TERT, HRAS, and EIF1AX Mutations in a Patient with Follicular Adenoma

Thyroid, Ahead of Print.


https://ift.tt/2GvAHyU

Innate effector cells in angiogenesis and lymphangiogenesis

Gilda Varricchi | Stefania Loffredo | Maria Rosaria Galdiero | Giancarlo Marone | Leonardo Cristinziano | Francescopaolo Granata | Gianni Marone

https://ift.tt/2LcRJ8E

Strategies for a multi-stage neutralizing antibody-based HIV vaccine

Raiees Andrabi | Jinal N Bhiman | Dennis R Burton

https://ift.tt/2KC8Rnr

Lymphatics in the liver

Masatake Tanaka | Yasuko Iwakiri

https://ift.tt/2KATdIH

Basal Cell Carcinoma, PART II: Contemporary Approaches to Diagnosis, Treatment, and Prevention

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education article will provide a comprehensive and contemporary review of basal cell carcinoma. Part II of this series will present both standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.

https://ift.tt/2wU5Mgj

Basal Cell Carcinoma: Part 1

As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education article will provide a comprehensive and contemporary review of basal cell carcinoma. Part I of this series will describe our current understanding of this disease in regards to epidemiology, cost, clinical and histopathologic presentations, carcinogenesis, natural history, and disease associations.

https://ift.tt/2rRpkgj

Ability of blue laser imaging with magnifying endoscopy for the diagnosis of gastric intestinal metaplasia

Abstract

We aimed to determine the utility of blue laser imaging (BLI) with magnifying endoscopy (BLI-ME) for the prediction and diagnosis of gastric intestinal metaplasia (GIM). Participants, aged between 40 and 75 years, undergoing gastroscopy from January to April 2017 were included in this study. The ability of BLI-ME and white light endoscopy (WLE) to detect GIM was assessed by comparing the endoscopic findings with the histological findings. The correlation between the grades of light blue crest (LBC) appearance and histology grade of GIM was calculated. We included 100 participants in this study. GIM was diagnosed in 27 participants; 20 participants were detected by both BLI and WLE, four by BLI only, and three exclusively by random biopsies. The values of sensitivity, specificity, positive predictive values, and negative predictive values for detecting GIM were 34.9, 38.9, 25.4, and 57.1%, respectively, for WLE and 88.9, 96.7, 94.1, and 93.3%, respectively, for BLI-ME. The diagnostic accuracy for GIM was 43% for WLE and 94.0% for BLI-ME. A good correlation between the grades of LBC and the grades of GIM on histology was observed (P < 0.01). BLI-ME achieved a good diagnostic efficiency for detection of GIM. LBC seen on BLI-ME is a typical indicator of GIM.

https://ift.tt/2rWx4Nc

Fracture probability assessed using FRAX® in elderly women with benign paroxysmal positional vertigo

Patients with benign paroxysmal positional vertigo (BPPV) can have vitamin D deficiency, which is a cause of abnormal bone turnover. Several studies have established a relationship between osteoporosis and BPPV. The World Health Organization Fracture Risk Assessment Tool, widely known as FRAX® (https://ift.tt/1pISdme), is a computer-based algorithm for assessing fracture risk. No direct comparison has been made between the FRAX scores of patients with BPPV and controls. The purpose of this study was to determine whether women with BPPV are at high risk of fracture as assessed using FRAX.

https://ift.tt/2kcHdlP

Rates and causes of 30-day readmission and emergency room utilization following head and neck surgery

Unplanned returns to hospital are common, costly, and potentially avoidable. We aimed to investigate and characterize reasons for all-cause readmissions to hospital as in-patients (IPs) and visits to the Emerg...

https://ift.tt/2rUYRP5

Three-dimensional stability analysis of maxillomandibular advancement surgery with and without articular disc repositioning

This retrospective cohort study aimed to assess, three-dimensionally, mandible and maxilla changes following maxillomandibular advancement (MMA), with and without repositioning of TMJ articular discs. The sample comprised cone-beam computed tomography data from 32 subjects: group 1 (n = 12) without disc displacement and group 2 (n = 20) with bilateral disc repositioning. An automatic cranial base superimposition method was used to register the images at three time points: T1 (preoperative), T2 (postoperative), and T3 (at least 11 months follow-up).

https://ift.tt/2Iw57mx

Modified maxillary vestibular approach with subperiostal intranasal dissection for surgical extractions of mesiodentes impacted in the floor of the nasal cavity

Impacted mesiodentes in the inverted position may interfere with the base of the nasal cavity or the nasal septum. They can rarely erupt into the nose as well. Traditionally they are extracted via intraoral approaches (transpalatal or vestibular). Also, an endoscopically assisted transnasal approach can be used. In this paper, the authors are the first to present a group of patients suffering from impacted mesiodentes who have been surgically treated using a modified maxillary vestibular approach with subperiostal intranasal dissection.

https://ift.tt/2IQWZ3y

Open treatment of condylar fractures via extraoral approaches: a review of complications

Anatomical reduction and adequate fixation rely on good surgical exposure of the fracture site (Dunaway and Trott, 1996). Thus, the ideal approach should allow enough exposure to reduce the fracture and position the hardware, but also have the lowest rate of surgical complications, be the least invasive, result in the least conspicuous postoperative scarring, and be performed easily and rapidly (Biglioli and Colletti, 2009; Benech et al., 2011; Rao et al., 2014). (see Figs. 1 and 2)

https://ift.tt/2Iw536h

The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint

Various causes for bone defects of the lower jaw have been described. As a result, patients often suffer from compromised aesthetics and a loss of, or reduction in, important physiological functions, such as swallowing, breathing, and speaking. A change in the shape of the lower jaw can impair the natural occlusion and leads to an atypical or modified position of the temporomandibular joint. Titanium reconstruction plates are the standard approach to jaw reconstruction, and are used for temporary bridging of a jaw defect or fixation of a bone graft.

https://ift.tt/2ITQ6yy

Cochleostomy and facial recess packing alter cochlear implant electrode location in a human cochlea model

Determine the effect of cochleostomy and facial recess packing on cochlear implant electrode distance from the modiolus.

https://ift.tt/2KEbsgG

Finding the Whey to Improve Surgical Outcomes: Perioperative Nutrition Screening and Intervention

No abstract available

https://ift.tt/2wVpQ1O

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

https://ift.tt/2Iu8kau

No Guts, No Recovery: A Rational Approach to Postoperative Gastrointestinal Dysfunction

No abstract available

https://ift.tt/2IsqQA6

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

https://ift.tt/2wRbbVB

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

https://ift.tt/2Kzq7cS

New approach to the reconstruction of defects deep in the orbital roof

The orbital roof is composed predominantly of thin bone. While many fractures do not require surgical repair, mobile fragments can result in the transmission of cerebral pulsations into the orbit that symptomatically affect the globe.1 Mild symptoms usually settle spontaneously,2 but in symptomatic or severely displaced cases, repair may be indicated.3 Bone grafts, titanium mesh, and other alloplastic materials may be used for reconstruction,4 but we prefer to use the patient's original or autogenous bone, as it allows for a degree of remodelling.

https://ift.tt/2GwLid4

Laser-speckle imaging to measure tissue perfusion in free flaps in oral and maxillofacial surgery: a potentially exciting and easy to use monitoring method

Free flaps are often used in the reconstruction of defects in the head and neck. For survival of the flap in the early phase of healing, the maintenance of good tissue perfusion and the prompt recognition of any vascular compromise are essential before irreversible changes occur. Advanced methods for flap monitoring are known to be more effective than clinical assessment alone.1 Techniques include Doppler and non-Doppler-based implantable devices, infrared imaging, and methods that use dyes such as indocyanine green or methylene blue.

https://ift.tt/2rTX8cI

Plasmacytoma

Publication date: Available online 18 May 2018
Source:Oral Oncology
Author(s): Shadaab Mumtaz




https://ift.tt/2rUjpXi

Osteoblastoma of the mandible: A rare locally aggressive benign tumour

Publication date: Available online 18 May 2018
Source:Oral Oncology
Author(s): Saad Khokhar, Shadaab Mumtaz, Steven Liggins




https://ift.tt/2k9ynoR

Intensity Discrimination and Speech Recognition of Cochlear Implant Users

Abstract

The relation between speech recognition and within-channel or across-channel (i.e., spectral tilt) intensity discrimination was measured in nine CI users (11 ears). Within-channel intensity difference limens (IDLs) were measured at four electrode locations across the electrode array. Spectral tilt difference limens were measured with (XIDL-J) and without (XIDL) level jitter. Only three subjects could perform the XIDL-J task with the amount of jitter required to limit use of within-channel cues. XIDLs (normalized to %DR) were correlated with speech recognition (r = 0.67, P = 0.019) and were highly correlated with IDLs. XIDLs were on average nearly 3 times larger than IDLs and did not vary consistently with the spatial separation of the two component electrodes. The overall pattern of results was consistent with a common underlying subject-dependent limitation in the two difference limen tasks, hypothesized to be perceptual variance (how the perception of a sound differs on different presentations), which may also underlie the correlation of XIDLs with speech recognition. Evidence that spectral tilt discrimination is more important for speech recognition than within-channel intensity discrimination was not unequivocally shown in this study. However, the results tended to support this proposition, with XIDLs more correlated with speech performance than IDLs, and the ratio XIDL/IDL also being correlated with speech recognition. If supported by further research, the importance of perceptual variance as a limiting factor in speech understanding for CI users has important implications for efforts to improve outcomes for those with poor speech recognition.

