En bloc corpectomy for late gastrointestinal stromal tumor metastasis: a case report and review of the literature

Spinal metastases of gastrointestinal stromal tumors are rare; however, the incidence has been increasing since the introduction of tyrosine kinase inhibitors, which have improved overall survival. Due to the ...

https://ift.tt/2QNzR6q

Testicular adrenal rest tumour in an adult patient with congenital adrenal hyperplasia: a case report and review of literature

Abstract

Late presentations of testicular adrenal rest tumours (TART) are rarely seen in males with congenital adrenal hyperplasia, and are often misdiagnosed as primary testicular germ cell tumours. We report a case of bilateral TART in an adult patient with congenital adrenal hyperplasia who had defaulted treatment. He presented with a gradually increasing swelling of the left testis and genital examination revealed a large hard indurated swelling of both epididymes more prominent on the left side. As imaging was inconclusive, a biopsy was performed which showed features in favour of TART rather than Leydig cell neoplasm and he had good response to steroids. Histopathological evaluation is helpful in cases where there is a strong need for excluding a malignancy. Optimal steroid replacement is the treatment of choice and leads to regression of the lesion in the majority.

https://ift.tt/2pWxYZI

Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting

Abstract

A cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis with cholecystitis. Cholecystocolonic fistulas (CCFs) account for 8–26.5% of all CEFs. CCFs can cause colonic bleeding, obstruction or perforation, with such complications being mainly reported in the narrower sigmoid colon. Colonic biliary ileus, or obstruction due to the colonic gallstone impaction, is extremely rare in the proximal colon and its best management is yet to be elucidated. We present the case of a 73-year-old male patient with multiple comorbidities and previous abdominal surgeries who presented with hematochezia and intestinal obstructive symptoms. Imaging revealed a giant 5 × 7 cm² gallstone in the proximal transverse colon. Laparotomy and stone extraction via colotomy were performed. Complicated proximal colonic gallstones are exceedingly rare with several operative and non-operative treatments already described. A time-saving surgery in a patient with serious comorbidities is reasonable when compared to a more extensive procedure including enterolithotomy, cholecystecomy and fistula closure.

https://ift.tt/2NIYS0w

Tracheopleural fistula after thoracoscopic esophagectomy: novel therapeutic approach with pericardial and intercostal muscle flaps

Abstract

Tracheal rupture following thoracoscopic esophagectomy is a dangerous event requiring primary repair with flap reinforcement. If the injury is not diagnosed during the surgery, morbidity and mortality increase significantly. Meanwhile, primary repair in such cases is not feasible due to the inflammation and difficulty in approximating the defect. Here, we report a case of tracheal injury during thoracoscopic esophagectomy with primary repair failure. We successfully repaired the injury by covering the defect first by a pericardial flap, then reinforcing it with an intercostal muscle flap. To our knowledge, there are few reports of such novel surgical techniques.

https://ift.tt/2pUbOY3

A giant duodenal diverticulum causing Lemmel syndrome

Abstract

An 80-year-old female, with a known periampullary giant duodenal diverticulum, presented to the emergency department with general deterioration. While not clinically icteric, her laboratory investigations revealed an obstructive jaundice. MRCP demonstrated mild distension of the gallbladder with several calculi. There was intra- and extra-hepatic biliary dilatation to the level of the ampulla. A giant fluid and air filled periampullary duodenal diverticulum measuring ~8 cm in the long axis was noted. The CBD was dilated to the level of this diverticulum and the cause of the patient's biliary dilatation and obstruction. A rare pancreaticobiliary complication of duodenal diverticula is Lemmel syndrome. Lemmel syndrome is defined as an obstructive jaundice caused by a periampullary duodenal diverticulum compressing the intra-pancreatic portion of the common bile duct with resultant dilatation of the extra- and intra-hepatic bile ducts. Recognition of this condition is important, as delayed diagnosis can result in unnecessary further investigations.

https://ift.tt/2NJNL7D

Oral immunotherapy with the ingestion of house dust mite extract in a murine model of allergic asthma

