Objective:Pituitary apoplexy(PA)is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies,endocrinopathies,and even death.Human immunodeficiency virus(H...Objective:Pituitary apoplexy(PA)is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies,endocrinopathies,and even death.Human immunodeficiency virus(HIV)has been shown to have some association with pituitary apoplexy,however,large-scale studies have not been performed.Methods:A retrospective cohort study of subjects greater than 18 years of age was performed using the national TriNetX database.The general population was first compared with those undergoing treatment for PA to compare general demographics and incidence of HIV.The PA cohort was then substratified by HIV status and propensity matched by age and sex to evaluate differences in visual outcomes and endocrine metrics.Using the diagnosis of pituitary apoplexy as an index event,the rate of HIV diagnosis at the time of presentation or in the three months following treatment was calculated.Two-tailed,unpairedt-tests were performed.Results:A total 2066 patients were identified(902 HIV,1158 controls).Those with HIV showed an increased rate of pituitary apoplexy(odds ratio[OR]:19.8)versus healthy adults and were more likely to be younger and male.Among patients treated for pituitary apoplexy,patients with HIV were more likely to have increased thyroid stimulating hormone,reduced T4,and increased prolactin compared with healthy controls.There were no significant differences in visual outcomes between HIV positive and control patients.Importantly,74%of patients did not carry a diagnosis of HIV on presentation but were diagnosed at the time of or in the three months following treatment for pituitary apoplexy.Conclusions:Diagnosis and treatment of pituitary apoplexy shows a high rate of concurrent or subsequent diagnosis of HIV.Screening for HIV should be considered in patients undergoing treatment for pituitary apoplexy.展开更多
Background:Carcinosarcomas are rare,aggressive malignancies that can arise in the nasal cavity and paranasal sinuses.There are limited outcome data available.Accordingly,we sought to use the National Cancer Database(N...Background:Carcinosarcomas are rare,aggressive malignancies that can arise in the nasal cavity and paranasal sinuses.There are limited outcome data available.Accordingly,we sought to use the National Cancer Database(NCDB)to characterize patient demographics and outcomes.Method:A retrospective analysis of the NCDB from 2004 to 2016 for patients with sinonasal carcinosarcoma was conducted.Results:Thirty patients were included.The patients were predominantly male(n=20),white(n=23),and privately insured(n=15),with an average age of 62.4 years.The nasal cavity was the most common subsite(n=14),followed by the maxillary sinus(n=8).Most patient were treated with surgery followed by radiation(n=23),with the remaining undergoing surgery alone(n=4),radiation alone(n=2),or no treatment(n=1).One-third(n=10)received adjuvant chemotherapy.The 1-and 5-year overall survival(OS)in the cohort were 79.2%and 43.3%,respectively.Univariate log-rank testing showed OS varied based on intervention(P<0.029),sex(P<0.042),and age(P<0.025),while on multivariate analysis none of these factors independently predicted OS.Conclusions:We describe the demographics and presenting features of a national cohort of sinonasal carcinosarcoma patients.Future research is needed to identify predictors of overall survival,and to assess the optimal roles for radiation and systemic chemotherapy.展开更多
Objective:Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal.Given the ubiquitous nature of the instrument,we sought to be...Objective:Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal.Given the ubiquitous nature of the instrument,we sought to better define the patterns of device failure using the postmarket surveillance openFDA database.Methods:The openFDA database was queried for all microdebrider‐related adverse events from January 1,2000 to November 1,2020.Descriptive information on the nature of device failure and any associated patient injury was compiled.Reports not directly related to device failure were excluded from the analysis.Results:A total of 641 events were included in the analysis.The most common device failure was overheating(n=348,54.3%),followed by material separation(n=173,27%),and inconsistent device activation(n=52,8.1%).Of the reported events,the vast majority did not result in patient harm(n=579,90.3%).On review of the remaining cases,only 24 events(3.7%)resulted in true harm to the patient,defined as a temporary or permanent injury or>30 min of additional anesthesia time.Of these cases,the need to reschedule surgical cases(n=5,0.8%),retained foreign body(n=5,0.8%),and thermal tissue injury(n=3,0.5%)were the most common.Five patients suffered an injury due to surgeon error unrelated to device malfunction(n=5,0.8%).Conclusions:Microdebrider device failures are extremely rare.When they do occur,less than 10%result in patient harm.In cases of patient harm related to microdebrider failure,preoperative testing of the device before use could prevent many of the reported malfunctions.展开更多
