Aberrant gastroduodenal artery with splenic origin

Abstract

Purpose

Knowledge of the wide variability in celiac trunk branches is of paramount importance when planning an abdominal surgery.

Methods

We, hereby, report a previously undescribed origin of the gastroduodenal artery discovered on an abdominal angio-CT.

Results

CT-angiogram performed on a 33-year-old female randomly revealed a new variant of gastroduodenal artery arising directly from the splenic artery along with other vascular aberrations. The latter were previously described in medical literature.

Conclusion

High-quality preoperative imaging is crucial for identification of visceral artery variations, as those can technically modify the surgical or interventional procedure.

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Bilateral brachiocephalic trunks

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Different phenotypes of non-classical monocytes associated with systemic inflammation, endothelial alteration and hepatic compromise in patients with dengue.

This article is protected by copyright. All rights reserved. PMID: 30315653 [PubMed - as supplied by publisher] (Source: Immunology)

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Aberrant gastroduodenal artery with splenic origin

Abstract

Purpose

Knowledge of the wide variability in celiac trunk branches is of paramount importance when planning an abdominal surgery.

Methods

We, hereby, report a previously undescribed origin of the gastroduodenal artery discovered on an abdominal angio-CT.

Results

CT-angiogram performed on a 33-year-old female randomly revealed a new variant of gastroduodenal artery arising directly from the splenic artery along with other vascular aberrations. The latter were previously described in medical literature.

Conclusion

High-quality preoperative imaging is crucial for identification of visceral artery variations, as those can technically modify the surgical or interventional procedure.

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Bilateral brachiocephalic trunks

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Different phenotypes of non-classical monocytes associated with systemic inflammation, endothelial alteration and hepatic compromise in patients with dengue.

This article is protected by copyright. All rights reserved. PMID: 30315653 [PubMed - as supplied by publisher] (Source: Immunology)

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The student who is allergic to almost EVERYTHING

Cheyanne Perry, from South Carolina, has mast cell activation syndrome (MCAS) which sends the immune system haywire and causes her to have reactions to everyday smells like perfumes. (Source: the Mail online | Health)

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The student who is allergic to almost EVERYTHING

Cheyanne Perry, from South Carolina, has mast cell activation syndrome (MCAS) which sends the immune system haywire and causes her to have reactions to everyday smells like perfumes. (Source: the Mail online | Health)

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Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Abstract

Skull base defects following endonasal surgery for pituitary macroadenoma need to be addressed during the surgery to prevent serious postoperative complications like cerebrospinal fluid (CSF) leak. The objective of this study is to assess the incidence of CSF leak following pituitary surgery and the methods of effective skull base repair. This is a retrospective observational study conducted in a tertiary care hospital after obtaining due clearance from the Institutional ethics committee. The charts of patients who underwent endonasal pituitary surgery between 2013 and 2018 were studied and details noted. Patients undergoing revision surgery or with history of preoperative radiotherapy were excluded from the study. 52 patients were included in the study. Based on the type of CSF leak, the patients were grouped into four. 19 patients (36.5%) had an intraoperative CSF leak. 3 patients developed a postoperative CSF leak. Based on the histopathology, 4 patients had ACTH secreting tumor. 8 patients had growth hormone secreting tumor, 22 had gonadotropin secreting tumor, 9 patients had a non-functioning tumour and 9 patients had prolactinoma. The type of skull base repair performed in these patients were grouped into 4.18 patients underwent type I repair, 21 patients underwent type II repair, 8 patients underwent type III repair and 5 patients underwent type IV repair. We have observed that the pedicled nasoseptal flap is particularly advantageous over other repair techniques, especially in low pressure leaks. The strategy for skull base repair should be tailored to suit each patient to minimise the occurrence of morbidity and the duration of hospital stay.

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The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules

Abstract

To investigate the efficacy of perfusion magnetic resonance imaging (MRI) in benign-malignant differentiation of thyroid nodules. Images from 24 patients with thyroid masses were obtained using dynamic contrast enhanced MRI (DCE-MRI) at 3-T MR. DCE-MRI images were evaluated by post-processing of selected regions of interest (ROIs) on software, thus eliciting quantitative data for each voxel within the ROI. Ktrans, Ve, Kep, iAUC and chi² were calculated automatically. The DCE-MRI values of benign and malignant lesions were then compared. Mean Ktrans and iAUC values in malignant lesions were significantly lower than those in benign lesions (p = 0.028 and 0.049). Ktrans, Kep, and iAUC values in malignant lesions were statistically significantly lower than normal parenchyma values. In contrast to other tissues, the perfusion MRI findings of thyroid masses exhibit a decrease in Ktrans and iAUC values as malignancy increases. Perfusion MRI may be useful in differentiating benign and malignant thyroid nodules once a cut-off value has been determined by other studies.

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Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Abstract

Skull base defects following endonasal surgery for pituitary macroadenoma need to be addressed during the surgery to prevent serious postoperative complications like cerebrospinal fluid (CSF) leak. The objective of this study is to assess the incidence of CSF leak following pituitary surgery and the methods of effective skull base repair. This is a retrospective observational study conducted in a tertiary care hospital after obtaining due clearance from the Institutional ethics committee. The charts of patients who underwent endonasal pituitary surgery between 2013 and 2018 were studied and details noted. Patients undergoing revision surgery or with history of preoperative radiotherapy were excluded from the study. 52 patients were included in the study. Based on the type of CSF leak, the patients were grouped into four. 19 patients (36.5%) had an intraoperative CSF leak. 3 patients developed a postoperative CSF leak. Based on the histopathology, 4 patients had ACTH secreting tumor. 8 patients had growth hormone secreting tumor, 22 had gonadotropin secreting tumor, 9 patients had a non-functioning tumour and 9 patients had prolactinoma. The type of skull base repair performed in these patients were grouped into 4.18 patients underwent type I repair, 21 patients underwent type II repair, 8 patients underwent type III repair and 5 patients underwent type IV repair. We have observed that the pedicled nasoseptal flap is particularly advantageous over other repair techniques, especially in low pressure leaks. The strategy for skull base repair should be tailored to suit each patient to minimise the occurrence of morbidity and the duration of hospital stay.

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The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules

Abstract

To investigate the efficacy of perfusion magnetic resonance imaging (MRI) in benign-malignant differentiation of thyroid nodules. Images from 24 patients with thyroid masses were obtained using dynamic contrast enhanced MRI (DCE-MRI) at 3-T MR. DCE-MRI images were evaluated by post-processing of selected regions of interest (ROIs) on software, thus eliciting quantitative data for each voxel within the ROI. Ktrans, Ve, Kep, iAUC and chi² were calculated automatically. The DCE-MRI values of benign and malignant lesions were then compared. Mean Ktrans and iAUC values in malignant lesions were significantly lower than those in benign lesions (p = 0.028 and 0.049). Ktrans, Kep, and iAUC values in malignant lesions were statistically significantly lower than normal parenchyma values. In contrast to other tissues, the perfusion MRI findings of thyroid masses exhibit a decrease in Ktrans and iAUC values as malignancy increases. Perfusion MRI may be useful in differentiating benign and malignant thyroid nodules once a cut-off value has been determined by other studies.

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Evaluating the IgMi mouse as a novel tool to study B cell biology.

Authors: Sahputra R, Yam-Puc JC, Waisman A, Muller W, Else KJ Abstract The current study aims to provide a detailed characterisation of IgMi mice by comparing them to their wild type controls to evaluate the use of the IgMi mouse as a novel tool to study B cell biology. PMID: 30315705 [PubMed - as supplied by publisher] (Source: European Journal of Immunology)

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Eosinophilia and reduced STAT3 signalling affect neutrophil cell death in autosomal-dominant Hyper-IgE syndrome.

This study was undertaken to functionally characterize neutrophils in STAT3-deficient HIES patients and to analyse whether the patients` eosinophilia affects the neutrophil phenotype in S. aureus infection. Neutrophil functions and cell death kinetics were studied in eight STAT3-deficient patients. Moreover, the response of STAT3-deficient neutrophils to S. aureus and the impact of autologous eosinophils on pathogen-induced cell death were analysed. No specific aberrations in neutrophil functions were detected within this cohort. However, the half-life of STAT3-deficient neutrophils ex vivo was reduced, which was partially attributable to the presence of eosinophils. Increased S. aureus-induced cell lysis, dependent on the staphylococcal virulence controlling agr-locus, was observed in STA...

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Evaluating the IgMi mouse as a novel tool to study B cell biology.

Authors: Sahputra R, Yam-Puc JC, Waisman A, Muller W, Else KJ Abstract The current study aims to provide a detailed characterisation of IgMi mice by comparing them to their wild type controls to evaluate the use of the IgMi mouse as a novel tool to study B cell biology. PMID: 30315705 [PubMed - as supplied by publisher] (Source: European Journal of Immunology)

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Eosinophilia and reduced STAT3 signalling affect neutrophil cell death in autosomal-dominant Hyper-IgE syndrome.