Allergen-specific immunotherapy (ASIT) has the potential to modify allergic diseases, and it is also considered a potential therapy for allergic asthma. House dust mite (HDM) allergens, a common source of airb...

https://ift.tt/2QTdJYb

A Novel Grading System for Salpingopharyngeal Fold Hypertrophy in Obstructive Sleep Apnoea

Abstract

The present study aimed at reporting the incidence of Salpingopharyngeal Fold (SPF) hypertrophy on Drug Induced Sleep Endoscopy (DISE) in patients with Obstructive Sleep Apnoea (OSA, validate a grading system and analyse the impact of various grades on the clinical presentation while ascertaining its relation with Apnoea-Hypopnoea Index (AHI). A retrospective analysis of 169 patients with polysomnographic confirmation of obstructive sleep apnoea has been done in the study. The DISE video data of 169 patients was evaluated by two ENT surgeons individually and they graded the hypertrophy of the fold as Grade 0 being normal anatomy, Grade 1 being hypertrophy causing partial obstruction and Grade 2 being hypertrophy causing complete obstruction of lateral pharyngeal wall. It was found that the presence of SPF hypertrophy independently adds considerably to the severity of the obstruction, attributing to lateral collapse at the upper retropalatal level and also significantly increases AHI. It is thus advised to consider the grade of SPF hypertrophy while surgically planning the management of patients with OSA.

https://ift.tt/2Acgm23

The relationship between seizure in electroconvulsive therapy and pupillary response using an automated pupilometer

Abstract

Objectives

Seizure duration and morphology, postictal suppression, and sympathetic nervous system activation are all recommended as assessments of adequate seizure in electroconvulsive therapy (ECT). However, blood pressure and heart rate are not typically assessed as part of sympathetic nervous system activation because of the administration of anesthetic or cardiovascular agents during ECT. Although the pupils are known to reflect to the activity of autonomic nervous system and the degree of brain damage, previous studies have not examined the relationship between seizure of electroconvulsive therapy and pupillary response.

Methods

We conducted 98 sessions of ECT with 13 patients, divided into two groups according to seizure quality: (1) adequate or (2) inadequate. Pupillary light reflex [% constriction = (maximum resting pupil size {MAX} − minimum pupil size after light stimulation)/MAX × 100] was measured using a portable infrared quantitative pupilometer before anesthesia induction and immediately after electrical stimulation.

Results

The number regarded as adequate was 67 times and as inadequate was 31 times. Maximum pupil size at the control and immediately after electrical stimulation was similar between the adequate and inadequate groups. Pupillary light reflex was similar at the control between both groups, but significantly smaller immediately after stimulation in the adequate group (2.5 ± 3.6%) compared with the inadequate group (10.6 ± 11.5%). Receiver operating characteristic curve analysis revealed that pupillary light reflex (> 5.5%) predicted adequate seizure.

Conclusions

The current findings suggest that pupillary constriction immediately after ECT could provide a helpful method for assessing the efficacy of ECT.

https://ift.tt/2NISd6o

A Novel Grading System for Salpingopharyngeal Fold Hypertrophy in Obstructive Sleep Apnoea

Abstract

The present study aimed at reporting the incidence of Salpingopharyngeal Fold (SPF) hypertrophy on Drug Induced Sleep Endoscopy (DISE) in patients with Obstructive Sleep Apnoea (OSA, validate a grading system and analyse the impact of various grades on the clinical presentation while ascertaining its relation with Apnoea-Hypopnoea Index (AHI). A retrospective analysis of 169 patients with polysomnographic confirmation of obstructive sleep apnoea has been done in the study. The DISE video data of 169 patients was evaluated by two ENT surgeons individually and they graded the hypertrophy of the fold as Grade 0 being normal anatomy, Grade 1 being hypertrophy causing partial obstruction and Grade 2 being hypertrophy causing complete obstruction of lateral pharyngeal wall. It was found that the presence of SPF hypertrophy independently adds considerably to the severity of the obstruction, attributing to lateral collapse at the upper retropalatal level and also significantly increases AHI. It is thus advised to consider the grade of SPF hypertrophy while surgically planning the management of patients with OSA.

https://ift.tt/2Acgm23

Circulating Epithelial Cell Characterization and Correlation with Remission and Survival in Patients with Thyroid Cancer

Thyroid, Ahead of Print.


https://ift.tt/2OrMVS1

Do High Levels of Antibodies to the IGF-1 Receptor Ameliorate Orbitopathy in Some Patients with Graves’ Disease?

