A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

Objective Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources PubMed and Ovid Medline. Review Methods A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045). Conclusion Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence 3.

The use of artwork to document geologic systems in The Geology of Russia (1845)

ABSTRACT Artwork in The Geology of Russia (1845) documents the extent and fossil content of several Paleozoic systems in Europe and large tracts of Russia. That artwork conveys a sense of landscape, portrays the distribution of strata both at and below the surface, and documents the fossil evidence for identifying several Paleozoic geologic systems. The artwork includes wood engravings, lithographs, zincographs, and copper plate engravings. The choice of technique was governed by the content and desired character of the images and the logistics of printing. Roderick Murchison was a master of organization who commissioned, assembled, and oversaw the production of artwork that was crucial to presenting the evidence for the Paleozoic systems documented in The Geology of Russia (1845).

Does Localization Technique Matter for Non-palpable Breast Cancers?

Background There are several techniques for localization of non-palpable breast tumors, but comparisons of these techniques in terms of margin positivity and volume of tissue resected are lacking. Methods Between 2011-2013 and 2016-2018, 2 randomized controlled trials involving 10 centers across the United States accrued 631 patients with stage 0-3 breast cancer, all of whom underwent breast conserving surgery. Of these, 522 had residual non-palpable tumors for which localization was required. The localization technique was left to the discretion of the individual surgeon. We compared margin positivity and volume of tissue resected between various localization techniques. Results The majority of the patients (n = 465; 89.1%) had wire localization (WL), 50 (9.6%) had radioactive seed (RS) localization, and 7 (1.3%) had Savi Scout (SS) localization. On bivariate analysis, there was no difference in terms of margin positivity (37.8% vs. 28.0% vs. 28.6%, P = .339) nor re-excision rates (13.3% vs. 12.0% vs. 14.3%, P = .961) for the WL, RS, and SS groups, respectively. Further, the volume of tissue removed was not significantly different between the 3 groups (71.9 cm3 vs. 55.8 cm3 vs. 86.6 cm3 for the WL, RS, and SS groups, respectively, P = .340). On multivariate analysis, margin status was affected by tumor size (OR = 1.336; 95% CI: 1.148-1.554, P<.001) but not by type of localization ( P = .670). Conclusions While there are a number of methods for tumor localization, choice of technique does not seem to influence volume of tissue resected nor margin status.

A materialidade da memória na animação não ficcional

The gesture of the author who produces manually in accordance with the chosen technique and the material specificities that determine it, a non-fictional animation that originates in memories, carries meanings beyond aesthetics. Colors, textures and shapes can be determinants in the metaphysical relationship intrinsic to the technique itself and recode the past in visual signs. Each animated technique carries unmistakable characteristics in its DNA, which, in the narrative, can perform functions far beyond aesthetics. There is still a little studied complexity about the epistemological meaning generated in each set of textures offered by the different manual animation techniques for the range of themes that non-fictional animation can encompass. Each of these textures carries a load of signs and symbologies that, in themselves, can generate meaning, which makes the choice of technique a circumstantial factor for the theme to be portrayed. In an approach on the triggering of stop motion characteristics under a documentary record, especially when memories are represented by a three-dimensional technique manually constructed, and even when there is hybridization, in the specific case, point insertions of classic 2D animation. The more the topic is confronted and deepened, the more questions arise, which allow future research for an analytical approach to the animated process as an option of documentary registration, unfolding for the metaphysical function of animation, its textures in the narrative of a non-fictional film and the network of metaphors generated by it.

Physiotherapists’ use of airway clearance techniques during an acute exacerbation of bronchiectasis: a survey study

Background Airway clearance techniques are recommended for individuals with bronchiectasis both in stable state and during an acute exacerbation, however the current use of airway clearance techniques in the management of individuals during an acute exacerbation is unclear. The aims of this study were to establish what current physiotherapy clinical practice comprises for adults and paediatrics during an acute exacerbation of bronchiectasis; identify physiotherapist’s perceptions of the effectiveness of airway clearance techniques and identify what factors influence their treatment decisions in this population. Methods An anonymous online survey was distributed to the members of the Australian Physiotherapy Association and Physiotherapy New Zealand between August 2016 and April 2017. Results The survey was accessed by 130 physiotherapists and 121 of those deemed themselves eligible and consented to participate. Most participants (89%) reported prescribing airway clearance techniques for 81–100% of individuals during an acute exacerbation of bronchiectasis. The most commonly used airway clearance techniques with adults were huffing (92%), exercise (89%) and the active cycle of breathing technique (89%). The techniques perceived most effective for adults were physical exercise (100%), oscillating positive expiratory pressure devices (97%), directed huffing (95%) the active cycle of breathing technique (90%) and positive expiratory pressure (90%). The most commonly used airway clearance techniques for paediatric patients were: newborn-3 years - percussion (85%) and modified postural drainage (85%); 4–10 years - huffing (100%) and exercise (85%); 11–18 years - huffing (92%) and exercise (77%), active cycle of breathing technique (77%) and positive expiratory pressure therapy (77%). The techniques perceived most effective for paediatric patients were directed huffing (100%), percussion (100%) and positive expiratory pressure via a mask or mouthpiece (93%). The most commonly reported factors influencing choice of technique were patient clinical presentation (72%) and the presence/absence of contra-indications (72%). Conclusion This survey demonstrates that airway clearance techniques are routinely used as part of physiotherapy management of individuals experiencing an acute exacerbation of bronchiectasis, and that choice of technique and perceived effectiveness varies depending on the age of the patient.