https://ift.tt/2wVnHTO

Intensity Discrimination and Speech Recognition of Cochlear Implant Users

Abstract

The relation between speech recognition and within-channel or across-channel (i.e., spectral tilt) intensity discrimination was measured in nine CI users (11 ears). Within-channel intensity difference limens (IDLs) were measured at four electrode locations across the electrode array. Spectral tilt difference limens were measured with (XIDL-J) and without (XIDL) level jitter. Only three subjects could perform the XIDL-J task with the amount of jitter required to limit use of within-channel cues. XIDLs (normalized to %DR) were correlated with speech recognition (r = 0.67, P = 0.019) and were highly correlated with IDLs. XIDLs were on average nearly 3 times larger than IDLs and did not vary consistently with the spatial separation of the two component electrodes. The overall pattern of results was consistent with a common underlying subject-dependent limitation in the two difference limen tasks, hypothesized to be perceptual variance (how the perception of a sound differs on different presentations), which may also underlie the correlation of XIDLs with speech recognition. Evidence that spectral tilt discrimination is more important for speech recognition than within-channel intensity discrimination was not unequivocally shown in this study. However, the results tended to support this proposition, with XIDLs more correlated with speech performance than IDLs, and the ratio XIDL/IDL also being correlated with speech recognition. If supported by further research, the importance of perceptual variance as a limiting factor in speech understanding for CI users has important implications for efforts to improve outcomes for those with poor speech recognition.

https://ift.tt/2wVnHTO

Long-term familial Mediterranean fever remission on successful hepatitis C virus treatment in a patient not responding to colchicine: a case report

Familial Mediterranean fever is an autosomal recessive disorder characterized by periodic febrile attacks of aseptic serositis and/or arthritis. The main treatment is colchicine which prevents attacks in the m...

https://ift.tt/2Gw3lQt

Standardization of the Classification of Impaired Postoperative Gastric Function Within the Enhanced Recovery Pathways

No abstract available

https://ift.tt/2ITp5LE

In Response

No abstract available

https://ift.tt/2rQRo3l

Activation of Melatonin Receptors by Ramelteon Induces Cardioprotection by Postconditioning in the Rat Heart

Activation of melatonin receptors protects the heart against ischemia-reperfusion injury. Ramelteon, a clinically used drug for insomnia, acts via activation of melatonin receptors. We investigated whether ramelteon induces acute infarct size reduction by postconditioning. Male Wistar rats were randomized to 6 groups. Hearts were treated with melatonin and ramelteon at the beginning of reperfusion. The melatonin receptor inhibitor luzindole was administered with and without melatonin and ramelteon, respectively. Ramelteon reduced infarct size to the same extent as melatonin. Both effects were completely abolished by luzindole. The results show for the first time that ramelteon induces cardioprotection by postconditioning.

https://ift.tt/2GuF39Q

Finding the Whey to Improve Surgical Outcomes: Perioperative Nutrition Screening and Intervention

No abstract available

https://ift.tt/2wVpQ1O

World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

https://ift.tt/2rT1sJf

Enhanced Recovery After Surgery: Is It Time to Drive Patient-Reported Outcomes Through Robust Measurement?

No abstract available

https://ift.tt/2Iu8oqK

Textbook of Rapid Response Systems: Concept and Implementation, 2nd ed

No abstract available

https://ift.tt/2GuhEFz

Perioperative Nutrition: A High-Impact, Low-Risk, Low-Cost Intervention

No abstract available

https://ift.tt/2KDIai9

No Guts, No Recovery: A Rational Approach to Postoperative Gastrointestinal Dysfunction

No abstract available

https://ift.tt/2IsqQA6

Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database

BACKGROUND: Regional anesthesia is of benefit for outpatient surgery given its demonstrated improvement in analgesia and decrease in complications, resulting in shorter average recovery room times and lower hospital readmission rates. Unfortunately, there are few epidemiological studies outlining the overall utilization of peripheral nerve blocks (PNBs) in this setting. Therefore, the primary objective of this study was to report the overall utilization of several types of PNBs among all candidate cases in the outpatient setting within the United States. METHODS: We identified all cases from the National Anesthesia Clinical Outcomes Registry that were performed as an outpatient surgery. We reported the frequency of various types of PNBs among all candidate cases, defined as cases that potentially could have received a PNB. Changes in prevalence of PNB utilization from 2010 to 2015 were analyzed by using logistic regression. RESULTS: Of the 12,911,056 outpatient surgeries in the National Anesthesia Clinical Outcomes Registry, 3,297,372 (25.5%) were amenable to a PNB. However, the overall PNB frequency was only 3.3% of the possible cases. The overall utilization for PNB of the brachial plexus, sciatic nerve, and femoral nerve were 6.1%, 1.5%, and 1.9%, respectively. The surgical procedures generating the highest volume of PNBs were shoulder arthroscopies and anterior cruciate ligament reconstruction, in which 41% and 32% received a PNB, respectively. During this time period, there was a significant increase in overall PNB utilization for both single-injection and continuous PNB (P

https://ift.tt/2rTdcve

Worldwide Standards of Practice for Anesthesia

No abstract available

https://ift.tt/2KykA6s

Is It Time to Reconsider the Concepts of “Universal Donor” and “ABO Compatible” Transfusions?

No abstract available

https://ift.tt/2Gxmguj

Old Ways Do Not Open New Doors: Norepinephrine for First-Line Treatment of Spinal Hypotension

No abstract available

https://ift.tt/2IN40m3

Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

https://ift.tt/2rSN83A

From Invention to Innovation: Bringing Perioperative Physiological Closed-Loop Systems to the Bedside

No abstract available

https://ift.tt/2wVpMPC

In Response

No abstract available

https://ift.tt/2Gu0bNt

By FAER Means or Foul: The Road to Advancement for the Academic Anesthesiologist

No abstract available

https://ift.tt/2IUcSXa

The Evolving Dilemma of Factor XI in Pregnancy: Suggestions for Management

A case of a patient with severe factor XI (FXI) deficiency who presented for her seventh labor and delivery is presented. The nature of FXI deficiency, its prevalence, and issues related to genetic screening are discussed. Published literature on the topic is reviewed, including criteria that were developed to assess bleeding, laboratory tools used to estimate bleeding risk, and available treatments. Within the context of this challenging clinical dilemma, specific recommendations are provided for the antepartum, intrapartum, and postpartum stages of pregnancy. These include recommendations that take into account both FXI levels and history of any abnormal bleeding. While there are effective treatments available, it is important to consider that institutional multidisciplinary protocols are needed to manage this complex disorder. More work is needed to define the best management protocols.

https://ift.tt/2IRiVvm

Myocardial Postconditioning by the Melatonin Receptor Agonist Ramelteon: Putting Pieces to the Puzzle

No abstract available

https://ift.tt/2wVpKHu

Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound

While standardized examinations and data from simulators and phantom models can assess knowledge and manual skills for ultrasound, an Objective Structured Clinical Examination (OSCE) could assess workflow understanding. We recruited 8 experts to develop an OSCE to assess workflow understanding in perioperative ultrasound. The experts used a binary grading system to score 19 graduating anesthesia residents at 6 stations. Overall average performance was 86.2%, and 3 stations had an acceptable internal reliability (Kuder–Richardson formula 20 coefficient >0.5). After refinement, this OSCE can be combined with standardized examinations and data from simulators and phantom models to assess proficiency in ultrasound.

https://ift.tt/2IyNxyt

Book Review—Diagnostic immunohistochemistry, 5th edition

https://ift.tt/2LbbT2V

Rates and causes of 30-day readmission and emergency room utilization following head and neck surgery

Abstract

Background

Unplanned returns to hospital are common, costly, and potentially avoidable. We aimed to investigate and characterize reasons for all-cause readmissions to hospital as in-patients (IPs) and visits to the Emergency Department (ED) within 30-days following patient discharge post head and neck surgery (HNS).

