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Purpose of Review
Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments.Recent Findings
Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable.Summary
More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.4.
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Mouen Khashab Ahmad S. Alawad Eun Ji Shin Katherine Kim Nicolas Bourdel Vikesh K. Singh Anne Marie Lennon Susan Hutfless Reem Z. Sharaiha Stuart Amateau Patrick I. Okolo Martin A. Makary Christopher Wolfgang Marcia Irene Canto Anthony N. Kalloo 《Surgical endoscopy》2013,27(6):2068-2075
Background and aims
Endoscopic placement of enteral self-expandable metallic stents is an alternative to surgical gastrojejunostomy (GJ) for palliation of malignant gastric outlet obstruction (GOO). Factors associated with clinical outcomes are not known. The aims of this study are to compare the overall complication rate and effectiveness (duration of oral intake) between endoscopic stenting (ES) and GJ in patients with GOO and identify predictors of clinical outcomes.Patients and methods
This was a retrospective cohort study at a single tertiary academic center. Patients who underwent ES or GJ for treatment of GOO between 1/2001 and 12/2010 were identified using an institutional claims database. The electronic medical records for each patient were reviewed. Univariate and multivariate logistic regression analyses were performed to study the association of treatment outcomes with patient factors and cancer therapy.Results
120 patients had ES while 227 had GJ. Technical success was higher for GJ (99 vs. 96 %, p = 0.004). Complication rates were higher in the GJ group (22.10 vs. 11.66 %, p = 0.02). Reintervention was more common with ES [adjusted odds ratio (OR) 9.18, p < 0.0001]. Mean length of hospital stay (LOHS) was shorter (adjusted p = 0.005) in the ES compared with the GJ group. However, mean hospital charges, including reinterventions, were greater in the ES group (US $34,250 vs. US $27,599, p = 0.03). ES and GJ had comparable reintervention-free time in patients who had reintervention (88 vs. 106 days, respectively, p = 0.79). Chemotherapy [adjusted hazard ratio (HR) 3 > 0.57, p = 0.04] and radiation therapy (adjusted HR 0.35, p = 0.03) were associated with significantly longer duration of oral intake after ES or GJ.Conclusion
ES is associated with fewer complications, shorter LOHS, but higher reintervention rates and overall charges. 相似文献6.
Gaya Spolverato Fabio Bagante Matthew Weiss Jin He Christopher L. Wolfgang Fabian Johnston Martin A. Makary Will Yang Steven M. Frank Timothy M. Pawlik 《Journal of gastrointestinal surgery》2016,20(12):2010-2020
Background
Delta hemoglobin (ΔHb) is defined as the difference between the preoperative Hb and the lowest post-operative Hb level. We sought to define the impact of ΔHb relative to nadir Hb levels on the likelihood of transfusion, as well as characterize the impact of ΔHb and nadir Hb on morbidity among a large cohort of patients undergoing complex hepatopancreatobiliary (HPB) surgery.Methods
Patients who underwent pancreatic or hepatic resection between January 1, 2009 and June 30, 2015 at Johns Hopkins Hospital were identified. Data on the perioperative ΔHb, nadir Hb, as well as blood utilization were obtained and analyzed. Multivariable logistic regression models were used to identify the factors associated with ΔHb and the impact of ΔHb on perioperative morbidity. A Bayesian model was used to evaluate the correlation of ΔHb and nadir Hb with the likelihood of transfusion, as well as the impact on morbidity.Results
A total of 4363 patients who underwent hepatobiliary (n?=?2200, 50.4 %) or pancreatic (n?=?2163, 49.6 %) surgery were identified. More than one quarter of patients received at least one unit of packed red blood cells (PRBC) (n?=?1187, 27.2 %). The median nadir Hb was 9.2 (IQR 7.9–10.5)?g/dL resulting in an average ΔHb of 3.4 mg/dL (IQR 2.2–4.7) corresponding to 26.3 %. Both ΔHb and nadir Hb strongly influenced provider behavior with regards to use of transfusion. Among patients with the same nadir Hb, ΔHb was strongly associated with use of transfusion; among patients who had a nadir Hb ≤6 g/dL, the use of transfusion was only 17.9 % when the ΔHb?=?10 % versus 49.1 and 80.9 % when the ΔHb was 30 or 50 %, respectively. Perioperative complications occurred in 584 patients (13.4 %) and were more common among patients with a higher value of ΔHb, as well as patients who received PRBC (both P?<?0.001).Conclusions
The combination of the Hb trigger with ΔHb was associated with transfusion practices among providers. Larger ΔHb values, as well as receipt of transfusion, were strongly associated with risk of perioperative complication following HPB surgery.7.
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R. Makary M. Tucker R.P. Fernandes S. Shuja 《International journal of oral and maxillofacial surgery》2009,38(8):891-894
Ewing family of tumors (EFTs) comprise highly malignant, nearly undifferentiated neoplasms including Ewing's sarcoma (ES), primitive neuroectodermal tumor (PNET) and a spectrum of other unusual variants. In general, EFTs are included among small blue cell tumors. Establishing histological diagnosis can be difficult; CD99 and FLI1 immunohistochemical staining has improved diagnosis, but these markers are not specific for EFTs. The diagnosis of EFTs is confirmed by molecular diagnostic testing showing the presence of established rearrangements of the EWS gene. The use of this molecular signature in EFTs revealed rare variants in the histomorphologic spectrum of these tumors. The authors report an unusual variant of EFT in the mandible of a 17-year-old patient, which was confirmed by translocation rearrangement in EWR1 gene at 22q12 by fluorescence in situ hybridization. The unusual histologic features, with prominent spindling of tumor cells and deviation from the classic features of Ewing's sarcoma posed a diagnostic challenge for the medical centers involved in the diagnosis and treatment of this patient. This highlights the importance of the genetic study of undifferentiated sarcomas to identify rare morphologic variants of ES, in view of the chemosensitivity of EFTs and how this affects patient management. 相似文献