This study was undertaken to functionally characterize neutrophils in STAT3-deficient HIES patients and to analyse whether the patients` eosinophilia affects the neutrophil phenotype in S. aureus infection. Neutrophil functions and cell death kinetics were studied in eight STAT3-deficient patients. Moreover, the response of STAT3-deficient neutrophils to S. aureus and the impact of autologous eosinophils on pathogen-induced cell death were analysed. No specific aberrations in neutrophil functions were detected within this cohort. However, the half-life of STAT3-deficient neutrophils ex vivo was reduced, which was partially attributable to the presence of eosinophils. Increased S. aureus-induced cell lysis, dependent on the staphylococcal virulence controlling agr-locus, was observed in STA...

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A non-interventional multicenter study to document the implants success and survival rates in daily dental practices of the CONELOG screw-line implant

Abstract

Objective

This multicenter prospective non-interventional study evaluated the success and survival of the CONELOG implants inserted according to the standard protocol with one- or two-step surgery in daily practice three years after loading. Changes of soft tissue and bone level over time, esthetical outcome, and patient satisfaction were assessed.

Materials and methods

The study included patients in six centers. The implants were used in accordance with standard practice of each particular center, and the use was documented systematically. Failure rate, implant success, bone level changes, different clinical parameters, and patients' satisfaction were assessed.

Results

In total, 130 dental implants were placed in 94 patients (64 female, 30 male). Mean age of patients was 50.4 ± 13.7. At 3-year post-loading, 108 implants in 78 patients were available for evaluation. Success and survival rate were 98.4% after placement and 100% 36 months post-loading. Bone loss from surgery to loading was 0.52 ± 0.55 mm. From loading to 36 months post-loading, the bone level change remained stable. Patient assessments were performed for function, ability to chew, speech, esthetics, and general satisfaction. Patients were very satisfied (82.3%) or satisfied (16.1%). None of the patients was dissatisfied.

Conclusion

The 3-year results of this non-interventional multicenter study indicate that the CONELOG implants are reliable and effective over the course of the observation while used in standard conditions of daily environment and confirm the results obtained in controlled clinical trials.

Clinical relevance

Performance of CONELOG implants under daily routine is similar to controlled clinical trials.

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A non-interventional multicenter study to document the implants success and survival rates in daily dental practices of the CONELOG screw-line implant

Abstract

Objective

This multicenter prospective non-interventional study evaluated the success and survival of the CONELOG implants inserted according to the standard protocol with one- or two-step surgery in daily practice three years after loading. Changes of soft tissue and bone level over time, esthetical outcome, and patient satisfaction were assessed.

Materials and methods

The study included patients in six centers. The implants were used in accordance with standard practice of each particular center, and the use was documented systematically. Failure rate, implant success, bone level changes, different clinical parameters, and patients' satisfaction were assessed.

Results

In total, 130 dental implants were placed in 94 patients (64 female, 30 male). Mean age of patients was 50.4 ± 13.7. At 3-year post-loading, 108 implants in 78 patients were available for evaluation. Success and survival rate were 98.4% after placement and 100% 36 months post-loading. Bone loss from surgery to loading was 0.52 ± 0.55 mm. From loading to 36 months post-loading, the bone level change remained stable. Patient assessments were performed for function, ability to chew, speech, esthetics, and general satisfaction. Patients were very satisfied (82.3%) or satisfied (16.1%). None of the patients was dissatisfied.

Conclusion

The 3-year results of this non-interventional multicenter study indicate that the CONELOG implants are reliable and effective over the course of the observation while used in standard conditions of daily environment and confirm the results obtained in controlled clinical trials.

Clinical relevance

Performance of CONELOG implants under daily routine is similar to controlled clinical trials.

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In Vivo therapeutic efficacy of the Allium sativum ME in experimentally Echinococcus granulosus infected mice

In conclusions, administration of A. sativum ME used at 40 and 80 mL/L concentrations might be beneficial in the treatment of CE due to anti-parasitic effects similar to albendazole but less hepatotoxic effects. (Source: Comparative Immunology, Microbiology and Infectious Diseases)

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Adults Who Present for Evaluation of Multiple Food Allergies

Publication date: Available online 13 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Benjamin L. Wright, Matthew A. Rank (Source: The Journal of Allergy and Clinical Immunology: In Practice)

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In Vivo therapeutic efficacy of the Allium sativum ME in experimentally Echinococcus granulosus infected mice

In conclusions, administration of A. sativum ME used at 40 and 80 mL/L concentrations might be beneficial in the treatment of CE due to anti-parasitic effects similar to albendazole but less hepatotoxic effects. (Source: Comparative Immunology, Microbiology and Infectious Diseases)

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Adults Who Present for Evaluation of Multiple Food Allergies

Publication date: Available online 13 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Benjamin L. Wright, Matthew A. Rank (Source: The Journal of Allergy and Clinical Immunology: In Practice)

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Comparison of Sino-Nasal Outcome Test 22 Symptom Scores in Rhinogenic and Odontogenic Sinusitis.

Conclusion With controlling of covariates that may influence the severity of the disease, this study showed some significant differences in symptom patterns and HRQL impairment between patients with OMS and RS. Malodor is the most characteristic feature of OMS. Therefore, OMS should always be suspected in patients complaining of bad breath. PMID: 30311505 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

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Comparison of Sino-Nasal Outcome Test 22 Symptom Scores in Rhinogenic and Odontogenic Sinusitis.

Conclusion With controlling of covariates that may influence the severity of the disease, this study showed some significant differences in symptom patterns and HRQL impairment between patients with OMS and RS. Malodor is the most characteristic feature of OMS. Therefore, OMS should always be suspected in patients complaining of bad breath. PMID: 30311505 [PubMed - as supplied by publisher] (Source: American Journal of Rhinology and Allergy)

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Cardiac magnetic resonance T1 mapping. Part 1: Aspects of acquisition and evaluation

Publication date: Available online 13 October 2018

Source: European Journal of Radiology

Author(s): Gert Reiter, Clemens Reiter, Corina Kräuter, Michael Fuchsjäger, Ursula Reiter

Abstract

While an enormous number of studies have documented pathological alterations of the myocardial native longitudinal relaxation time (T1) and the fraction of the extracellular myocardial volume (ECV), it has also become clear that continuously evolving T1 mapping sequence, acquisition and evaluation techniques have a substantial impact on quantitative results, making the translation of reported findings into routine clinical use particularly challenging. To provide a basis for the discussion of pathological myocardial T1 and ECV alterations, the present review aims to summarize the methodological aspects of myocardial T1 mapping along with technical and physiological factors influencing results and normal ranges of myocardial native T1 and ECV reported across studies.

Graphical abstract

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Cardiac magnetic resonance T1 mapping. Part 1: Aspects of acquisition and evaluation

Publication date: Available online 13 October 2018

Source: European Journal of Radiology

Author(s): Gert Reiter, Clemens Reiter, Corina Kräuter, Michael Fuchsjäger, Ursula Reiter

Abstract

While an enormous number of studies have documented pathological alterations of the myocardial native longitudinal relaxation time (T1) and the fraction of the extracellular myocardial volume (ECV), it has also become clear that continuously evolving T1 mapping sequence, acquisition and evaluation techniques have a substantial impact on quantitative results, making the translation of reported findings into routine clinical use particularly challenging. To provide a basis for the discussion of pathological myocardial T1 and ECV alterations, the present review aims to summarize the methodological aspects of myocardial T1 mapping along with technical and physiological factors influencing results and normal ranges of myocardial native T1 and ECV reported across studies.

Graphical abstract

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Use of Non-Invasive Measures to Predict Cochlear Synapse Counts

Publication date: Available online 13 October 2018

Source: Hearing Research

Author(s): Naomi F. Bramhall, Garnett P. McMillan, Sharon G. Kujawa, Dawn Konrad-Martin

Abstract

Cochlear synaptopathy, the loss of synaptic connections between inner hair cells and auditory nerve fibers, has been documented in animal models of aging, noise, and ototoxic drug exposure, three common causes of acquired sensorineural hearing loss in humans. In each of these models, synaptopathy begins prior to changes in threshold sensitivity or loss of hair cells; thus, this underlying injury can be hidden behind a normal threshold audiogram. Since cochlear synaptic loss cannot be directly confirmed in living humans, non-invasive assays will be required for diagnosis. In animals with normal auditory thresholds, the amplitude of wave 1 of the auditory brainstem response (ABR) is highly correlated with synapse counts. However, synaptopathy can also co-occur with threshold elevation, complicating the use of the ABR alone as a diagnostic measure. Using an age-graded series of mice and a partial least squares regression approach to model structure-function relationships, this study shows that the combination of a small number of ABR and distortion product otoacoustic emission (DPOAE) measurements can predict synaptic ribbon counts at various cochlear frequencies to within 1-2 synapses per inner hair cell of their true value. In contrast, the model, trained using the age-graded series of mice, overpredicted synapse counts in a small sample of young noise-exposed mice, perhaps due to differences in the underlying pattern of damage between aging and noise-exposed mice. These results provide partial validation of a noninvasive approach to identify synaptic/neuronal loss in humans using ABRs and DPOAEs.