Clinical Thyroidology, Volume 30, Issue 10, Page 464-467, October 2018.


https://ift.tt/2IZfbFD

Thyroid Cancers with Nodules of Indeterminate Cytology Have a Specific Distribution of Histologic Types

Clinical Thyroidology, Volume 30, Issue 10, Page 480-484, October 2018.


https://ift.tt/2OsOaQX

Persistent Disease is 3.5-Fold More Common Than Recurrent Disease After Initial Therapy for Differentiated Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 10, Page 447-449, October 2018.


https://ift.tt/2J124Uz

Integrated Cervical Ultrasound by the Same Specialist Who Performed Parathyroid Scintigraphy Improves Parathyroid Adenoma Detection

Clinical Thyroidology, Volume 30, Issue 10, Page 471-475, October 2018.


https://ift.tt/2Opb2AW

Male Sex Is Associated with Increased Mortality from Papillary Thyroid Cancers with BRAF V600E Mutation

Clinical Thyroidology, Volume 30, Issue 10, Page 450-452, October 2018.


https://ift.tt/2IX5Iia

Radioactive Iodine Therapy Is Associated with Clonal Hematopoiesis, a Precursor for Hematologic Malignancies

Clinical Thyroidology, Volume 30, Issue 10, Page 443-446, October 2018.


https://ift.tt/2OqwdT7

Varying Levothyroxine Doses Within or Near the Reference Range Does Not Affect Energy Expenditure or Body Composition

Clinical Thyroidology, Volume 30, Issue 10, Page 453-455, October 2018.


https://ift.tt/2IX5EPs

Thermal Inkjet Printing of Combination Synthetic LT3+LT4 May Be a Novel Method for Personalizing the Treatment of Hypothyroidism in the Future

Clinical Thyroidology, Volume 30, Issue 10, Page 468-470, October 2018.


https://ift.tt/2OqrOQ9

Levothyroxine Replacement for Primary Hypothyroidism Can Be Given Between Meals with Similar Effectiveness at Various Times of the Day

Clinical Thyroidology, Volume 30, Issue 10, Page 456-459, October 2018.


https://ift.tt/2IX3IXf

Benign Nodules Show Little Change in Sonographic Appearance over Time

Clinical Thyroidology, Volume 30, Issue 10, Page 476-479, October 2018.


https://ift.tt/2OvnC1P

Low Maternal Iodine Availability During Pregnancy Is Associated with Poorer Child Language Development

Clinical Thyroidology, Volume 30, Issue 10, Page 460-463, October 2018.


https://ift.tt/2IYkohb

Paul Walfish—In Memoriam

Clinical Thyroidology, Volume 30, Issue 10, Page 485-485, October 2018.


https://ift.tt/2Ool850

The connection of pollen concentrations and crowd-sourced symptom data: new insights from daily and seasonal symptom load index data from 2013 to 2017 in Vienna

Online pollen diaries and mobile applications nowadays allow easy and fast documentation of pollen allergy symptoms. Such crowd-sourced symptom data provides insights into the development and the onset of a po...

https://ift.tt/2PCFrby

Adenocarcinoma de Saco Endolinfático

Adenocarcinoma de saco endolinfático

 

https://ift.tt/2Abtm83

A retrospective comparative study of mandibular fracture treatment with internal fixation using reconstruction plate versus miniplates

This study compared the clinical success rates of mandibular fracture treatment using reconstruction plates or miniplates and clarified the selection criteria for reconstruction plates.

