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Otolaryngology--head and Neck Surgery :... Apr 2022To conduct a systematic review on the demographics, characteristics, management, treatment, complications, and outcomes of Ewing sarcomas in the craniofacial bones.
OBJECTIVES
To conduct a systematic review on the demographics, characteristics, management, treatment, complications, and outcomes of Ewing sarcomas in the craniofacial bones.
DATA SOURCES
Using Cochrane Library, EmBase, and PubMed, the authors identified 71 studies to be included.
REVIEW METHODS
The Cochrane Library, EmBase, and PubMed databases were used to identify literature relating to Ewing sarcomas in the craniofacial bone to conduct a systematic review. Patient demographics, clinical characteristics, and treatment strategies were extracted.
RESULTS
Seventy-one studies encompassing 102 patients were identified. The most common craniofacial locations involved were the frontal bone (16.7%, n = 17), nasal cavity (16.7%, n = 17), and temporal bone (14.7%, n = 15). Stratified by location, the most common presenting symptoms were frontal bone (palpable mass, n = 8, 47.1%), nasal cavities (epistaxis, n = 9, 52.9%), and temporal bones (headache, n = 5, 33.3%). The 3 most commonly used treatment strategies were a combination of surgical intervention/radiotherapy/chemotherapy (n = 43, 43%), a combination of radiotherapy/chemotherapy (n = 18, 18%), and a combination of surgical intervention/chemotherapy (n = 15, 15%). Patients who received a combination of surgical intervention/radiotherapy/chemotherapy experienced local recurrence rate of 16.6%. However, other combinations of therapies such as surgical intervention/chemotherapy and radiotherapy/chemotherapy had a lower local recurrence rate but were limited by small sample size. Most patients (79.0%) were disease free without evidence of recurrence.
CONCLUSION
Ewing Sarcoma of the craniofacial bones has a good prognosis when treated appropriately. Given that our study was limited by retrospective data, we advise clinicians to use the findings of this article with their own clinical judgment to determine which treatment strategy they should pursue.
Topics: Bone Neoplasms; Disease-Free Survival; Humans; Retrospective Studies; Sarcoma, Ewing; Temporal Bone
PubMed: 34255595
DOI: 10.1177/01945998211022228 -
Anticancer Research Apr 2020Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
Wire-guided localisation (WGL) remains the most widely used technique for the localisation of non-palpable breast lesions; however, recent technological advances have resulted in non-wire, non-radioactive alternatives, such as magnetic seeds (Magseeds). The aim of this pooled analysis was to determine whether Magseeds are an effective tool for localising non-palpable breast lesions.
MATERIALS AND METHODS
Various databases were searched for publications which reported data on the localisation and placement rates of Magseed. Data on re-excision rates under use of Magseed and WGL were also collected.
RESULTS
Sixteen studies, spanning the insertion of 1,559 Magseeds, were analysed. The pooled analysis showed a successful placement rate of 94.42% and a successful localisation rate of 99.86%. Four studies were analysed in a separate pooled analysis and showed no statistically significant difference between re-excision rates using Magseeds and WGL.
CONCLUSION
The use of Magseeds is an effective, non-inferior alternative to WGL that overcomes many of the limitations of the latter.
Topics: Breast; Breast Neoplasms; Female; Humans; Magnetic Field Therapy; Magnetic Fields; Magnetics; Mastectomy, Segmental
PubMed: 32234869
DOI: 10.21873/anticanres.14135 -
The Bone & Joint Journal Mar 2023The 'pink, pulseless hand' is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in...
The 'pink, pulseless hand' is often used to describe the clinical situation in which a child with a supracondylar fracture of the humerus has normal distal perfusion in the absence of a palpable peripheral pulse. The management guidelines are based on the assessment of perfusion, which is difficult to undertake and poorly evaluated objectively. The aim of this study was to review the available literature in order to explore the techniques available for the preoperative clinical assessment of perfusion in these patients and to evaluate the clinical implications. A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered prospectively with the International Prospective Register of Systematic Reviews. Databases were explored in June 2022 with the search terms (pulseless OR dysvascular OR ischaemic OR perfused OR vascular injury) AND supracondylar AND (fracture OR fractures). A total of 573 papers were identified as being suitable for further study, and 25 met the inclusion criteria for detailed analysis. These studies included a total of 504 patients with a perfused, pulseless limb associated with a supracondylar humeral fracture. Clinical examination included skin colour (23 studies (92%)), temperature (16 studies (64%)), and capillary refill time (13 studies (52%)). Other investigations included peripheral oxygen saturation (SaO2) (six studies (24%)), ultrasound (US) (14 (56%)), and CT angiogram (two studies (8.0%)). The parameters of 'normal perfusion' were often not objectively defined. The time to surgery ranged from 1.5 to 12 hours. A total of 412 patients (82%) were definitively treated with closed or open reduction and fixation, and 92 (18%) required vascular intervention, ranging from simple release of entrapped vessels to vascular grafts. The description of the vascular assessment of the patient with a supracondylar humeral fracture and a pulseless limb in the literature is variable, with few objective criteria being used to define perfusion. The evidence base for decision-making is limited, and further research is required. We were able, however, to make some recommendations about objective criteria for the assessment of these patients, and we suggest that these are performed frequently to allow the detection of any deterioration of perfusion.
