Influence of Monoenergetic Images at Different Energy Levels in Dual-Energy Spectral CT on the Accuracy of Computer-Aided Detection for Pulmonary Embolism

Publication date: Available online 22 February 2019

Source: Academic Radiology

Author(s): Guangming Ma, Yuequn Dou, Shan Dang, Nan Yu, Yanbing Guo, Chuangbo Yang, Shuanhong Lu, Dong Han, Chenwang Jin

Purpose

To investigate the influence of monoenergetic images of different energy levels in spectral computed tomography (CT) on the accuracy of computer aided detection (CAD) for pulmonary embolism (PE).

Materials and Methods

CT images of 20 PE patients who underwent spectral CT pulmonary angiography were retrospectively analyzed. Nine sets of monochromatic images from 40 to 80 keV at 5 keV interval were reconstructed and then independently analyzed for detecting PE using a commercially available CAD software. Two experienced radiologists reviewed all images and recorded the number of emboli manually, which was used as the reference standard. The CAD findings for the number of PE at different energies were compared with the reference standard to determine the number of true positives and false positives with CAD and to calculate the sensitivity and false positive rate at different energies.

Result

There were 120 true emboli. The total numbers of CAD-detected PE at 40–80 keV were 48, 67, 63, 87, 106, 115, 138, 157, and 226. Images at low energies had low sensitivities and low false positive rates; images at high energies had high sensitivities and high false positive rates. At 60 keV and 65 keV, CAD achieved sensitivity at 81.67% and 84.17%, respectively and false positive rate at 7.55% and 12.17%, respectively to provide the optimum combination of high sensitivity and low false positive rate.

Conclusion

Monochromatic images of different energies in dual-energy spectral CT affect the accuracy of CAD for PE. The combination of CAD with images at 60–65 keV provides the optimum combination of high sensitivity and low false positive rate in detecting PE.

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Implementation of Institutional Size-Specific Diagnostic Reference Levels for CT Angiography

Publication date: Available online 22 February 2019

Source: Academic Radiology

Author(s): Yan Klosterkemper, Christoph Thomas, Oliver T Bethge, Elisabeth Appel, Joel Aissa, Judith Boeven, Gerald Antoch, Johannes Boos

Rationale and Objectives

To generate institutional size-specific diagnostic reference levels (DRLs) for computed tomography angiography (CTA) examinations and assess the potential for dose optimization compared to size-independent DRLs.

Materials and Methods

CTA examinations of the aorta, the pulmonary arteries and of the pelvis/lower extremity performed between January 2016 and January 2017 were included in our retrospective study. Water equivalent diameter (Dw) was automatically calculated for each patient. The relationship between Dw and computed tomography dose index (CTDI_vol) was analyzed and the 75th percentile was chosen as the upper limit for institutional DRLs. Size-specific institutional DRLs were compared to national size-independent DRLs from Germany and the UK.

Results

A total of 1344 examinations were included in our study (n = 733 aortic CTA, n = 406 pulmonary CTA, n = 205 pelvic/lower extremity CTA). Mean Dw was 26 ± 9 cm and mean CTDI_vol was 7.0 ± 4.6 mGy. For all CTA protocols, there was a linear progression of CTDI_vol with increasing Dw with an R² = 0.95 in aortic CTA, R² = 0.94 in pulmonary CTA and R² = 0.93 in pelvic/lower extremity CTA. Median CTDI_vol increased by 0.57 mGy per additional cm Dw in aortic CTA, by 1.1 mGy in pulmonary CTA and by 0.31 mGy in pelvic/lower extremity CTA. Institutional DRLs were lower than national DRLs for average size patients (aortic CTA: Dw 28.2 cm, CTDI_vol 7.6 mGy; pulmonary CTA, Dw 27.9 cm, CTDI_vol 11.8 mGy; pelvic/lower extremity CTA, Dw 20.0 cm, CTDI_vol 6.4 mGy). More dose outliers in small patients were detected with size-specific DRLs compared to national size-independent DRLs (56.4% vs 16.2%).

Conclusion

We implemented institutional size-specific DRLs for CTA examinations which enabled a more precise analysis compared to national sizeindependent DRLs.

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Spectral CT Imaging in the Differential Diagnosis of Small Bowel Adenocarcinoma From Primary Small Intestinal Lymphoma

Publication date: Available online 22 February 2019

Source: Academic Radiology

Author(s): Chuang-bo Yang, Nan Yu, Yong-jun Jian, Yong Yu, Hai-feng Duan, Xi-rong Zhang, Guang-ming Ma, Youmin Guo, Xiaoyi Duan

Purpose

To investigate the value of dual-energy spectral computed tomography (CT) imaging in the differential diagnosis of small bowel adenocarcinoma (SBA) from primary small intestinal lymphoma (PSIL).

Materials and Methods

We retrospectively analyzed the images of 27 SBA cases and 15 PSIL cases. These patients underwent spectral CT imaging in the arterial phase (AP) and venous phase (VP). CT attenuation values of tumors at different energy levels were measured to generate spectral attenuation curve and to calculate curve slope (λ_HU). Iodine concentration (IC) in tumors at AP and VP were measured and normalized to that of aorta as normalized iodine concentration (NIC). Independent samples t test was used to analyze the spectral CT parameters; Receiver operating characteristic curves were generated to evaluate the diagnostic efficacy of each parameter.

Results

There were significant differences between SBA and PSIL in IC (2.09 ± 0.71 vs 1.33 ± 0.15 mg/ml), NIC (0.20 ± 0.06 vs 0.13 ± 0.02) and slope (λ_HU) (2.78 ± 1.06 vs 1.86 ± 0.30) in AP and (1.86 ± 0.68 vs 1.37 ± 0.18 mg/ml for IC; 0.47 ± 0.13 vs 0.33 ± 0.02 for NIC and 2.00 ± 0.56 vs 1.50 ± 0.26 for λ_HU) in VP (all p < 0.05). For the CT value measurement, there were significant differences between SBA and PSIL in the 40–60keV energy range (p < 0.05), but not in the 70–140keV range (p > 0.05). Using 1.38 mg/ml as a threshold value for iodine concentration at AP, one could obtain the area-under-curve of 0.93 for receiver operating characteristic study and sensitivity of 94% and specificity of 85% for differentiating SBA from PSIL. The sensitivity and specificity values were significantly higher than the respective values of 62% and 60% with the conventional CT numbers at 70keV.