Methods

Retrospective case series with chart review. All patients within the Department of Otolaryngology – Head and Neck Surgery who underwent HNS for benign and malignant disease from January 1, 2010 to May 31, 2015 were identified. The electronic medical records of readmitted patients were reviewed for reasons of readmission, demographic data, and comorbidities.

Results

Following 1281 surgical cases, there were 41 (3.20%) IP readmissions and 109 (8.43%) ED visits within 30-days after discharge for HNS. For IP readmissions, most common causes included infection (26.8%), respiratory symptoms (17.1%), and pain (17.1%). Most common reasons for ED visits were for pain (31.5%), bleeding (17.6%), and infection (14.8%). Readmitted IPs had significantly higher health burden at pre-operative baseline as compared to patients who visited the ED when assessed with the American Society of Anesthesiology scores (p = 0.002) and the Cumulative Illness Rating Scale (p = 0.004).

Conclusion

Rate of 30-day IP readmission and ED utilization was 3.20 and 8.43%, respectively. Pain and infection were common causes for returns to hospital. Discharge planning may be improved to target common causes for post-surgical hospital visits in order to decrease readmission rates.

https://ift.tt/2rTLaPI

Do eyelashes grow back? What you need to know

Losing a few eyelashes from time to time is normal. However, sometimes a person loses many or all of their eyelashes, perhaps as a result of a burn, a medical therapy, or a health condition. In this article, learn how quickly the eyelashes grow back, as well as treatments and home remedies to help the process.

https://ift.tt/2rQV3y9

Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy

BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies. Correspondence to Steven Roth, MD, Department of Anesthesiology, University of Illinois, 835 South Wolcott, Room E714, Chicago, IL 60612, USA Tel: +1 312 996 0052; e-mail: rothgas@uic.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

https://ift.tt/2rMIF2n

Aortic intramural haematoma associated with pulmonary artery periadventitial haematoma

Description 

A 54-year-old man who has a medical history of untreated hypertension presented to the emergency department with sudden onset of back pain and sweat. His back pain suddenly started while he was washing the dishes. The pain was sharp, continuous and radiating to his chest. His vital signs were normal and physical examination revealed neither heart murmur nor pulse deficit. Laboratory test revealed elevated D-dimer level of 2.5 µg/mL (reference range <0.5 µg/mL), but normal troponin-T level. Electrocardiography was normal. Chest X-ray showed widened mediastinum.

Non-contrast enhanced and contrast-enhanced CT was obtained. Non-contrast enhanced CT showed crescentic high attenuation sign along the aortic wall from the ascending to the descending aorta (figure 1), whereas contrast-enhanced CT showed a hypoattenuating aortic wall, with no evidence of dissection (figure 2). The haematoma was extended along the aortopulmonary connective sheath (figure 3). The patient was transferred to...

https://ift.tt/2Iwe835

Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva

Description 

A 77-year-old woman with multiple risk factors for coronary artery disease, was referred for left heart catheterisation after abnormal dobutamine stress test, revealing anterior and anterolateral hypokineses. Coronary angiogram revealed a large, dominant right coronary artery (figure 1A), originating from the right coronary cusp along with underdeveloped anomalous left coronary system. Left main artery was absent. Left anterior descending artery (LAD) was originating from right coronary cusp posteriorly (figure 1B), while the left circumflex artery (LCx) from the same cusp anteriorly (figure 1C). Probably the small calibre of the LAD and LCx might be the cause of abnormal stress echo findings. No significant obstructive disease was noted and the patient was qualified for medical treatment. Subsequent CT of the heart confirmed the anomalous coronary anatomy (figure 2).

Figure 1

(A) LAO cranial view. Dominant large calibre right...

https://ift.tt/2wRjEYF

Rectal mucocele in the anterior wall of the rectum

An 84-year-old man presented in 2009 with a sensation of discomfort in his anus, combined with difficulty in urination. He had previously undergone a haemorrhoidectomy in 1964. After examination, he was diagnosed with a rectal mucosal cyst and followed up for observation. In 2015, he presented to our hospital complaining that the cyst was prolapsing from his anus. CT revealed a 48x41 mm cystic mass in the anterior wall of the rectum. Tumour extirpation, via a transanal route, was performed. The postoperative pathological diagnosis confirmed a rectal mucocele. Rectal mucoceles are extremely rare, with no prior report of a mucocele in the anterior wall of the rectum. In this case, we believe the mucocele developed from an invagination of the mucous membrane or obstruction of the anal gland during suturing during the previous haemorrhoid surgery.

https://ift.tt/2IOFZuO

An unusual case of chronic nasal foreign body

Description 

A 15-year-old boy was referred to the ear, nose and throat department with a 5-year history of left-sided nasal obstruction and purulent, foul-smelling nasal discharge. On flexible nasendscopy, mucopurulent discharge from the left middle meatus was noted and the nasendoscope could not be passed beyond this point. The right nasal passage was entirely normal.

A CT scan of the sinuses demonstrated a hyperdense, irregular mass measuring 2.5x2.5 cm in the left posterior nasal airway, projecting into the nasopharynx (figure 1). There was no history of foreign body insertion.

Figure 1

A coronal CT of the foreign body in the left nasal cavity.

Operative findings during examination under anaesthetic were of a large occlusive foreign body lodged in the posterior nasal cavity between the septum and inferior turbinate, eroding into the nasal septum (figure 2). There was distortion of the floor...

https://ift.tt/2wYCjSG

Unmasking of poorly controlled diabetes mellitus by pulmonary nocardiosis

Description 

A 60-year-old Indian woman, known case of hypertension with no other comorbidities, presented with productive cough since 20 days and high-grade fever since 5 days. She also had breathlessness since 10 days which was insidious in onset, was initially exertional and had progressed such that it was now present at rest. There was no history of tuberculosis. Her appetite had been significantly reduced since 20 days prior to presentation.

On examination, she was tachypnoeic with a respiratory rate of 30/min, tachycardic with a pulse rate of 140/min, febrile with a temperature of 101°F. Her blood pressure was normal. Oxygen saturation was 91% on room air. Coarse inspiratory crackles could be heard in bilateral infra-axillary and infrascapular areas and the right infraclavicular area.

Chest X-ray showed consolidation in bilateral lower and mid zones and a well-demarcated homogenous opacity in right upper zone (figure 1), suggestive of...

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Postpartum pneumomediastinum and subcutaneous emphysema

We present the case of a 22-year-old primigravida with symptoms of neck swelling and difficulty breathing 3 hours after uneventful vaginal delivery. On examination, there was surgical emphysema. A CT scan confirmed air in the subcutaneous tissues and also revealed pneumomediastinum. There was no evidence of pneumothorax and gastro-oesophageal endoscopy showed no signs of oesophageal rupture. The patient remained clinically stable throughout her admission and was discharged home after 48 hours of observation. Pneumomediastinum is one of the rare causes of shortness of breath and chest pain during the postpartum period, and it should be considered in the differential diagnosis. Despite the significant abnormalities seen on plain radiography and CT scan, this condition spontaneously resolves. Although postpartum pneumomediastinum has been related to prolonged labour, this was not the case in our patient.

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Bilateral lower limb ischaemia following acetabular reconstruction and arthroplasty

The incidence of acetabular fractures has increased markedly in patients over 60 in the last quarter of a century, with open reduction and internal fixation being regarded to be the treatment of choice in most patients with displaced acetabular fractures. Lower limb ischaemia following acetabular fixation or arthroplasty is rare. However, such complications can be limb or life threatening, and therefore, it is important to recognise them as early as possible. We present the case of a 70-year-old man with no significant medical history who underwent acetabular fixation with simultaneous arthroplasty complicated with bilateral lower limb ischaemia. We highlight the importance of having a high degree of suspicion which allows early diagnosis and corrective measures to be implemented which can ultimately lead to excellent outcome.

https://ift.tt/2IvUtjG

Giant left parietal lobe arachnoid cyst presenting as early-onset dementia

Description

A 56-year-old woman with no significant medical history was brought for evaluation of difficulty with speaking for 1 month. Family reported patient having short-term and long-term memory impairment and gradual cognitive decline over a course of 2 years. Her mother had Alzheimer's dementia in her 60s and the patient attributed her symptoms to Alzheimer's and did not seek medical attention until she developed word finding difficulty. On neurological examination, she had expressive aphasia and scored 20 on Mini-mental state examination (MMSE). Laboratory work-up showed normal haemogram, metabolic panel, thyroid function tests, vitamin B12 and folic acid levels and a negative rapid plasma reagin (RPR) test. MRI showed a giant left cerebral hemisphere arachnoid cyst with 11 mm midline shift to the right (figure 1). She underwent stereotactic craniotomy with microsurgical excision of the arachnoid cyst. Postoperative hospital course was complicated by generalised tonic–clonic seizure, controlled with antiepileptic...