Long Process Incus necrosis in Revision Stapedotomy: Retrospective Clinical Study

Objectives: We describe our experience with long process incus (LPI) necrosis in revision stapedotomy and discuss the different management methods proposed in the literature to identify surgical techniques that can lead to satisfactory results over time. Methods: Twenty-two stapedotomy revisions, in 21 patients with the necrosis of the long process of the incus, are performed from 1997 to 2017. In cases of erosion or minimal necrosis of LPI, a new prosthesis of the same type or an angled prosthesis was applied higher on the residual incus stump. In cases of partial necrosis of LPI, a Donaldson type ventilation tube reshaped and placed on the residual incus stump to stabilize prosthesis, or glass ionomer bone cement was used. In cases of subtotal necrosis of LPI, a cup piston prosthesis in polycel was applied on incus residual stump. Pre- and postoperative (≥1 year) pure tone audiometry was performed for all cases. Air conduction threshold, bone conduction (BC) threshold, and air-bone gap (ABG) were documented according to the American Academy of Otolaryngology Head and Neck Surgery Committee of Hearing and Equilibrium guidelines. Results: At 1-year follow-up, postoperative ABG was reduced to ≤10 dB in 13 (59%) cases and ≤20 dB in 19 (86.4%) cases. The mean postoperative ABG significantly decreased in each group. There was no significant change in postoperative BC thresholds, and there were no cases with postoperative SNHL. Conclusion: Excellent functional results can also be achieved in cases of long incus process necrosis. The choice of technique should be considered according to the degree of necrosis. Piston replacement with the same type or angled type prosthesis, in cases of erosion or minimal LPI necrosis, and modified Donaldson type ventilation tube, in cases of partial LPI necrosis, provided excellent hearing results.

Lung Isolation Procedures

Lung isolation is used for many thoracic surgeries to provide exclusive ventilation of the nonoperative lung. This allows for the operative lung to be desufflated, improving surgical conditions and exposure. Additionally, in severe cases of unilateral lung infection or bleeding, ventilation of only the healthy lung can decrease the risk for contamination with blood and infected material from the diseased lung. Techniques used for achieving lung isolation include bronchial blocker placement, mainstem intubation, and use of a double-lumen tube. Although provider comfort and surgical preference often influence choice of technique, patient size and quality of lung isolation required are also guiding factors.

Study of clinical and morphological features of postoperative nasal septum perforations

The literature provides many ways to close perforations of the nasal septum (NS), there is no differential approach to the choice of technique depending on the etiological factor. Objective: to study the clinical and morphological features of tissues at the edges of postoperative nasal septum perforations (PNSP) to substantiate the choice of the optimal surgical technique. Materials and methods. 52 patients are divided into 3 groups in accordance with the area (S) of PNSP: 1st S < 1 cm2 (10%); 2nd S 1–2 cm2 (75%), 3rd S > 2 cm2 (15%). In group 2, the subgroups are: 2A – PNSP without curvature of the NS (CNS) (52%); 2B – PNSP with CNS (48%). The state of the mucous membrane (MM) and supporting tissues at the edges of the PNSP, the results of a cytological study from the edges of the PNSP, and specific complaints of the patients were evaluated. Results: In group 1 and 2 at the edges of the PNSP, there was a significant decrease in tissue elasticity compared with group 3, indicating a deficit in supporting tissues (p < 0.05). The ratio of the area of the defect of supporting tissues and PNSP in group 1 was 1 to 3.5, in group 2 – 1 to 1.5, in group 3 – 1 to 1.1. A high degree of elasticity of the posterior edge of PNSP is accompanied by pronounced clinical manifestations, regardless of the size of PNSP, and is confirmed by the cytological picture of inflammation (p <0.01). The presence of CNS enhances the clinical manifestations of PNSPI (p < 0.05). Conclusion: the structure of the edges of PNSP forms the clinical picture of the disease. When choosing a closure method for PNSP, the surgeon must solve the following problems: the size of the NS defect required for replacement is determined not so much by the dimensions of the PNSP as the area of the defect in the supporting tissues of the NS; with a deficit of local tissues, it is advisable to additionally use grafts; MM in the area of the posterior and lower edges has pronounced signs of inflammation, these tissues should be removed during the operation.