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Background: This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit., Methodology: A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications., Results: The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra- and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone., Conclusions: This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

Introduction: Chronic kidney disease-associated pruritus (CKD-aP) is a common, yet underdiagnosed condition among patients on hemodialysis. Considering the lack of established treatment pathways, we sought to evaluate the use of antidepressant, systemic antihistamines, or gabapentinoid medications among patients with CKD-aP in the year following pruritus assessment., Methods: We included 6209 patients on hemodialysis in the analysis. We retrospectively extracted clinical and patient-reported data from electronic health records. The intensity of CKD-aP was assessed by KDQOL-36 and 5-D Itch questionnaires. Prescription of antidepressant, antihistamine, and gabapentinoids was ascertained by the occurrence of a relevant active medical order in patients' medical records., Results: We observed a consistent and graded association between the severity of CKD-aP and the use of antidepressant, systemic antihistamines, and gabapentinoid medications. This association remained consistent and intensified over the duration of the year after pruritus screening. This trend was robust even after accounting for potential confounding factors., Conclusions: Patterns of antipruritic medication use in a cohort of patients with CKD-aP was identified and the frequent use of off-label treatments in the absence of approved therapies was highlighted. These observations reflect clinical practices aimed at managing severe pruritus but do not imply a causal relationship between the medications and pruritus severity. Even though we cannot exclude the possibility that these drugs have been prescribed to treat medical conditions warranting their use, previous evidence suggested that doctors may also use such medications in an attempt to buffer CKD-aP. These findings underline the importance of further elucidating current treatment strategies adopted in clinical practice to address CKD-aP., Competing Interests: Declarations. Conflict of Interest: Jasmine Ion Titapiccolo, Luca Neri, Hans-Juergen Arens, Len Usvyat, Stefano Stuard are employees of Fresenius Medical Care. Marco Soro and Thilo Schaufler are employees of CSL Vifor and have CSL share options. Hans-Juergen Arens has share options/ownership in Fresenius Medical Care, Abbott Laboratories, and AbbVie Inc. Len Usvyat has share options/ownership in Fresenius Medical Care and he is inventor of patents in the field of dialysis. Len Usvyat is an advisory board member for Privacy Analytics Inc. Ethical Approval: All the patients consented to their data being used for secondary data analysis and research. Ethical approval was waived by the Ethics Committee of the Hospital Clinic of Barcelona, Spain with the protocol number Reg. HCB/2022/0586. All research was performed in accordance with relevant guidelines and regulations and in particular in accordance with the World Medical Association Declaration of Helsinki regarding the ethical principles for medical research involving human subjects. Patients were involved in the initial design of the study through feedback gathered in patient-reported outcomes from previous quality of life assessments. Additionally, the results of this study will be shared with the patient community through appropriate channels to inform them of the findings and potential implications for future treatment strategies. We are committed to patient-centered research while always safeguarding patient confidentiality., (© 2024. The Author(s).)