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Outcomes of transanal endorectal pull-through for rectal atresia

Rectal atresia is a rare anorectal malformation, and it has been reported to represent 1%–2% of all anorectal malformations. We report three newborns who were admitted to the neonatal intensive care unit for abdominal distention, bilious vomiting and failure to pass meconium. The external anus and genitalia were normal and well formed. Digital rectal examination showed a blind-ending anal canal. All three infants were initially managed with diverting colostomy and then transanal resection of the rectal atresia with primary anastomosis, followed by colostomy closure. All patients eventually developed normal bowel habits and gained complete bowel control at 3–5 years of age, with mild constipation managed with laxatives. Contrast enema in a newborn with distal bowel obstruction is helpful to delineate the anatomy to show the gaps and to facilitate the procedure. In conclusion, transanal endorectal pull-through is a feasible and safe procedure with satisfactory clinical outcomes.

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Ocular manifestations of rickettsia in children: common but frequently overlooked

We review two cases of ocular manifestations of Rickettsia conorii infection in children. A girl who presented unilateral visual loss with focal retinitis and macular oedema and a boy with unilateral central scotoma and bilateral anterior uveitis. Progressive functional and anatomic recovery was observed after oral antibiotics and steroids were initiated.

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Mycophenolate mofetil-induced colitis in a patient with systemic sclerosis

We present the case of a 44-year-old woman affected by systemic sclerosis (SSc) who was admitted to our department for abdominal pain, nausea, vomiting and fever. Imaging studies showed the presence of a thickened colon wall involving the descending colon and the sigma, while a subsequent endoscopy revealed multiple serpiginous ulcers covered with fibrin and exudates. Under the hypothesis of drug-induced colitis, mycophenolate mofetil (MMF), which she was taking for SSc-related interstitial lung disease (ILD), was readily suspended, with a rapid recovery without further treatment. A follow-up colonoscopy showed the complete resolution of the ulcers. This is the first case of MMF-induced colitis in a patient being treated for SSc-ILD.

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Pelvic epidermoid cyst: A rare cause of lower urinary tract symptoms

Pelvic retroperitoneum is a bizarre location of an epidermoid cyst and obstructive voiding caused by it even being stranger. Voiding symptoms related to such an abnormal location of cyst are extremely rare and literature that taps into such cases is scarce. We are presenting here a case of 26-year-old man who was presented with obstructive lower urinary tract symptoms and chronic constipation. On evaluation, he was found to have well-defined cyst in pelvic retroperitoneum. Complete excision of the cyst was done; histopathology confirmed it as an epidermoid cyst. His symptoms were completely relieved over a 12-month follow-up.

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Primary cutaneous osteosarcoma of the scalp

Primary cutaneous extraskeletal osteosarcoma (PCEO) is a rare malignant neoplasm with less than 20 cases reported in the literature to date. Presenting as a nodule or mass on the skin, commonly at sites of previous trauma or radiation, these lesions are differentiated from other neoplasms through their characteristic microscopic appearance. This report highlights a case of PCEO in a 75-year-old man with a history of squamous cell carcinoma (SCC) of the scalp. Histological examination of a scalp nodule in the region of a previously excised SCC revealed proliferation of osteoid surrounded by malignant osteocytes. An overview of this condition and differential diagnoses are presented in this report.

https://ift.tt/2IrQVix

Ethambutol and isoniazid induced severe neurotoxicity in a patient undergoing continuous ambulatory peritoneal dialysis

Ethambutol (EMB) and isoniazid (INH) are the first-line antituberculosis (anti-TB) drugs. However, their neurotoxicity could cause adverse effect and the patients with end-stage renal disease are especially vulnerable due to the reduction in renal drug clearance. Here, we report a 36-year-old man receiving peritoneal dialysis developed progressive paralysis in lower extremities, vision loss and hoarseness 4 months after anti-TB treatment with INH, EMB and rifapentine because of concomitant pulmonary tuberculosis. A diagnosis of EMB/INH-induced peripheral neuropathy, retrobulbar neuritis and laryngoparalysis was made. The patient's neuropathy gradually improved 2 years after discontinuation of EMB/INH. Since EMB and INH may cause simultaneously severe and complex multineuropathy in dialysis patients, their adverse effects should be closely supervised in dialysis patients.

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Successful treatment of fulminant neonatal enteroviral myocarditis in monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir

Neonatal cardiogenic shock most commonly occurs due to critical congenital heart disease, sepsis, metabolic disorder or arrhythmias. In particular, enterovirus infections are common in the neonatal period, and patients can present with fulminant myocarditis. Early recognition is imperative due to its high morbidity and mortality without prompt and aggressive treatment. We present the successful treatment of fulminant neonatal enteroviral myocarditis in a pair of monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir, an enteroviral capsid inhibitor. The twins took an almost exact parallel hospital course, including day of extracorporeal membrane oxygenation (ECMO) cannulation, day of ECMO decannulation, improvement of cardiac function, discharge and status at follow-up. While it was difficult to assess the relative contribution of each intervention, our case shows promise in the use of pocapavir for treatment of severe enteroviral infections. Remarkably, both twins demonstrated remarkable recovery within 2 weeks, underscoring that early aggressive cardiopulmonary support, and potentially pocapavir, contributed to their recovery.

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Giant left atrium: look before you leap into invasive procedures

Description 

A 67-year-old woman with history of mechanical mitral valve replacement for severe rheumatic mitral stenosis and permanent atrial fibrillation on warfarin presented with worsening dyspnoea and bilateral lower extremity swelling over the past 3 weeks. Physical examination revealed hypoxaemia with an oxygen saturation of 85% on room air, jugular venous distension, absent breath sound at right middle and lower lung zones, a crisp prosthetic valve click with a grade 1/6 holosystolic murmur at the apex and 2+ lower extremity oedema. Laboratory showed a brain natriuretic peptide of 799 pg/mL and an international normalized ratio of 2.7. A venous blood gas revealed respiratory acidosis with PaCO₂ of 75 mm Hg. Chest X-ray (CXR) revealed cardiomegaly and complete opacification of right mid-to-lower lung zones (figure 1). Concerned for massive right-sided pleural effusion or right thoracic mass, a CT of the chest (figure 2) was performed, which showed massive left atrial...

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Coiling of ruptured, wide-necked basilar tip aneurysm using double Comaneci technique

In this report, we present a novel technique of successful coil embolisation using temporary deployment of two Comaneci devices placed in Y configuration across a wide-neck ruptured basilar tip aneurysm. The placement of two devices across the wide aneurysm neck allowed optimal coverage for safe coil delivery, while maintaining parent vessel patency. This case highlights the unique and safe applicability of two crossed Comaneci devices in a ruptured aneurysm with unfavourable anatomy, ultimately resulting in complete aneurysm obliteration. To our knowledge, this is the first reported case of double Comaneci usage in a wide-neck ruptured aneurysm. This technique can be potentially applied in challenging wide-neck bifurcation aneurysms, particularly when double antiplatelet therapy is of concern.

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Primary bilateral ovarian Burkitt lymphoma; a rare issue in gynecologic oncology

Abstract

We report a rare case of 42-year-old female patient with bilateral primary ovarian Burkitt lymphoma (BL). Primary BLs are rare ovarian oncology neoplasms. Only few cases are reported in English literature, most of them are presented in pediatric and young adult age groups. Rare cases are reported in adult females. Although BL is a rare primary ovarian neoplasm, it is very important to establish an accurate diagnosis as early as possible for therapeutic purposes.

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Laparoscopic management of snare entrapment during colonoscopic polypectomy

Abstract

Colonoscopic polypectomy reduces the risk of colon cancer development by interrupting the adenoma to carcinoma progression. A variety of techniques are available to perform polypectomy including the use of forceps or snare device with or without electrocautery. While forceps polypectomy tends to be the procedure of choice for small polyps, snare polypectomy has been found to be the preferred method for removal of polyps 1 cm or greater in size. The two most common post-polypectomy complications are bleeding and perforation. Though rare in the case of polypectomy, any mechanical device used in a procedure has an inherent risk of malfunction. Here, we present a case of an attempted snare polypectomy with malfunctioning of the device, failure of endoscopic retrieval and subsequent management with laparoscopic resection of the affected segment.

