Flap choice for closure of open window thoracotomy: a response to the author of the article entitled “the omentum flap for empyema treatment: indications and disadvantages”

The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD’s role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.

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Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

SAGE Open Medicine ◽

10.1177/20503121211022582 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110225

Author(s):

Mark A Pianka ◽

Joseph Serino ◽

Steven F DeFroda ◽

Blake M Bodendorfer

Keyword(s):

Wide Spectrum ◽

Pain Syndrome ◽

Operative Management ◽

Hip Pain ◽

Greater Trochanteric Pain Syndrome ◽

Trochanteric Bursitis ◽

Treatment Indications ◽

Careful Clinical Examination ◽

Wide Range ◽

Tendon Pathology

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

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Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06957-5 ◽

2021 ◽

Author(s):

Cesare Piazza ◽

Alberto Paderno ◽

Elisabeth V. Sjogren ◽

Patrick J. Bradley ◽

Hans E. Eckel ◽

...

Keyword(s):

Carbon Dioxide ◽

Functional Outcomes ◽

Postoperative Management ◽

Transoral Laser Microsurgery ◽

Laser Microsurgery ◽

Invasive Approach ◽

Treatment Indications ◽

Preoperative Diagnostic ◽

Diagnostic Work ◽

European Laryngological Society

Abstract Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.

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Effects of urban noise variability on cognitive abilities in indoor spaces: Gender differences

Noise & Vibration Worldwide ◽

10.1177/09574565211030703 ◽

2021 ◽

pp. 095745652110307

Author(s):

Massimiliano Masullo ◽

Gennaro Ruggiero ◽

Daniel Alvarez Fernandez ◽

Tina Iachini ◽

Luigi Maffei

Keyword(s):

Working Memory ◽

Verbal Memory ◽

Cognitive Abilities ◽

Cognitive Domain ◽

Cognitive Tasks ◽

Indoor Environments ◽

Urban Noise ◽

Male And Female ◽

Open Window ◽

Indoor Spaces

Previous evidence has shown that exposure to urban noise negatively influences some cognitive abilities (i.e. verbal fluency and delayed recall of prose memory) of people in indoor spaces. However, long-standing literature in the cognitive domain has reported that men and women can show different performance on cognitive tasks. Here, we aimed to investigate if and how different patterns of perceived urban noises in indoor environments could affect male and female participants’ cognitive abilities. Ambisonic sound recordings representing scenarios with varying noise patterns (low, medium and high variability) were acquired with an open window at three dwellings in a southern Italian city. As a control condition, the recordings were caught inside a quiet room. While exposed to theses four auditory conditions, participants had to perform cognitive tasks assessing free verbal memory recall, auditory–verbal recognition and working memory. The results show that male and female participants have a different tolerance to noise patterns. Women overperform men on verbal tasks, while the contrary effect emerges with men outperforming women on visuospatial working memory tasks.

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THE NATIONAL STANDARDS SYSTEM NETWORK: AN OPEN WINDOW TO THE TRILOGY OF STANDARDS, DOCUMENTATION, AND QUALITY

Quality Engineering ◽

10.1080/08982119608919044 ◽

1996 ◽

Vol 9 (2) ◽

pp. 279-285

Author(s):

Rolf Schneider

Keyword(s):

National Standards ◽

Open Window

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Choroidal neovascular membrane in paediatric patients: clinical characteristics and outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310497 ◽

2017 ◽

Vol 102 (9) ◽

pp. 1232-1237 ◽

Cited By ~ 2

Author(s):

Tapas Ranjan Padhi ◽

Bradley J Anderson ◽

Ashkan M Abbey ◽

Yoshihiro Yonekawa ◽

Maxwell Stem ◽

...

Keyword(s):

Clinical Characteristics ◽

Adult Population ◽

Initial Therapy ◽

Macular Dystrophy ◽

Vascular Endothelial ◽

Fluorescein Angiogram ◽

Anti Vegf ◽

Treatment Indications ◽

Endothelial Growth Factor

PurposeTo analyse the clinical characteristics and treatment outcomes of choroidal neovascular membranes (CNVM) in paediatric subjects at three paediatric retina referral centres.MethodsMedical charts of patients aged 18 years or less with a diagnosis of CNVM were retrospectively reviewed. The demographic profile, laterality, presenting complaint, corrected vision, underlying pathology, fundus, fundus fluorescein angiogram and optical coherence tomogram (OCT) were analysed. CNVM type, frequency, treatment indications, recurrences and final visual acuity were noted.ResultsThere were a total of 35 subjects (43 eyes) with a mean age of 11.2 years. The CNVMs were mostly type 2 (90.0%), classic (90.9%), subfoveal (59.09%) and active (84.1%). Best vitelliform macular dystrophy was found to be the most common association (32.5%). Intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent was the initial therapy of choice in all. Eyes with CNVMs responsive to anti-VEGF alone required a mean of 2.11 injections. Patients with recurrent disease (21.21%) had an average of 1.14 episodes per eye. While 50% of recurrent CNVMs stabilised with repeat anti-VEGF treatment, the remaining patients required photodynamic therapy, laser or surgery.ConclusionPaediatric CNVMs in this series differed from those in the adult population with regard to aetiology, OCT and angiographic characteristics, treatment response and rate of recurrence.

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Bevacizumab and Breast Cancer: A Meta-Analysis of First-Line Phase III Studies and a Critical Reappraisal of Available Evidence

Journal of Oncology ◽

10.1155/2012/417673 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 50

Author(s):

José R. Rossari ◽

Otto Metzger-Filho ◽

Marianne Paesmans ◽

Kamal S. Saini ◽

Alessandra Gennari ◽

...

Keyword(s):

Breast Cancer ◽

Fixed Effects ◽

Meta Analysis ◽

Metastatic Breast ◽

Progression Free Survival ◽

Phase Iii ◽

First Line ◽

Statistical Estimates ◽

Treatment Indications ◽

Phase Iii Studies

Background. Randomized studies have shown different magnitude of bevacizumab benefit in the treatment of advanced breast cancer. Regulatory agencies have modified bevacizumab treatment indications across different regions. In this study, we perform a meta-analysis of phase III studies aiming to interrogate the magnitude of bevacizumab benefit for the treatment of first-line HER2-negative metastatic breast cancer (MBC).Methods. Data from studies E2100, AVADO and RIBBON-1 were used to calculate the benefit of bevacizumab in terms of tumor overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and toxicities. Combined statistical estimates of hazard ratios (HR) and odds ratios were calculated using fixed-effects or random-effects models.Results. A total of 2,695 patients were evaluated. Combining bevacizumab with different chemotherapy backbones resulted in a 30% risk reduction of PFS events (HR = 0.70; 95% confidence interval [CI], 0.57–0.86) and increased ORR (odds ratio 1.81; 95% CI, 1.53–2.14). No OS benefit could be demonstrated (HR = 0.95; 95% CI, 0.85–1.06). Bevacizumab significantly increased the incidence of adverse events such as proteinuria, hypertension and cardiovascular events.Conclusions. Bevacizumab combined with chemotherapy in the first-line treatment of MBC significantly improved ORR and PFS, but also increased grade 3-4 toxicities. No significant OS advantage was observed.

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