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Previously described as inflammatory pseudotumor, inflammatory myofibroblastic tumors (IMT) are now considered as distinct tumors of specific histopathologic features. This rare mesenchymal tumor consists of spindle shaped fibroblasts associated with various amounts of inflammatory cells. Head and neck region, is an unusual site of involvement. In this article, we will introduce two separate cases with the diagnosis of IMT involving the nasopharynx and the temporal bone which are both rare locations of presentation. Inflammatory myofibroblastic tumor should be considered in the differential diagnosis list of every mass in head and neck region. [ABSTRACT FROM AUTHOR]

Introduction: One concern in meta-analyses is the presence of publication bias (PB) which leads to the dissemination of inflated results. In this study, we assessed how much the meta-analyses in the field of otorhinolaryngology in 2021 evaluated the presence of PB. Methods: Six of the most influential journals in the field were selected. A search was conducted, and data were extracted from the included studies. In cases where PB was not assessed by the authors, we evaluated the risk of its presence by designing funnel plots and performing statistical tests. Results: Seventy-five systematic reviews were included. Fifty-one percent of them used at least one method for assessing the risk of PB, with the visual inspection of a funnel plot being the most frequent method used. Twenty-nine percent of the studies reported a high risk of PB presence. We replicated the results of 11 meta-analyses that did not assess the risk of PB and found that 63.6% were at high risk. We also found that a considerable proportion of the systematic reviews that found a high risk of PB did not take it into consideration when making conclusions and discussing their results. Discussion: Our results indicate that systematic reviews published in some of the most influential journals in the field do not implement enough measures in their search strategies to reduce the risk of PB, nor do they assess the risk of its presence or take the risk of its presence into consideration when inferring their results. [ABSTRACT FROM AUTHOR]

The article presents author views on objective method for author determination (OMAD).Topics discussed include studies subject to several self‐proclaimed limitations; revising manuscript critically for important intellectual content; and activities involved in conducting research and the scholarly work involved in preparing a final manuscript.

Objective The aim of this study was to compare the performance of three search methods in the retrieval of relevant clinical trials from PubMed to answer specific clinical questions. Methods Included studies of a sample of 100 Cochrane reviews which recorded in PubMed were considered as the reference standard. The search queries were formulated based on the systematic review titles. Precision, recall and number of retrieved records for limiting the results to clinical trial publication type, and using sensitive and specific clinical queries filters were compared. The number of keywords, presence of specific names of intervention and syndrome in the search keywords were used in a model to predict the recalls and precisions. Results The Clinical queries-sensitive search strategy retrieved the largest number of records (33) and had the highest recall (41.6%) and lowest precision (4.8%). The presence of specific intervention name was the only significant predictor of all recalls and precisions ( P = 0.016). Conclusion The recall and precision of combination of simple clinical search queries and methodological search filters to find clinical trials in various subjects were considerably low. The limit field strategy yielded in higher precision and fewer retrieved records and approximately similar recall, compared with the clinical queries-sensitive strategy. Presence of specific intervention name in the search keywords increased both recall and precision. [ABSTRACT FROM AUTHOR]

Objectives We assessed the quality of a sample of clinical guidelines for thyroid nodules and thyroid cancers, using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. We also evaluated the reliability and validity of the AGREE instrument and summarized the key recommendations of the appraised guidelines. Methods Twenty-six clinical researchers and endocrinologists who had been trained in the principles of developing clinical guidelines and using the AGREE instrument participated in the study and appraised the guidelines. Clinical guidelines selected via a systematic search were assessed, each by eight participants. We compared the AGREE domain scores of the guidelines, and compared the participants' scores before and after group discussions. We used Cronbach's alpha, and intraclass correlation coefficients to assess the reliability, and the Spearman's rho to assess the correlation between the overall assessment and other variables. Results Seven guidelines were included in the study. 'Scope and purpose' and 'clarity and presentation' achieved the highest domain scores. 'Applicability' received the lowest domain scores and reliability coefficients. 'Rigor of development' and 'clarity and presentation' obtained the highest correlations with overall assessment scores. There was a significant relationship between the overall assessment score and the numbers of algorithms, tables and figures in the guidelines. Conclusions We identified three clinical guidelines that obtained high overall assessment scores and were recommended for use in practice. Our findings have important implications for those developing clinical guidelines, especially as clarity and presentation significantly influenced the participants' assessment of the guidelines. The developers should ensure that the recommendations are presented clearly and unambiguously, and flowcharts, algorithms and other tools are developed to help the users in applying the recommendations into practice. The optimal number of appraisers for each guideline is four. Further work is needed to improve the 'applicability' domain of the AGREE. [ABSTRACT FROM AUTHOR]