https://ift.tt/2CjqtDB

Increasing Frequency and Share of Dermatologic Procedures Billed by Non-Physician Clinicians from 2012-2016

https://ift.tt/2RRW0ld

Complications and loss of free flaps after reconstructions for oral cancer

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients' clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n=86, 45%) and the anterolateral thigh free flap (ALTFF) (n=48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n=25, 13%).

https://ift.tt/2OrQbx3

Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy

We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1–9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19–78) years. The flaps took a maximum of 17minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.

https://ift.tt/2J46LgB

New method for retention of glasses while operating

Wearers of glasses often complain that their glasses slip down the nose in theatre, which leads to discomfort and a reduced visual field, and (occasionally) they fall into the surgical wound. Here I describe a simple, quick, clean way to secure glasses without the need for straps, which pull straight back on the nose and can be uncomfortable.

https://ift.tt/2OswEMW

Anterior convex lateral orbital wall: distinctive morphology in Apert syndrome

Bony malformations of the orbit and alterations to the soft tissue in Apert syndrome contribute to ophthalmic dysfunction. Recognised structural malformation of the sphenoid and ethmoid sinuses, together with corresponding deformities in the anterior and middle cranial base, are characteristic. Our aim was to explore the underlying structural components of disfigurement and the consequent development of the orbit in patients with Apert syndrome over time by studying 18 preoperative computed tomographic (CT) scans of affected patients and 36 scans from controls.

https://ift.tt/2IZrmCu

“Sodium bicarbonate”: an adjunct to painless palatal anesthesia

Abstract

Purpose

It is believed that whenever we inject local anesthesia into the palate it is a painful experience for the patients. The aim of this study was to make palatal anesthesia painless by adding 7.4% sodium bicarbonate as an adjunct in local anesthesia.

Methods

Fifty subjects requiring extraction of maxillary bilateral premolar teeth for orthodontic purpose free from periapical infections. These extractions were divided in such a way that all right-sided extractions were done under 2% lignocaine with 1:80,000 adrenaline; and all left-sided extractions were done under 2% lignocaine with 1:80,000 adrenaline with 7.4% sodium bicarbonate added. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of the local anesthetic solution. Data records of these patients were procured on the basis of VAS and VRS, requirement of repeated injection, and onset and duration of anesthesia.

Results

Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics reduces pain and decreased the onset and increased duration of local anesthesia in the palatal site, as compared to injection of local anesthetic without sodium bicarbonate.

Conclusion

Effect of sodium bicarbonate on reducing pain while injecting into the palatal aspect was noted in this study.

https://ift.tt/2yEP7ed

“Sodium bicarbonate”: an adjunct to painless palatal anesthesia

Abstract

Purpose

It is believed that whenever we inject local anesthesia into the palate it is a painful experience for the patients. The aim of this study was to make palatal anesthesia painless by adding 7.4% sodium bicarbonate as an adjunct in local anesthesia.

Methods

Fifty subjects requiring extraction of maxillary bilateral premolar teeth for orthodontic purpose free from periapical infections. These extractions were divided in such a way that all right-sided extractions were done under 2% lignocaine with 1:80,000 adrenaline; and all left-sided extractions were done under 2% lignocaine with 1:80,000 adrenaline with 7.4% sodium bicarbonate added. All extractions were performed using a consistent intra-alveolar technique by a single operator. Both the patient and the operator were blinded to the contents of the local anesthetic solution. Data records of these patients were procured on the basis of VAS and VRS, requirement of repeated injection, and onset and duration of anesthesia.

Results

Clinical and statistical data confirmed that the addition of sodium bicarbonate in local anesthetics reduces pain and decreased the onset and increased duration of local anesthesia in the palatal site, as compared to injection of local anesthetic without sodium bicarbonate.

