1
|
Jolly K, Gupta KK, Egbuji O, Naik PP, Ahmed SK. Endoscopic transsphenoidal surgery reconstruction using the fibrin sealant patch Tachosil ®. Br J Neurosurg 2024; 38:498-502. [PMID: 33769186 DOI: 10.1080/02688697.2021.1905771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/25/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The incidence of CSF leak following endoscopic transsphenoidal surgery remains the most important measure in the success of any repair. The nasoseptal flap (NSF) has played a pivotal role in reconstructing defects. However, morbidity associated with the NSF includes bleeding, septal injury, altered smell and crusting. Tachosil® is an absorbable fibrin sealant patch that promotes haemostasis and wound healing. The purpose of this study was to evaluate the effectiveness of Tachosil® to repair intraoperative defects during an endoscopic transsphenoidal approach. MATERIALS AND METHODS All patients who underwent an endoscopic transsphenoidal approach with the use of Tachosil® at the Queen Elizabeth Hospital Birmingham, between January 2013 and June 2020 were retrospectively analysed. Tachosil® was used as an overlay patch over of the bony defect, in a multi-layered repair depending on the defect and grade of CSF leak. The primary outcome measure was post-operative CSF leak. RESULTS A total of 52 primary procedures where Tachosil® was used as the overlay were analysed. There were 23 (44.2%) intraoperative CSF leaks. The overall post-operative CSF leak rate was 7.8% (n = 4), with all cases having had a Tachosil® overlay reconstruction with no NSF. A formal NSF was harvested in only five cases alongside the Tachosil® patch, where a grade 2 or more leak was identified at the time of the primary procedure, none of which developed a post-operative leak. No patient had any post-operative adverse outcomes that were attributed to Tachosil®. CONCLUSIONS We believe this to be the largest case series evaluating the endoscopic use of Tachosil® in skull base reconstruction. Our data show that in endoscopic transsphenoidal approach, Tachosil® may be used safely in a multi-layered approach as an effective alternative to the NSF in low flow CSF leak cases, or alongside a NSF in higher flow leaks.
Collapse
Affiliation(s)
- Karan Jolly
- Department of Otolaryngology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Keshav Kumar Gupta
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ofuchi Egbuji
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paresh Pramod Naik
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shahzada Khuram Ahmed
- Department of Otolaryngology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
2
|
Abstract
Keloids are the result of aberrant tissue scarring typically occurring in injured skin, and are caused by the overgrowth of granulation tissue or collagen type III during the healing process. There is a genetic component, thus a predisposition can be genetically transmitted. Keloids are difficult to treat because of their postexcisional recurrence, and they have an impact on patient quality of life due to psychological distress caused by cosmetic concerns and functional disability. Treatment ranges from classic corticosteroid therapy to multimodal approaches such as injections, cryotherapy, laser, radiation, radiofrequency ablation and extracorporeal shockwave therapy. Recent discoveries into the pathogenesis of keloid have enabled clinicians to expand the therapeutic options for treatment. The aim of this paper was to review the literature, clarify the general concept of keloid development, and assess emerging treatment options such as stem cell therapy, mitomycin C, bleomycin, interferon, botulinum toxin type A, calcium channel blockers, angiotensin-converting enzyme inhibitors and fat grafting, and the evolutionary advancement towards epigenetic modifications and gene therapy.