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Use of Non-Invasive Measures to Predict Cochlear Synapse Counts

Publication date: Available online 13 October 2018

Source: Hearing Research

Author(s): Naomi F. Bramhall, Garnett P. McMillan, Sharon G. Kujawa, Dawn Konrad-Martin

Abstract

Cochlear synaptopathy, the loss of synaptic connections between inner hair cells and auditory nerve fibers, has been documented in animal models of aging, noise, and ototoxic drug exposure, three common causes of acquired sensorineural hearing loss in humans. In each of these models, synaptopathy begins prior to changes in threshold sensitivity or loss of hair cells; thus, this underlying injury can be hidden behind a normal threshold audiogram. Since cochlear synaptic loss cannot be directly confirmed in living humans, non-invasive assays will be required for diagnosis. In animals with normal auditory thresholds, the amplitude of wave 1 of the auditory brainstem response (ABR) is highly correlated with synapse counts. However, synaptopathy can also co-occur with threshold elevation, complicating the use of the ABR alone as a diagnostic measure. Using an age-graded series of mice and a partial least squares regression approach to model structure-function relationships, this study shows that the combination of a small number of ABR and distortion product otoacoustic emission (DPOAE) measurements can predict synaptic ribbon counts at various cochlear frequencies to within 1-2 synapses per inner hair cell of their true value. In contrast, the model, trained using the age-graded series of mice, overpredicted synapse counts in a small sample of young noise-exposed mice, perhaps due to differences in the underlying pattern of damage between aging and noise-exposed mice. These results provide partial validation of a noninvasive approach to identify synaptic/neuronal loss in humans using ABRs and DPOAEs.

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Herpetic Anterior Uveitis - Analysis of Presumed and PCR Proven Cases.

CONCLUSION: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease. PMID: 30311824 [PubMed - as supplied by publisher] (Source: Ocular Immunology and Inflammation)

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Herpetic Anterior Uveitis - Analysis of Presumed and PCR Proven Cases.

CONCLUSION: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease. PMID: 30311824 [PubMed - as supplied by publisher] (Source: Ocular Immunology and Inflammation)

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Vestibular evoked myogenic potential in healthy adolescents

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Gitte Stokvad Brix, Therese Ovesen, Louise Devantier

Abstract

Objective

Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents.

Methods

Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children.

Results

cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%.

oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%.

In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR).

Conclusion

The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.

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Congenital Infantile Fibrosarcoma of the Glabella: Nuances of Achieving Surgical Cure without Cosmetic or Functional Deformity

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Robert G. Nicholas, Tara E. Brennan

Abstract

Congenital Infantile Fibrosarcoma is a rare neoplasm that typically presents during the first year of life, but uncommonly in the head and neck. We report a six-day old male presenting with an expanding mass of the right glabella associated with visual field obstruction. The patient underwent a two-staged procedure for surgical removal of the tumor due to the initial unclear pathologic diagnosis of the tumor, combined with the desire to close the defect while incurring minimal aesthetic deformity. We describe this patient's postnatal presentation and curative surgical management and review the relevant literature to date.

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The Arabic translation, cultural adaptation, and validation of the pediatric voice-related quality of life survey

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tamer A. Mesallam, Badr Alabdulkarim, AlMaha A. AlQabbani, Nawaf A. Bin Suhaym, Sulaiman AlAjlan

Abstract

Objective

The aim of this study was to develop an Arabic version of the pediatric voice-related quality of life (PVRQOL) and test its validity and reliability.

Subjects

and methods: Fifty-one children with voice problems were included in the study along with 60 control children without any voice disorders. The translated Arabic PVRQOL and the Arabic pediatric voice handicap index (PVHI) have been distributed to the study subjects. The Arabic PVRQOL was tested for its internal consistency, test-retest reliability, and clinical validity.

Results: the Arabic PVRQOL showed strong internal consistency and excellent test-retest reliability (Cronbach α = 0.9 and ICC = 0.92 respectively). There was a significant difference between the patients and control group regarding Arabic PVRQOL scores (P < 0.0001). Also, significant correlation was demonstrated between the Arabic PVRQOL and Arabic PVHI.

Conclusion

The Arabic version of PVRQOL maintained its validity and reliability and may be considered in the assessment of voice disorders for Arabic speaking children.

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Vestibular evoked myogenic potential in healthy adolescents

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Gitte Stokvad Brix, Therese Ovesen, Louise Devantier

Abstract

Objective

Vestibular dysfunction, which may lead to delayed motor development and reduced quality of life, is an overlooked entity among children and adolescents. Vestibular evoked myogenic potential (VEMP) is a common, safe diagnostic tool in adults with vestibular disorders. No normative data exist for children and adolescents. Our objective was to collect and assess normative VEMP data for adolescents.

Methods

Cervical VEMP (cVEMP) with air-conducted sound. Endpoints were peak latencies after 13 and 23 ms (P13 and N23) and amplitude. Ocular VEMP (oVEMP) with bone-conducted vibration on the mastoid. Endpoints were latencies (N10 and P15) and amplitude. A meta-analysis of existing cVEMP data in children.

Results

cVEMP response rate (RR) was 85%, mean P13 and N23 latencies were 15.44 and 25.55 ms, respectively, and the asymmetry ratio (AR) was 14%.

oVEMP RR was 100%, mean N10 and P15 were 10.61 and 16.58 ms, respectively, and the AR was 12%.

In the meta-analysis, the pooled mean P13 and N23 were 12.75 and 21.8 ms, respectively. Head elevation (HE) gave shorter latencies than head rotation (HR).

Conclusion

The oVEMP data represents normal values for adolescents aged 13-16 years. Height should be considered more important than age when interpreting cVEMP in adolescents. Separate normative cVEMP data should be established for HE and HR.

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Congenital Infantile Fibrosarcoma of the Glabella: Nuances of Achieving Surgical Cure without Cosmetic or Functional Deformity

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Robert G. Nicholas, Tara E. Brennan

Abstract

Congenital Infantile Fibrosarcoma is a rare neoplasm that typically presents during the first year of life, but uncommonly in the head and neck. We report a six-day old male presenting with an expanding mass of the right glabella associated with visual field obstruction. The patient underwent a two-staged procedure for surgical removal of the tumor due to the initial unclear pathologic diagnosis of the tumor, combined with the desire to close the defect while incurring minimal aesthetic deformity. We describe this patient's postnatal presentation and curative surgical management and review the relevant literature to date.

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The Arabic translation, cultural adaptation, and validation of the pediatric voice-related quality of life survey

Publication date: Available online 13 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tamer A. Mesallam, Badr Alabdulkarim, AlMaha A. AlQabbani, Nawaf A. Bin Suhaym, Sulaiman AlAjlan

Abstract

Objective

The aim of this study was to develop an Arabic version of the pediatric voice-related quality of life (PVRQOL) and test its validity and reliability.

Subjects

and methods: Fifty-one children with voice problems were included in the study along with 60 control children without any voice disorders. The translated Arabic PVRQOL and the Arabic pediatric voice handicap index (PVHI) have been distributed to the study subjects. The Arabic PVRQOL was tested for its internal consistency, test-retest reliability, and clinical validity.

Results: the Arabic PVRQOL showed strong internal consistency and excellent test-retest reliability (Cronbach α = 0.9 and ICC = 0.92 respectively). There was a significant difference between the patients and control group regarding Arabic PVRQOL scores (P < 0.0001). Also, significant correlation was demonstrated between the Arabic PVRQOL and Arabic PVHI.

Conclusion

The Arabic version of PVRQOL maintained its validity and reliability and may be considered in the assessment of voice disorders for Arabic speaking children.

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Age-Related Declines in Occipital GABA are Associated with Reduced Fluid Processing Ability

Publication date: Available online 14 October 2018

Source: Academic Radiology

Author(s): Molly Simmonite, Joshua Carp, Bradley R. Foerster, Lynn Ossher, Myria Petrou, Daniel H. Weissman, Thad A. Polk

Rationale and Objectives

Healthy aging is associated with pervasive declines in cognitive, motor, and sensory functioning. There are, however, substantial individual differences in behavioral performance among older adults. Several lines of animal research link age-related reductions of gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter, to age-related cognitive, motor, and sensory decline. Our study used proton magnetic resonance spectroscopy (MRS) at 3T to explore whether occipital GABA declines with age in humans and whether individual differences in occipital GABA are linked to individual differences in fluid processing ability.

