < .001). Ti had statistically higher success than HA in both techniques: POP ( P = .0478) and TOP ( P = .0251). There was a 98% graft take rate. Conclusion Planned malleus removal during ossicular chain reconstruction, regardless of disease extent, allows for simpler reconstruction and comparable favorable results to preservation of the malleus and should be considered during surgical planning.

scholarly journals Role of neoadjuvant Radio-Chemotherapy for retroperitoneal Liposarcoma in primary and secondary surgical intervention

2020 ◽  
Author(s):  
Ruth Ladurner ◽  
Jens Strohäcker ◽  
Christian Birkert ◽  
Hans-Georg Kopp ◽  
Alfred Königsrainer ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Recurrent Disease ◽  
Distant Metastases ◽  
Radical Resection ◽  
Soft Tissue Tumors ◽  
High Rate ◽  
Neoadjuvant Radiotherapy ◽  
Time To Recurrence ◽  
Repeated Surgery ◽  
Center Of Expertise

Abstract Background: Approximately 30–40 % of all retroperitoneal soft tissue tumors are sarcomas with liposarcoma prevailing in approximately 50% of these cases. Retroperitoneal liposarcomas typically show a high rate of local recurrence and late distant metastases. The aim of our retrospective analysis was to investigate the efficacy of treatment in our patients with liposarcoma. Methods: Thirty-four consecutive patients underwent surgery in our clinic between October 2004 and November 2017. Liposarcomas arising from the mesenteric or abdominal adipose tissue or the pelvis were excluded. In 2011 we had introduced neo-adjuvant therapy according to IAWS-Guidelines in patients younger than seventy without severe comorbidities to pretreatement. Results: Out of 34 patients, 23 (67,6%) presented with primary and 11 (32,4%) with recurrent disease. In 8 of the 27 patients (30 %), a radical resection (R0) could be achieved, and in 17 patients (63%) resection was marginal (R1). Time to recurrence was not affected by neoadjuvant radiotherapy. Patients that underwent systemic chemotherapy followed by radiotherapy developed earlier recurrences (p = 0.016). Overall survival appeared to be better in the neoadjuvant group but was not significant (0.080) Conclusions: Combining surgical resection with neoadjuvant radiation treatment showed survival benefits in primary but not recurrent disease. Repeated surgery stays a valid approach in carefully selected patients but all patients should be referred to a center of expertise in multimodal treatment approaches for retroperitoneal liposarcomas.

Recurrent disease in patients with stage III melanoma in the era of adjuvant immune and targeted therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21570-e21570
Author(s):  
Victor Lo ◽  
Valerie Francescutti ◽  
Elaine McWhirter ◽  
Forough Farrokhyar ◽  
Linda May Lee
Keyword(s):  
Targeted Therapy ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Systemic Therapy ◽  
Recurrent Disease ◽  
Stage Iii ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Stage Iii Melanoma

e21570 Background: Advancements in systemic therapy have reduced recurrence, and the adoption of nodal surveillance in place of dissection has reduced morbidity for patients with Stage III melanoma. The objective of this study was to describe the timing and pattern of recurrence in stage III melanoma patients and evaluate the impact of adjuvant treatment and nodal surveillance. Methods: A multicenter retrospective chart review of patients with pathologically confirmed Stage III cutaneous melanoma seen at either the Juravinski Cancer Centre or Walker Family Cancer Centre in Ontario, Canada from January 1, 2017 to December 31, 2019. Results: There were 137 patients with Stage III melanoma: 18% IIIA, 22% IIIB, 52% IIIC, and 8% Stage IIID as per the 8th American Joint Committee on Cancer (AJCC) 2018 staging system. 103 (75%) patients had sentinel lymph node biopsy (SLNB) only as part of initial surgical therapy, 6 (4%) had SLNB with completion dissection, and 25 (18%) had upfront radical nodal dissection. 67 (49%) patients received adjuvant therapy, of which 50 (74%) had immunotherapy, 17 (25%) received BRAF-targeted therapy, and 1 (1%) had interferon. 54 (39%) patients developed recurrent disease, with a median time to recurrence of 8.5 months (IQR: 4.3-14.9). The recurrence rates were 63% in patients who did not have adjuvant treatment and 37% in those who had adjuvant therapy, with a median time-to-recurrence of 7.5 and 9.0 months respectively. There were 30 (56%) loco-regional recurrences and 24 (44%) distant recurrences. Of the patients with loco-regional recurrence, 26 (87%) had SLNB only compared to 4 (13%) who had upfront or completion dissection. 12 (24%) patients recurred while on adjuvant treatment (7 distant recurrences and 5 loco-regional recurrences), and 8 (13%) patients recurred following completion of adjuvant treatment (5 distant recurrences and 3 loco-regional recurrences). Recurrences were detected by patients, clinicians, CT and nodal US surveillance in 43%, 20%, 28% and 9% of cases, respectively. The majority of loco-regional recurrence was detected clinically (67%) rather than by radiologic surveillance (33%). Of the 30 loco-regional recurrences, 24 underwent surgical resection of the recurrence, 4 had subsequent systemic therapy without surgery, 1 had intra-tumoral injections and 1 had no treatment. Conclusions: Recurrences in Stage III melanoma occur early, often within a year, with higher rates of loco-regional rather than distant disease. Recurrence rates were lower in those who received adjuvant therapy, but the majority of recurrences were detected by patients or clinicians, including loco-regional recurrences in patients who had SLNB only despite surveillance nodal US.