Conclusion

Quantitative parameters obtained in spectral CT, especially iodine concentration in AP, provide high accuracy for differentiating SBA from PSIL.

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Influence of Monoenergetic Images at Different Energy Levels in Dual-Energy Spectral CT on the Accuracy of Computer-Aided Detection for Pulmonary Embolism

Publication date: Available online 22 February 2019

Source: Academic Radiology

Author(s): Guangming Ma, Yuequn Dou, Shan Dang, Nan Yu, Yanbing Guo, Chuangbo Yang, Shuanhong Lu, Dong Han, Chenwang Jin

Purpose

To investigate the influence of monoenergetic images of different energy levels in spectral computed tomography (CT) on the accuracy of computer aided detection (CAD) for pulmonary embolism (PE).

Materials and Methods

CT images of 20 PE patients who underwent spectral CT pulmonary angiography were retrospectively analyzed. Nine sets of monochromatic images from 40 to 80 keV at 5 keV interval were reconstructed and then independently analyzed for detecting PE using a commercially available CAD software. Two experienced radiologists reviewed all images and recorded the number of emboli manually, which was used as the reference standard. The CAD findings for the number of PE at different energies were compared with the reference standard to determine the number of true positives and false positives with CAD and to calculate the sensitivity and false positive rate at different energies.

Result

There were 120 true emboli. The total numbers of CAD-detected PE at 40–80 keV were 48, 67, 63, 87, 106, 115, 138, 157, and 226. Images at low energies had low sensitivities and low false positive rates; images at high energies had high sensitivities and high false positive rates. At 60 keV and 65 keV, CAD achieved sensitivity at 81.67% and 84.17%, respectively and false positive rate at 7.55% and 12.17%, respectively to provide the optimum combination of high sensitivity and low false positive rate.

Conclusion

Monochromatic images of different energies in dual-energy spectral CT affect the accuracy of CAD for PE. The combination of CAD with images at 60–65 keV provides the optimum combination of high sensitivity and low false positive rate in detecting PE.

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Implementation of Institutional Size-Specific Diagnostic Reference Levels for CT Angiography

Publication date: Available online 22 February 2019

Source: Academic Radiology

Author(s): Yan Klosterkemper, Christoph Thomas, Oliver T Bethge, Elisabeth Appel, Joel Aissa, Judith Boeven, Gerald Antoch, Johannes Boos

Rationale and Objectives

To generate institutional size-specific diagnostic reference levels (DRLs) for computed tomography angiography (CTA) examinations and assess the potential for dose optimization compared to size-independent DRLs.

Materials and Methods

CTA examinations of the aorta, the pulmonary arteries and of the pelvis/lower extremity performed between January 2016 and January 2017 were included in our retrospective study. Water equivalent diameter (Dw) was automatically calculated for each patient. The relationship between Dw and computed tomography dose index (CTDI_vol) was analyzed and the 75th percentile was chosen as the upper limit for institutional DRLs. Size-specific institutional DRLs were compared to national size-independent DRLs from Germany and the UK.

Results

A total of 1344 examinations were included in our study (n = 733 aortic CTA, n = 406 pulmonary CTA, n = 205 pelvic/lower extremity CTA). Mean Dw was 26 ± 9 cm and mean CTDI_vol was 7.0 ± 4.6 mGy. For all CTA protocols, there was a linear progression of CTDI_vol with increasing Dw with an R² = 0.95 in aortic CTA, R² = 0.94 in pulmonary CTA and R² = 0.93 in pelvic/lower extremity CTA. Median CTDI_vol increased by 0.57 mGy per additional cm Dw in aortic CTA, by 1.1 mGy in pulmonary CTA and by 0.31 mGy in pelvic/lower extremity CTA. Institutional DRLs were lower than national DRLs for average size patients (aortic CTA: Dw 28.2 cm, CTDI_vol 7.6 mGy; pulmonary CTA, Dw 27.9 cm, CTDI_vol 11.8 mGy; pelvic/lower extremity CTA, Dw 20.0 cm, CTDI_vol 6.4 mGy). More dose outliers in small patients were detected with size-specific DRLs compared to national size-independent DRLs (56.4% vs 16.2%).

Conclusion

We implemented institutional size-specific DRLs for CTA examinations which enabled a more precise analysis compared to national sizeindependent DRLs.

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Effect of labelling plane angulation and position on labelling efficiency and cerebral blood flow quantification in pseudo-continuous arterial spin labelling

Publication date: Available online 22 February 2019

Source: Magnetic Resonance Imaging

Author(s): Magdalena Sokolska, Alan Bainbridge, Alvaro R. Villabona, Xavier Golay, David Thomas

Abstract

Pseudo-continuous arterial spin labelling (pCASL) is the MRI method of choice for non-invasive perfusion measurement in research and clinical practice. Knowledge of the labelling efficiency, α, is essential for accurate quantification of cerebral blood flow (CBF). Typically, a theoretical α value is used, based on an idealistic model and an assumption of spins flowing perpendicularly to the labelling plane. The aim of this work was to investigate the effect of violating this assumption, and to characterize the influence of labelling plane angulation with respect to the vessel direction on labelling efficiency and measured CBF.

The effect of labelling plane angulation on labelling efficiency was demonstrated using a numerical simulation of spins at different velocities. Acquisitions from healthy volunteers were used to test the effect of a range of angulation offsets. Additional sub-optimal positions of the labelling plane with respect to the vertebral arteries, at locations where the direction of flow changes significantly from the head-foot direction, were also considered.

No significant change in the measured CBF was seen when the labelling plane was angled up to 60° to the labelled vessel or when it was placed in sub-optimal positions. This study shows that in adult subjects, the efficiency of pCASL is robust to the angulation and positioning of the labelling plane beyond the range of potential operator error.

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Effect of labelling plane angulation and position on labelling efficiency and cerebral blood flow quantification in pseudo-continuous arterial spin labelling

Publication date: Available online 22 February 2019

Source: Magnetic Resonance Imaging

Author(s): Magdalena Sokolska, Alan Bainbridge, Alvaro R. Villabona, Xavier Golay, David Thomas

Abstract

Pseudo-continuous arterial spin labelling (pCASL) is the MRI method of choice for non-invasive perfusion measurement in research and clinical practice. Knowledge of the labelling efficiency, α, is essential for accurate quantification of cerebral blood flow (CBF). Typically, a theoretical α value is used, based on an idealistic model and an assumption of spins flowing perpendicularly to the labelling plane. The aim of this work was to investigate the effect of violating this assumption, and to characterize the influence of labelling plane angulation with respect to the vessel direction on labelling efficiency and measured CBF.