Introduction: Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx. Case Report: This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient's symptoms were all relieved post operatively and he was discharged on the second day following the procedure. Conclusion: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water. [ABSTRACT FROM AUTHOR]

Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastases to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy. [ABSTRACT FROM AUTHOR]

Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastases to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorders have been on the rise in recent years with increasing caesarean rates. The purpose of this prospective observational study was to describe our detection rates and to review outcomes in PAS after the introduction of an institutional screening and management protocol. Twenty-one patients with suspected PAS over 5 years were identified. 20/21 patients had an accurate determination of placental invasion and positive correlation with surgical and histopathological examination. Early morbidity (massive haemorrhage) was found in 7/21 patients, whilst late morbidity (hospital readmission) was found in 5/21 patients. There were no maternal deaths and admissions to intensive therapy unit (ITU). In summary, our centre demonstrated a high antenatal detection rate for PAS using an evidence-based protocol. This has led to timely intervention by an experienced multidisciplinary team and excellent outcomes. Immediate and delayed postoperative counselling was effective for optimal patient understanding and experience. What is already known on this subject? With rising caesarean section rates, the incidence of placenta accreta spectrum (PAS) disorders is increasing. Despite this, most obstetricians have personally managed only a small number of patients with PAS. Moreover, there appears to be some debate over the optimal diagnostic and management strategy. What do the results of this study add? As the incidence increases, development of institutional screening and management protocol is a necessity for large units. Timely diagnosis, extensive pre and postoperative counselling and multidisciplinary teamwork ensure reduced early and late morbidity. What are the implications of these findings for clinical practice and/or further research? Evidence based screening protocols for PAS disorders reduce the likelihood of undiagnosed cases and should be developed in every unit. Consideration must also be given to standardisation of the diagnostic and management protocols, including contingency plan for emergencies. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common problem in otolaryngology. In this case report, we present a patient with fish bone ingestion with a unique route of extraction. A 50-year-old woman was presented with a complaint of odynophagia while eating fish. Rigid laryngoscopy revealed nothing except ecchymosis on the right pyriform sinus. We performed an axial neck computed tomography (CT) scan and found the fish bone at the retropharyngeal space. After three days there was a tender bulging in the neck. We extracted the fish bone thorough a small incision on the neck. We recommend the performance of CT scan in patients with suspected hypopharyngeal and esophageal sharp foreign body impaction. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common problem in otolaryngology. In this case report, we present a patient with fish bone ingestion with a unique route of extraction. A 50-year-old woman was presented with a complaint of odynophagia while eating fish. Rigid laryngoscopy revealed nothing except ecchymosis on the right pyriform sinus. We performed an axial neck computed tomography (CT) scan and found the fish bone at the retropharyngeal space. After three days there was a tender bulging in the neck. We extracted the fish bone thorough a small incision on the neck. We recommend the performance of CT scan in patients with suspected hypopharyngeal and esophageal sharp foreign body impaction. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the Student Scientific Research Center (SSRC) in Tehran, Iran.

Ulipristal acetate (UPA), is a selective progesterone-receptor modulator, it decreases fibroid size and reduces menstrual bleeding. We reviewed its use at the Heart of England Foundation Trust (HEFT), one of the largest prescribing trusts in the UK. The electronic records of patients treated with UPA from January 2013 to August 2015 were reviewed. One hundred and thirty four patients received UPA, 20 women (15%) received a second course. Eighty percent reported subjective global improvements in symptoms after the first course; 45.5% described amenorrhoea or light bleeding compared to 4.5% prior to treatment. Fewer patients were anaemic (Hb <11 g/dL) following treatment (8.2% versus 33.6%). The majority of fibroids (34%) reduced or remained the same size (25%). Two-thirds of women treated for symptom control avoided surgical intervention. UPA improves symptoms and modifies the use of surgery in treating fibroids. Correcting anaemia prior to major surgery reduces the risk of blood transfusion and optimises a patient's condition as part of an enhanced recovery pathway. Impact Statement What is already known on this subject: In women with heavy menstrual bleeding secondary to fibroids, UPA has been shown to reduce fibroid size and control uterine bleeding, inducing amenorrhoea in the majority. Initially, only licenced for pre-operative use, an expansion of the licence has included on-going intermittent use for symptomatic fibroids. What the results of this study add: Our review is the largest published cohort of women treated with UPA. It demonstrates symptomatic improvements and advantageous modifications in fibroid size in women of all ethnicities and ages. Our inclusion of women with a uterine size greater than 16 weeks and fibroid diameter larger than 10 cm demonstrates the benefits of UPA with increased fibroid dimensions. What the implications are of these findings for clinical practice and/or further research: These findings can allow clinicians to consider alternative surgical interventions or even avoid surgery completely in a proportion of patients with fibroids. Correcting anaemia and optimising a patient's pre-operative condition reduces post-operative complications and ongoing morbidity. However, 25% of fibroids failed to respond to UPA treatment, further research into the characteristics of women and fibroids that show favourable clinical outcomes will allow identification of those women who are likely to benefit from treatment and prevent futile use in others. [ABSTRACT FROM AUTHOR]