Materials and Methods

We used a MEGA-PRESS sequence that combines frequency spectral editing with a point-resolved spectroscopy sequence to quantify GABA. Spectra were obtained from a 30 × 30 × 25mm voxel placed in the occipital cortex of 20 young adults (mean age 20.7 years) and 18 older adults (mean age 76.5 years). Participants also performed 11 fluid processing tasks outside the scanner, the results of which were z-scored and averaged to calculate a summary measure of fluid processing ability. Regression analysis was employed to determine the relationship between GABA concentrations in the occipital cortex and a summary measure of fluid processing ability.

Results

Occipital GABA was significantly lower in older participants compared to the younger participants. We also observed a significant positive relationship between occipital GABA and fluid processing ability. In fact, higher GABA was associated with better task performance in 10 of the 11 tasks.

Conclusion

These findings suggest that GABA levels decline with age in humans and are associated with declines in fluid processing ability.

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Responses to cigarette health warning labels, harm perceptions and knowledge in a national sample of pregnant and non-pregnant women of reproductive age

Publication date: Available online 13 October 2018

Source: Addictive Behaviors

Author(s): Erin L. Mead, Raul Cruz-Cano, Allison Groom, Joy L. Hart, Kandi L. Walker, Aida L. Giachello, Rose Marie Robertson, Cheryl Oncken

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Age-Related Declines in Occipital GABA are Associated with Reduced Fluid Processing Ability

Publication date: Available online 14 October 2018

Source: Academic Radiology

Author(s): Molly Simmonite, Joshua Carp, Bradley R. Foerster, Lynn Ossher, Myria Petrou, Daniel H. Weissman, Thad A. Polk

Rationale and Objectives

Healthy aging is associated with pervasive declines in cognitive, motor, and sensory functioning. There are, however, substantial individual differences in behavioral performance among older adults. Several lines of animal research link age-related reductions of gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter, to age-related cognitive, motor, and sensory decline. Our study used proton magnetic resonance spectroscopy (MRS) at 3T to explore whether occipital GABA declines with age in humans and whether individual differences in occipital GABA are linked to individual differences in fluid processing ability.

Materials and Methods

We used a MEGA-PRESS sequence that combines frequency spectral editing with a point-resolved spectroscopy sequence to quantify GABA. Spectra were obtained from a 30 × 30 × 25mm voxel placed in the occipital cortex of 20 young adults (mean age 20.7 years) and 18 older adults (mean age 76.5 years). Participants also performed 11 fluid processing tasks outside the scanner, the results of which were z-scored and averaged to calculate a summary measure of fluid processing ability. Regression analysis was employed to determine the relationship between GABA concentrations in the occipital cortex and a summary measure of fluid processing ability.

Results

Occipital GABA was significantly lower in older participants compared to the younger participants. We also observed a significant positive relationship between occipital GABA and fluid processing ability. In fact, higher GABA was associated with better task performance in 10 of the 11 tasks.

Conclusion

These findings suggest that GABA levels decline with age in humans and are associated with declines in fluid processing ability.

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Responses to cigarette health warning labels, harm perceptions and knowledge in a national sample of pregnant and non-pregnant women of reproductive age

Publication date: Available online 13 October 2018

Source: Addictive Behaviors

Author(s): Erin L. Mead, Raul Cruz-Cano, Allison Groom, Joy L. Hart, Kandi L. Walker, Aida L. Giachello, Rose Marie Robertson, Cheryl Oncken

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Evaluating the IgMi mouse as a novel tool to study B cell biology

European Journal of Immunology,Volume 0, Issue ja, -Not available-. (Source: European Journal of Immunology)

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Eosinophilia and reduced STAT3 signalling affect neutrophil cell death in autosomal ‐dominant Hyper‐IgE syndrome

European Journal of Immunology,Volume 0, Issue ja, -Not available-. (Source: European Journal of Immunology)

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Evaluating the IgMi mouse as a novel tool to study B cell biology

European Journal of Immunology,Volume 0, Issue ja, -Not available-. (Source: European Journal of Immunology)

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Eosinophilia and reduced STAT3 signalling affect neutrophil cell death in autosomal ‐dominant Hyper‐IgE syndrome

European Journal of Immunology,Volume 0, Issue ja, -Not available-. (Source: European Journal of Immunology)

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Ventral striatum links motivational and motor networks during operant-conditioned movement in rats

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Yuki Hori, Naoki Ihara, Chiaki Sugai, Jun Ogura, Manabu Honda, Koichi Kato, Yoshikazu Isomura, Takashi Hanakawa

Abstract

Voluntary actions require motives. It is already known that the medial prefrontal cortex (MPFC) assess the motivational values. However, it remains unclear how the motivational process gains access to the motor execution system in the brain. Here we present evidence that the ventral striatum (VS) plays a hub-like role in mediating motivational and motor processing in operant behavior. We used positron emission tomography (PET) to detect the neural activation areas associated with motivational action. Using obtained regions, partial correlation analysis was performed to examine how the motivational signals propagate to the motor system. The results revealed that VS activity propagated to both MPFC and primary motor cortex through the thalamus. Moreover, muscimol injection into the VS suppressed the motivational behavior, supporting the idea of representations of motivational signals in VS that trigger motivational behavior. These results suggest that the VS-thalamic pathway plays a pivotal role for both motivational processing through interactions with the MPFC and for motor processing through interactions with the motor BG circuits.

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A 3D population-based brain atlas of the mouse lemur primate with examples of applications in aging studies and comparative anatomy

Publication date: Available online 13 October 2018

Source: NeuroImage

Author(s): Nachiket A. Nadkarni, Salma Bougacha, Clément Garin, Marc Dhenain, Jean-Luc Picq

Abstract

The gray mouse lemur (Microcebus murinus) is a small prosimian of growing interest for studies of primate biology and evolution, and notably as a model organism of brain aging. As brain atlases are essential tools for brain investigation, the objective of the current work was to create the first 3D digital atlas of the mouse lemur brain. For this, a template image was constructed from in vivo magnetic resonance imaging (MRI) data of 34 animals. This template was then manually segmented into 40 cortical, 74 subcortical and 6 cerebro-spinal fluid (CSF) regions. Additionally, we generated probability maps of gray matter, white matter and CSF. The template, manual segmentation and probability maps, as well as imaging tools used to create and manipulate the template, can all be freely downloaded. The atlas was first used to automatically assess regional age-associated cerebral atrophy in a cohort of mouse lemurs previously studied by voxel based morphometry (VBM). Results based on the atlas were in good agreement with the VBM ones, showing age-associated atrophy in the same brain regions such as the insular, parietal or occipital cortices as well as the thalamus or hypothalamus. The atlas was also used as a tool for comparative neuroanatomy. To begin with, we compared measurements of brain regions in our MRI data with histology-based measures from a reference article largely used in previous comparative neuroanatomy studies. We found large discrepancies between our MRI-based data and those of the reference histology-based article. Next, regional brain volumes were compared amongst the mouse lemur and several other mammalian species where high quality volumetric MRI brain atlases were available, including rodents (mouse, rat) and primates (marmoset, macaque, and human). Unlike those based on histological atlases, measures from MRI atlases indicated similar cortical to cerebral volume indices in all primates, including in mouse lemurs, and lower values in mice. On the other hand, white matter to cerebral volume index increased from rodents to small primates (mouse lemurs and marmosets) to macaque, reaching their highest values in humans.

Graphical abstract

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The Prognostic Value of Immune Checkpoints in Oral Squamous Cell Carcinoma

Oral Diseases,Volume 0, Issue ja, -Not available-. (Source: Oral Diseases)

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Ventral striatum links motivational and motor networks during operant-conditioned movement in rats

Publication date: 1 January 2019

Source: NeuroImage, Volume 184

Author(s): Yuki Hori, Naoki Ihara, Chiaki Sugai, Jun Ogura, Manabu Honda, Koichi Kato, Yoshikazu Isomura, Takashi Hanakawa

Abstract

Voluntary actions require motives. It is already known that the medial prefrontal cortex (MPFC) assess the motivational values. However, it remains unclear how the motivational process gains access to the motor execution system in the brain. Here we present evidence that the ventral striatum (VS) plays a hub-like role in mediating motivational and motor processing in operant behavior. We used positron emission tomography (PET) to detect the neural activation areas associated with motivational action. Using obtained regions, partial correlation analysis was performed to examine how the motivational signals propagate to the motor system. The results revealed that VS activity propagated to both MPFC and primary motor cortex through the thalamus. Moreover, muscimol injection into the VS suppressed the motivational behavior, supporting the idea of representations of motivational signals in VS that trigger motivational behavior. These results suggest that the VS-thalamic pathway plays a pivotal role for both motivational processing through interactions with the MPFC and for motor processing through interactions with the motor BG circuits.