Collapse
Affiliation(s)
- P P Naik
- Department of Dermatology, Saudi German German Hospitals and Clinics, Dubai, United Arab Emirates
| |
Collapse
|
3
|
Naik PP, Tsermoulas G, Paluzzi A, McClelland L, Ahmed SK. Endonasal surgery in the coronavirus era - Birmingham experience. J Laryngol Otol 2020; 134:1-4. [PMID: 33143753 PMCID: PMC7729149 DOI: 10.1017/s0022215120002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The World Health Organization declared coronavirus disease 2019 a pandemic on 11th March 2020. There is concern regarding performing endonasal surgical procedures because of a high viral load in the nasopharynx. This paper describes our experience in conducting emergency and urgent endonasal operations during the peak of the coronavirus disease 2019 pandemic in the UK. OBJECTIVES To show the outcome of endonasal surgery during the peak of the coronavirus disease 2019 pandemic and to assess the post-operative rate of nosocomial coronavirus disease 2019 infection. METHODS A retrospective cohort study was conducted of all patients who underwent high priority endoscopic nasal surgery or anterior skull base surgery between 23rd March and 15th June 2020 at University Hospitals Birmingham NHS Trust. RESULTS Twenty-four patients underwent endonasal surgery during the study period, 12 were males and 12 were females. There was no coronavirus-related morbidity in any patient. CONCLUSION This observational study found that it is possible to safely undertake urgent endonasal surgery; the nosocomial risk of coronavirus disease 2019 can be mitigated with appropriate peri-operative precautions.
Collapse
Affiliation(s)
- P P Naik
- Department of ENT, University Hospital Birmingham, UK
| | - G Tsermoulas
- Department of Neurosurgery, University Hospital Birmingham, UK
| | - A Paluzzi
- Department of Neurosurgery, University Hospital Birmingham, UK
| | - L McClelland
- Department of ENT, University Hospital Birmingham, UK
| | - S K Ahmed
- Department of ENT, University Hospital Birmingham, UK
| |
Collapse
|
4
|
Jolly K, Kontogiannis T, Pankhania M, Hussain K, Naik PP, Ahmed SK. Use of the medial canthal point (MCP) as a reliable anatomical landmark to the frontal sinus. Laryngoscope Investig Otolaryngol 2020; 5:791-795. [PMID: 33134524 PMCID: PMC7585238 DOI: 10.1002/lio2.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Frontal sinus surgery is considered one of the more challenging aspects of Functional Endoscopic Sinus Surgery, due to the complex variations in normal sinus anatomy but also increased morbidity due to the close proximity of critical structures such as the anterior cranial fossa and orbits. We aim to investigate the medial canthal point (MCP) as an anatomical landmark for safe frontal sinus access. METHODS The MCP intranasally is identified during surgery with non-tooth forceps, with one limb just anterior to the medial canthus and the other intranasally in the same coronal plane along the skull base. This point was identified on 100 paranasal sinus computed tomography (CT) scan reconstructions. The distance between the anterior cranial fossa and MCP was measured on imaging-medial canthal point distance (MCPD). The maximal anterior-posterior (AP) distance was measured on all scans. RESULTS The average MCPD for males was 13.0 mm (8.7-20.4 mm) and for females 12.0 mm (6.8-22.8 mm). Mean AP distance for males was 12.0 mm (4.5-20.2 mm) and for females 10.4 mm (3.8-15.9 mm). Mean distance for all 100 patients was 12.6 mm (range 7.5-22.8 mm). In all cases, the MCP was anterior to the cranial fossa. Mixed effects modelling analysis showed a significant correlation between the MCPD and AP distance (P = .006). CONCLUSION The MCP is a consistent anatomical landmark that can serve as an adjunct to safe frontal sinus access alongside the first olfactory fiber and CT navigation systems. However, patient selection continues to be very important, with larger well pneumatized frontal sinuses being ideal to tackle earlier in a surgeon's career. LEVEL OF EVIDENCE NA.
Collapse
Affiliation(s)
- Karan Jolly
- Department of Otolaryngology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - Miran Pankhania
- Department of Otolaryngology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Khalid Hussain
- Department of Otolaryngology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Paresh Pramod Naik
- Department of Otolaryngology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Shahzada K. Ahmed
- Department of Otolaryngology, Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| |
Collapse
|
5
|
Naik PP, Richards EC, Ahmed SK. Turbinate stitch: modification of Ahmed's three-layered flap for oroantral fistulas. A technical note. Br J Oral Maxillofac Surg 2020; 59:240-241. [PMID: 33239202 DOI: 10.1016/j.bjoms.2020.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- P P Naik
- Department of Otolaryngology, University Hospital Birmingham, UK.
| | - E C Richards
- Department of Otolaryngology, University Hospital Birmingham, UK.