Topics: Child; Humans; Humeral Fractures; Humerus; Upper Extremity; Physical Examination; Databases, Factual
PubMed: 36854326
DOI: 10.1302/0301-620X.105B3.BJJ-2022-0699.R2 -
Endocrine Nov 2021Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid... (Meta-Analysis)
Meta-Analysis
PURPOSE
Nearly half the cases of thyroid cancer, a malignancy rapidly rising in incidence within the United States, are attributable to small and asymptomatic papillary thyroid cancers that will not increase mortality. A primary driver of thyroid cancer overdiagnosis is ultrasound use. It is therefore valuable to understand how inappropriate use of thyroid ultrasound is defined, analyze the current evidence for its frequency, and identify interventions to lessen misuse.
METHODS
Ovid MEDLINE(R), Ovid EMBASE, and Scopus databases were searched from inception to June 2020 for studies assessing inappropriate use of thyroid ultrasound. Reviewers, working independently and in duplicate, evaluated studies for inclusion, extracted data, and graded risk of bias. We used a random-effects model with a generalized linear mixed approach to calculate the mean overall proportion estimates of inappropriate use.
RESULTS
Seven studies (total n = 1573) met the inclusion criteria with moderate to high risk of bias. Inappropriate thyroid ultrasound use was described variably, using published practice guidelines, third-party expert reviewers, or author interpretations of the literature. The overall frequency of inappropriate thyroid ultrasound use was 46% (95% CI 15-82%; n = 388) and 34% (95% CI 16-57%; n = 190) among studies using guideline based definitions. The pooled frequency of iUS due to thyroid dysfunction (either hypothyroidism or thyrotoxicosis) was 17% (95% CI 7-37%; n = 191) and the frequency of iUS due to nonspecific symptoms without a palpable mass was 11% (95% CI 5-22%; n = 124). No study examined interventions to address inappropriate use.
CONCLUSIONS
Low quality evidence suggests that inappropriate use of thyroid ultrasound is common. Interventional studies aiming to decrease the inappropriate use of thyroid ultrasound are urgently needed.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Ultrasonography
PubMed: 34379311
DOI: 10.1007/s12020-021-02820-z -
Diagnostics (Basel, Switzerland) Aug 2023This study evaluates the role of high-intensity focused ultrasound (HIFU) ablative therapy in treating primary breast cancer. (Review)
Review
BACKGROUND
This study evaluates the role of high-intensity focused ultrasound (HIFU) ablative therapy in treating primary breast cancer.
METHODS
PubMed and Scopus databases were searched according to the PRISMA guidelines to identify studies from 2002 to November 2022. Eligible studies were selected based on criteria such as experimental study type, the use of HIFU therapy as a treatment for localised breast cancer with objective clinical evaluation, i.e., clinical, radiological, and pathological outcomes. Nine studies were included in this study.
RESULTS
Two randomised controlled trials and seven non-randomised clinical trials fulfilled the inclusion criteria. The percentage of patients who achieved complete (100%) coagulation necrosis varied from 17% to 100% across all studies. Eight of the nine studies followed the treat-and-resect protocol in which HIFU-ablated tumours were surgically resected for pathological evaluation. Most breast cancers were single, solitary, and palpable breast tumours. Haematoxylin and eosin stains used for histopathological evaluation showed evidence of coagulation necrosis. Radiological evaluation by MRI showed an absence of contrast enhancement in the HIFU-treated tumour and 1.5 to 2 cm of normal breast tissue, with a thin peripheral rim of enhancement indicative of coagulation necrosis. All studies did not report severe complications, i.e., haemorrhage and infection. Common complications related to HIFU ablation were local mammary oedema, pain, tenderness, and mild to moderate burns. Only one third-degree burn was reported. Generally, the cosmetic outcome was good. The five-year disease-free survival rate was 95%, as reported in two RCTs.