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Locally advanced colon cancer resulting in en bloc right hemicolectomy and pancreaticoduodenectomy: case report and review of literature

Abstract

Locally advancement of right colon cancer to the surrounding organs requiring surgical intervention is an extensive procedure associated with numerous risks. There are not many cases of which this phenomenon may occur. En bloc pancreaticoduodenectomy and resection of involved viscera should be considered for patients who can appropriately undergo this exhaustive surgery. Our objective is to report the experience we had with this patient who underwent an en bloc pancreaticoduodenectomy and right hemicolectomy and review literature. Our method was a retrospective review of a patient with colon cancer

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Postoperative Analgesic Effect of Ultrasound-Guided Intermediate Cervical Plexus Block on Unipolar Sternocleidomastoid Release With Myectomy in Pediatric Patients With Congenital Muscular Torticollis: A Prospective, Randomized Controlled Trial

Background and Objectives Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate cervical plexus block on postoperative pain after USRM. Methods Thirty-two patients (1–7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial. In the block group, 0.25% ropivacaine (0.2 mL/kg) was injected into the interfascial plane between the sternocleidomastoid muscle and the prevertebral fascia under ultrasound guidance at the fourth to fifth cervical vertebral level. The primary outcome measure was the face, legs, activity, cry, and consolability (FLACC) score at 5 minutes after entering the postanesthesia care unit (PACU), and secondary outcome measures were the FLACC score at discharge from the PACU and 3, 6, and 24 hours after operation and the use of rescue analgesic in the PACU and ward. Results The FLACC score at 5 minutes after admission to the PACU was significantly reduced (3 vs 8; median difference, 4; 95% confidence interval, 1–7; P = 0.044), and the fentanyl dose and the number of patients requiring rescue analgesics in the PACU were significantly lower (0.0 vs 0.5 μg/kg, P = 0.014; 5 [29.4%] vs 12 [75.0%], P = 0.032) in the block than in the control group. However, after discharge from PACU, there was no difference in FLACC scores and use of rescue analgesics between groups. Conclusions Ultrasound-guided intermediate cervical plexus block decreased immediate postoperative pain and opioid requirements in the PACU in pediatric patients who underwent USRM. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02651311. Accepted for publication January 15, 2018. Address correspondence to: Yun Jeong Chae, MD, PhD, Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea (e-mail: yjchae06@hotmail.com). This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Ultrasound Assessment of Ice-Ball Formation by Cryoneurolysis Device in an Ex Vivo Model

Background and Objectives Real-time ice-ball formation during cryoneurolysis has sparsely been assessed with ultrasound (US). Cryoneurolysis in lower back pain syndrome represents a validated management option in cases of facet joint syndrome. Ultrasound may be a useful tool to perform facet joint cryodenervation. The objective of this study was to assess, ex vivo, the ability of US to assess the ice-ball formation of a cryoneurolysis device. Methods Ultrasound assessment of the ice-ball depiction was done using chicken muscle at 22°C in which several freezing cycles were performed with both 2.1- and 1.3-mm cryoprobes. For each freezing cycle, static images and dynamic videos were generated for both needle insertion and ice-ball formation with 18-, 11-, and 6-MHz transducers. The following data were assessed in each combination of cryoprobe and transducers: quality of needle tip visualization, quality of the ice-ball formation depiction, size of the ice ball, presence of a shadow cone, and usefulness of power Doppler mode to assess ice-ball formation. Results The 18- and 11-MHz linear transducers allowed to directly depict the formation of the ice ball. Visualization of the cone shadowing allowed indirect visualization of the ice ball with both 18- and 11-MHz transducers. However, the ice ball was not depicted (directly or indirectly) with the convex 6-MHz transducer, and power Doppler was the only way to indirectly monitor the ice ball during the freezing cycles. Conclusions Ultrasound is a useful tool to monitor the formation of ice ball during a cryoneurolysis freezing cycle. Power Doppler appears as the only option to monitor the ice ball with low-frequency transducers. This novel finding may be useful in cases of lumbar medial branch cryoneurolysis, an application we plan to assess in a future pilot prospective study. Accepted for publication January 15, 2018. Address correspondence to: Adrian Kastler, MD, PhD, Neuroradiology Unit, Centre Hospitalier Universitaire Grenoble Alpes, Bvd de la Chantourne CS 10217, 38043 Grenoble CEDEX 9, France (e-mail: kastler.radio@gmail.com). Attribution: This work should be attributed to the Radiology Unit of the Medical University of Innsbruck, Innsbruck, Austria. No financial sources have supported this work. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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How do I stop my hair from being dry?

Many people have problems with their hair becoming brittle or dry. Medical conditions may be the cause, but it is often down to lifestyle or personal hygiene habits. Potential remedies are diverse and often simple, and we give 12 here, including oils and plant products that make good conditioners and hair masks.

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Integra ® -Dermal Regeneration Template and Split-Thickness Skin Grafting: A Therapy Approach to Correct Aplasia Cutis Congenita and Epidermolysis Bullosa in Carmi Syndrome

Abstract

The association of junctional epidermolysis bullosa with pyloric atresia (JEB-PA) and aplasia cutis congenita (ACC) was described by El Shafie et al. (J Pediatr Surg 14(4):446–449, 1979) and Carmi et al. (Am J Med Genet 11:319–328, 1982). Most patients die in the first weeks of life, and no curative treatment options are available so far. We describe a patient with JEB-PA and ACC (OMIM # 226730) who was treated for extensive areas of ACC by Integra^®-Dermal Regeneration Template and split-thickness skin grafting (STSG). Clinically, the dermal template changed into well-vascularized neodermis, and after STSG, full take of the transplants was detected. No infections of the huge ACC areas were seen. Further studies must validate this treatment option in severe and acute cases of JEB-PA with ACC. Based on clinical findings, we postulate that placement of Integra^®-Dermal Regeneration Template with STSG could be a new treatment option for patients having JEB-PA with ACC to prevent severe infection, compartment-syndrome-like conditions, and deformities. Based on literature findings, we assume that Integra^®-Dermal Regeneration Template with STSG could even be able to prevent new blistering and thereby be a treatment option in cases of ACC and JEB.

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CNG Staging Compared With 8th UICC of NPC for Treatment Decision-marking and Selection of Chemotherapy and Radiotherapy

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: CNG Chemotherapy;   Drug: NCCN Chemotherapy;   Radiation: CNG Radiation;   Radiation: NCCN Radiation
Sponsor:   Sun Yat-sen University
Not yet recruiting

https://ift.tt/2L6RAnn

FOLFIRI Alternate With FOLFOX in Untreated Metastatic Gastric and Esophageal Adenocarcinoma

Condition:   Metastatic Gastro-esophageal Adenocarcinoma
Intervention:   Drug: FOLFOX and FOLFIRI
Sponsor:   University of Saskatchewan
Not yet recruiting

https://ift.tt/2KA1Djy

Cytosponge™ for Post‐Chemoradiation Surveillance of Oesophageal Cancer

Condition:   Oesophageal Cancer
Intervention:   Device: Cytosponge™
Sponsors:   University of Oxford;   Centre for Statistics in Medicine;   CRUK Population Research Committee;   Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology;   MRC Cancer Cell Unit Hutchison‐MRC Research Centre, University of Cambridge;   Cambridge University Hospitals NHS Foundation Trust
Recruiting

https://ift.tt/2LeoKBA

Study of Porcine Fibrin Sealant in Preventing Cervical Anastomotic Leakage After Esophagectomy for Esophageal Carcinoma.

Conditions:   Esophageal Cancer;   Gastroesophageal Junction Cancer;   Anastomotic Leak
Interventions:   Biological: Porcine Fibrin Sealant (PFS);   Procedure: Surgery
Sponsor:   Sun Yat-sen University
Recruiting

https://ift.tt/2Iv4pWI

Phase I Durvalumab and Tremelimumab With Radiotherapy for Adjuvant Treatment of Intermediate Risk SCCHN

Conditions:   Larynx;   Lip;   Oral Cancer;   Digestive Organs--Diseases
Interventions:   Drug: Durvalumab;   Radiation: Intensity Modulated Radiotherapy Treatments;   Drug: Tremelimumab
Sponsors:   UNC Lineberger Comprehensive Cancer Center;   AstraZeneca
Not yet recruiting

https://ift.tt/2L6RvQB

Short-term Effect of Chewing Gum in Patients With Mild-moderate Dysphagia After Anterior Cervical Fusion

Condition:   Dysphagia
Intervention:   Other: chewing gum
Sponsor:   Guangdong General Hospital
Recruiting

https://ift.tt/2Iv55eI

Nonoperating room anesthesia for gastrointestinal endoscopic procedures

Purpose of review To assess the trends in nonoperating room anesthesia (NORA) for gastrointestinal endoscopy over the past few years, and to describe alternative methods of delivering propofol sedation in selected low-risk patients. Recent findings The use of NORA for routine gastrointestinal endoscopic procedures has been rising steadily over the past decade in the United States, considerably increasing healthcare costs. Because of this, there have been attempts to develop nonanesthesiologist-administered propofol sedation methods in low-risk patients. There is controversy as to whether properly trained nonanesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation Summary The deployment of nonanesthesia-administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall healthcare costs without sacrificing sedation quality. We also address the realm of anesthesia provider care for advanced endoscopic procedures including setup for administration of anesthesia, decision-making regarding placement of an endotracheal tube, and the potential need to move a challenging case to the operating room. Correspondence to Otto S. Lin, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA. Tel: +1 206 625 7373x67694; fax: +1 206 341 1405; e-mail: Otto.Lin@vmmc.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Scheduling the nonoperating room anesthesia suite