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A 3D population-based brain atlas of the mouse lemur primate with examples of applications in aging studies and comparative anatomy

Publication date: Available online 13 October 2018

Source: NeuroImage

Author(s): Nachiket A. Nadkarni, Salma Bougacha, Clément Garin, Marc Dhenain, Jean-Luc Picq

Abstract

The gray mouse lemur (Microcebus murinus) is a small prosimian of growing interest for studies of primate biology and evolution, and notably as a model organism of brain aging. As brain atlases are essential tools for brain investigation, the objective of the current work was to create the first 3D digital atlas of the mouse lemur brain. For this, a template image was constructed from in vivo magnetic resonance imaging (MRI) data of 34 animals. This template was then manually segmented into 40 cortical, 74 subcortical and 6 cerebro-spinal fluid (CSF) regions. Additionally, we generated probability maps of gray matter, white matter and CSF. The template, manual segmentation and probability maps, as well as imaging tools used to create and manipulate the template, can all be freely downloaded. The atlas was first used to automatically assess regional age-associated cerebral atrophy in a cohort of mouse lemurs previously studied by voxel based morphometry (VBM). Results based on the atlas were in good agreement with the VBM ones, showing age-associated atrophy in the same brain regions such as the insular, parietal or occipital cortices as well as the thalamus or hypothalamus. The atlas was also used as a tool for comparative neuroanatomy. To begin with, we compared measurements of brain regions in our MRI data with histology-based measures from a reference article largely used in previous comparative neuroanatomy studies. We found large discrepancies between our MRI-based data and those of the reference histology-based article. Next, regional brain volumes were compared amongst the mouse lemur and several other mammalian species where high quality volumetric MRI brain atlases were available, including rodents (mouse, rat) and primates (marmoset, macaque, and human). Unlike those based on histological atlases, measures from MRI atlases indicated similar cortical to cerebral volume indices in all primates, including in mouse lemurs, and lower values in mice. On the other hand, white matter to cerebral volume index increased from rodents to small primates (mouse lemurs and marmosets) to macaque, reaching their highest values in humans.

Graphical abstract

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The Prognostic Value of Immune Checkpoints in Oral Squamous Cell Carcinoma

Oral Diseases,Volume 0, Issue ja, -Not available-. (Source: Oral Diseases)

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Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism

Publication date: Available online 13 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Veyrat, H. Fessi, J.-P. Haymann, P. Ronco, J. Lacau St Guily, S. Périé

Abstract

Objective

There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment.

Study design

Prospective observational study in a university teaching hospital between 2010 and 2014.

Methods

The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups.

Results

Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24 pg/mL, respectively; P < 0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P = 0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P = 0.04).

Conclusions

In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay.

Level of evidence

3b, individual case-control study.

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Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism

Publication date: Available online 13 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Veyrat, H. Fessi, J.-P. Haymann, P. Ronco, J. Lacau St Guily, S. Périé

Abstract

Objective

There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment.

Study design

Prospective observational study in a university teaching hospital between 2010 and 2014.

Methods

The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups.

Results

Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24 pg/mL, respectively; P < 0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P = 0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P = 0.04).

Conclusions

In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay.

Level of evidence

3b, individual case-control study.

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Avocado: An Emerging Culprit in Food Protein-Induced Enterocolitis Syndrome?

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mera Goodman, Elizabeth Feuille

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ORAL FOOD CHALLENGE FAILURES AMONG FOODS RESTRICTED DUE TO ATOPIC DERMATITIS

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): AA Eapen, KM Kloepfer, FE Leickly, JE Slaven, G Vitalpur

Abstract

BACKGROUND

Recent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy tests, may lead to immediate allergic reactions on reintroduction of that food.

OBJECTIVE

The purpose of this study was to examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the five major food allergens in the US.

METHODS

OFCs to egg, milk, peanut, soy, and wheat, performed from 2008-14, at a children's hospital's allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within two hours); sensitization only (lack of introduction due to positive test results); and removal due to test results during AD evaluation.

RESULTS

There were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320/442; 72.4%); food sensitization without any introduction (77/442; 17.4%); and AD (45/442; 10.2%). OFC failures among those who had food allergy (70/320; 21.9%); sensitization only (13/77; 16.9%); and suspected AD trigger (6/45; 13.3%) did not significantly differ (p=0.63). Wheat was more likely to be avoided than the other four foods for AD concerns (p<0.0001).

CONCLUSION

The frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.

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Within-tester repeatability and between-tester reproducibility of skin test endpoint titration: A quality assurance study

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Christianne M Blais, Beth E Davis, Donald W. Cockcroft

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Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Ping-Ping Cao, Zhi-Chao Wang, Robert. P. Schleimer, Zheng Liu

ABSTRACT

Objective

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with distinct pathophysiologic mechanisms. Based on the transcription factor expression and cytokine production patterns in different types of innate lymphoid cells (ILCs), in parallel with those of adaptive CD4⁺ T helper (Th) cells and CD8⁺ cytotoxic T (Tc) cells, new perspectives on endotypes of patients are emerging around the immune response deviation into type 1 (orchestrated by ILC1s, Tc1 and Th1 cells), type 2 (characterized by ILC2s, Tc2 and Th2 cells), and type 3 (mediated by ILC3s, Tc17 and Th17 cells) responses. Additionally, cluster analysis has been applied to the endotyping of CRS in recent years, which has provided additional novel insights into the CRS pathogenesis. This article aims to review pathological mechanisms of CRS on the basis of type 1, type 2, and type 3 immune responses and how they inform us to begin to understand CRS endotypes. This article also reviews the recent cluster analysis studies of CRS endotypes. Finally, the impact of endotype on therapeutic management of CRS is summarized.

Data Sources

Review of published literature.

Study Selections

Relevant literature concerning CRS endotypes and the possible underlying mechanisms were obtained from a PubMed search and summarized here.

Results and Conclusion

Both CRSwNP and CRSsNP are comprised of distinct endotypes with distinct deviated immune responses, pathogenic mechanisms, and different responses to medical and surgical treatment. An endotype of CRS with prominent type 2 immune responses is the most well studied endotype, and generally can benefit from treatment with steroids and specific type 2 disrupting biologics.

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Avocado: An Emerging Culprit in Food Protein-Induced Enterocolitis Syndrome?

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mera Goodman, Elizabeth Feuille

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Author's Response to Hopp's Commentary

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Jonathan M. Spergel, Evan S. Dellon, Chris A. Liacouras, Ikuo Hirano, Javier Molina-Infante, Albert J. Bredenoord, Glenn T. Furuta

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ORAL FOOD CHALLENGE FAILURES AMONG FOODS RESTRICTED DUE TO ATOPIC DERMATITIS

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): AA Eapen, KM Kloepfer, FE Leickly, JE Slaven, G Vitalpur

Abstract

BACKGROUND

Recent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy tests, may lead to immediate allergic reactions on reintroduction of that food.

OBJECTIVE

The purpose of this study was to examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the five major food allergens in the US.

METHODS

OFCs to egg, milk, peanut, soy, and wheat, performed from 2008-14, at a children's hospital's allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within two hours); sensitization only (lack of introduction due to positive test results); and removal due to test results during AD evaluation.

RESULTS

There were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320/442; 72.4%); food sensitization without any introduction (77/442; 17.4%); and AD (45/442; 10.2%). OFC failures among those who had food allergy (70/320; 21.9%); sensitization only (13/77; 16.9%); and suspected AD trigger (6/45; 13.3%) did not significantly differ (p=0.63). Wheat was more likely to be avoided than the other four foods for AD concerns (p<0.0001).

CONCLUSION

The frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2A9p0OJ

Within-tester repeatability and between-tester reproducibility of skin test endpoint titration: A quality assurance study

Publication date: Available online 14 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Christianne M Blais, Beth E Davis, Donald W. Cockcroft

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QKxSQa

Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Ping-Ping Cao, Zhi-Chao Wang, Robert. P. Schleimer, Zheng Liu

ABSTRACT

Objective

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with distinct pathophysiologic mechanisms. Based on the transcription factor expression and cytokine production patterns in different types of innate lymphoid cells (ILCs), in parallel with those of adaptive CD4⁺ T helper (Th) cells and CD8⁺ cytotoxic T (Tc) cells, new perspectives on endotypes of patients are emerging around the immune response deviation into type 1 (orchestrated by ILC1s, Tc1 and Th1 cells), type 2 (characterized by ILC2s, Tc2 and Th2 cells), and type 3 (mediated by ILC3s, Tc17 and Th17 cells) responses. Additionally, cluster analysis has been applied to the endotyping of CRS in recent years, which has provided additional novel insights into the CRS pathogenesis. This article aims to review pathological mechanisms of CRS on the basis of type 1, type 2, and type 3 immune responses and how they inform us to begin to understand CRS endotypes. This article also reviews the recent cluster analysis studies of CRS endotypes. Finally, the impact of endotype on therapeutic management of CRS is summarized.

Data Sources

Review of published literature.

Study Selections

Relevant literature concerning CRS endotypes and the possible underlying mechanisms were obtained from a PubMed search and summarized here.

Results and Conclusion

Both CRSwNP and CRSsNP are comprised of distinct endotypes with distinct deviated immune responses, pathogenic mechanisms, and different responses to medical and surgical treatment. An endotype of CRS with prominent type 2 immune responses is the most well studied endotype, and generally can benefit from treatment with steroids and specific type 2 disrupting biologics.