The effect of labelling plane angulation on labelling efficiency was demonstrated using a numerical simulation of spins at different velocities. Acquisitions from healthy volunteers were used to test the effect of a range of angulation offsets. Additional sub-optimal positions of the labelling plane with respect to the vertebral arteries, at locations where the direction of flow changes significantly from the head-foot direction, were also considered.

No significant change in the measured CBF was seen when the labelling plane was angled up to 60° to the labelled vessel or when it was placed in sub-optimal positions. This study shows that in adult subjects, the efficiency of pCASL is robust to the angulation and positioning of the labelling plane beyond the range of potential operator error.

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Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Abstract

Background

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.

Methods

We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.

Results

There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.

Conclusions

Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.

Level of Evidence: Level IV, therapeutic study

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Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

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Flexor pulley reconstruction using a transverse carpal ligament: a case report

Abstract

Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

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Thromboprophylaxis in breast microvascular reconstruction: a review of the literature

Abstract

Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: "venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin." Results were combined with the terms "breast microsurgery" and "breast free flap." All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

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Anatomical position of umbilicus in Latin-American patients

Abstract

Background

The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being.

Methods

The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization.

Results

In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1.

Conclusions

Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values.

Level of Evidence: Level III, risk / prognostic study.

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Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Abstract

Background

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.

Methods

We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.

Results

There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.

Conclusions

Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.

Level of Evidence: Level IV, therapeutic study

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Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2E7r9v6

Flexor pulley reconstruction using a transverse carpal ligament: a case report

Abstract

Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

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

Thromboprophylaxis in breast microvascular reconstruction: a review of the literature

Abstract

Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: "venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin." Results were combined with the terms "breast microsurgery" and "breast free flap." All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2E7r5eQ

Anatomical position of umbilicus in Latin-American patients

Abstract

Background

The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being.

Methods

The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization.

Results

In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1.

Conclusions

Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values.

Level of Evidence: Level III, risk / prognostic study.

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The accuracy of young adult cannabis users' perceptions of friends' cannabis and alcohol use

Publication date: Available online 23 February 2019

Source: Addictive Behaviors

Author(s): Michael J. Mason, Aaron Brown, Matthew Moore

Abstract

Objective

Understanding the complex influence of peers on young adult substance use is an important component of intervention research and is challenging methodologically. The false consensus theory suggests that individuals falsely attribute their own substance use behaviors onto others, producing biased data.

Methods

We tested this theory with 39 young adults who had a cannabis use disorder and a mean age of 20. Participants (egos) recruited three of their close friends (alters). Egos reported their past 30-day cannabis and alcohol use and their perceptions of alters' use. Alters also reported their actual past 30-day cannabis and alcohol use.

Results

Results demonstrated that egos were very accurate in their perceptions of the frequency of alters' cannabis (ρ = 0.82, p < 0.001) and alcohol (ρ = 0.74, p < 0.001) use. Linear regression models predicted alters' actual cannabis and alcohol use based on egos' perceptions of alters' use, controlling for egos' own substance use. Egos' perceptions of alters' cannabis use strongly predicted alters' actual use (β = 0.80, p < 0.001, adj-R² = 0.67), and egos' perceptions of alters' alcohol use also predicted alters' actual use (β = 0.66, p < 0.001, adj-R² = 0.62). Egos' own substance use did not predict alters' use in either model.

Conclusions

Results provide evidence that the false consensus theory may be limited when applied to young adults with cannabis use disorder within a close-friend research framework. The results support the hypothesis that young adults are very accurate in their perceptions of the frequency of close friends' substance use and that these perceptions are independent of egos' own use. These findings support the continued use of ego-centric reported close peer substance use for understanding peer effects.

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A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain

Publication date: Available online 22 February 2019

Source: Addictive Behaviors

Author(s): Lynne Dawkins, Allison Ford, Linda Bauld, Sema Balaban, Allan Tyler, Sharon Cox

Abstract

Background

Smoking is a key contributor to health and social inequalities and homeless smoking prevalence rates are 4 times higher than the general population. Research on homelessness and smoking to date has been concentrated predominantly in the US and Australia. This study aimed to describe smoking and quitting behaviour in homeless adult smokers in Great Britain. Data on perceptions of, and willingness to try, e-cigarettes were also gathered.

Methods

Cross sectional survey of 283 adult smokers accessing homeless support services in Kent, the Midlands, London and Edinburgh. Participants answered a four-part survey: i) demographics; ii) current smoking behaviour and dependence (including the Fagerström Test of Cigarette Dependence [FTCD]); iii) previous quit attempts; and iv) e-cigarettes perceptions.

Results

High levels of cigarette dependence were observed (FTCD: M = 7.78, sd ± 0.98). Although desire to quit was high, most had made fewer than 5 quit attempts and 90% of these lasted less than 24 h. 91.5% reported that others around them also smoked. Previous quit methods used included cold turkey (29.7%), NRT (24.7%), varenicline (22.3%) and bupropion (14.5%). 34% were willing or able to spend £20 or more for an e-cigarette and 82% had tried one in the past although 54% reported that they preferred smoking.

Conclusion

We observed high nicotine dependence, few long-term quit attempts, strong desire to quit and amenability to both traditional cessation methods and e-cigarettes. Community embedded and non-routine approaches to cessation may be promising avenues promoting engagement with the homeless community. Likely barriers to uptake include low affordability, preference for cigarettes and high numbers of smoking acquaintances.

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The accuracy of young adult cannabis users' perceptions of friends' cannabis and alcohol use

Publication date: Available online 23 February 2019

Source: Addictive Behaviors

Author(s): Michael J. Mason, Aaron Brown, Matthew Moore

Abstract

Objective

Understanding the complex influence of peers on young adult substance use is an important component of intervention research and is challenging methodologically. The false consensus theory suggests that individuals falsely attribute their own substance use behaviors onto others, producing biased data.

Methods

We tested this theory with 39 young adults who had a cannabis use disorder and a mean age of 20. Participants (egos) recruited three of their close friends (alters). Egos reported their past 30-day cannabis and alcohol use and their perceptions of alters' use. Alters also reported their actual past 30-day cannabis and alcohol use.