Purpose of review Nonoperating room anesthesia (NORA) and procedural services often are associated with dispersed geographic settings and small volumes of cases. These lead to scheduling challenges that, if not managed well, result in decreased patient and healthcare team satisfaction and reduced efficiency. This review describes recent studies and provides examples on how NORA scheduling issues have been addressed. Recent findings Increased use of blocked time for consolidated NORA services can lead to sufficiently large volumes of cases that allow improved scheduling and maintain patient and healthcare team satisfaction and better efficiency of care. In general, patients and proceduralists find that service blocks offered at least once every 2 weeks are acceptable. With the ability to perform the full scope of perioperative practices such as preoperative assessment and postoperative management, anesthesiologists are well positioned to lead NORA services. There is a rising expectation for both graduate medical education experiences and continuing education in quality improvement for NORA services. Summary Many factors play a role in successful scheduling of NORA services. Increasing consolidation of services, the use of block scheduling, and leadership by anesthesiologists can help improve patient and healthcare team satisfaction and practice efficiencies. Correspondence to Mary E. Warner, MD, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 1-121 Charlton Building, Rochester, MN 55905 USA. Tel: +1 507 284 9698; e-mail: warner.mary@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The future of anesthesia for interventional radiology

Purpose of review To review novel procedures in interventional radiology and describe anesthetic implications. Recent findings Noninvasive treatment options for patients who are nonsurgical candidates are on the rise. The complication rate for patients receiving anesthesia in the interventional radiology suite is higher than other nonoperating room anesthetizing locations. The investigative use of catheter-directed thrombolysis for acute submassive pulmonary embolism will likely lead to an increased demand for anesthesia assistance. Treatment of prostate cancer with high-intensity focused ultrasound with MRI guidance is an alternative to surgical treatment and has unique anesthetic implications. With advances in technology, interventional radiologists have expanded their treatment armamentarium for benign and malignant bony lesions and thus the need for anesthesia assistance. Summary As the complexity of procedures and patients increases, the demand for anesthesia support in interventional radiology rises. As novel techniques are being developed, anesthesiologists must be mindful of the increased complication rate in interventional radiology and work in a multidisciplinary approach to improve patient safety. Correspondence to Annie Amin, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA. E-mail: aamin@dacc.uchicago.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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OPTN Vascularized Composite Allograft (VCA) Waiting List: Current Status and Trends in the United States

Background Vascularized Composite Allograft (VCA) transplantation is a developing area in the field of transplantation. Methods This study used Organ Procurement and Transplantation Network (OPTN) VCA waiting list and transplant data from July 3, 2014 through February 28, 2018 to characterize the OPTN VCA waiting list in terms of composition, removal patterns, waiting time, resulting transplants, and trends over time. Results Between implementation of the OPTN VCA waiting list on July 3, 2014 and February 28, 2018, 54 candidates – 53.7% male, 79.6% white, and 70.4% aged 18-44 - were added to the OPTN VCA waiting list. Of these, 22 received deceased donor VCA transplants (6 bilateral upper limb, 4 unilateral upper limb, 5 craniofacial, 1 scalp, 1 abdominal wall, 1 penile, and 4 uterine), and 6 received living donor uterine transplants. Registrations increased in 2016 after uterine and penile transplants were introduced in the US, resulting in a large shift in the composition of the VCA waiting list. Waiting times for VCA candidates vary greatly, with some VCA candidates receiving deceased donor transplants quickly and others waiting more than 3 years before transplantation. Conclusions The field of VCA transplantation and the composition of the OPTN VCA waiting list are evolving rapidly. Additional research is needed to understand these changes and investigate whether differences in need or differences in access have resulted in the variation seen on the VCA waiting list. Corresponding Author: Jennifer L. Wainright, 700 N 4th Street, Richmond, VA 23219. jennifer.wainright@unos.org Authorship: Participated in research design: Jennifer Wainright, Christopher Wholley, Wida Cherikh, David Klassen Participated in writing of paper: Jennifer Wainright, Christopher Wholley, Wida Cherikh, Jennifer Musick, David Klassen Participated in performance of the research: Jennifer Wainright Participated in data analysis: Jennifer Wainright Disclosure: The authors declare no conflicts of interest. Funding: This work was conducted under the auspices of the United Network for Organ Sharing (UNOS), contractor for OPTN, under Contract 234-2005-370011C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2rRdJ04

Report of the Key Opinion Leaders Meeting on Stem Cell-Derived Beta Cells

Beta cell replacement has the potential to restore euglycemia in patients with insulin dependent diabetes. While great progress has been made in establishing allogeneic islet transplantation from deceased donors as the standard of care for those with the most labile diabetes, it is also clear that the deceased donor organ supply cannot possibly treat all those who could benefit from restoration of a normal beta cell mass, especially if immunosuppression were not required. Against this background, the International Pancreas and Islet Transplant Association (IPITA) in collaboration with the Harvard Stem Cell Institute (HSCI), the Juvenile Diabetes Research Foundation (JDRF), and the Helmsley Foundation held a 2-day Key Opinion Leaders Meeting in Boston in 2016 to bring together experts in generating and transplanting beta cells derived from stem cells. The following summary highlights current technology, recent significant breakthroughs, unmet needs and roadblocks to stem-cell-derived beta cell therapies, with the aim of spurring future preclinical collaborative investigations and progress toward the clinical application of stem cell-derived beta cells. CONFLICTS OF INTEREST DISCLOSURE: No conflicts are present for all authors. AUTHORSHIP: All authors participated in planning and writing the paper. Corresponding Author: James F. Markmann MD, PhD, Division of Transplantation, Massachusetts General Hospital, 55 Fruit Street, WHT 517, Boston, MA 02114. jmarkmann@partners.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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T-bet or IFNγ neutralization for blocking islet allograft rejection?

No abstract available

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Optimizing Temperature and Oxygen Supports Long-term Culture of Human Islets

Background Islet transplantation is a promising treatment for type-1 diabetes; however, donor shortage is a concern. Even when a pancreas is available, low islet yield limits the success of transplantation. Islet culture enables pooling of multiple low-yield isolations into an effective islet mass, but isolated islets rapidly deteriorate under conventional culture conditions. Oxygen depletion in the islet core, which leads to central necrosis and volume loss, is one of the major reasons for this deterioration. Methods To promote long-term culture of human islets in PIM-R medium (used for islet research), we adjusted temperature (12, 22, and 37°C) and oxygen concentration (21% and 50%). We simulated the oxygen distribution in islets based on islet oxygen consumption rate and dissolved oxygen in the medium. We determined the optimal conditions for oxygen distribution and volume maintenance in a 2-week culture and assessed viability and insulin secretion compared to noncultured islets. In vivo islet engraftment was assessed by transplantation into diabetic NOD-SCID mouse kidneys. We validated our results using CMRL 1066 medium (used for clinical islet transplantation). Results Simulation revealed that 12°C–50% oxygen PIM-R culture supplied oxygen effectively into the islet core. This condition maintained islet volume at >90% for 2 weeks. There were no significant differences in viability and function in vitro or diabetic reversal rate in vivo between 2-week cultured and noncultured islets. Similar results were obtained using CMRL 1066. Conclusion By optimizing temperature and oxygen concentration, we cultured human islets for 2 weeks with minimal loss of volume and function. Corresponding author: Hirotake Komatsu, MD, PhD, Division of Developmental and Translational Diabetes and Endocrinology Research, Department of Diabetes and Metabolic Research, Beckman Research Institute of City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA. E-mail: hkomatsu@coh.org Authorship Hirotake Komatsu designed the study, collected and analyzed data, and wrote the manuscript. Jeffrey Rawson, Leonard Medrano, Colin A. Cook, Alyssa Barriga, Nelson Gonzalez, and Mayra Salgado collected data. Keiko Omori, Fouad Kandeel, Yu-Chong Tai, and Yoko Mullen reviewed and edited the manuscript. Disclosure: All authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript. Funding: This study was supported by a grant from the Nora Eccles Treadwell Foundation (Title of Grant: CURE OF DIABETES, Grant Period: July 1, 2012–June 30, 2020, P.I.: Yoko Mullen, MD, PhD). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2k54BRY

