RESUMEN
OBJECTIVES/HYPOTHESIS: Many human immunodeficiency virus (HIV)-infected pediatric patients develop otolaryngologic disease. We aimed to characterize their otolaryngologic manifestations by type and demographic variation, and model temporal trends. STUDY DESIGN: Retrospective cohort review. METHODS: A retrospective review utilizing the Kids' Inpatient Database (KID) was conducted. International Classification of Diseases, Ninth Revision, Clinical Modification codes for HIV and otolaryngologic diagnoses were used to query data from the triennially published KID files from 1997 to 2012. A subset analysis of infectious versus non-infectious admitting otolaryngologic diagnoses was conducted. RESULTS: A total of 11,150 cases met the inclusion criteria. Of these cases, 21.8% were admitted for otolaryngologic manifestations, with 18.0% presenting with infectious symptomatology, 4.8% with noninfectious disease, and 1.0% with both. On average, patients presenting with infectious disease were younger (8.17 years vs. 9.65 years, P < .001). Patients in the South were significantly more likely to be admitted for infection (54.8% vs. 42.0%, P < .001), with non-infectious predominance in the Northeast and West. HIV-infected children in 1997 were more likely to present with infectious otolaryngologic disease (56.3% vs. 45.8%, P < .001); however, there has been a decrease in the prevalence of infectious head and neck presentations (46.5%, 19.9%, 11.5%, 6.7%, 3.7%, and 1.9% from 1997 to 2012), and a gradual shift toward noninfectious manifestation with notable differences in 2000 and 2012 (19.9% vs. 25.2%; P = .017; and 1.9% vs. 4.8%, P < .001, respectively). CONCLUSIONS: Otolaryngologic disease accounts for nearly one-fifth of hospitalizations in HIV-infected children; however, rates of hospitalization as well as otolaryngologic manifestations have progressively decreased over time. HIV-infected children nowadays are more likely to present with noninfectious rather than infectious disease. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E377-E382, 2019.
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Infecciones por VIH/complicaciones , VIH , Hospitalización/estadística & datos numéricos , Enfermedades Otorrinolaringológicas/epidemiología , Niño , Bases de Datos Factuales , Femenino , Infecciones por VIH/virología , Humanos , Masculino , Enfermedades Otorrinolaringológicas/virología , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES/HYPOTHESIS: Postoperative complications is an important marker of healthcare quality. The aim of this study was to analyze the impact of resident and fellow participation on postoperative complications in transsphenoidal pituitary surgery in a multi-institutional setting. STUDY DESIGN: Retrospective analysis of population-based surgical registry. SETTING: Academic medical center. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was utilized to generate transsphenoidal pituitary surgery patient cohorts. The attending with resident and/or fellow group was compared to the attending alone based on demographics and preoperative and postoperative variables. RESULTS: A total of 469 cases were included in the analysis, with 315 performed with resident participation and 154 by attendings alone. The attending group had higher rates of diabetics (20.1% vs. 11.7%, P = 0.015) and patients with a history of previous percutaneous coronary intervention (6.0 vs. 1.6%, P = 0.009). Although the attending group demonstrated higher rates of surgical complications, and the resident/fellow group showed increased incidence in medical and overall complication rates, there was no statistical difference between the two groups. Multivariate analysis further demonstrated lack of significance in complication rates between attendings and residents/fellows. CONCLUSION: Resident and fellow participation in transsphenoidal surgery is not associated with significant differences in surgical complications, medical complications, mortality, operating time, reoperation rates, or readmission rates when compared to attendings. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2707-2713, 2018.
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Becas/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/estadística & datos numéricos , Hipófisis/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Competencia Clínica , Bases de Datos Factuales , Becas/normas , Femenino , Humanos , Incidencia , Internado y Residencia/normas , Masculino , Persona de Mediana Edad , Análisis Multivariante , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/normas , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Sistema de Registros , Estudios Retrospectivos , Seno Esfenoidal/cirugía , Resultado del TratamientoRESUMEN
Background Endoscopic pituitary surgery (EPS) is increasingly being used for the treatment of pituitary lesions. Obesity is a growing epidemic in our nation associated with numerous comorbidities known to impact surgical outcomes. We present a multi-institutional database study evaluating the association between body mass index (BMI) and postsurgical outcomes of EPS. Methods Patients who underwent EPS from 2005 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Preoperative variables, comorbidities, and postoperative outcomes, such as 30-day complications, morbidity, and mortality, were analyzed. Results A total of 789 patients were analyzed, of which 382 were obese (BMI ≥ 30) (48.4%). No difference in reoperation rate ( P = .928) or unplanned readmission rates ( P = .837) was found between the obese versus nonobese group. A higher overall complication rate was observed in the obese group compared to the nonobese counterparts ( P = .005). However, when separated into surgical complications (3.7% vs 1.5%, P = .068) and medical complications (7.6% vs 3.9%, P = .027), only medical complications, specifically pneumonia, remained significantly different. EPS on obese patients was also associated with prolonged operating time (154.8 min vs 141.0 min, P = .011). Conclusions EPS may be a safe treatment option for pituitary lesions in the obese population. Although obese patients undergoing EPS are at increased risk of medical complications and prolonged operating times, this did not influence mortality, reoperation, or readmission rate.
