Sinonasal quality of life in patients after an endoscopic endonasal surgery of a sellar tumour

Endoscopic endonasal approach uses the nasal cavity and paranasal sinuses to access the cranial base and may be a source of post-surgical morbidity in many patients with a sellar tumour. The objective of the presented study was to evaluate sinonasal quality of life and assess the effect of chosen reconstruction of the cranial base on the final condition. 65 patients, 33 male and 32 female who underwent an endoscopic endonasal surgery due to sellar expansion, were included into this prospective study. Sinonasal quality of life was evaluated using the Sinonasal Outcome Test-22 (SNOT-22) questionnaire before the surgery and six months after the surgery. Sinonasal quality of life was evaluated for the total cohort of patients and for patients after reconstruction (fascia lata, muscle) and without reconstruction. The minimum follow-up period was one year. There was no significant difference between the score (SNOT-22) before the surgery (average 14.4 points) and after the surgery (average 17.5 points), p = 0.067 in the whole cohort. Statistically significant differences were found in the following items—the need to blow nose, nasal congestion, loss of smell and taste, and thick discharge from the nose. The comparison of subgroups with and without the reconstruction yielded statistically significant differences in favour of patients with reconstruction in the following items—lack of high-quality sleep and feeling exhaustion. The endoscopic endonasal approach in patients with a sellar tumour is a gentle method with minimal effects on sinonasal quality of life over a period longer than six months. The most common complaints are the need to blow nose, nasal congestion, loss of smell and taste, and thick discharge from the nose. Cranial base reconstruction using the muscle and fascia lata seems to be a potential factor positively influencing sinonasal quality of life.

Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p = 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p = 0,001; p = 0,005; e p = 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p = 0,003; 30 a 60°, p = 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

O08 BIOMECHANICS OF MANUAL, STAPLED, AND MANUAL-STAPLED SUTURES ON FASCIA LATA. TIPS FOR ABDOMINAL WALL SURGEONS

Aim No data on the biomechanical properties of staplers’ use in the repair of abdominal wall defects are available. Our objective is to study prospectively the biomechanical properties of manual, stapled and mixed manual/stapled fascial sutures. Material-Methods Stress/strain tests were performed on 16 human cadaver fascial samples. The data on strength, strain (deformability), Young’s modulus (elasticity), and dissipated energy (toughness modulus) were recorded for each type of suture. Results Stapled and mixed suture showed a significantly higher strength (manual 0.83, stapled 2.10, mixed 2.68 MPa), and a trend towards a higher strain as compared to manual sutures (manual 344, stapled 249, mixed 280%). Stapled and mixed suture were four-fold higher as compared to manual sutures (manual 1.779, stapled 7.374, mixed 6.964 MPa). Manual and mixed sutures showed significantly higher dissipated energy (manual 0.99, vs stapled 0.73, vs mixed 1.35 mJ-mm3). Conclusions Stapled and mixed sutures have better strength performances than manual sutures. On the other hand, stapled and mixed sutures have significantly higher Young’s modulus and lower ultimate strain, showing less deformability, possibly translating in less efficiency in large midline defects, where manual sutures might display higher elasticity. Also, hand-sewn sutures (in manual or over-sewn stapled) appear to increase the ability to absorb mechanical energy, whereas stapled sutures showed to be less tough. Furthermore, an over-sewn stapled suture, as compared to a stapled suture, gains in term of strength, ultimate strain, Young’s modulus, and dissipated specific energy, suggesting the need of over-sewn stapled sutures in case of larger fascial defects.