Objectives:The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied.We quantified long‐term impact of postoperative steroid ir...Objectives:The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied.We quantified long‐term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS.Methods:Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019.Data on patient demographics and postoperative treatment with nasal saline irrigation twice daily with and without dissolved steroids (mometasone or budesonide) was collected.Preoperative,and 1‐,3‐,6‐,12‐,18‐,and 24‐month postoperative Sino‐Nasal Outcome Test (SNOT‐22) scores were assessed.Results:A total of 727 patients were assessed (53.4% males),with 479 patients in the no SI group and 248 patients in the SI group.Preoperative SNOT‐22 scores did not differ significantly (P = 0.19).1‐,3‐,6‐,12‐,18‐,and 24‐month post‐op SNOT‐22 scores did not significantly differ between groups.However,mometasone irrigations resulted in significantly lower postoperative 2‐year SNOT‐22 scores compared to budesonide (P < 0.01) and saline (P = 0.03).Conclusions:Though corticosteroid irrigations are routine in managing inflammatory sinus disease,their role in postoperative management after ESBS for tumors is unclear.Our findings suggest that mometasone irrigation may be effective at improving postoperative quality of life in patients after ESBS.展开更多
Objectives:Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery(FESS)are managed carefully due to concern for bleeding.Little is known regarding the increase in the risk of ...Objectives:Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery(FESS)are managed carefully due to concern for bleeding.Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area.We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs(NSAIDs)versus opioids.We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin.Data Source:Retrospective analysis of patients undergoing FESS using the TriNetX database.Methods:Patients were propensity-matched,and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids.We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery.Results:A total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs.After propensity matching,1918 patients were in each group and odds of epistaxis were similar between the NSAID group and the opioid group(odds ratio[OR]:1.32,95%confidence interval(CI):0.90-1.94);7.67%of the NSAID group required rescue opioids.Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67%compared to 9.00%in propensity-matched controls who were not on aspirin(OR:1.74,95%CI:1.20-2.51).Conclusions:NSAID use appears to be a safe alternative to opioids for patients without pre-existing risk factors for bleeding.Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis.展开更多
文摘Objective:Pituitary apoplexy(PA)is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies,endocrinopathies,and even death.Human immunodeficiency virus(HIV)has been shown to have some association with pituitary apoplexy,however,large-scale studies have not been performed.Methods:A retrospective cohort study of subjects greater than 18 years of age was performed using the national TriNetX database.The general population was first compared with those undergoing treatment for PA to compare general demographics and incidence of HIV.The PA cohort was then substratified by HIV status and propensity matched by age and sex to evaluate differences in visual outcomes and endocrine metrics.Using the diagnosis of pituitary apoplexy as an index event,the rate of HIV diagnosis at the time of presentation or in the three months following treatment was calculated.Two-tailed,unpairedt-tests were performed.Results:A total 2066 patients were identified(902 HIV,1158 controls).Those with HIV showed an increased rate of pituitary apoplexy(odds ratio[OR]:19.8)versus healthy adults and were more likely to be younger and male.Among patients treated for pituitary apoplexy,patients with HIV were more likely to have increased thyroid stimulating hormone,reduced T4,and increased prolactin compared with healthy controls.There were no significant differences in visual outcomes between HIV positive and control patients.Importantly,74%of patients did not carry a diagnosis of HIV on presentation but were diagnosed at the time of or in the three months following treatment for pituitary apoplexy.Conclusions:Diagnosis and treatment of pituitary apoplexy shows a high rate of concurrent or subsequent diagnosis of HIV.Screening for HIV should be considered in patients undergoing treatment for pituitary apoplexy.