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Author's Response to Hopp's Commentary

Publication date: Available online 13 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Jonathan M. Spergel, Evan S. Dellon, Chris A. Liacouras, Ikuo Hirano, Javier Molina-Infante, Albert J. Bredenoord, Glenn T. Furuta

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Comment on “Streptococcus anginosus Dental Implant-Related Osteomyelitis of the Jaws: An Insidious and Calamitous Entity”

Publication date: Available online 14 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Romain Nicot, Matthias Schlund, Gwenael Raoul

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Comment on “Streptococcus anginosus Dental Implant-Related Osteomyelitis of the Jaws: An Insidious and Calamitous Entity”

Publication date: Available online 14 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Romain Nicot, Matthias Schlund, Gwenael Raoul

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Adults Who Present for Evaluation of Multiple Food Allergies

Publication date: Available online 13 October 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Benjamin L. Wright, Matthew A. Rank

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Adults Who Present for Evaluation of Multiple Food Allergies

Publication date: Available online 13 October 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Benjamin L. Wright, Matthew A. Rank

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Early onset oral tongue cancer in the United States: A literature review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Benjamin R. Campbell, James L. Netterville, Robert J. Sinard, Kyle Mannion, Sarah L. Rohde, Alexander Langerman, Young J. Kim, James S. Lewis, Krystle A. Lang Kuhs

Abstract

The incidence of early onset oral tongue squamous cell carcinoma (OTC) has been increasing in the United States, and no clear etiology has been identified. Studies on this topic have generally been small and presented varied results. The goal of this review is to analyze and synthesize the literature regarding early onset OTC risk factors, outcomes, and molecular analyses within the US. To date, studies suggest that early onset OTC patients tend to have less heavy cigarette use than typical onset patients, but there may be an association between early onset OTC and smokeless tobacco (chewing tobacco and snuff) use. Early onset OTC is associated with similar or possibly improved survival compared to typical onset OTC. There has been no evidence to support a significant role for human papillomavirus in development of early onset OTC. Further research with larger cohorts of these patients is needed to better characterize this disease entity.

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Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS)

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Richard B. Cannon, Jeffrey J. Houlton, Sapna Patel, Sharat Raju, Anisha Noble, Neal D. Futran, Upendra Parvathaneni, Eduardo Méndez

Abstract

Objectives

(1) Report the patterns of cervical node positivity for HPV + oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic surgery (TORS) and a unilateral level II–IV node dissection. (2) Investigate the regional failure rate following this operation. (3) Report the rate of pharyngocutaneous fistula (PCF) formation intraoperatively and postoperatively following TORS/neck dissection.

Methods

Retrospective case series of 88 patients with HPV+ OPSCC treated with TORS and simultaneous neck dissection levels II–IV at the University of Washington from 2010 to 2016. Primary endpoints were PCF, regional recurrence, disease-free survival (DFS), and overall survival (OS).

Results

The overall frequency of cervical node positivity was 93%, with 84% in level IIa, 7% in IIb, 23% in III, and 13% in IV. Two patients developed PCF intraoperatively, repaired with a local digastric flap, and no postoperative PCF occurred. Sixteen patients (18%) received surgery alone, 49 patients (56%) received adjuvant radiation, and 23 patients (26%) underwent adjuvant chemoradiation. DFS at 2 years was 95% and OS at 2 years was 100%. No concerning level Ib nodes were identified preoperatively or during surgery, and no regional failures occurred in this location.

Conclusion

Our data suggests, in TORS for HPV+ OPSCC, neck dissection of levels II–IV accurately stages the neck pathologically and prevents regional recurrences, with adjuvant therapy when indicated, and survival outcomes are excellent. Single-staged operations did not result in any postoperative PCF. Avoiding dissection of level Ib with TORS oropharyngectomy limits morbidity to the marginal mandibular nerve and salivary function, and resulted in no postoperative fistulas with minimal reconstruction interventions.

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Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Marcelo R. Bonomi, Adriana Blakaj, Dukagjin Blakaj

Abstract

The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients' desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.

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Early onset oral tongue cancer in the United States: A literature review

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Benjamin R. Campbell, James L. Netterville, Robert J. Sinard, Kyle Mannion, Sarah L. Rohde, Alexander Langerman, Young J. Kim, James S. Lewis, Krystle A. Lang Kuhs

Abstract

The incidence of early onset oral tongue squamous cell carcinoma (OTC) has been increasing in the United States, and no clear etiology has been identified. Studies on this topic have generally been small and presented varied results. The goal of this review is to analyze and synthesize the literature regarding early onset OTC risk factors, outcomes, and molecular analyses within the US. To date, studies suggest that early onset OTC patients tend to have less heavy cigarette use than typical onset patients, but there may be an association between early onset OTC and smokeless tobacco (chewing tobacco and snuff) use. Early onset OTC is associated with similar or possibly improved survival compared to typical onset OTC. There has been no evidence to support a significant role for human papillomavirus in development of early onset OTC. Further research with larger cohorts of these patients is needed to better characterize this disease entity.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2A9I53b

Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS)

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Richard B. Cannon, Jeffrey J. Houlton, Sapna Patel, Sharat Raju, Anisha Noble, Neal D. Futran, Upendra Parvathaneni, Eduardo Méndez

Abstract

Objectives

(1) Report the patterns of cervical node positivity for HPV + oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic surgery (TORS) and a unilateral level II–IV node dissection. (2) Investigate the regional failure rate following this operation. (3) Report the rate of pharyngocutaneous fistula (PCF) formation intraoperatively and postoperatively following TORS/neck dissection.

Methods

Retrospective case series of 88 patients with HPV+ OPSCC treated with TORS and simultaneous neck dissection levels II–IV at the University of Washington from 2010 to 2016. Primary endpoints were PCF, regional recurrence, disease-free survival (DFS), and overall survival (OS).

Results

The overall frequency of cervical node positivity was 93%, with 84% in level IIa, 7% in IIb, 23% in III, and 13% in IV. Two patients developed PCF intraoperatively, repaired with a local digastric flap, and no postoperative PCF occurred. Sixteen patients (18%) received surgery alone, 49 patients (56%) received adjuvant radiation, and 23 patients (26%) underwent adjuvant chemoradiation. DFS at 2 years was 95% and OS at 2 years was 100%. No concerning level Ib nodes were identified preoperatively or during surgery, and no regional failures occurred in this location.

Conclusion

Our data suggests, in TORS for HPV+ OPSCC, neck dissection of levels II–IV accurately stages the neck pathologically and prevents regional recurrences, with adjuvant therapy when indicated, and survival outcomes are excellent. Single-staged operations did not result in any postoperative PCF. Avoiding dissection of level Ib with TORS oropharyngectomy limits morbidity to the marginal mandibular nerve and salivary function, and resulted in no postoperative fistulas with minimal reconstruction interventions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2QMweh1

Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Marcelo R. Bonomi, Adriana Blakaj, Dukagjin Blakaj

Abstract

The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients' desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.

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The prognostic impact of lymphocyte subsets in newly diagnosed acute myeloid leukemia.

Conclusion: Lymphocyte subsets at diagnosis differ between patients with different specific subtypes of AML. A low proportion of NK cells is associated with adverse genetic abnormalities, whereas a high proportion is related to death before remission. However, the proportion of NK cells may not show independent correlations with survival. PMID: 30310785 [PubMed] (Source: Blood Research)

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The prognostic impact of lymphocyte subsets in newly diagnosed acute myeloid leukemia.

Conclusion: Lymphocyte subsets at diagnosis differ between patients with different specific subtypes of AML. A low proportion of NK cells is associated with adverse genetic abnormalities, whereas a high proportion is related to death before remission. However, the proportion of NK cells may not show independent correlations with survival. PMID: 30310785 [PubMed] (Source: Blood Research)

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Utilisation des lambeaux libres dans la prise en charge des plaies chroniques

Publication date: Available online 14 October 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J. Laporte, C. Herlin, J. Delicque, D. Saunière, P. Perrot, F. Duteille

Résumé

Introduction

Les plaies chroniques représentent une problématique de santé majeure mais leur traitement chirurgical est encore peu standardisé. L'utilisation des lambeaux libres reste peu abordée dans la littérature, avec une propension supposée à l'échec compte tenu des conditions locales défavorables et à un terrain souvent débilité. Nous exposons ici l'analyse de notre expérience monocentrique de l'utilisation des lambeaux libres dans le traitement curatif de plaies chroniques.

Patients et méthodes

Nous avons réalisé une étude monocentrique rétrospective sur 15 ans de tous les lambeaux libres réalisés pour le traitement d'une plaie chronique entre janvier 2001 et septembre 2016. Plusieurs critères ont été évalués sur les patients, les plaies, les lambeaux libres utilisés et les suites opératoires immédiates et à distance.