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Índice de Masa Corporal , Endoscopía , Obesidad/cirugía , Neoplasias Hipofisarias/cirugía , Neumonía/epidemiología , Complicaciones Posoperatorias/epidemiología , Reoperación/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/mortalidad , Readmisión del Paciente/estadística & datos numéricos , Neoplasias Hipofisarias/epidemiología , Neoplasias Hipofisarias/mortalidad , Neumonía/etiología , Riesgo , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: This study is designed to analyze the survival benefits of elective neck dissection (END) in the treatment of squamous cell carcinoma of the maxillary sinus (MS-SCC) with clinically negative neck lymph nodes (N0) and no metastasis (M0). STUDY DESIGN: The aim of this study was to evaluate whether END improves survival in patients with MS-SCC. METHODS: This study is a population-based, concurrent retrospective database analysis of patients diagnosed with N0M0 MS-SCC from 2004 to 2013. Data were acquired from the Surveillance, Epidemiology, and End Results database. Frequency functions, Kaplan-Meier and Cox regression models were queried to analyze demographics, treatment status, and survival outcomes. RESULTS: There were a total of 927 MS-SCC cases in the database between 2004 and 2013. This analysis revealed that for the overall cohort, END significantly and independently reduces the 5-year hazard of death in MS-SCC (hazard ratio [HR] = 0.646, 95% confidence interval [CI] = 0.419-0.873, P = 0.047). For early tumor (T)1/T2 tumors and T4 tumors, END did not independently improve 5-year survival. However, for T3 disease, END significantly reduced the 5-year hazard of death in MS-SCC (HR = 0.471, 95% CI = 0.261-0.680, P = 0.001), regardless of other covariates, including adjuvant radiation. There has been an increase in the percentage of MS-SCC surgeries that have been accompanied by END since SEER started collecting this data, although this did not demonstrate significance (R2 = 0.622). CONCLUSION: END improves disease-specific survival in patients with MS-SCC size > 4 cm and advanced T-stage (American Joint Committee on Cancer AJCC TIII). Therefore, surgeons performing maxillectomies should consider conducting an END concurrent with maxillectomy for those with size > 4 cm advanced stage cancer. LEVEL OF EVIDENCE: 4. Laryngoscope, 1835-1841, 2018.
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Carcinoma de Células Escamosas/cirugía , Disección del Cuello/métodos , Neoplasias de los Senos Paranasales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/epidemiología , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Neoplasias de los Senos Paranasales/epidemiología , Estudios Retrospectivos , Programa de VERF , Estados Unidos/epidemiologíaRESUMEN
This study investigated the effects of local delivery of manganese chloride (MnCl2), an insulin-mimetic compound, upon fracture healing using a rat femoral fracture model. Mechanical testing, histomorphometry, and immunohistochemistry were performed to assess early and late parameters of fracture healing. At 4 weeks post-fracture, maximum torque to failure was 70% higher (P<0.05) and maximum torsional rigidity increased 133% (P<0.05) in animals treated with 0.125 mg/kg MnCl2 compared to saline controls. Histological analysis of the fracture callus revealed percent new mineralized tissue was 17% higher (P<0.05) at day 10. Immunohistochemical analysis of the 0.125 mg/kg MnCl2 treated group, compared to saline controls, showed a 379% increase in the density of VEGF-C+ cells. In addition, compared to saline controls, the 0.125 mg/kg MnCl2 treated group showed a 233% and 150% increase in blood vessel density in the subperiosteal region at day 10 post-fracture as assessed by detection of PECAM and smooth muscle α actin, respectively. The results suggest that local MnCl2 treatment accelerates fracture healing by increasing mechanical parameters via a potential mechanism of amplified early angiogenesis leading to increased osteogenesis. Therefore, local administration of MnCl2 is a potential therapeutic adjunct for fracture healing.
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Cloruros/farmacología , Cloruros/uso terapéutico , Fracturas del Fémur/tratamiento farmacológico , Curación de Fractura/efectos de los fármacos , Compuestos de Manganeso/farmacología , Compuestos de Manganeso/uso terapéutico , Actinas/metabolismo , Animales , Fenómenos Biomecánicos , Femenino , Fracturas del Fémur/metabolismo , Masculino , Modelos Animales , Neovascularización Fisiológica/efectos de los fármacos , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Ratas , Ratas Endogámicas BB , Ratas Wistar , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
Mature dendritic cells (DCs) were generated by culturing human peripheral blood monocytes for 7 days and, then, treating them with a cytokine cocktail for 2 days. The viability of the mature DCs (Day 9) obtained was approximately 60-70%, and this gradually declined when they were recultured in X-VIVO 15 media containing 2% human plasma (40% viability after 3 days of reculture). DC death accelerated on withdrawing plasma from the culture (20% viability after 3 days). However, the addition of tumor necrosis factor-alpha (TNF-alpha) to the medium completely restored DC viability in the absence of plasma. Such a protective effect was not afforded by other cytokines, such as granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1alpha (IL-1alpha), IL-4, IL-6 and prostaglandin E2 which are used for the maturation of DCs. These results indicate that TNF-alpha is specifically required to maintain the viability of mature DCs. The withdrawal of plasma rapidly (within 15 min) elevated cellular levels of reactive oxygen intermediates (ROIs), which have been proposed to regulate the ability of DCs to control inflammatory reactions. The possibility that ROIs act as mediators of DC death was eliminated by the observation that scavengers of ROIs, such as catalase, N-acetylcysteine, glutathione, failed to prolong DC life span in the absence of plasma. Interestingly, TNF-alpha was found to almost completely abolish the production of ROIs induced by plasma withdrawal. To summarize, our results suggest that TNF-alpha controls not only the inflammatory functions of DCs but also their survival.