Keeping Secrets: Localized immunosuppression in VCA

No abstract available

https://ift.tt/2rT5JMa

Range and consistency of outcomes reported in randomized trials conducted in kidney transplant recipients: a systematic review

Background The potential for clinical trials to impact patient care may be limited if the outcomes reported vary by trial and lack direct relevance to patients. Despite the many trials conducted in kidney transplantation, premature death due to cardiovascular disease, infection and malignancy remains high. We aimed to assess the range and consistency of outcomes reported in trials in kidney transplantation. Methods We searched for randomized trials conducted in kidney transplantation. We extracted the outcome measures, classified them into outcome domains, and into categories (clinical, surrogate or patient-reported outcome [PRO]). We assessed the measures used for the top 4 domains. Results Overall, 397 trials reported 12 047 outcomes measures and time points (median 19 per trial, interquartile range 9 to 42) across 106 different domains, of which 55 (52%) were surrogate, 35 (33%) clinical and 16 (15%) PRO. The 4 most frequently reported were graft function (322 (81%) trials, 118 outcome measures), acute rejection (234 [59%], 93 measures), graft loss (215 [54%], 48 measures) and mortality (204 [51%], 51 measures). The remaining 102 domains were reported in less than 50% of trials. Conclusion Mortality and graft related outcome domains were frequently reported, and assessed with a multiplicity of measures. The majority of outcome domains were surrogate outcomes, and the reporting of relevant life-threatening complications and PRO were uncommon. Establishing core outcomes based on the shared priorities of patients/caregivers and health professionals in kidney transplantation may improve the relevance and consistency of outcome reporting in trials to better inform clinical decision-making. Corresponding author: Benedicte Sautenet, Nephrology and Clinical Immunology department, Hospital Bretonneau, 2 boulevard Tonnellé, 37000 Tours, France, Email: benedicte.sautenet@univ-tours.fr Authors' specific contributions: BS participated in the research design, data collection, data analysis, and drafted the manuscript. AT participated in the research design, data collection, data analysis, and drafted the manuscript. JRC participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. AW participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. DR participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. GW participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. JG participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. KB participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. LR participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. LM participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. MAJ participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. PR participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. TP participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. NE participated in the research design, data analysis, and provided intellectual input on the manuscript and contributed to manuscript writing. JCC participated in the research design, data collection, data analysis, and drafted the manuscript. Disclosure: The authors declare no conflicts of interest. Funding: The project is funded by a National Health and Medical Research Council Project Grant (APP1128564) and a National Health and Medical Research Council Program Grant (APP109279). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Outcomes of pediatric ABO-incompatible living kidney transplantations from 2002 to 2015: An analysis of the Japanese Kidney Transplant Registry

Background Extensive data have been accumulated for adults who have undergone ABO-incompatible (ABOi)-living kidney transplantation (LKT). In contrast, available published data on pediatric recipients who underwent ABOi-LKT from the early to middle 2000s is very limited. Thus, pediatric ABOi-LKT has remained relatively rare and there is a lack of large, multicenter data. Methods We analyzed data from the Japanese Kidney Transplant Registry to clarify the patient and graft outcomes of pediatric recipients who underwent ABOi-LKT from 2002 to 2015. A total of 102 ABOi and 788 ABO-compatible (ABOc) recipients were identified in this study. All recipients had received basiliximab and a triple immunosuppressive protocol comprising calcineurin inhibitors, mycophenolate mofetil, and steroids. ABOi recipients also received preconditioning therapies including B cell depletion by a splenectomy or rituximab treatment and therapeutic apheresis. Results Death rates for ABOi and ABOc recipients were 0.17 versus 0.17 deaths per 100 patient-years. Graft loss rates for ABOi and ABOc recipients were 1.58 versus 1.45 events per 100 patient-years. No particular causes of death or graft loss predominantly affected ABOi or ABOc recipients. Conclusions The results of this registry analysis suggest that pediatric ABOi-LKT can be performed efficiently. Although further studies are clearly required to perform pediatric ABOi-LKT more safely and less invasively, ABOi-LKT is now an acceptable treatment for pediatric patients with end-stage renal disease. Correspondence to: Motoshi Hattori, MD, PhD, Department of Pediatric Nephrology, Tokyo Women's Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. (hattori@twmu.ac.jp). Authorship M.H. participated in research design, the performance of the research and the writing of the manuscript. M.M. participated in research design, the performance of the research and data analysis. S.S. participated in research design and the performance of the research. A.A., H.U., S.O., K.T., and A.H. participated in the performance of the research. The authors declare no conflicts of interest or funding. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2rTWP0T

Regression: The Apple Does Not Fall Far From the Tree

Researchers and clinicians are frequently interested in either: (1) assessing whether there is a relationship or association between 2 or more variables and quantifying this association; or (2) determining whether 1 or more variables can predict another variable. The strength of such an association is mainly described by the correlation. However, regression analysis and regression models can be used not only to identify whether there is a significant relationship or association between variables but also to generate estimations of such a predictive relationship between variables. This basic statistical tutorial discusses the fundamental concepts and techniques related to the most common types of regression analysis and modeling, including simple linear regression, multiple regression, logistic regression, ordinal regression, and Poisson regression, as well as the common yet often underrecognized phenomenon of regression toward the mean. The various types of regression analysis are powerful statistical techniques, which when appropriately applied, can allow for the valid interpretation of complex, multifactorial data. Regression analysis and models can assess whether there is a relationship or association between 2 or more observed variables and estimate the strength of this association, as well as determine whether 1 or more variables can predict another variable. Regression is thus being applied more commonly in anesthesia, perioperative, critical care, and pain research. However, it is crucial to note that regression can identify plausible risk factors; it does not prove causation (a definitive cause and effect relationship). The results of a regression analysis instead identify independent (predictor) variable(s) associated with the dependent (outcome) variable. As with other statistical methods, applying regression requires that certain assumptions be met, which can be tested with specific diagnostics. Accepted for publication April 2, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2IPaocp

We’ve Had Our Fill of Magill

No abstract available

https://ift.tt/2ItoNaB

Neuromonitoring Techniques: Quick Guide for Clinicians and Residents

No abstract available

https://ift.tt/2IPahgZ

Remifentanil Induces Cardio Protection Against Ischemia/Reperfusion Injury by Inhibiting Endoplasmic Reticulum Stress Through the Maintenance of Zinc Homeostasis

BACKGROUND: Although it is well known that remifentanil (Rem) elicits cardiac protection against ischemia/reperfusion (I/R) injury, the underlying mechanism remains unclear. This study tested if Rem can protect the heart from I/R injury by inhibiting endoplasmic reticulum (ER) stress through the maintenance of zinc (Zn2+) homeostasis. METHODS: Isolated rat hearts were subjected to 30 minutes of regional ischemia followed by 2 hours of reperfusion. Rem was given by 3 consecutive 5-minute infusions, and each infusion was followed by a 5-minute drug-free perfusion before ischemia. Total Zn2+ concentrations in cardiac tissue, cardiac function, infarct size, and apoptosis were assessed. H9c2 cells were subjected to 6 hours of hypoxia and 2 hours of reoxygenation (hypoxia/reoxygenation [H/R]), and Rem was given for 30 minutes before hypoxia. Metal-responsive transcription factor 1 (MTF1) overexpression plasmids were transfected into H9c2 cells 48 hours before hypoxia. Intracellular Zn2+ level, cell viability, and mitochondrial injury parameters were evaluated. A Zn2+ chelator N,N,N′,N′-tetrakis-(2-pyridylmethyl) ethylenediamine (TPEN) or an ER stress activator thapsigargin was administrated during in vitro and ex vivo studies. The regulatory molecules related to Zn2+ homeostasis and ER stress in cardiac tissue, and cardiomyocytes were analyzed by Western blotting. RESULTS: Rem caused significant reversion of Zn2+ loss from the heart (Rem + I/R versus I/R, 9.43 ± 0.55 vs 7.53 ± 1.18; P

https://ift.tt/2IwEBJK

Global Health: Issues, Challenges, and Global Action

No abstract available

https://ift.tt/2IPab97

Whole Blood for Resuscitation in Adult Civilian Trauma in 2017: A Narrative Review

After a hiatus of several decades, the concept of cold whole blood (WB) is being reintroduced into acute clinical trauma care in the United States. Initial implementation experience and data grew from military medical applications, followed by more recent development and data acquisition in civilian institutions. Anesthesiologists, especially those who work in acute trauma facilities, are likely to be presented with patients either receiving WB from the emergency department or may have WB as a therapeutic option in massive transfusion situations. In this focused review, we briefly discuss the historical concept of WB and describe the characteristics of WB, including storage, blood group compatibility, and theoretical hemolytic risks. We summarize relevant recent retrospective military and preliminary civilian efficacy as well as safety data related to WB transfusion, and describe our experience with the initial implementation of WB transfusion at our level 1 trauma hospital. Suggestions and collective published experience from other centers as well as ours may be useful to those investigating such a program. The role of WB as a significant therapeutic option in civilian trauma awaits further prospective validation. Accepted for publication April 3, 2018. Funding: Departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Evan G. Pivalizza, MD, Department of Anesthesiology, University of Texas Health McGovern Medical School, Houston, TX. Address e-mail to evan.g.pivalizza@uth.tmc.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2IyffLA

Flupirtine Is an Effective Analgesic: Is the Associated Rare Liver Injury a Limiting Factor to Its Use?