Résultats

Quatre-vingt-onze patients ont été inclus (sex-ratio 3,55) avec un âge moyen de 41,6 ± 16 ans. Les plaies étaient localisées à la jambe dans 92,3 % des cas et 58 % des patients présentaient une ostéomyélite lorsque les patients nous ont été confiés. Les lambeaux utilisés étaient majoritairement musculaires purs (61,6 %). Le taux de survie des lambeaux était de 92,3 %. Avec un recul moyen de 50 mois, l'échec de reconstruction était de 20,9 %. La présence d'une ostéomyélite chronique est le seul facteur statistiquement significatif d'échec de reconstruction (p = 0,0169) avec un risque d'échec multiplié par 5.

Conclusion

Notre étude met en évidence que la fiabilité des lambeaux libres dans le traitement des plaies chroniques est comparable, quel que soit le délai depuis la lésion cutanée initiale, à celle existante dans le traitement des plaies aiguës ou dans la reconstruction post-exérèse carcinologique. La présence d'une ostéomyélite chronique représente toutefois le principal risque d'échec de la reconstruction significatif en multipliant par 5 le risque d'échec à distance. Les changements récents de paradigme de reconstruction tégumentaire du membre inférieur permettront sans doute dans les prochaines années d'établir plus rationnellement la place des lambeaux libres musculaires dans l'arsenal thérapeutique de traitement des plaies chroniques au membre inférieur.

Summary

Introduction

Chronic wounds represent a major health challenge with no current standardized surgical treatment. The use of free flaps is little discussed in the literature, with a supposed propensity to failure given unfavorable local conditions and land often debility. We present here the analysis of our monocentric experience of the use of free flaps in the curative treatment of chronic wounds.

Patients et methods

We performed a retrospective monocentric study over 18 years of all free flaps used for the treatment of a chronic wound between January 2001 and September 2016. Several criteria were evaluated on patients, wounds, free flaps used and immediate to late outcomes.

Results

Ninety-one patients were included (sex ratio M/F: 3.55) with an average age of 41.6 ± 16 years. Wounds were localized to the leg in 92.3% of cases and 58% of patients had initial osteomyelitis. The flaps used were predominantly muscle flaps (61.6%). The flaps survival rate was 92.3%. With a mean follow-up of 50 months, the reconstructive failure rate was 20.9%. The presence of a chronic osteomyelitis is the only statistically significant factor of reconstruction failure (P = 0.0169) with a risk of failure multiplied by 5.

Conclusion

Our study demonstrates that the reliability of free flaps in the treatment of chronic wounds is comparable, regardless of the time since the initial cutaneous lesion, to that existing in the treatment of acute wounds or in the reconstruction after oncological excision. The presence of a chronic osteomyelitis, however, represents a major risk of reconstruction failure by increasing 5 times the risk of failure. Recent changes in the integumentary reconstruction paradigm of the lower limb will undoubtedly allow in the next few years to establish more rationally the place of muscle free flaps in the therapeutic armamentarium of chronic wounds.

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Intraoperative superficial inferior epigastric vein preservation for venous compromise prevention in breast reconstruction by deep inferior epigastric perforator flap

Publication date: Available online 13 October 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Al Hindi, C. Ozil, K. Rem, J. Rausky, V. Moris, D. Guillier, J.P. Binder, M. Revol, S. Cristofari

Summary

Objective

The aim of this study was to analyze our technique of intraoperative venous compromise management based on conservation of the superficial inferior epigastric vein (SIEV), and to undertake a retrospective review of our series of breast reconstructions by deep inferior epigastric perforator (DIEP) flap, followed by a review of other techniques reported in the literature.

Materials and methods

This retrospective study involves 198 breast reconstructions by DIEP flap performed between January 2010 and September 2017. Our surgical technique is related in detail, with a focus on venous compromise management. Operative time, re-intervention rate, hospital stay, and complications were all noted and analyzed, and a literature review dealt with other techniques of prevention and management of flap venous congestion.

Results

Among breast reconstructions by DIEP, 7.5% contained an episode of intraoperative venous compromise, as opposed to 6.5% postoperatively. The SIEV was used in 65% of cases of venous congestion. In our series, 15.1% of cases presented postoperative complications, and we observed a 2.5% flap failure rate (2%: venous thrombosis; 0.5%: arterial thrombosis). In all patients for whom venous drainage augmentation was performed, the flaps survived without partial loss. While average length of hospital stay in the group having undergone intraoperative secondary anastomosis was 7.5 days, in the group having undergone postoperative secondary anastomosis, it was 13.5 days.

Conclusion

In cases of intraoperative venous congestion, while a second venous anastomosis may immediately increase duration of an initial intervention by 1 hour and 45 minutes, it is nonetheless likely to pronouncedly decrease need for surgical revision, cases of failure, rate of partial necrosis and overall hospital stay.

Résumé

Objectif

Le but de notre étude est l'analyse de notre technique de prise en charge de la congestion veineuse peropératoire en préservant la veine superficielle épigastrique inférieure (SIEV), ainsi qu'une revue rétrospective de notre série de reconstructions mammaires autologues par lambeau de perforateur épigastrique inférieure profond (DIEP). Par ailleurs, nous avons effectué une revue d'autres techniques dans la littérature.

Patients et méthodes

Il s'agit d'une étude rétrospective de 198 reconstructions mammaires par lambeau DIEP réalisées entre janvier 2010 et septembre 2017, notre technique chirurgicale est décrite avec une mise au point sur la prise en charge de la congestion veineuse. Le temps opératoire, le taux de reprise, la durée de séjour et les complications ont été enregistrés, puis une revue de la littérature a été réalisée pour d'autres techniques de prise en charge de la congestion veineuse.

Résultats

Parmi les reconstructions mammaires réalisées par DIEP, 7,5 % ont eu un épisode de drainage veineux insuffisant peropératoire contre 6,5 % en postopératoire. La SIEV a été utilisée dans 65 % des cas. Notre taux de reprise globale est de 15,1 % pour toutes les complications postopératoires, le taux d'échec est de 2,5 %, divisé entre 2 % pour la thrombose veineuse et 0,5 % pour la thrombose artérielle. Chez les patientes ayant bénéficié d'une augmentation du drainage veineux, les lambeaux ont survécu sans nécrose partielle. La durée moyenne d'hospitalisation chez le groupe ayant eu une anastomose secondaire peropératoire est de 7,8 jours, contre 13,5 jours dans le groupe ayant subi une anastomose secondaire postopératoire.

Conclusion

En cas de congestion veineuse peropératoire, la réalisation immédiate d'une seconde anastomose veineuse semble augmenter la durée d'intervention initiale de 1 h 45 h, mais pourrait permettre de réduire à la fois le nombre de reprise chirurgicale, le taux d'échec, le taux de nécrose partielle et la durée d'hospitalisation globale.

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Évaluation du risque de saignement postopératoire en chirurgie de la main sans interruption des anticoagulants de type AntiVitamines K (AVK), étude rétrospective

Publication date: Available online 13 October 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): B. Gerenton, V. Moris, H. Shipkov, P.J. Regnard, D. Guillier

Résumé

Objectifs

La gestion des anticoagulants type AntiVitamines K (AVK) est un problème de santé publique. Une intervention chirurgicale est la première cause de suspension du traitement anticoagulant. Cette étude rétrospective contribue à la définition du groupe de risque de la chirurgie de la main sous AVK.

Patients et méthodes

Il s'agit d'une étude rétrospective monocentrique réalisée entre janvier 2013 et décembre 2015. Les critères d'inclusion étaient les patients adultes pris en charge aux urgences mains ou en chirurgie programmée dont l'anticoagulation par AVK n'avait pas été stoppée avant leur intervention. Un INR inférieur à 3 datant de moins de 24 h était exigé. Les critères d'exclusion étaient un INR supérieur à 3 ou la mise en place d'un relais par héparine. Le critère de jugement principal était la survenue d'un saignement du site opératoire durant les 7 jours suivant l'intervention. Les critères secondaires étaient les complications autres chirurgicales.

Résultats

Cent quatre procédures pour quatre-vingt-treize patients ont été incluses. L'âge moyen était de 74,36 ans [27–90] avec un sexe-ratio homme-femme de 2,47. La chirurgie programmée représentait 61,5 % des actes opératoires contre 36,5 % réalisés en urgences. Un INR a été contrôlé en moyenne à 2,29 [1,07–3]. Un patient a présenté à j4 un hématome postopératoire n'ayant pas nécessité de reprise opératoire. Aucune autre complication n'a été rapportée.

Conclusion

Le risque hémorragique postopératoire en chirurgie de la main sans interruption d'un traitement par AVK est faible sous couvert d'un INR récent inférieur à trois.

Summary

Objective

The management of patients on Vitamine K Antagonist (VKA) anticoagulation is a public health issue with surgery being the primary cause of VKA interruption. The aim of this study was to evaluate the bleeding risk in patients operated on hand surgery without interruption of VKA treatment.

