Search

This superbly illustrated atlas provides step-by-step descriptions of surgical procedures to the airways based on use of the sheep as an animal model, which has been demonstrated scientifically to be comparable to the human. The procedures covered – tracheotomy, laryngotracheoplasty, slide tracheoplasty, tracheal reconstruction, partial cricotracheal reconstruction, and main endoscopic techniques – are relevant to a range of frequent surgical indications, such as stenosis, laryngotracheomalacia, and tracheal tumor. The book is the first to describe such surgery on the basis of this animal model and includes a full description of preparation of the model. The practical guidance provided will equip surgical trainees with the knowledge required before embarking on these procedures in humans, but will also be highly relevant to more experienced surgeons wishing to upgrade their skills. The book is the outcome of a successful collaboration between the Head and Neck Surgery Departments of the University Hospital of Modena and the Bambino Gesù Hospital in Rome.

Background: Speech and language therapy (SLT) interventions for people with aphasia are complex – for example, interventions vary by delivery model (face-to-face, tele-rehabilitation), dynamic (group, 1-to-1) and provider. Therapists tailor the functional relevance and intervention difficulty to the individual’s needs. Therapy regimes are planned at a specific intensity (hours per week), frequency (number of weekly sessions), duration (time from start to end of therapy intervention) and dose (total number of therapy hours). Detailed and transparent description of interventions for people with aphasia facilitates replication in clinic, between-study comparisons and data-syntheses. Incomplete intervention reporting and inconsisten-cies in the use of terminology have been observed (RELEASE: REhabilitation and recovery of peopLE with Aphasia after StrokE Collaborators, 2015-2018; Brady, Kelly, Godwin, Enderby, & Campbell, 2016; Pierce, O’Halloran, Togher, & Rose, in press). Even when similar terms are used there may be little agreement on their use (Pierce et al., in press). Our RELEASE Collaboration includes 72 multidisciplinary, multilingual aphasia researchers from 28 countries. In preparation for planned meta-analyses (HS&DR 14/04/22) we sought to extract and synthesise information on SLT interventions for aphasia. Description of interventions in research reports have benefited from the Template for Intervention Description and Replication (TIDieR; (Hoffmann et al., 2014). The TIDieR checklist supports transparent reporting, data extraction and synthesis in aphasia research. It has facilitated an exploration of the contribution specific parameters (for example intensity) may make to the effectiveness of (or tolerance to) an intervention (Brady et al., 2016). However, while the variables described above are readily summarised, other aspects of therapeutic interventions such as the theoretical approach, the materials used and the procedures employed (the “Why” and “What” within TIDieR) are more challenging to summarise in manner supporting data synthesis and meta-analyses. The World Health Organisation’s (“International Classification of Health Interventions (ICHI),”) also seeks a framework which supports the synthesis and statistical analysis of healthcare interventions based on (a) the treatment target, (b) the intended action to the target and (c) the processes and methods required to carry out the action (ICHI, 2018). However a framework which complements these initiatives and which supports greater consistency in the description of SLT interventions for aphasia is required.\ud \ud Aims: We sought to develop international consensus on a framework to support the description of SLT interventions for people with aphasia. Methods and procedures: Two researchers independently extracted information about the SLT interventions in our RELEASE database (Hoffmann et al., 2014). Information on therapy approaches, materials and procedures were extracted, where possible, as direct quotes from published reports. Using the narrative descriptions, similar approaches were grouped and assigned to one or more category labels by an experienced speech and language therapist. These preliminary groupings were shared with RELEASE Collaborators for review. Each reviewed interventions included within up to four category labels and responses via email were requested. There followed an opportunity for group discussion on the proposed categorisation via videoconference.\ud \ud Outcomes and results: Therapy interventions were categorised based on three per-spectives (a) the role of the intervention within the study design e.g., usual care as a comparison control (b) the intervention target e.g., rehabilitation of spoken language production and (c) the theoretical approach e.g., semantic therapy. We identified 15 SLT approaches. Categories were not mutually exclusive; rather they represented different ways of categorising a complex intervention. Inadequate reporting of therapy interven-tions, procedures and materials hampered some classifications. The Collaboration facilitated knowledge sharing relating to emerging treatment category definitions such as multimodal treatment (Pierce et al., in press) which reflected interventions aimed to utilise a range of learning mechanisms and neural networks to facilitate language recovery.\ud \ud Conclusions: Our collaboration agreed on a framework which supports transparent description, data synthesis and meta-analyses of SLT interventions for people with aphasia after stroke.