Results

Results demonstrated that egos were very accurate in their perceptions of the frequency of alters' cannabis (ρ = 0.82, p < 0.001) and alcohol (ρ = 0.74, p < 0.001) use. Linear regression models predicted alters' actual cannabis and alcohol use based on egos' perceptions of alters' use, controlling for egos' own substance use. Egos' perceptions of alters' cannabis use strongly predicted alters' actual use (β = 0.80, p < 0.001, adj-R² = 0.67), and egos' perceptions of alters' alcohol use also predicted alters' actual use (β = 0.66, p < 0.001, adj-R² = 0.62). Egos' own substance use did not predict alters' use in either model.

Conclusions

Results provide evidence that the false consensus theory may be limited when applied to young adults with cannabis use disorder within a close-friend research framework. The results support the hypothesis that young adults are very accurate in their perceptions of the frequency of close friends' substance use and that these perceptions are independent of egos' own use. These findings support the continued use of ego-centric reported close peer substance use for understanding peer effects.

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A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain

Publication date: Available online 22 February 2019

Source: Addictive Behaviors

Author(s): Lynne Dawkins, Allison Ford, Linda Bauld, Sema Balaban, Allan Tyler, Sharon Cox

Abstract

Background

Smoking is a key contributor to health and social inequalities and homeless smoking prevalence rates are 4 times higher than the general population. Research on homelessness and smoking to date has been concentrated predominantly in the US and Australia. This study aimed to describe smoking and quitting behaviour in homeless adult smokers in Great Britain. Data on perceptions of, and willingness to try, e-cigarettes were also gathered.

Methods

Cross sectional survey of 283 adult smokers accessing homeless support services in Kent, the Midlands, London and Edinburgh. Participants answered a four-part survey: i) demographics; ii) current smoking behaviour and dependence (including the Fagerström Test of Cigarette Dependence [FTCD]); iii) previous quit attempts; and iv) e-cigarettes perceptions.

Results

High levels of cigarette dependence were observed (FTCD: M = 7.78, sd ± 0.98). Although desire to quit was high, most had made fewer than 5 quit attempts and 90% of these lasted less than 24 h. 91.5% reported that others around them also smoked. Previous quit methods used included cold turkey (29.7%), NRT (24.7%), varenicline (22.3%) and bupropion (14.5%). 34% were willing or able to spend £20 or more for an e-cigarette and 82% had tried one in the past although 54% reported that they preferred smoking.

Conclusion

We observed high nicotine dependence, few long-term quit attempts, strong desire to quit and amenability to both traditional cessation methods and e-cigarettes. Community embedded and non-routine approaches to cessation may be promising avenues promoting engagement with the homeless community. Likely barriers to uptake include low affordability, preference for cigarettes and high numbers of smoking acquaintances.

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Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome.

Related Articles

Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome.

J Laryngol Otol. 2019 Feb 22;:1-4

Authors: Kovarik J, Bhabra M, Tin AW, Shaikh G, Iqbal MS

Abstract
OBJECTIVE: Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.
METHODS: Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain ('GRBAS') scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.
RESULTS: All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.
CONCLUSION: This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.

PMID: 30791965 [PubMed - as supplied by publisher]

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A novel computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube - a case series.

Related Articles

A novel computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube - a case series.

J Laryngol Otol. 2019 Feb 21;:1-4

Authors: Alli A, Shukla R, Cook JL, Waddell A

Abstract
BACKGROUND: Patulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.
METHODS: This paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.
RESULTS: The combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.
CONCLUSION: Computed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.

PMID: 30789119 [PubMed - as supplied by publisher]

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The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology.

Related Articles

The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology.

J Laryngol Otol. 2019 Feb 21;:1-3

Authors: Suzuki M, Nakaegawa Y, Kobayashi T, Kawase T, Matsuzuka T, Murono S

Abstract
OBJECTIVES: This study focused on parotid gland tumours diagnosed as benign by fine-needle aspiration cytology and investigated the necessity of frozen section biopsy.
METHODS: There were 104 cases of parotid gland tumour where fine-needle aspiration cytology was benign and frozen section biopsy was subsequently performed, between April 2006 and June 2016. In this retrospective study, the results of frozen section biopsy were analysed and compared with the final histological diagnosis.
RESULTS: Among the 104 cases diagnosed as benign by fine-needle aspiration cytology, 102 cases and 2 cases were diagnosed as benign and malignant, respectively, by frozen section biopsy. The final histological diagnoses showed that 98 cases were benign and 6 cases were malignant. The sensitivity and specificity values of frozen section biopsy in detecting malignant tumours were 33 per cent and 100 per cent, respectively.
CONCLUSION: The necessity of frozen section biopsy in cases with benign fine-needle aspiration cytology may be low in parotid gland surgery.

PMID: 30789118 [PubMed - as supplied by publisher]

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Rhinological interventions for obstructive sleep apnoea - a systematic review and descriptive meta-analysis.

Related Articles

Rhinological interventions for obstructive sleep apnoea - a systematic review and descriptive meta-analysis.

J Laryngol Otol. 2019 Feb 21;:1-9

Authors: Sharma S, Wormald JCR, Fishman JM, Andrews P, Kotecha BT

Abstract
OBJECTIVES: Obstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.
METHODS: A systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.
RESULTS: Sixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.
CONCLUSION: Nasal surgery may have limited benefit for a subset of patients based on current evidence.

PMID: 30789116 [PubMed - as supplied by publisher]

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Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome.

Related Articles

Intensity-modulated radiotherapy (55 Gy in 20 fractions) for high-grade laryngeal dysplasia: report of acute toxicity and functional outcome.

J Laryngol Otol. 2019 Feb 22;:1-4

Authors: Kovarik J, Bhabra M, Tin AW, Shaikh G, Iqbal MS

Abstract
OBJECTIVE: Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.
METHODS: Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain ('GRBAS') scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.
RESULTS: All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.
CONCLUSION: This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.

PMID: 30791965 [PubMed - as supplied by publisher]

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A novel computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube - a case series.

Related Articles

A novel computed tomography guided, transcutaneous approach to treat refractory autophony in patients with a patulous Eustachian tube - a case series.