CONCLUSIONS
HIFU ablation can induce tumour coagulation necrosis in localised breast cancer, with a favourable safety profile and cosmetic outcome. However, there is variable evidence of complete coagulation necrosis in the HIFU-treated tumour. Histopathological evidence of coagulation necrosis has been inconsistent, and there is no reliable radiological modality to assess coagulation necrosis confidently. Further exploration is needed to establish the accurate ablation margin with a reliable radiological modality for treatment and follow-up. HIFU therapy is currently limited to single, palpable breast tumours. More extensive and randomised clinical trials are needed to evaluate HIFU therapy for breast cancer, especially where the tumour is left in situ.
PubMed: 37568958
DOI: 10.3390/diagnostics13152595 -
Cureus Dec 2022Epithelioid sarcoma is a rare entity that shows a predilection for the young and middle-aged population. There are two subtypes, i.e., the distal or conventional type,...
Epithelioid sarcoma is a rare entity that shows a predilection for the young and middle-aged population. There are two subtypes, i.e., the distal or conventional type, which is located in distal extremities, and the proximal type, located in proximal areas of the extremities, pelvis, perineal, and genital region. The latter is characterized by more aggressive behavior, a higher recurrence rate, and poor prognosis. Histopathological and immunohistochemical diagnoses are key to correct and timely treatment and a higher survival rate. We report a case of a 41-year-old man who presented a palpable progressive growth mass in the hypogastrium. The disease time was of nine months, and the tumor was resected, but it recurred a few months later in the same location. Computed tomography (CT) scans showed images suggestive of lung metastasis and the patient had to undergo a second surgery. He received eight cycles of chemotherapy and a subsequent CT scan control showed the progression of the disease, so a new chemotherapy regimen was established. The patient received three cycles of chemotherapy without improvement, so he decided to discontinue treatment. His last outpatient medical consultation was in January 2022. A systematic review of the studies published in PubMed and Google Scholar was performed. We identified 291 articles, but only 41 reports and case series were included, with a total of 55 patients. It is important to include this type of tumor in the differential diagnosis of epithelial tumors due to its aggressive behavior. Correct and timely diagnosis is crucial to obtain lower recurrence rates, lower mortality, and higher survival rates in these patients.
PubMed: 36712724
DOI: 10.7759/cureus.32962 -
European Journal of Surgical Oncology :... Jan 2022Several localization techniques are in use for localization of non palpable breast cancer but data on comparative effectiveness of these techniques are sparse. Our aim... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Several localization techniques are in use for localization of non palpable breast cancer but data on comparative effectiveness of these techniques are sparse. Our aim was to provide the first comparative effectiveness data on the topic.
METHODS
PubMed, Ovid, Scopus and Cochrane library were searched for randomized controlled trials. Pairwise meta-analysis was performed when more than 2 studies reported on the same head-to-head comparison. Network meta-analysis was performed in Stata.
RESULTS
Eighteen studies with 3112 patients were identified. A star shaped network was formed for every outcome as all studies had as common comparator the wire localization technique (WGL). Ultrasound guided surgery (UGS) had decreased positive margin both in the pairwise [OR = 0.19(0.11, 0.35); P < 0.01] and network meta-analysis OR = 0.19 (0.11,0.60). There was also a statistically significant reduction in re-operation rate [OR = 0.19 (0.11, 0.36); P < 0.01] and operative time [MD = -4.24(-7.85,-0.63); P = 0.02] as compared to WGL in pairwise meta-analysis. Re-operation rate and operative time did not hold there statistical significance in network meta-analysis. On network meta-analysis UGS had a statistically significant reduction in positive margin as compared to radio-guided occult lesion localization (ROLL) OR = 0.19 (0.11,0.6) and radioactive seed localization (RSL) OR = 0.26(0.13, 0.52). UGS had a 54.6% of being the best technique for positive margin. All techniques were equivalent for successful excision, localization complications, operative time and overall complications.
CONCLUSIONS
UGS has potential benefits in reduction of positive surgical margin, the rest of the techniques seem to have equivalent efficacy. Further randomized trials are required to verify these results.