No abstract available

https://ift.tt/2rRdVNA

Do Not Opiate! Anesthesiologists Must Be Prepared to Care for Patients Who Sign a “Nonopioid Directive”

No abstract available

https://ift.tt/2GuKQfw

Complications in Anesthesia, 3rd ed

No abstract available

https://ift.tt/2rRYzIO

Family Functions and Life Quality of Parents of Children With Cleft Lip and Palate

Objective: This study was designed to identify variables affecting family functions and life quality of parents with cleft lip and/or palate children. Materials and Methods: Family Assesment Scale (FAS) and short form of World Health Organization quality of life (WHOQOL-BREF-TR) were used to measure family functions and life quality of parents. Questionnaire Forms were given to 146 parents: 74 having cleft lip and/or palate children (cleft-group), and the other 72 with healthy children (control-group). Parents were divided into 3 subgroups according to children's age as 0 to 6, 7 to 12, and 13 to 18 years. Kruskal-Wallis and Mann–Whitney U tests were used to evaluate differences between the groups. Results: Behavior of cleft patients' parents was found to be problematic in behavioral control, required attention and role areas at 0 to 6 years, required attention area at ages 7 to 12 and 13 to 18 years. When compared to control group, significant differences were detected in required attention at ages 0 to 6 years, problem-solving, and communication areas at 7 to 12 years. Findings of life quality were found to be over medium level in physical, social, psychological and environmental areas in cleft group at all age groups; however, life quality was found better in control group in physical, psychological, and social subtests at age 13 to 18 years. Conclusion: Cleft children influence family functions in behavioral control, required attention and role areas at early childhood, and continue to affect required attention through adolescence. Also social, physical, and psychological fields of life quality were found lower in cleft parents compared to control group at adolescence. Address correspondence and reprint requests to Dr Belma I. Aslan, PhD, DDS, Associate Professor, Department of Orthodontics, Faculty of Dentistry, University of Gazi, 06510 Emek, Ankara, Turkey; E-mail: belmaslan2003@yahoo.com Received 12 October, 2017 Accepted 12 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2rR3jye

The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy

Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable and its analysis is crucial to establish effective treatment and prevention of these injuries. The aim of this multicentric retrospective study was to analyze causes, demographics, incidence, characteristics of 987 patients diagnosed with maxillofacial trauma between 2011 and 2015 at Complex Operative Unit of Maxillofacial Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro, Italy; 657 male and 310 female patients were admitted in the study. The most frequently observed fracture involved the mandible (399 patients, 35.4%), followed by zygomatic complex (337 patients, 29.9%), orbital walls (160 patients, 14.2%), and nasal bones (129 patients, 11.4%). The most frequent cause of fracture was assaults (30.4%), followed by road traffic injuries (27.2%), falls (23.2%), sport accidents (15.4%), and others causes (2.6%). Significant variations of etiology have been detected between the 2 hospitals in relationship with different migration flow trends and cultural and socioeconomic features. Epidemiological analysis of maxillofacial fractures is crucial to identify the trauma burden and to help in developing a more efficient system to plan resource allocation and to deliver care and preventive measures establishing clinical and research priorities for effective treatment and prevention of these injuries. Address correspondence and reprint requests to Ida Barca, MD, Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy; E-mail: barca.ida@gmail.com Received 1 June, 2017 Accepted 11 March, 2018 The authors report no conflicts of interest © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2IvEqP4

Pediatric Nasal Traumas: Contribution of Epidemiological Features to Detect the Distinction Between Nasal Fractures and Nasal Soft Tissue Injuries

Objectives: Nasal bone is prone to injury due of its prominent position on the face. Epidemiologic surveys are necessary to investigate nasal traumas. The aim of the present study is to examine the distribution of trauma etiologies according to age, sex, and seasonality in pediatric patients who present with nasal trauma, and to classify the pathologies according to their etiology as nasal fractures or nasal soft tissue injuries. Methods: A total of 200 pediatric patients aged between 0 and 18 years who were admitted to the emergency room with sustained nasal trauma between September 1, 2015 and August 1, 2016 and who were diagnosed with an either nasal fracture or nasal soft tissue injury were retrospectively analyzed. The relationship between the nasal bone fractures and nasal soft tissue injuries and age, sex, admission date, and trauma etiology were investigated. Results: Of 200 patients, 70.5% were males and 29.5% were females with a mean age of 8.93 ± 5.50 years. Of these patients, 33.0% were in the 0 to 5 years age group, 24.0% were in the 6 to 10 years age group, 18.5% were in the 11 to 14 years age group, and 24.5% were in the 15 to 18 years age group. Of these, 82.5% had a nasal soft tissue injury and 17.5% had a nasal fracture. The etiology of trauma was most commonly fall from a height in 42.5% of the patients. Impact injuries and falls were the most common etiologies in the 0 to 5 age group, falls were the most common etiologies in the 6 to 10 age group, sports injuries were the most common etiologies in the 11 to 14 age group, and physical assault was the most common etiology in the 15 to 18 age group (P = 0.001; P 

https://ift.tt/2rPYYLA

Results Following Adoption of a Modified Melbourne Technique of Total Scaphocephaly Correction

The Melbourne technique was described in 2008 as a novel method for complete correction of scaphocephaly. Since 2015, it has become our operation of choice for children with sagittal synostosis who are too old at presentation for minimally invasive techniques. Our modifications were 2-position (initially supine then prone) technique and undertaking a formal fronto-orbital remodeling to correct forehead contour. Retrospective chart review was used to record demographics, blood transfusion frequency and volumes, operating time, length of stay, clinical outcome, and complications. Eleven underwent modified Melbourne procedure between July 2015 and March 2017; 9 of 11 were male. All had a diagnosis of nonsyndromic sagittal synostosis. Mean age at surgery was 29 months. Mean surgical time was 6 hours. All patients required blood transfusion with a mean volume transfused of 29 mL/kg (range 13–83 mL/kg). For those 5 patients where preoperative and postoperative measurements were available, there was an increase in mean cephalic index (CI) from 0.64 to 0.75. All postoperative patients had a CI of over 0.70. Three-dimensional shape analysis indicated head shape change addressing all phenotypic aspects of scaphocephaly. In the 5 patients in which analysis could be undertaken, the mean intracranial volume increased from 1481 cm3 preoperatively to 1671 cm3 postoperatively, a mean increase in intracranial volume of 14%. The postoperative intracranial volume was higher than preoperative in all 5 patients. There were 4 minor and no major complications. Modified Melbourne procedure is safe and effective for the treatment of severe scaphocephaly in sagittal synostosis. Address correspondence and reprint requests to Greg James, PhD, FRCS, Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; E-mail: greg.james@ucl.ac.uk Received 24 January, 2018 Accepted 10 March, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2rR40HQ

Repairing a Facial Cleft by Polyether–Ether–Ketone Implant Combined With Titanium Mesh

The Tessier Number 4 cleft is one of the rarest, most complex craniofacial anomalies that presents difficulties in surgical treatment. In this article, we report a case of simultaneous facial depression, eye displacement, and medial canthus deformity. In this case, the maxillary bony defect was reconstructed using computer-assisted design computer-assisted manufacturing (CAD-CAM) polyether–ether–ketone (PEEK) material, and the orbital floor defect was repaired with AO prefabricated titanium mesh. Additionally, the medial canthus was modified with canthopexy and a single Z-plasty flap. Owing to its relative rarity and varied clinical presentations, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. This study presents the combination of CAD-CAM manufactured PEEK material and titanium mesh as an alternative approach for reconstructing the bony defect of Tessier No. 4 facial clefts. Address correspondence and reprint requests to Zhengkang Li, MD, Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China; E-mail: lizhengkang58@hotmail.com Received 16 November, 2017 Accepted 11 March, 2018 This work was supported by the National Natural Science Foundation of China (81501605), the Chenguang Plan of the Shanghai Education Development Foundation (16CG16), and The Science and Technology Commission of Shanghai (17DZ2260100). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2GslcrK