The article presents a case study of women with bilateral hearing loss. The woman had tinnitus for one year and physical examination revealed she was Schwartze sign positive with an intact tympanic membrane. After audiometric evaluation she was prescribed sodium fluoride that reduced the Schwartze sign. Stapedotomy for right ear cured the tinnitus.

In this study, high-resolution, multislice computed tomography findings are compared with surgical findings in terms of the fracture location in patients with traumatic facial paralysis. Patients with traumatic facial paralysis with grade VI House-Brackmann scale who met the criteria for surgical decompression between 2008 and 2012 were included in this study. All the patients underwent a multislice high-resolution, multislice computed tomography (HRCT) using 1-mm-thick slices with a bone window algorithm. The anatomical areas of the temporal bone (including the Fallopian canal) were assessed by CT and during the surgery (separately by the radiologist and the surgeon), and fracture line involvement was recorded. Forty-one patients entered this study. The perigeniculate area was the most commonly involved region (46.34 %) of the facial nerve. The sensitivity and specificity of HRCT to detect a fracture line seems to be different in various sites, but the overall sensitivity and specificity were 77.5 and 77.7 %, respectively. Although HRCT is the modality of choice in traumatic facial paralysis, the diagnostic value may differ according to the fracture location. The results of HRCT should be considered with caution in certain areas. [ABSTRACT FROM AUTHOR]

This paper presents our surgical technique and the results of using bipedicled superior chest flaps for head and neck reconstructions. The study design consisted of a case series of surgical technique. The study was conducted at tertiary referral centers with otorhinolaryngology-head and neck surgery departments. In seven patients, we used bipedicled superior chest flaps for reconstruction of anterior cutaneous neck defects due to surgery for the recurrence of laryngopharyngeal carcinoma. The largest flap size was 45 × 14 cm. All donor sites were closed primarily with advancement in the lateral part and split thickness skin grafts in the superior midline of chest. The highest point of reconstruction was in the hypopharynx internally and hyoid externally. All flaps survived without major complications. A bipedicled upper chest flap can reliably cover the skin defects that create following salvage total laryngectomies in patients with advanced stage tumors with skin involvement. [ABSTRACT FROM AUTHOR]

Pancreas islet transplantation is one of the potential cure for type 1 diabetes. However Current isolation techniques lead to loss of number and function of isolated islets during procedure, needing in any cases two donors for each transplant. To overcome this problem many factors and added extra protocols should be investigated during isolation process. Low level laser irradiation (LLLI) is currently being used to treat wide variety of medical conditions. Many studies have proved cellular proliferation after in-vitro irradiation of low level laser. Effects of LLLI in secretory cells have been also considered. It has been shown that products of these cells are amplified after irradiation. These effects on LLLI are explained by increasing intracellular ATP and Ca2+ flux. Based on these findings, it can be hypothesized that low level laser could be beneficial for islet viability and function, if it irradiates to islets during isolation procedure. [ABSTRACT FROM AUTHOR]

Introduction: Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions. Case Report: In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision. Conclusion: Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision. [ABSTRACT FROM AUTHOR]

Abdominal wall endometriosis, the commonest type of extra-pelvic endometriosis, may rarely develop spontaneously in the absence of prior surgical scar. We aim to report 3 cases with this unique characteristic, two of them with a diagnosis of unusual development of umbilical endometriosis and one with inguinal endometriosis, from the perspective of a general surgeon. Because of the potential pitfalls in its diagnosis, endometriosis should be emphasized in the differential diagnosis of abdominal wall masses. [ABSTRACT FROM AUTHOR]

Objective: To describe the presentation and outcome of a patient with an unusual association of VATER/VACTERL syndrome (vertebra/anus/cardiac/trachea/esophogus/radius/renal/limb) and noncommunicating functioning uterine horn and a unicornuate uterus. Design: Descriptive case report. Setting: A foundation trust in the United Kingdom. Materials and Method(s): A patient known to have VATER/VACTERL syndrome was diagnosed with a hematometra of a noncommunicating uterine horn and hematosalpinx. She underwent multidisciplinary surgery to remove the functioning uterine horn, after which she had a full recovery. Conclusion(s): This case documents the association of VATER/VACTERL syndrome with a unicornuate uterus and noncommunicating horn. [Copyright &y& Elsevier]