| | - S K Ahmed
- Department of Otolaryngology, University Hospital Birmingham, UK.
| |
Collapse
|
6
|
Naik PP, Savery N, Kuruvilla L, Nayakar G, Raghul T. Longus Colli Tendinitis: The Lost Twin of Retropharyngeal Abscess. Indian J Otolaryngol Head Neck Surg 2018; 71:771-775. [PMID: 31742062 DOI: 10.1007/s12070-018-1541-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
Longus colli calcific tendinitis is a rare condition which mimics the alarming condition, retropharyngeal abscess. Clinically, the patient presents which acute cervical pain, dysphagia and fever. Since this condition is little known to otorhinolaryngologists, it is usually misdiagnosed as a retropharyngeal abscess which is more common. This is a case report of a 52 year old female who presented with complaints of neck pain and difficulty in swallowing along with fever which were acute in onset. Clinically, the symptoms overlapped with those of a retropharyngeal abscess. The diagnosis was confirmed as longus colli calcific tendinitis. Longus colli calcific tendinitis is a rare entity which can be diagnosed solely based on radiological investigation. The knowledge of this disease is crucial to otorhinolaryngolists as it avoids over treatment, unwarranted chance surgical exposure.
Collapse
Affiliation(s)
| | - Nishanth Savery
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Linu Kuruvilla
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - T Raghul
- Pondicherry Institute of Medical Sciences, Puducherry, India
| |
Collapse
|
7
|
Naik PP, Poduval J, Divakaran S. Review Article: Retropharyngeal Abscess-Mimickers and Masqueraders. Indian J Otolaryngol Head Neck Surg 2017; 69:269-273. [PMID: 28607904 DOI: 10.1007/s12070-017-1105-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/21/2017] [Indexed: 12/19/2022] Open
Abstract
To discuss a case of suspected retropharyngeal abscess having important clinical and academic significance. This paper discusses an unusual presentation and evolution of a well known condition such as retropharyngeal abscess. Though the diagnosis in this case was initially a retropharyngeal abscess, several unusual findings were evident, which interfered with the optimal management of the patient. A literature review revealed rare causes and lesions mimicking a retropharyngeal abscess, such as retropharyngeal calcific tendinitis and Kawasaki disease, which are neither familiar to otolaryngologists nor other specialists such as orthopedicians. It is possible that this patient was both over treated and undertreated at the same time. Though the diagnosis in this case could not be established with certainty, several important pieces of information came up, especially unusual causes of retropharyngeal abscess and management of the same. Retropharyngeal abscess is a well-known condition with established modes of management. However, certain variations may occur and may pose challenges in diagnosis and management. These variations are little known and need to be highlighted so that optimal management is ensured.
Collapse
Affiliation(s)
- Paresh Pramod Naik
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
| | - Jayita Poduval
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
| | - Shilpa Divakaran
- Department of ENT, Pondicherry Institute of Medical Sciences, Kalapet, Ganapathychetikulam, Puducherry 605014 India
| |
Collapse
|
8
|
Abstract
A number of epidemiologic studies has been published in recent years showing an increase risk of death from cancer in subjects with low plasma cholesterol levels. Although several authors proposed that hypocholesterolemia is predisposing factor for cancer development, no causative relation has been established so far and that it may be that low plasma cholesterol is secondary to malignant disease. Hence, the present study was undertaken to examine the lipid profile in children patients with leukemia and Hodgkin's disease in comparison with age matched controls. The study included 52 normal healthy controls and 105 patients with leukemia and Hodgkin's disease. Lipid profile included serum cholesterol, HDL & LDL cholesterol and triglycerides. Serum cholesterol, HDL & LDL cholesterol were found to be inversely associated with incidence of cancer, whereas triglycerides were significantly elevated in cancer patients. The inverse association between cancer and serum cholesterol may reflect a physiological response to early undiagnosed stages of cancer.
