Transoral robotic vertical partial laryngectomy (hemilaryngectomy) extended to the hypopharynx.

Locally advanced laryngeal cancers treatment often involves total laryngectomy, which some patients are unwilling to undergo, even if this choice reduces their survival probability. Therefore, the objective of laryngeal oncologic surgery is not only to remove the tumor, but also to preserve the organ and its functions. To overcome these concerns, several partial laryngectomy techniques have been developed. This article describes the surgical technique and a case study of a 64-year-old male patient with locally advanced laryngeal squamous cell carcinoma who underwent vertical partial laryngectomy extending to the subglottis and hypopharynx using transoral robotic surgery (TORS) with a da Vinci Single Port surgical robot. The video and article provide a detailed description of the surgical technique, which resulted in successful tumor removal with excellent oncological and functional outcomes.

Comparison of Treatment Outcome between Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcutaneous Direct Current Stimulation (tDCS) in Intractable Tinnitus.

Repetitive transcranial magnetic stimulation (rTMS) and transcutaneous direct current stimulation (tDCS) are non-invasive treatments for chronic tinnitus based on neuromodulation of cortical activity. Both are considered effective, but with heterogeneous results due to lack of established protocols. Because the target groups for both modalities overlap, it is difficult to recommend one of them. We tried to unify the inclusion criteria and treatment schedules to compare the two modalities. The medical charts of 36 patients who underwent rTMS as part of clinical routine were reviewed and data for 34 patients who underwent tDCS about 7 years later were collected prospectively. Both groups had chronic unilateral tinnitus refractory to medication. Patients were treated for 5 consecutive days, and tinnitus symptoms were evaluated by survey both at the end of the treatment schedule and 1 month after the treatment. The ratio of responders who showed >20% reduction in tinnitus handicap inventory scores were compared. At the end of the treatment, the rTMS group showed a rapid response compared to the tDCS group (rTMS, 30.6%; tDCS, 12.1%; p = 0.054). However, both groups showed a significant and similar reduction in tinnitus symptoms 1 month after the treatment (rTMS, 47.2%; tDCS, 36.4%; p = 0.618). As both groups showed comparable results for tinnitus reduction, tDCS may be superior in terms of cost-effectiveness.

Imperforate Hymen: A Comprehensive Systematic Review.

Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed, Scopus and Medline databases was performed for sources published up to 3 July 2018 for English-language studies with the term "imperforate hymen". The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.