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Single Stage Conservative Surgery to Avoid Recurrence in Combined Laryngocele: Important Modifications.

ABSTRACT: Laryngocele is very uncommon and no consensus regarding its surgical management is yet established. While traditional external approach is still being recommended some suggest a better microlaryngoscopic management assisted by CO₂ laser that has gained popularity. Recurrence is better known with conservative surgery but this paper presents a modified single stage endolaryngeal technique for combined laryngoceles to overcome the same. The salient features are (1) A comparatively larger operculum is created and all the visible mucosa is excised; (2) the base of residual postoperative cavity is moistened with cotton soaked with concentrated carbolic acid for 1 min and (3) the residual 'charred' base with intermittent oozing is packed with single layer of surgicel. The reader is further encouraged to see surgical video of entire procedure.

SUBMITTER: Mishra A

PROVIDER: S-EPMC9701937 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Single Stage Conservative Surgery to Avoid Recurrence in Combined Laryngocele: Important Modifications.

Mishra Anupam A

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 20200720 Suppl 2

Laryngocele is very uncommon and no consensus regarding its surgical management is yet established. While traditional external approach is still being recommended some suggest a better microlaryngoscopic management assisted by CO<sub>2</sub> laser that has gained popularity. Recurrence is better known with conservative surgery but this paper presents a modified single stage endolaryngeal technique for combined laryngoceles to overcome the same. The salient features are (1) A comparatively larger ...[more]

PMID: 36452588

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Project description:BackgroundTo investigate the factors associated with postoperative recurrence in patients with ovarian-type endometriosis (EMS) who were treated with conservative surgery and to provide ideas for preventing disease recurrence in advance of treatment.MethodsThe study included data from 289 inpatients with ovarian-type EMS who underwent conservative laparoscopic surgery in the Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, from 2018 to 2020. We collected general clinical data, postoperative recurrence, drug treatment, and follow-up information. The factors associated with recurrence were analyzed using SPSS 26.0 software.ResultsA total of 289 patients were included in this study, including 49 patients with recurrence and 240 without recurrence. In the univariate analysis of recurrence, revised American Fertility Society (r-AFS) score, preoperative dysmenorrhea, EMS fertility index (EFI) score, combined myoma, and postoperative pregnancy affected postoperative recurrence of patients. The critical value of r-AFS was 70 according to the subject receiver operating characteristic curve (ROC), and the Youden index was 0.513. R-AFS >70 had a sensitivity of 57.1%, specificity of 94.2%, the positive predictive value of 66.7%, the negative predictive value of 91.5%, and diagnostic accuracy of 87.9% for the diagnosis of recurrent ovarian endometrioid cysts. Using multifactorial binary logistic regression, results showed that r-AFS score >70 [odd ratio (OR) =1.042; 95% confidence interval (CI): 1.028-1.055; P<0.05], myoma (OR =2.995; 95% CI: 1.429-6.275; P<0.05), and preoperative dysmenorrhea (OR =1.994; 95% CI: 1.071-3.713; P<0.05) were risk factors for recurrence. EFI score (OR =0.785; 95% CI: 0.661-0.931; P<0.05), postoperative pregnancy (OR =0.349; 95% CI: 0.132-0.920; P<0.05) were protective factors for recurrence. The differences were statistically significant, and the remaining differences were not statistically significant.ConclusionsPreoperative r-AFS level, preoperative dysmenorrhea, and combined myoma are risk factors for postoperative recurrence, so patients with an r-AFS score over 70 should be more alert to possible recurrence. Moreover, EFI score and postoperative pregnancy are protective factors for postoperative recurrence. Postoperative patients should routinely take medication for prevention, and patients with the intention to become pregnant should be encouraged to conceive as soon as possible to reduce recurrence.

Project description:ObjectiveRecurrence remains the main cause of the poor prognosis in stage I-IIIA lung squamous cell carcinoma (LUSC) after surgical resection. In the present study, we aimed to identify the long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and messenger RNAs (mRNAs) related to the recurrence of stage I-IIIA LUSC. Moreover, we constructed a risk assessment model to predict the recurrence of LUSC patients.MethodsRNA sequencing data (including miRNAs, lncRNAs, and mRNAs) and relevant clinical information were obtained from The Cancer Genome Atlas (TCGA) database. The differentially expressed lncRNAs, miRNAs, and mRNAs were identified using the "DESeq2" package of the R language. Univariate Cox proportional hazards regression analysis and Kaplan-Meier curve were used to identify recurrence-related genes. Stepwise multivariate Cox regression analysis was carried out to establish a risk model for predicting recurrence in the training cohort. Moreover, Kaplan-Meier curves and receiver operating characteristic (ROC) curves were adopted to examine the predictive performance of the signature in the training cohort, validation cohort, and entire cohort.ResultsBased on the TCGA database, we analyzed the differentially expressed genes (DEGs) among 27 patients with recurrent stage I-IIIA LUSC and 134 patients with non-recurrent stage I-IIIA LUSC, and identified 431 lncRNAs, 36 miRNAs, and 746 mRNAs with different expression levels. Out of these DEGs, the optimal combination of DEGs was finally determined, and a nine-joint RNA molecular signature was constructed for clinical prediction of recurrence, including LINC02683, AC244517.5, LINC02418, LINC01322, AC011468.3, hsa-mir-6825, AC020637.1, AC027117.2, and SERPINB12. The ROC curve proved that the model had good predictive performance in predicting recurrence. The area under the curve (AUC) of the prognostic model for recurrence-free survival (RFS) was 0.989 at 3 years and 0.958 at 5 years (in the training set). The combined RNA signature also revealed good predictive performance in predicting the recurrence in the validation cohort and entire cohort.ConclusionsIn the present study, we constructed a nine-joint RNA molecular signature for recurrence prediction of stage I-IIIA LUSC. Collectively, our findings provided new and valuable clinical evidence for predicting the recurrence and targeted treatment of stage I-IIIA LUSC.

Dataset Information

Single Stage Conservative Surgery to Avoid Recurrence in Combined Laryngocele: Important Modifications.

Publications

Single Stage Conservative Surgery to Avoid Recurrence in Combined Laryngocele: Important Modifications.

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