Collapse
Affiliation(s)
- P P Naik
- Department of Biochemistry, Tata Memorial Hospital, 5th Floor, Annexe Building, Dr. E. Borges Marg, Parel, 400012 Mumbai
| | | | | |
Collapse
|
9
|
Yadav MR, Gandhi HP, Naik PP, Giridhar R. Revelation on the potency of α(1) -blockers - parallel blockade of angiotensin II receptor: a new finding. Pharm Biol 2012; 50:439-442. [PMID: 22136253 DOI: 10.3109/13880209.2011.611144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT The problem of hypertension has gained enormous proportions in the past decade. Multifactorial etiology and complex pathophysiology of the disease has rendered the treatment of the disease a hard task. Sympathetic nervous system and the renin-angiotensin-aldosterone system are primary contributors of blood pressure homeostasis. OBJECTIVE Structural similarities were identified among AT(1) and α(1)-antagonists, initiating a speculation that α(1)-antagonists could possibly block the AT(1) receptor and vice-versa. METHODS To corroborate this speculation, we screened prototypical α(1)-antagonists such as prazosin, doxazosin, and terazosin for antagonism of angiotensin II on rat aortic strips. We also examined the AT(1) antagonists losartan, valsartan, and olmesartan for their possible antagonistic effect, on contractions of rat aortic strips induced by phenylephrine. RESULTS To our astonishment, we found that prazosin and its analogs which have been reported to have α(1)-antagonistic activity only, were able to shift concentration response curves of angiotensin II. CONCLUSION Our findings suggest that the potent antihypertensive effect of prazosin-type α(1)-antagonists is not purely due to α(1)-receptor blocking activity of these compounds but also due to blockade of AT(1) receptors. This finding may lead to the development of more potent dual inhibitors which would prove to be of immense value in the control of the scourge of hypertension.
Collapse
MESH Headings
- Adrenergic alpha-1 Receptor Antagonists/chemistry
- Adrenergic alpha-1 Receptor Antagonists/pharmacology
- Angiotensin II Type 1 Receptor Blockers/chemistry
- Angiotensin II Type 1 Receptor Blockers/pharmacology
- Animals
- Antihypertensive Agents/chemistry
- Antihypertensive Agents/pharmacology
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/metabolism
- Dose-Response Relationship, Drug
- Doxazosin/pharmacology
- Imidazoles/pharmacology
- In Vitro Techniques
- Losartan/pharmacology
- Male
- Molecular Structure
- Prazosin/analogs & derivatives
- Prazosin/pharmacology
- Rats
- Rats, Wistar
- Receptor, Angiotensin, Type 1/drug effects
- Receptor, Angiotensin, Type 1/metabolism
- Receptors, Adrenergic, alpha-1/drug effects
- Receptors, Adrenergic, alpha-1/metabolism
- Structure-Activity Relationship
- Tetrazoles/pharmacology
- Valine/analogs & derivatives
- Valine/pharmacology
- Valsartan
- Vasodilation/drug effects
- Vasodilator Agents/chemistry
- Vasodilator Agents/pharmacology
Collapse
Affiliation(s)
- M R Yadav
- Pharmacy Department, Faculty of Technology and Engineering, Kalabhavan, The M. S. University of Baroda, Vadodara, Gujarat, India.
| | | | | | | |
Collapse
|
10
|
Raste AS, Naik PP. Clinical significance of lipid profile in cancer patients. Indian J Med Sci 2000; 54:435-41. [PMID: 11262860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In the present study, we have examined lipid profile in normal healthy age matched control and patients with various malignancies. Analysis of data revealed that total lipids, cholesterol and HDL cholesterol levels are inversely associated with incidence of cancer where as triglycerides levels were significantly elevated in cancer patients. Electrophoretic separation of lipoproteins revealed a significant decrease in the mean values of alpha fraction in patients with malignancy when compared with the corresponding control group. The other fractions beta and pre-beta did not show any change in the mean values in patients with cancer as compared to the normal corresponding control group.
Collapse
Affiliation(s)
- A S Raste
- Department of Biochemistry, Tata Memorial Hospital, Dr E Borges Marg, Parel, Mumbai-400 012
| | | |
Collapse
|