Topics: Breast Neoplasms; Comparative Effectiveness Research; Female; Humans; Indocyanine Green; Magnetic Resonance Imaging; Margins of Excision; Mastectomy, Segmental; Methylene Blue; Network Meta-Analysis; Operative Time; Radiopharmaceuticals; Reoperation; Surgery, Computer-Assisted; Ultrasonography
PubMed: 34656392
DOI: 10.1016/j.ejso.2021.10.001 -
Journal of Clinical Nursing Sep 2023To map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk. (Review)
Review
AIMS AND OBJECTIVES
To map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk.
BACKGROUND
Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices.
DESIGN
A scoping review.
METHODS
Arksey and O'Malley's six-step framework and the PRISMA-ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008-2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data.
RESULTS
Nine studies were selected from 1676 sources. Two point-of-care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design.
CONCLUSIONS
Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end-users of point-of-care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research.
RELEVANCE TO CLINICAL PRACTICE
International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation.
REGISTRATION
Open Science DOI https://doi.org/10.17605/OSF.IO/AB6Y5-7th of March 2022.
Topics: Humans; Pressure Ulcer; Point-of-Care Systems; Skin; Edema; Skin Care
PubMed: 36717978
DOI: 10.1111/jocn.16630 -
Journal of Reconstructive Microsurgery Jul 2020Anastomotic couplers expedite venous microvascular anastomoses and have been established as an equivalent alternative to hand-sewn anastomoses. However, complications...
BACKGROUND
Anastomotic couplers expedite venous microvascular anastomoses and have been established as an equivalent alternative to hand-sewn anastomoses. However, complications unique to the coupler such as palpability and extrusion can occur. The purpose of this study was to perform a systematic review of the literature to assess complications distinct to the venous anastomotic coupler.
METHODS
A Medline, PubMed, EBSCO host search of articles involving anastomotic venous couplers was performed. Studies involving arterial anastomotic couplers, end-to-side anastomoses, and reviews were excluded. Data points of interest were flap failure, venous thrombosis, hematoma, partial flap necrosis, infection, coupler extrusion, and coupler palpability.
RESULTS
The search identified 165 articles; 41 of these met inclusion criteria. A total of 8,246 patients underwent 8,955 venous-coupled anastomoses. Combined reoperation rate was 3.3% and all-cause unsalvageable flap failure was 1.0%. Complications requiring reoperation included venous thrombosis (2.0%), hematoma (0.4%), partial flap necrosis (0.4%), and infection (0.3%). Eight patients had palpable couplers and 11 patients had extrusion of couplers (head/neck, hand, and feet) and required operative management.
CONCLUSION
Venous couplers remain an equivalent alternative to conventional hand-sewn anastomosis. However, venous coupler extrusion and palpability in the late postoperative period is a complication unique to anastomotic couplers, particularly in radiated head and neck, feet and hand free flaps. Removing extruded venous couplers is safe after tissue integration 3 weeks postoperatively. Coupler palpability and extrusion should be integrated into preoperative patient counseling and assessed in follow-up examinations.
Topics: Anastomosis, Surgical; Free Tissue Flaps; Humans; Microsurgery; Plastic Surgery Procedures; Retrospective Studies
PubMed: 32106314
DOI: 10.1055/s-0040-1702151 -
Journal of Plastic, Reconstructive &... Aug 2023Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is... (Review)
Review
Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is the harvesting and grafting of patients' own fat tissue. The last review comparing the safety of these methods was written 7 years ago, which warrants the writing of a new one. PubMed, Cochrane, and Medline were searched for studies focusing on the methods of gluteal augmentation listed previously. Five search terms were used and 15 studies fulfilled the criteria. The data were cataloged according to the method described and outcomes compared. Seven articles focused on gluteal implants and another seven assessed autologous fat grafting, whereas one detailed both. The most common complications in 524 implant procedures were wound dehiscence (9.16%), excessive implant palpability (5.92%), and seroma (3.82%), with an overall complication rate of 25%. The most common complications in 1788 gluteal fat augmentation procedures were seroma (6.9%), infection (3.0%), and transient sciatic paresthesia (1.0%), with an overall complication rate of 13%. Several articles listed satisfaction figures, but these were not assessed because this article was not powered to assess this outcome. Overall, gluteal augmentation using autologous fat grafting leads to fewer postoperative complications than implants and allows greater contouring of the buttocks and the surrounding areas. However, it can also be a far more dangerous procedure if certain recommendations are not followed.
Topics: Humans; Seroma; Adipose Tissue; Plastic Surgery Procedures; Prostheses and Implants; Postoperative Complications; Buttocks
PubMed: 37320936
DOI: 10.1016/j.bjps.2023.04.066