J Laryngol Otol. 2019 Feb 21;:1-4

Authors: Alli A, Shukla R, Cook JL, Waddell A

Abstract
BACKGROUND: Patulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.
METHODS: This paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.
RESULTS: The combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.
CONCLUSION: Computed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.

PMID: 30789119 [PubMed - as supplied by publisher]

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The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology.

Related Articles

The role of frozen section biopsy for parotid gland tumour with benign fine-needle aspiration cytology.

J Laryngol Otol. 2019 Feb 21;:1-3

Authors: Suzuki M, Nakaegawa Y, Kobayashi T, Kawase T, Matsuzuka T, Murono S

Abstract
OBJECTIVES: This study focused on parotid gland tumours diagnosed as benign by fine-needle aspiration cytology and investigated the necessity of frozen section biopsy.
METHODS: There were 104 cases of parotid gland tumour where fine-needle aspiration cytology was benign and frozen section biopsy was subsequently performed, between April 2006 and June 2016. In this retrospective study, the results of frozen section biopsy were analysed and compared with the final histological diagnosis.
RESULTS: Among the 104 cases diagnosed as benign by fine-needle aspiration cytology, 102 cases and 2 cases were diagnosed as benign and malignant, respectively, by frozen section biopsy. The final histological diagnoses showed that 98 cases were benign and 6 cases were malignant. The sensitivity and specificity values of frozen section biopsy in detecting malignant tumours were 33 per cent and 100 per cent, respectively.
CONCLUSION: The necessity of frozen section biopsy in cases with benign fine-needle aspiration cytology may be low in parotid gland surgery.

PMID: 30789118 [PubMed - as supplied by publisher]

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Rhinological interventions for obstructive sleep apnoea - a systematic review and descriptive meta-analysis.

Related Articles

Rhinological interventions for obstructive sleep apnoea - a systematic review and descriptive meta-analysis.

J Laryngol Otol. 2019 Feb 21;:1-9

Authors: Sharma S, Wormald JCR, Fishman JM, Andrews P, Kotecha BT

Abstract
OBJECTIVES: Obstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.
METHODS: A systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.
RESULTS: Sixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.
CONCLUSION: Nasal surgery may have limited benefit for a subset of patients based on current evidence.

PMID: 30789116 [PubMed - as supplied by publisher]

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Prenatal diagnosis of arachnoid cysts: MRI features and neurodevelopmental outcome

Publication date: Available online 22 February 2019

Source: European Journal of Radiology

Author(s): Orr Yahal, Eldad Katorza, Elad Zvi, Michal Berkenstadt, Chen Hoffman, Reuven Achiron, Omer Bar-Yosef

Abstract

objective

Arachnoid cysts (AC) are congenital lesions comprising 1% of all intracranial mass lesions. The aim of this study was to characterize arachnoid cysts and their neurodevelopmental outcome and to compare it with the outcome of children without AC.

Methods

This is a retrospective cohort study of arachnoid cysts detected prenatally by fetal MRI in 29 fetuses compared to a control group of 59 fetuses without arachnoid cyst who were examined by MRI. The cohort was investigated from two different angles: anatomical and developmental. Anatomical analyzation, the cohort was divided into 2 groups by the arachnoid cyst anatomical location: group A (n = 9), which included cases with supratentorial cyst, and group B (n = 20), which included cases with infratentorial cyst. Developmental analyzation, the cohort was divided into 2 groups by the neurodevelopmental outcome: group γ (n = 5) which included cases that were affected by arachnoid cyst presence, and group δ (n = 17) which included cases that had neurodevelopmental outcome within the normal range.

Data collected included prenatal history, MRI features, sonographic follow up, and neurodevelopmental outcome.

Results

In 22/29 cases we achieved a long-term follow up, by evaluation of children development in a range of ages from 6 months to 6 years. In group A (n = 9), 4 infants had normal outcome, 2 had abnormal outcome, 1 pregnancy was terminated, and 2 cases were not cooperative with the study. In group B (n = 20), 13 infants had normal outcome, 3 had abnormal outcome, and 4 cases were not cooperative with the study.

Conclusions

From all cases with AC detected by fetal MRI, 77.3% had normal neurodevelopmental outcome and 22.7% had abnormal neurodevelopment.

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Prenatal diagnosis of arachnoid cysts: MRI features and neurodevelopmental outcome

Publication date: Available online 22 February 2019

Source: European Journal of Radiology

Author(s): Orr Yahal, Eldad Katorza, Elad Zvi, Michal Berkenstadt, Chen Hoffman, Reuven Achiron, Omer Bar-Yosef

Abstract

objective

Arachnoid cysts (AC) are congenital lesions comprising 1% of all intracranial mass lesions. The aim of this study was to characterize arachnoid cysts and their neurodevelopmental outcome and to compare it with the outcome of children without AC.

Methods

This is a retrospective cohort study of arachnoid cysts detected prenatally by fetal MRI in 29 fetuses compared to a control group of 59 fetuses without arachnoid cyst who were examined by MRI. The cohort was investigated from two different angles: anatomical and developmental. Anatomical analyzation, the cohort was divided into 2 groups by the arachnoid cyst anatomical location: group A (n = 9), which included cases with supratentorial cyst, and group B (n = 20), which included cases with infratentorial cyst. Developmental analyzation, the cohort was divided into 2 groups by the neurodevelopmental outcome: group γ (n = 5) which included cases that were affected by arachnoid cyst presence, and group δ (n = 17) which included cases that had neurodevelopmental outcome within the normal range.

Data collected included prenatal history, MRI features, sonographic follow up, and neurodevelopmental outcome.

Results

In 22/29 cases we achieved a long-term follow up, by evaluation of children development in a range of ages from 6 months to 6 years. In group A (n = 9), 4 infants had normal outcome, 2 had abnormal outcome, 1 pregnancy was terminated, and 2 cases were not cooperative with the study. In group B (n = 20), 13 infants had normal outcome, 3 had abnormal outcome, and 4 cases were not cooperative with the study.

Conclusions

From all cases with AC detected by fetal MRI, 77.3% had normal neurodevelopmental outcome and 22.7% had abnormal neurodevelopment.