Background: Beliefs of dementia experts about the pathogenic role of amyloid in Alzheimer's disease (AD) may affect the use of amyloid positron emission tomography (PET). Objective: To assess the role attributed to amyloid in AD pathogenesis by Italian dementia experts, and whether this modulates the impact of amyloid PET results in their diagnostic workup. Methods: 22 dementia experts rated their beliefs about the pathogenic role of amyloid. Then, we asked them to rate the probability of change in diagnosis based on the result of amyloid PET for 7 case vignettes, depicting patients who initially received a diagnosis based on a comprehensive workup and later received amyloid PET results consistent or inconsistent with the clinical picture. Results: 55% of the experts assigned a dominant role to amyloid, and 32% attributed a similar role to amyloid and tau in AD pathogenesis. The probability of change in diagnosis ranged from 17% (SD = 21.6) for cases with consistent to 51% (SD = 34) for cases with inconsistent PET versus clinical data. Diagnostic change was not biased by the clinicians' beliefs about AD pathogenesis. Conclusions: This work supports an unbiased interpretation of amyloid PET across different beliefs about the pathogenic role of amyloid, and a belief-independent reluctance to change diagnosis in cases where change is expected and recommended.

Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy and the most difficult to manage. It often causes increased morbidity, delays starting adjuvant therapy, prolongs hospitalisation, increases treatment costs and reduces the quality of life (QoL). The objective of this study is to analyse the predisposing factors and the most important nutritional parameters related to the development of PCF in patients undergoing total laryngectomy and to suggest medical alternatives that might improve results. We performed a retrospective study of 69 patients who underwent either primary or salvage total laryngectomy in our department between January 2008 and January 2012. Risk factors for fistula formation were analysed including tumour characteristics (histology, grading, AJCC stage), treatment (primary or salvage surgery, extent of resection, flap reconstruction, preoperative radiotherapy), comorbidity and nutritional status (preoperative haemoglobin, albumin and prealbumin levels and their changes during hospitalisation). Twenty-four patients developed a PCF (overall incidence 34.8%). Fistula formation was significantly higher in patients with diabetes, preoperative malnutrition (identified from low preoperative albumin and prealbumin levels). After specific nutritional evaluation and support, no patient developed a PCF. Risk factors for PCF formation are extensively treated in the literature but identification of high-risk patients is still controversial. Our study demonstrates that nutritional status of the patient, assessed by preoperative albumin, is also an important risk factor for PCF formation in addition to classical factors. Maintenance of a normal perioperative nutritional status can be helpful to avoid this complication.La formazione di fistole faringocutanee è una delle complicanze più frequenti dopo laringectomia totale e la più difficile da gestire. La comparsa di una fistola faringocutanea determina spesso aumento della morbidità, ritardo nell'inizio delle terapie adiuvanti, prolungata ospedalizzazione, aumento dei costi di trattamento e riduzione della qualità di vita. L'obiettivo di questo studio è analizzare i principali fattori di rischio e i parametri nutrizionali correlati allo sviluppo di fistole faringocutanee nei pazienti sottoposti a laringectomia totale e valutare i possibili interventi terapeutici finalizzati a ridurre l'incidenza di tale complicanze. Abbiamo effettuato uno studio retrospettivo su 69 pazienti sottoposti presso il nostro istituto a laringectomia totale, come trattamento primitivo o di salvataggio, fra gennaio 2008 e gennaio 2012. I fattori di rischio per la formazione di fistole faringocutanee analizzati sono stati: caratteristiche del tumore (istologia, grading, stadio, ecc.), trattamento (chirurgia primitiva o di salvataggio, estensione della resezione, ricostruzione con lembo, radioterapia preoperatoria, ecc.), comorbidità e stato nutrizionale (valori e trend di emoglobina preoperatoria, albumina e prealbumina). Dopo valutazione e supporto nutrizionale mirato nessun paziente ha sviluppato fistole faringocutanee. L'identificazione dei pazienti ad alto rischio di fistola faringocutanea dopo laringectomia totale è argomento ancora dibattuto in letteratura. Il nostro studio ha dimostrato che lo stato nutrizionale del paziente, valutato attraverso i valori di albumina preoperatoria, è anch'esso un fattore di rischio per lo sviluppo di fistole faringocutanee. Quindi il mantenimento di un stato nutrizionale adeguato può essere utile per evitare tale complicanza.