文摘Background:Carcinosarcomas are rare,aggressive malignancies that can arise in the nasal cavity and paranasal sinuses.There are limited outcome data available.Accordingly,we sought to use the National Cancer Database(NCDB)to characterize patient demographics and outcomes.Method:A retrospective analysis of the NCDB from 2004 to 2016 for patients with sinonasal carcinosarcoma was conducted.Results:Thirty patients were included.The patients were predominantly male(n=20),white(n=23),and privately insured(n=15),with an average age of 62.4 years.The nasal cavity was the most common subsite(n=14),followed by the maxillary sinus(n=8).Most patient were treated with surgery followed by radiation(n=23),with the remaining undergoing surgery alone(n=4),radiation alone(n=2),or no treatment(n=1).One-third(n=10)received adjuvant chemotherapy.The 1-and 5-year overall survival(OS)in the cohort were 79.2%and 43.3%,respectively.Univariate log-rank testing showed OS varied based on intervention(P<0.029),sex(P<0.042),and age(P<0.025),while on multivariate analysis none of these factors independently predicted OS.Conclusions:We describe the demographics and presenting features of a national cohort of sinonasal carcinosarcoma patients.Future research is needed to identify predictors of overall survival,and to assess the optimal roles for radiation and systemic chemotherapy.
文摘Objective:Functional endoscopic sinus surgery is a commonly performed otolaryngologic procedure that often uses the microdebrider device for tissue removal.Given the ubiquitous nature of the instrument,we sought to better define the patterns of device failure using the postmarket surveillance openFDA database.Methods:The openFDA database was queried for all microdebrider‐related adverse events from January 1,2000 to November 1,2020.Descriptive information on the nature of device failure and any associated patient injury was compiled.Reports not directly related to device failure were excluded from the analysis.Results:A total of 641 events were included in the analysis.The most common device failure was overheating(n=348,54.3%),followed by material separation(n=173,27%),and inconsistent device activation(n=52,8.1%).Of the reported events,the vast majority did not result in patient harm(n=579,90.3%).On review of the remaining cases,only 24 events(3.7%)resulted in true harm to the patient,defined as a temporary or permanent injury or>30 min of additional anesthesia time.Of these cases,the need to reschedule surgical cases(n=5,0.8%),retained foreign body(n=5,0.8%),and thermal tissue injury(n=3,0.5%)were the most common.Five patients suffered an injury due to surgeon error unrelated to device malfunction(n=5,0.8%).Conclusions:Microdebrider device failures are extremely rare.When they do occur,less than 10%result in patient harm.In cases of patient harm related to microdebrider failure,preoperative testing of the device before use could prevent many of the reported malfunctions.
文摘Objectives:The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied.We quantified long‐term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS.Methods:Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019.Data on patient demographics and postoperative treatment with nasal saline irrigation twice daily with and without dissolved steroids (mometasone or budesonide) was collected.Preoperative,and 1‐,3‐,6‐,12‐,18‐,and 24‐month postoperative Sino‐Nasal Outcome Test (SNOT‐22) scores were assessed.Results:A total of 727 patients were assessed (53.4% males),with 479 patients in the no SI group and 248 patients in the SI group.Preoperative SNOT‐22 scores did not differ significantly (P = 0.19).1‐,3‐,6‐,12‐,18‐,and 24‐month post‐op SNOT‐22 scores did not significantly differ between groups.However,mometasone irrigations resulted in significantly lower postoperative 2‐year SNOT‐22 scores compared to budesonide (P < 0.01) and saline (P = 0.03).Conclusions:Though corticosteroid irrigations are routine in managing inflammatory sinus disease,their role in postoperative management after ESBS for tumors is unclear.Our findings suggest that mometasone irrigation may be effective at improving postoperative quality of life in patients after ESBS.
文摘Objectives:Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery(FESS)are managed carefully due to concern for bleeding.Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area.We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs(NSAIDs)versus opioids.We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin.Data Source:Retrospective analysis of patients undergoing FESS using the TriNetX database.Methods:Patients were propensity-matched,and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids.We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery.Results:A total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs.After propensity matching,1918 patients were in each group and odds of epistaxis were similar between the NSAID group and the opioid group(odds ratio[OR]:1.32,95%confidence interval(CI):0.90-1.94);7.67%of the NSAID group required rescue opioids.Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67%compared to 9.00%in propensity-matched controls who were not on aspirin(OR:1.74,95%CI:1.20-2.51).Conclusions:NSAID use appears to be a safe alternative to opioids for patients without pre-existing risk factors for bleeding.Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis.