scholarly journals Ologen Implantation versus Conjunctival Autograft Transplantation for Treatment of Pterygium

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Xiuping Chen ◽  
Fei Yuan
Keyword(s):  
Operative Time ◽  
Case Series ◽  
Retrospective Case ◽  
Short Operative Time ◽  
Conjunctival Autograft ◽  
Primary Surgery ◽  
Significant Difference ◽  
Autograft Group ◽  
Group 1 ◽  
Primary Pterygium

Purpose. To evaluate the effectiveness and safety of Ologen implantation versus conjunctival autograft transplantation for primary pterygium. Methods. A retrospective case-series analysis. Thirty-one eyes of 29 patients were included in the Ologen group and 42 eyes of 35 patients in the autograft group. The patients were followed up for 1 year and evaluated for slit-lamp biomicroscopy, intraocular pressure, and adverse events. Recurrence rate, complications, and final appearance of the cases were evaluated prospectively. Result. At 1 year after operation, 2 eyes recurred (6.5%) in the Ologen group and 4 eyes recurred (9.52%) in the autograft group. There was no statistically significant difference between both groups (P=0.157, χ2 = 3.781). There was no occurrence of serious complications. Two eyes among the 31 eyes of the Ologen group were conjunctivitis; the incidence of complications was 6.45% (2 eyes). There was conjunctivitis in 3 eyes of the autograft group, 1 eye complicated with symblepharon, and 1 eye with conjunctival granuloma; the incidence of complications was 11.90% (5 eyes), and there was no statistically significant difference between both groups (P=0.094). The conjuntiva was less vascular and inflamed at 1 month postoperatively in the Ologen group than in the autograft group. Conclusions. Ologen transplantation was technically easier, provided short operative time compared with conjunctival autograft transplantation, and preserved healthy conjunctiva with less complication and less recurrence; it may be a new, safe, and effective alternative for improving the short-term success rate of primary surgery.

Asymptomatic recurrence detection with surveillance scanning in children with medulloblastoma.

1997 ◽  
Vol 15 (5) ◽  
pp. 1811-1813 ◽  
Author(s):  
D W Shaw ◽  
J R Geyer ◽  
M S Berger ◽  
J Milstein ◽  
K L Lindsley
Keyword(s):  
Early Detection ◽  
Median Time ◽  
Recurrent Disease ◽  
Time To Recurrence

PURPOSE To assess the utility of surveillance neuroimaging in detecting recurrent disease in patients treated for medulloblastoma. PATIENTS AND METHODS Records and scans of 59 consecutive patients treated for medulloblastoma between 1984 and 1993 in one institution were retrospectively reviewed. RESULTS Nineteen of 59 patients had recurrence of tumor, of which 17 were available for this study. Eleven of the 17 recurrent patients were asymptomatic at the time of detection. The median time to recurrence was 13 months (range, 3 to 90). CONCLUSION Surveillance scanning detected a majority of recurrences before onset of symptoms. Although the outcome of those with recurrent disease remains poor, early detection with minimum disease provides the best setting in which to test newer therapies. Patients and their parents also were more likely to elect pursuing further treatment when relapse was detected asymptomatically.

scholarly journals Influence of Ossicular Chain Damage on Hearing After Chronic Otitis Media and Cholesteatoma Surgery

2015 ◽  
Vol 141 (11) ◽  
pp. 974 ◽  
Author(s):  
Erik F. Blom ◽  
Marlise N. Gunning ◽  
Nienke J. Kleinrensink ◽  
Alexander S. H. J. Lokin ◽  
Hanneke Bruijnzeel ◽  
...  
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Cholesteatoma Surgery

Defining failure after parathyroidectomy for primary hyperparathyroidism: case series

2011 ◽  
Vol 125 (4) ◽  
pp. 394-398
Author(s):  
S D Charlett ◽  
M Aye ◽  
S L Atkin ◽  
R J A England
Keyword(s):  
Primary Hyperparathyroidism ◽  
Outcome Measure ◽  
Case Series ◽  
Case Review ◽  
Cure Rate ◽  
Retrospective Case ◽  
Diagnostic Uncertainty ◽  
Primary Surgery ◽  
Primary Procedure ◽  
Cause Of Failure

