Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours

The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.11–0.71; p = 0.008) and Frey syndrome (OR = 0.12, 95% CI: 0.03–0.48; p = 0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR = 0.77, 95% CI: 0.35–1.70; p = 0.520), recurrence rate (OR = 0.17, 95% CI: 0.02–1.75; p = 0.14), infection (OR = 0.70, 95% CI: 0.07–6.67; p = 0.76), and salivary fistula/sialocele (OR = 0.40, 95% CI: 0.06–2.66; p = 0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.     

Multifocal infantile hemangiomas associated with concomitant giant hepatic rapidly involuting congenital hemangioma

We present a 9-day-old girl with multifocal cutaneous and hepatic infantile hemangiomas as well as a hepatic rapidly involuting congenital hemangioma. These two distinct vascular tumors have rarely been reported to co-occur. We additionally review the sonographic features that distinguish a hepatic congenital hemangioma from the hepatic infantile hemangioma.     

Nontarget Radiopaque Embolic Deposition during Prostatic Artery Embolization

This study evaluated detectable nontarget embolization (NTE) during prostatic artery embolization (PAE) and the safety and efficacy of using radiopaque particles in PAE. Ten patients aged >40 years with prostate glands of >50 mL and refractory lower urinary tract symptoms were analyzed. Unenhanced computed tomography scans at baseline and at 3 months after PAE, using 40–90-μm radiopaque spherical embolic beads, were compared to assess the NTE. Growth models evaluated changes from baseline to 3, 6, and 12 months in International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), quality of life (QoL), International Index of Erectile Function (IIEF), and postvoid residual (PVR). The IPSS, QoL, and Qmax improved at all time points (P < .05), with no trend in PVR or IIEF. Adverse events that occurred were minor. Radiographic NTE was seen in all patients, correlating at times with postprocedural symptoms (eg, rectal pain). Symptoms were not correlated with the NTE in some patients, whereas other patients remained asymptomatic despite NTE.     

Perioperative Blood Loss after Preoperative Prostatic Artery Embolization in Patients Undergoing Simple Prostatectomy: A Propensity Score‒Matched Study

PurposeTo assess perioperative blood loss following prostatic artery embolization (PAE) before surgery in patients undergoing simple prostatectomy.MethodsA retrospective chart review was used to identify 63 patients (mean age, 65.3 ± 8.0 years) with prostatic hypertrophy and severe lower urinary tract symptoms who underwent prostatectomy from September 2014 to December 2019, 18 (28.5%) of whom underwent PAE before surgery. Demographic data, pertinent laboratory results, procedural or operative information, hospital course details, and pathology reports were obtained. A 2:1 propensity score‒matching analysis was performed to compare intraoperative blood loss in patients who underwent prostatectomy alone with intraoperative blood loss in those who first underwent bilateral PAE before surgery.ResultsSixteen (89%) of the 18 patients underwent bilateral PAE before surgery. Thirty-two patients who underwent prostatectomy without embolization before surgery were selected for the 2:1 propensity score‒matched analysis based on age, race, surgery type, prostate gland size, and comorbidities. The mean estimated blood loss (EBL) for prostatectomy alone was 545 ± 380 mL (mean ± standard deviation). There was a statistically significant reduction in the EBL for patients who underwent bilateral PAE (303 ± 227 mL, P < .01). The operative time was also significantly decreased for patients who underwent PAE before surgery (P < .05). For patients who underwent PAE, there were no complications related to the procedure.ConclusionsBilateral PAE before surgery appears to be safe and may be effective in reducing perioperative bleeding and operative time.     

“Double-Down” Adrenal Vein Sampling Results in Patients with Apparent Bilateral Aldosterone Suppression: Utility of Repeat Sampling including Super-Selective Sampling

PurposeTo report outcomes of patients undergoing adrenal vein sampling (AVS) for primary aldosteronism with results indicating apparent bilateral adrenal suppression (ABAS), in which the adrenal aldosterone-to-cortisol ratios are decreased bilaterally (“double-down”) compared to the non-adrenal sample, and evaluate repeat AVS results.Materials and MethodsBetween 2003 and 2020, 762 patients underwent AVS. Twenty patients (2.6%; male, 12; female, 8; age 50.3 ± 9.7 years) with ABAS on initial AVS were identified. Ten underwent repeat AVS. Super-selective AVS (SS-AVS) was employed in 6 of 10 repeat AVS (60%). Outcomes after AVS were analyzed. A lateralization index (LI) >4 was considered an indication for adrenalectomy.ResultsRepeat AVS was diagnostic in 70% of patients (n = 7), with 6 of 7 lateralizing with LI >4 (median LI = 32.3; range 4.6–54.8) and 1 of 7 nearly lateralizing (LI = 3.5). All 7 patients underwent adrenalectomy. ABAS was redemonstrated in 3 patients (30%): 2 with unilateral adenomas on cross-sectional imaging underwent adrenalectomy despite ABAS results and 1 was lost to follow-up. Four of 6 patients (66%) who underwent SS-AVS were diagnosed with unilateral disease (median LI = 43.3; range 23.9–54.8), with one patient’s diagnosis reliant upon a single super-selective sample. In total, 9 patients underwent adrenalectomy after repeat AVS, all of whom had improved blood pressure control postoperatively. Ten patients did not undergo repeat AVS: 6 were lost to follow-up, 3 underwent medical management, and 1 underwent adrenalectomy.ConclusionsAVS should be repeated when “double-down” ABAS results are encountered. Super-selective sampling may provide worthwhile diagnostic data when employed during repeat AVS.