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Most Patients Do Not Disclose Complementary Medicine Use

Lack of inquiry from providers, fear of disapproval, belief CM is safe among reasons for nondisclosure (Source: The Doctors Lounge - Psychiatry)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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National Health Spending Set to Increase 5.5 Percent Annually

Long - observed demographic and economic factors expected to drive growth in health spending (Source: The Doctors Lounge - Psychiatry)

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Equivocal Results for Peanut Allergy Skin Patch

(Source: eMedicineHealth.com)

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Most Patients Do Not Disclose Complementary Medicine Use

Lack of inquiry from providers, fear of disapproval, belief CM is safe among reasons for nondisclosure (Source: The Doctors Lounge - Psychiatry)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Equivocal Results for Peanut Allergy Skin Patch

(Source: eMedicineHealth.com)

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National Health Spending Set to Increase 5.5 Percent Annually

Long - observed demographic and economic factors expected to drive growth in health spending (Source: The Doctors Lounge - Psychiatry)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2GGqk04

Equivocal Results for Peanut Allergy Skin Patch

(Source: eMedicineHealth.com)

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Most Patients Do Not Disclose Complementary Medicine Use

Lack of inquiry from providers, fear of disapproval, belief CM is safe among reasons for nondisclosure (Source: The Doctors Lounge - Psychiatry)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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National Health Spending Set to Increase 5.5 Percent Annually

Long - observed demographic and economic factors expected to drive growth in health spending (Source: The Doctors Lounge - Psychiatry)

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Equivocal Results for Peanut Allergy Skin Patch

(Source: eMedicineHealth.com)

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Characteristics of special circulations

Publication date: Available online 22 February 2019

Source: Anaesthesia & Intensive Care Medicine

Author(s): Marina Sawdon

Abstract

Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by both extrinsic and intrinsic mechanisms; sympathetic vasoconstriction of the afferent arterioles reduces renal blood flow in response to a decrease in effective circulating volume, myogenic mechanisms and tubuloglomerular feedback, as well as the release of vasoactive metabolites from the vascular endothelium regulate renal blood flow intrinsically. Hepatic blood flow is delivered via the portal vein and hepatic artery, and the amount of flow varies in these vessels reciprocally to maintain constant total blood flow. The pulmonary circulation receives the entire cardiac output, and blood flow is regulated both passively and actively. Pulmonary vessels are highly distensible and can accommodate increases in blood flow without significant increases in pressure.

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Iron metabolism

Publication date: Available online 22 February 2019

Source: Anaesthesia & Intensive Care Medicine

Author(s): Deirdre Conway, Mark A. Henderson

Abstract

Iron is a key micronutrient and has a vital role in oxygen transport through its presence in haemoglobin and a key part in oxidative phosphorylation via electron transfer in cytochromes. Total body iron is approximately 4000 mg in a 70 kg man. This goes through a continual cycle of conservation and re-utilization. Syndromes of iron deficiency and overload arise from aberrancy within the steps of iron metabolism.

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Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Abstract

Background

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.

Methods

We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.

Results

There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.

Conclusions

Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.

Level of Evidence: Level IV, therapeutic study

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Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

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Flexor pulley reconstruction using a transverse carpal ligament: a case report

Abstract

Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

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Thromboprophylaxis in breast microvascular reconstruction: a review of the literature

Abstract

Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: "venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin." Results were combined with the terms "breast microsurgery" and "breast free flap." All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

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Anatomical position of umbilicus in Latin-American patients

Abstract

Background

The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being.

Methods

The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization.

Results

In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1.

Conclusions

Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values.

Level of Evidence: Level III, risk / prognostic study.

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Characteristics of special circulations

Publication date: Available online 22 February 2019

Source: Anaesthesia & Intensive Care Medicine

Author(s): Marina Sawdon

Abstract

Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by both extrinsic and intrinsic mechanisms; sympathetic vasoconstriction of the afferent arterioles reduces renal blood flow in response to a decrease in effective circulating volume, myogenic mechanisms and tubuloglomerular feedback, as well as the release of vasoactive metabolites from the vascular endothelium regulate renal blood flow intrinsically. Hepatic blood flow is delivered via the portal vein and hepatic artery, and the amount of flow varies in these vessels reciprocally to maintain constant total blood flow. The pulmonary circulation receives the entire cardiac output, and blood flow is regulated both passively and actively. Pulmonary vessels are highly distensible and can accommodate increases in blood flow without significant increases in pressure.

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Iron metabolism

Publication date: Available online 22 February 2019

Source: Anaesthesia & Intensive Care Medicine

Author(s): Deirdre Conway, Mark A. Henderson

Abstract

Iron is a key micronutrient and has a vital role in oxygen transport through its presence in haemoglobin and a key part in oxidative phosphorylation via electron transfer in cytochromes. Total body iron is approximately 4000 mg in a 70 kg man. This goes through a continual cycle of conservation and re-utilization. Syndromes of iron deficiency and overload arise from aberrancy within the steps of iron metabolism.

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Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum

Abstract

Background

Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.

Methods

We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.

Results

There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.

Conclusions

Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.

Level of Evidence: Level IV, therapeutic study

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Reamputation in a cohort of critical limb ischemia patients surviving 2 years after minor amputation

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Flexor pulley reconstruction using a transverse carpal ligament: a case report

Abstract

Although various techniques exist for pulley reconstruction, none are useful for all patients. We performed flexor pulley reconstruction using a transverse carpal ligament which has the advantages of a useful gliding surface, sufficient width and thickness, anatomical similarity to the pulley, and adequate durability. Cosmetically, all the surgical scars are on the volar side while functionally, we can avoid invasion to both the flexion and extension sides.

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Thromboprophylaxis in breast microvascular reconstruction: a review of the literature

Abstract

Microsurgical breast reconstruction patients are at an increased risk for venous thromboembolism (VTE) due to numerous risk factors. A meta-analysis focusing on anti-thrombotics in breast microsurgery has yet to be completed. We aimed to perform a systematic review of the literature to examine the effects of thromboprophylaxis in breast microsurgical reconstruction with a focus on patient and flap complications. A PubMed, Cochrane, and Medline database search was conducted with the following keywords: "venous thrombosis, thromboprophylaxis, mechanical, pneumatic compression, aspirin, heparin, dextran, ketorolac, toradol, warfarin, and coumadin." Results were combined with the terms "breast microsurgery" and "breast free flap." All articles that resulted were analyzed. The reference list for each included article was analyzed for other applicable articles. Only articles that addressed pre-operative or post-operative anti-coagulation were included. For data analysis, if the article reported that there were no flap complications, it was assumed there were no operative hematomas, vessel thrombosis, or flap loss. Two hundred and fifty-seven studies were screened from the abovementioned search results and 17 fit inclusion criteria. The majority of included studies were retrospective chart reviews and the type of thromboprophylaxis and its effect on complications was rarely the primary end point. Due to lack of reporting on patient and flap characteristics that could impact outcomes, subgroup analysis was impossible. There has yet to be a consensus on the most effective way to prevent VTE in women undergoing microsurgical breast reconstruction without increasing the risk of hematoma and flap compromise. Studies published to date vary in their thromboprophylatic regimens and rarely include a control or comparison group to allow for intra- or inter-group analysis. There is a need for well-done, randomized, controlled trials in order to determine the best approach to thromboprophylaxis in these patients.