AbstractObjective:To identify the cause of operative failure in patients who have undergone parathyroid surgery for primary hyperparathyroidism.Design:Retrospective case review.Participants:Patients who had undergone a primary procedure for primary hyperparathyroidism between July 2003 and December 2007. Cases with incomplete post-operative serum calcium data were excluded.Main outcome measure:Operative failure was defined as failure to achieve normalisation of serum adjusted calcium levels post-operatively.Results:A total of 220 primary procedures were conducted over 4.5 years. Data were not available for 16 patients. Thirteen procedures (6.4 per cent) were considered failures, and these cases were individually reviewed and classified according to the reason for failure.Conclusion:Establishing the cause of failure following surgery for primary hyperparathyroidism can be a complex task. In some instances, diagnostic uncertainty remains despite detailed biochemical and radiological assessment. This paper outlines our approach to maximising the cure rate at primary surgery.

Effect of salvage radiofrequency ablation on local control of recurrent renal cell carcinoma.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 355-355
Author(s):  
S. P. Psutka ◽  
A. Daha ◽  
D. Gervais ◽  
A. S. Feldman
Keyword(s):  
Renal Cell Carcinoma ◽  
Radiofrequency Ablation ◽  
Cell Carcinoma ◽  
Local Control ◽  
Renal Cell ◽  
Recurrent Disease ◽  
Complete Response ◽  
Disease Recurrence ◽  
Disease Free

355 Background: Radiofrequency ablation (RFA) has emerged as a safe and efficacious option to manage small renal cell carcinoma (RCC) in patients for whom comorbidities preclude surgical treatment. Salvage surgical excision of disease recurrence after ablative therapy is often complicated by extensive perinephric fibrosis. There are no reports in the literature which assess salvage RFA (sRFA) of recurrent disease (RD). The aim of this study was to assess the overall efficacy, complications, and safety of sRFA. Methods: Between 1998 and 2008, 313 patients underwent RFA for RCC. RD was defined as detectable new enhancing tissue in the prior RFA-cavitation site after a documented complete response. We retrospectively compared patients who developed RD (RD+, n = 15, 5.1%) with patients who remained disease free after a complete response (RD−, n = 296, 95%), assessing tumor characteristics (size, location, biopsy pathology), complications, and disease-free survival. Mean follow-up was 3 years (SD 2.1). Results: RD+ and RD− groups did not differ significantly in age, gender, or tumor type. In tumors < 4cm, 3.3% were RD+. In tumors >= 4cm, 9.6% were RD+ (p<0.0001). RD+ groups were more likely to have central tumors (20% vs. 5.7%, p = 0.04). Mean time to disease recurrence was 1.47 years (SD 0.75, 0.5-3.5 yrs). Of the 15 patients with RD, 7 patients underwent sRFA, 6 patients elected observation due to comorbidities precluding further treatment, one patient received chemotherapy for widespread metastases and one patient underwent salvage partial nephrectomy, which was aborted due to extensive tumor burden and perirenal fibrosis. There were no complications related to sRFA. Of those who underwent sRFA, local recurrences were successfully ablated in 100% of cases with a single salvage RFA treatment. None of these sRFA cases developed locally recurrent disease at an average of 3 years follow-up. Conclusions: RD after RFA remains challenging to treat due to the significant comorbidities of the patients who are candidates for ablative treatment of RCC. RD was more likely to occur in centrally located tumors, > 4cm in size. Salvage RFA successfully can achieve local control in these patients without increased rates of complications. No significant financial relationships to disclose.

scholarly journals Management of thyroglossal tract disease after failed Sistrunk’s procedure

2003 ◽  
Vol 117 (9) ◽  
pp. 710-712 ◽  
Author(s):  
N. N. Patel ◽  
B. E. J. Hartley ◽  
D. J. Howard
Keyword(s):  
Local Excision ◽  
Wide Local Excision ◽  
Recurrent Disease ◽  
Retrospective Case ◽  
Applied Anatomy ◽  
Tract Disease ◽  
Thyroglossal Duct Remnants ◽  
Sistrunk Operation ◽  
Sistrunk’S Procedure ◽  
Case Note Review

Sistrunk’s procedure for thyroglossal duct remnants has a very high success rate, there remains the occasional patient, however, that will have recurrent disease despite a competently performed operation. Applied anatomy and embryology proffer a solution to this problem. Extending the Sistrunk operation, with an anterior wide local excision remaining within normal tissue, enables removal of the entire thyroglossal tract remnant.A retrospective case note review was conducted to study our experience using this extended procedure to treat patients with thyroglossal tract disease that had recurred after a previous Sistrunk’s operation.Six patients aged from five to 33 years were included in the study. There was one recurrence and the complication rate was comparable to the standard operation.It was concluded that a wide local excision is a valuable extension of the Sistrunk operation for the management of recurrent disease.

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