Patients and methods

This retrospective, monocentric study was conducted between 2013 and 2015. The inclusion criteria were, as follows: patients on VKA over 18 years of age who had emergency or scheduled surgery without interruption of VKA treatment; INR inferior to 3 analyzed less than 24 h before surgery. Exclusion criteria were, as follows: INR superior to 3; interruption of VKA treatment with or without switch to heparin treatment. The primary evaluation parameter was any form of bleeding that occurred during the first 7 post-operative days. The secondary criteria were other surgical complications.

Results

There were 93 patients and 104 procedures. The mean age was 74.36 years (from 27 to 90) with a sex ratio male-to-female of 2.47. The scheduled surgeries were 61.5% against 36.5% for the emergency cases. The mean INR was 2.29 (from 1.07 to 3). One patient presented a postoperative hematoma on the 4th postoperative day, which did not require any revision surgery. There were no other complications reported.

Conclusion

The results of this series suggest a small bleeding risk in hand surgery without interruption of VKA treatment provided that IRN is inferior to 3 less than 24 hours before the procedure.

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Utilisation des lambeaux libres dans la prise en charge des plaies chroniques

Publication date: Available online 14 October 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): J. Laporte, C. Herlin, J. Delicque, D. Saunière, P. Perrot, F. Duteille

Résumé

Introduction

Les plaies chroniques représentent une problématique de santé majeure mais leur traitement chirurgical est encore peu standardisé. L'utilisation des lambeaux libres reste peu abordée dans la littérature, avec une propension supposée à l'échec compte tenu des conditions locales défavorables et à un terrain souvent débilité. Nous exposons ici l'analyse de notre expérience monocentrique de l'utilisation des lambeaux libres dans le traitement curatif de plaies chroniques.

Patients et méthodes

Nous avons réalisé une étude monocentrique rétrospective sur 15 ans de tous les lambeaux libres réalisés pour le traitement d'une plaie chronique entre janvier 2001 et septembre 2016. Plusieurs critères ont été évalués sur les patients, les plaies, les lambeaux libres utilisés et les suites opératoires immédiates et à distance.

Résultats

Quatre-vingt-onze patients ont été inclus (sex-ratio 3,55) avec un âge moyen de 41,6 ± 16 ans. Les plaies étaient localisées à la jambe dans 92,3 % des cas et 58 % des patients présentaient une ostéomyélite lorsque les patients nous ont été confiés. Les lambeaux utilisés étaient majoritairement musculaires purs (61,6 %). Le taux de survie des lambeaux était de 92,3 %. Avec un recul moyen de 50 mois, l'échec de reconstruction était de 20,9 %. La présence d'une ostéomyélite chronique est le seul facteur statistiquement significatif d'échec de reconstruction (p = 0,0169) avec un risque d'échec multiplié par 5.

Conclusion

Notre étude met en évidence que la fiabilité des lambeaux libres dans le traitement des plaies chroniques est comparable, quel que soit le délai depuis la lésion cutanée initiale, à celle existante dans le traitement des plaies aiguës ou dans la reconstruction post-exérèse carcinologique. La présence d'une ostéomyélite chronique représente toutefois le principal risque d'échec de la reconstruction significatif en multipliant par 5 le risque d'échec à distance. Les changements récents de paradigme de reconstruction tégumentaire du membre inférieur permettront sans doute dans les prochaines années d'établir plus rationnellement la place des lambeaux libres musculaires dans l'arsenal thérapeutique de traitement des plaies chroniques au membre inférieur.

Summary

Introduction

Chronic wounds represent a major health challenge with no current standardized surgical treatment. The use of free flaps is little discussed in the literature, with a supposed propensity to failure given unfavorable local conditions and land often debility. We present here the analysis of our monocentric experience of the use of free flaps in the curative treatment of chronic wounds.

Patients et methods

We performed a retrospective monocentric study over 18 years of all free flaps used for the treatment of a chronic wound between January 2001 and September 2016. Several criteria were evaluated on patients, wounds, free flaps used and immediate to late outcomes.

Results

Ninety-one patients were included (sex ratio M/F: 3.55) with an average age of 41.6 ± 16 years. Wounds were localized to the leg in 92.3% of cases and 58% of patients had initial osteomyelitis. The flaps used were predominantly muscle flaps (61.6%). The flaps survival rate was 92.3%. With a mean follow-up of 50 months, the reconstructive failure rate was 20.9%. The presence of a chronic osteomyelitis is the only statistically significant factor of reconstruction failure (P = 0.0169) with a risk of failure multiplied by 5.

Conclusion

Our study demonstrates that the reliability of free flaps in the treatment of chronic wounds is comparable, regardless of the time since the initial cutaneous lesion, to that existing in the treatment of acute wounds or in the reconstruction after oncological excision. The presence of a chronic osteomyelitis, however, represents a major risk of reconstruction failure by increasing 5 times the risk of failure. Recent changes in the integumentary reconstruction paradigm of the lower limb will undoubtedly allow in the next few years to establish more rationally the place of muscle free flaps in the therapeutic armamentarium of chronic wounds.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pQ1dx4

Intraoperative superficial inferior epigastric vein preservation for venous compromise prevention in breast reconstruction by deep inferior epigastric perforator flap

Publication date: Available online 13 October 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Al Hindi, C. Ozil, K. Rem, J. Rausky, V. Moris, D. Guillier, J.P. Binder, M. Revol, S. Cristofari

Summary

Objective

The aim of this study was to analyze our technique of intraoperative venous compromise management based on conservation of the superficial inferior epigastric vein (SIEV), and to undertake a retrospective review of our series of breast reconstructions by deep inferior epigastric perforator (DIEP) flap, followed by a review of other techniques reported in the literature.

Materials and methods

This retrospective study involves 198 breast reconstructions by DIEP flap performed between January 2010 and September 2017. Our surgical technique is related in detail, with a focus on venous compromise management. Operative time, re-intervention rate, hospital stay, and complications were all noted and analyzed, and a literature review dealt with other techniques of prevention and management of flap venous congestion.

Results

Among breast reconstructions by DIEP, 7.5% contained an episode of intraoperative venous compromise, as opposed to 6.5% postoperatively. The SIEV was used in 65% of cases of venous congestion. In our series, 15.1% of cases presented postoperative complications, and we observed a 2.5% flap failure rate (2%: venous thrombosis; 0.5%: arterial thrombosis). In all patients for whom venous drainage augmentation was performed, the flaps survived without partial loss. While average length of hospital stay in the group having undergone intraoperative secondary anastomosis was 7.5 days, in the group having undergone postoperative secondary anastomosis, it was 13.5 days.

Conclusion

In cases of intraoperative venous congestion, while a second venous anastomosis may immediately increase duration of an initial intervention by 1 hour and 45 minutes, it is nonetheless likely to pronouncedly decrease need for surgical revision, cases of failure, rate of partial necrosis and overall hospital stay.

Résumé

Objectif

Le but de notre étude est l'analyse de notre technique de prise en charge de la congestion veineuse peropératoire en préservant la veine superficielle épigastrique inférieure (SIEV), ainsi qu'une revue rétrospective de notre série de reconstructions mammaires autologues par lambeau de perforateur épigastrique inférieure profond (DIEP). Par ailleurs, nous avons effectué une revue d'autres techniques dans la littérature.

Patients et méthodes

Il s'agit d'une étude rétrospective de 198 reconstructions mammaires par lambeau DIEP réalisées entre janvier 2010 et septembre 2017, notre technique chirurgicale est décrite avec une mise au point sur la prise en charge de la congestion veineuse. Le temps opératoire, le taux de reprise, la durée de séjour et les complications ont été enregistrés, puis une revue de la littérature a été réalisée pour d'autres techniques de prise en charge de la congestion veineuse.

Résultats

Parmi les reconstructions mammaires réalisées par DIEP, 7,5 % ont eu un épisode de drainage veineux insuffisant peropératoire contre 6,5 % en postopératoire. La SIEV a été utilisée dans 65 % des cas. Notre taux de reprise globale est de 15,1 % pour toutes les complications postopératoires, le taux d'échec est de 2,5 %, divisé entre 2 % pour la thrombose veineuse et 0,5 % pour la thrombose artérielle. Chez les patientes ayant bénéficié d'une augmentation du drainage veineux, les lambeaux ont survécu sans nécrose partielle. La durée moyenne d'hospitalisation chez le groupe ayant eu une anastomose secondaire peropératoire est de 7,8 jours, contre 13,5 jours dans le groupe ayant subi une anastomose secondaire postopératoire.

Conclusion

En cas de congestion veineuse peropératoire, la réalisation immédiate d'une seconde anastomose veineuse semble augmenter la durée d'intervention initiale de 1 h 45 h, mais pourrait permettre de réduire à la fois le nombre de reprise chirurgicale, le taux d'échec, le taux de nécrose partielle et la durée d'hospitalisation globale.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NFKmXe