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Anatomical position of umbilicus in Latin-American patients

Abstract

Background

The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5–3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key—its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological well-being.

Methods

The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization.

Results

In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1.

Conclusions

Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values.

Level of Evidence: Level III, risk / prognostic study.

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Add‐on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial

Objectives

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add‐on probiotics on symptoms and QoL of patients.

Methods

In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8‐week washout. The primary outcome was the change of the Short Form 36‐Item Health Survey (SF‐36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test‐22 (SNOT‐22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires.

Results

A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF‐36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF‐36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT‐22 and CARAT.

Conclusion

This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended.

Level of Evidence

1b. Laryngoscope, 2019

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3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

Objectives/Hypothesis

To report the clinical safety and efficacy of three‐dimensional (3D)–printed, patient‐specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia.

Study Design

Case series.

Methods

From 2012 to 2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was 8 months (range, 3–25 months). Nine children were female. Five subjects had a history of extracorporeal membrane oxygenation (ECMO), and 11 required continuous sedation, six of whom required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end‐expiratory pressure (PEEP) of 14 cm H₂O (range, 6–20 cm H₂0). Outcomes collected included level of respiratory support, disposition, and splint‐related complications.

Results

At the time of discharge from our institution, at a median of 28 days postimplantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge–baseline) of −2.5 cm H₂O (range, −15 to 2 cm H₂O, P = .022). At median follow‐up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent preoperatively, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent.

Conclusions

This case series demonstrates the initial clinical efficacy of the 3D‐printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

Level of Evidence

4 Laryngoscope, 2019

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3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

Objectives/Hypothesis

To report the clinical safety and efficacy of three‐dimensional (3D)–printed, patient‐specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia.

Study Design

Case series.

Methods

From 2012 to 2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was 8 months (range, 3–25 months). Nine children were female. Five subjects had a history of extracorporeal membrane oxygenation (ECMO), and 11 required continuous sedation, six of whom required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end‐expiratory pressure (PEEP) of 14 cm H₂O (range, 6–20 cm H₂0). Outcomes collected included level of respiratory support, disposition, and splint‐related complications.

Results

At the time of discharge from our institution, at a median of 28 days postimplantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge–baseline) of −2.5 cm H₂O (range, −15 to 2 cm H₂O, P = .022). At median follow‐up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent preoperatively, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent.

Conclusions

This case series demonstrates the initial clinical efficacy of the 3D‐printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

Level of Evidence

4 Laryngoscope, 2019

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Correction to: Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

The authors wish to clarify that Dina M. Badwai refers to Dina M. Badawi. The authors apologise for this error.

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Correction to: Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

The authors wish to clarify that Dina M. Badwai refers to Dina M. Badawi. The authors apologise for this error.

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Food allergies: A research update

(Children's National Health System) Families impacted by food allergies will need psychosocial support as they try promising new therapies that enable them to ingest a food allergen daily or wear a patch that administers a controlled dose of that food allergen. (Source: EurekAlert! - Social and Behavioral Science)

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Food allergies: A research update

(Children's National Health System) Families impacted by food allergies will need psychosocial support as they try promising new therapies that enable them to ingest a food allergen daily or wear a patch that administers a controlled dose of that food allergen. (Source: EurekAlert! - Social and Behavioral Science)

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Food allergies: A research update

(Children's National Health System) Families impacted by food allergies will need psychosocial support as they try promising new therapies that enable them to ingest a food allergen daily or wear a patch that administers a controlled dose of that food allergen. (Source: EurekAlert! - Social and Behavioral Science)

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Food allergies: A research update

(Children's National Health System) Families impacted by food allergies will need psychosocial support as they try promising new therapies that enable them to ingest a food allergen daily or wear a patch that administers a controlled dose of that food allergen. (Source: EurekAlert! - Social and Behavioral Science)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Eq7mbs

Correction to: Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

The authors wish to clarify that Dina M. Badwai refers to Dina M. Badawi. The authors apologise for this error.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2T0KcBG

Correction to: Optimization of the dermal wrap in inferior pedicle reduction mammoplasty: An Egyptian experience

The authors wish to clarify that Dina M. Badwai refers to Dina M. Badawi. The authors apologise for this error.

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Vocal Fold Paralysis/Paresis as a Marker for Poor Swallowing Outcomes After Thoracic Surgery Procedures

Abstract

(1) To examine the association between vocal fold paresis/paralysis (VFP) and poor swallowing outcomes in a thoracic surgery cohort at the population level, and (2) to assess utilization of ENT/speech-language pathology intervention in these cases. The National Inpatient Sample (NIS) represents a 20% stratified sample of discharges from US hospitals. Using ICD-9 codes, discharges undergoing general thoracic surgical procedures between 2008 and 2013 were identified in the NIS. Sub-cohorts of discharges with VFP and those who utilized ENT/SLP services were also identified. Weighted logistic regression models were used to compare binary outcomes such as dysphagia, aspiration pneumonia, and other complications; generalized linear models with generalized estimating equations (GEE) were used to compare total hospital costs and length of stay (LOS). We identified a weighted estimate of 673,940 discharges following general thoracic surgery procedures. The weighted frequency of VFP was 3738 (0.55%). Compared to those without VFP, patients who discharged with VFP had increased odds of dysphagia (6.56, 95% CI 5.07–8.47), aspiration pneumonia (2.54, 95% CI 1.74–3.70), post-operative tracheotomy (3.10, 95% CI 2.16–4.45), and gastrostomy tube requirement (2.46, 95% CI 1.66–3.64). Discharges with VFP also had a longer length of stay and total hospital costs. Of the discharges with VFP, 15.7% received ENT/SLP intervention. VFP after general thoracic procedures is associated with negative swallowing-related health outcomes and higher costs. Despite these negative impacts, most patients with VFP do not receive ENT/SLP intervention, identifying a potential opportunity for improving adverse swallowing-related outcomes.