Introduction:\ud Aphasia affects a third of stroke survivors (~5.6 million worldwide annually). The social and emotional impact of aphasia makes timely and effective rehabilitation vital. Speech and language therapy benefits recovery; however the specific patient, stroke, aphasia and intervention factors which optimise recovery and rehabilitation are unclear. We will explore these uncertainties in our RELEASE study (NIHR HS&DR 14/04/22). In Phase I of this study we aimed to create a large, collaborative, international database of individual patient data (IPD) from pre-existing aphasia research.\ud \ud Method:\ud Eligible datasets included IPD of ≥10 people with stroke-related aphasia, with time poststroke specified and aphasia severity data. Contributions were invited from international, multidisciplinary, aphasia research collaborators via the EU COST funded Collaboration of Aphasia Trialists. We also conducted a systematic search of the literature [Cochrane Stroke Group Trials, MEDLINE, CINAHL, AMED, Cochrane Library Databases (CDSR, DARE, CENTRAL, HTA), EMBASE, LLBA and SpeechBITE from inception to Sept 2015 for additional datasets. Two independent reviewers considered full texts, a third resolved any conflicts.\ud \ud Results:\ud As of June 2016 our database included 2,531 IPD from 11 countries (33 datasets). Nine were in the public domain. Following the systematic search of 5,272 records (of which 75 duplicates, 2,395 reference titles and 965 abstracts were excluded) further datasets were identified and the investigators of these datasets invited to collaborate.\ud \ud Conclusion:\ud We succeeded in creating a large, collaborative, international aphasia database of preexisting IPD. A systematic search process to identify additional datasets eligible for inclusion supplemented more informal dataset recruitment methods.

nn

Objectives/Hypothesis: To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces. Study Design: This was an anatomical study on a prospective case series. Methods: The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections. Results: Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the subpyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence. Conclusions: Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed anatomical descriptions of hidden areas. Improvement in our knowledge of the anatomy may decrease the possibility of residual disease during cholesteatoma surgery. © 2009 The American Laryngological, Rhinological and Otological Society, Inc.

Aim of this report is to describe the long-term results of endoscopic endonasal repair of cerebrospinal fluid leak using a septal mucoperichondrial graft. A case series of 52 patients operated for cerebrospinal fluid rhinorrhea between 1990 and 2006 is presented. All patients underwent surgical treatment for endoscopic endonasal closure of a cerebrospinal fluid leak using a septal mucoperichondrial graft. No lumbar drain and fluorescein tests were used. The intra-operative localization of the fistula was aided by Valsalva’s manoeuvre by the anaesthetist. The success rate, after the first attempt, was 88.5% (46/52 patients); for the remaining 11.5% (6/52 patients), a second attempt was necessary which proved successful in 5 cases, raising the overall success rate to 98.1% (51/52 patients). Relapse occurred in only one case (1.9%), after the second attempt. In conclusion, a free mucoperichondrial graft offered good results for cerebrospinal fluid leak repair. In the Authors’ experience, a high success rate can be achieved without the use of intrathecal fluorescein and lumbar drain.

A surgical series of 30 cervico-mediastinal thyroid cancer patients operated on has been retrospectively reviewed. Results were compared with those obtained in patients operated on for benign cervico-mediastinal goiter and thyroid cancer confined to cervical region. Of 4688 thyroidectomies performed, 30 patients were operated on for thyroid carcinoma with cervico-mediastinal extension. There were 15 males and 15 females. The mean age was 67 years (range, 21–86 years). Patients with cervico-mediastinal cancer were significantly older than patients with benign cervico-mediastinal goiter ( P < 0.0001). Time between onset of first symptoms and surgery was significantly longer in patients with cervico-mediastinal cancer than in those with benign cervico-mediastinal goiter ( P < 0.0001) and cervical thyroid cancer. Signs and symptoms at the time of surgery were cervical mass in 28 patients (93%), cervical lymphadenopathy in 20 patients (66%), dyspnea in 21 (70%), dysphagia in 9 (30%), dysphonia in 2 (7%), and venous stasis in 1 (3%). None of the patients was asymptomatic. Total thyroidectomy with functional lymphectomy was performed in 16 cases. Seven of these patients were operated on in 2 stages. In 8 cases the operation was a debulking procedure, and in 6 it was a near-total thyroidectomy. Sternotomy was performed in two cases. A differentiated thyroid cancer was found in 21 patients (70%), medullary in 5 (17%) and undifferentiated in 4 (13%). The incidence of medullary carcinoma was significantly higher compared with cervical cancer ( P < 0.008). Postoperative complications were higher than those occurring in benign cervico-mediastinal goiter and similar to those occurring in cervical cancer. The actuarial survival was similar to that of cervical cancer matched for age and sex. This analysis shows that the longer clinical history of goiter is related to its endothoracic development and its neoplastic transformation. This finding should further encourage surgeons to treat any cervico-mediastinal goiter as promptly as possible.