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Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome—part III

Abstract

Background

The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments.

Methods and results

The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet.

Conclusion

The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

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Vocal Fold Paralysis/Paresis as a Marker for Poor Swallowing Outcomes After Thoracic Surgery Procedures

Abstract

(1) To examine the association between vocal fold paresis/paralysis (VFP) and poor swallowing outcomes in a thoracic surgery cohort at the population level, and (2) to assess utilization of ENT/speech-language pathology intervention in these cases. The National Inpatient Sample (NIS) represents a 20% stratified sample of discharges from US hospitals. Using ICD-9 codes, discharges undergoing general thoracic surgical procedures between 2008 and 2013 were identified in the NIS. Sub-cohorts of discharges with VFP and those who utilized ENT/SLP services were also identified. Weighted logistic regression models were used to compare binary outcomes such as dysphagia, aspiration pneumonia, and other complications; generalized linear models with generalized estimating equations (GEE) were used to compare total hospital costs and length of stay (LOS). We identified a weighted estimate of 673,940 discharges following general thoracic surgery procedures. The weighted frequency of VFP was 3738 (0.55%). Compared to those without VFP, patients who discharged with VFP had increased odds of dysphagia (6.56, 95% CI 5.07–8.47), aspiration pneumonia (2.54, 95% CI 1.74–3.70), post-operative tracheotomy (3.10, 95% CI 2.16–4.45), and gastrostomy tube requirement (2.46, 95% CI 1.66–3.64). Discharges with VFP also had a longer length of stay and total hospital costs. Of the discharges with VFP, 15.7% received ENT/SLP intervention. VFP after general thoracic procedures is associated with negative swallowing-related health outcomes and higher costs. Despite these negative impacts, most patients with VFP do not receive ENT/SLP intervention, identifying a potential opportunity for improving adverse swallowing-related outcomes.

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Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome—part III

Abstract

Background

The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments.

Methods and results

The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet.

Conclusion

The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

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Risk factors associated with long-term outcomes after active and supporting periodontal treatments: impact of various compliance definitions on tooth loss

Abstract

Objectives

The aim of this retrospective study was to determine factors influencing tooth loss during a long-term follow-up, emphasizing the impact of various compliance definitions.

Materials and methods

Patients with periodontitis who were treated and presenting for maintenance care for at least up to 6 years were included. The effects of compliance and other patient- and treatment-related factors on tooth loss were assessed. Lack of compliance was defined in three ways: (1) fewer than 1.4 visits per year (irregular compliers), (2) no maintenance visit over a 2-year period (erratic compliers), and (3) no maintenance visit over a 2- to 5-year period (partial compliers) and no maintenance visit for a period of more than 5 years (non-compliers).

Results

One hundred and one patients were selected. The mean follow-up was 9.72 ± 1.17 years. Tooth loss per patient-year was significantly higher in erratic compliers (0.35 ± 0.19) and non-compliers (0.40 ± 0.20) compared with compliers (0.18 ± 0.10). No significant differences were found for irregular (0.30 ± 0.17) and partial (0.25 ± 0.15) compliers. Similar results were obtained for the number of patients who lost more than three teeth. Multivariable regression analysis showed that lack of compliance and periodontitis severity (more than 3% of periodontal pockets > 7 mm at baseline) were independent risk factors for tooth loss.

Conclusions

During long-term follow-up, non-compliance and initial periodontitis severity were the principal risk factors that increased tooth loss.

Clinical relevance

Tooth loss associated with lack of compliance was essentially observed in patients with long continuous periods without maintenance visits and was less influenced by patients' attended mean visit frequency.

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Risk factors associated with long-term outcomes after active and supporting periodontal treatments: impact of various compliance definitions on tooth loss

Abstract

Objectives

The aim of this retrospective study was to determine factors influencing tooth loss during a long-term follow-up, emphasizing the impact of various compliance definitions.

Materials and methods

Patients with periodontitis who were treated and presenting for maintenance care for at least up to 6 years were included. The effects of compliance and other patient- and treatment-related factors on tooth loss were assessed. Lack of compliance was defined in three ways: (1) fewer than 1.4 visits per year (irregular compliers), (2) no maintenance visit over a 2-year period (erratic compliers), and (3) no maintenance visit over a 2- to 5-year period (partial compliers) and no maintenance visit for a period of more than 5 years (non-compliers).

Results

One hundred and one patients were selected. The mean follow-up was 9.72 ± 1.17 years. Tooth loss per patient-year was significantly higher in erratic compliers (0.35 ± 0.19) and non-compliers (0.40 ± 0.20) compared with compliers (0.18 ± 0.10). No significant differences were found for irregular (0.30 ± 0.17) and partial (0.25 ± 0.15) compliers. Similar results were obtained for the number of patients who lost more than three teeth. Multivariable regression analysis showed that lack of compliance and periodontitis severity (more than 3% of periodontal pockets > 7 mm at baseline) were independent risk factors for tooth loss.

Conclusions

During long-term follow-up, non-compliance and initial periodontitis severity were the principal risk factors that increased tooth loss.

Clinical relevance

Tooth loss associated with lack of compliance was essentially observed in patients with long continuous periods without maintenance visits and was less influenced by patients' attended mean visit frequency.

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Unanticipated prognosis for a patient with type 2 Usher syndrome

ConclusionsThe patient demonstrated that the absence of visual symptoms and favorable findings on functional testing on initial presentation might yet belie a future for austere visual loss. Caution is thus warranted when predicting a visual prognosis in such a patient. Further, the value in electroretinographic testing for diagnosis is demonstrated. (Source: Documenta Ophthalmologica)

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Unanticipated prognosis for a patient with type 2 Usher syndrome

ConclusionsThe patient demonstrated that the absence of visual symptoms and favorable findings on functional testing on initial presentation might yet belie a future for austere visual loss. Caution is thus warranted when predicting a visual prognosis in such a patient. Further, the value in electroretinographic testing for diagnosis is demonstrated. (Source: Documenta Ophthalmologica)

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Acute cerebral infarction in a patient with an epidural catheter after left upper lobectomy: a case report

Abstract

Background

There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobectomy, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period.

Case presentation

A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 h after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility.

Conclusions

We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.

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