Conclusion

Effect of sodium bicarbonate on reducing pain while injecting into the palatal aspect was noted in this study.

https://ift.tt/2yEP7ed

Trefoil factor family 2 protein: a potential immunohistochemical marker for aiding diagnosis of lobular endocervical glandular hyperplasia and gastric-type adenocarcinoma of the uterine cervix

Abstract

Gastric-type adenocarcinoma (GA) is an aggressive subtype of cancer of the uterine cervix. Several immunohistochemical markers for gastric mucins, such as mucin 6 (MUC6) and N-acetylglucosamine α1 → 4galactose → R (αGlcNAc-R), which is recognized by HIK1083 antibody, have been introduced for diagnosis of GA and lobular endocervical glandular hyperplasia (LEGH). However, MUC6 is also expressed in normal endocervical glands and HIK1083 antibody has limited availability. Trefoil factor family 2 protein (TFF2) is secreted by gastric, but not normal endocervical glands. Here, we evaluated TFF2 immunostaining for detection of a gastric immunophenotype in endocervical glandular lesions. We compared TFF2, αGlcNAc-R, and MUC6 expression in 103 endocervical glandular lesions: LEGH (n = 23), adenocarcinoma in situ/microinvasive adenocarcinoma (AIS–MIA) (n = 29), and invasive adenocarcinoma (usual type [UA], n = 26; GA, n = 11; intestinal type [IA], n = 2; signet ring cell type [Sig], n = 2; and mucinous adenocarcinoma not otherwise specified [NOS], n = 10). TFF2 and αGlcNAc-R expression was completely concordant in each subtype: LEGH (100%), AIS–MIA (44.8%), UA (26.9%), GA (90.9%), IA (100%), Sig (0%), and NOS (20%). TFF2 staining scores were significantly correlated with those of αGlcNAc-R in these lesions. TFF2 and αGlcNAc-R immunoreactivity was present in cytoplasmic mucins and luminal secretions. TFF2 and αGlcNAc-R were not expressed in the normal endocervical glands. MUC6 was frequently expressed in normal endocervical glands and endocervical glandular lesions. Endocervical adenocarcinomas sometimes stained only for MUC6. TFF2 is a promising immunohistochemical marker and its identification in uterine cervical secretion is a potentially useful diagnostic test for endocervical glandular lesions with gastric differentiation.

https://ift.tt/2EnNxnk

Influence of static forces on the expression of selected parameters of inflammation in periodontal ligament cells and alveolar bone cells in a co-culture in vitro model

Abstract

Objective

Aim of this study was to investigate the impact of human PDL-derived fibroblasts (HPDF) and human alveolar bone-derived osteoblasts (HABO) co-culture on the expression of cytokines involved in tissue remodeling using an in vitro compressive force (CF) model.

Materials and methods

Static compressive force (CF) of 47.4 g/cm² was applied on mono- and co-cultured HPDFs and HABOs for 1, 2, or 4 h at 30 °C. TNFA, PTGS2, and IL6 gene expressions were determined by quantitative real-time polymerase chain reaction. TNF, PGE₂, and IL6 concentrations were measured using enzyme-linked immunosorbent assay.

Results

In mono-culture, TNFA, PTGS2, and IL6 gene expressions were upregulated under CF as compared to controls for each time period in both cell types. PGE₂ increased at 1 and 2 h in both cell types, and IL6 increased only at 2 and 4 h in HPDFs. Co-culture alleviated the force-induced increase of the expression of TNFA, PTGS2, IL6, PGE2, and IL6 in HPDFs at any time point. In HABOs, co-cultivation decreased the expression of PGE₂ after 1 h and 4 h, and that of IL6 after 1 h compared to mono-culture.

Conclusions

CF application on co-cultures of HPDFs and HABOs causes significant changes of TNFA, PTGS2, and IL6 gene expressions and PGE₂ and IL6 production in comparison to mono-culture indicating intercellular communication.

Clinical relevance

Mechanical stimulation of HPDFs and HABOs in co-culture induces a different gene expression pattern than stimulation of individual cell types alone. Co-culture might therefore be a relevant method to elucidate periodontal regeneration during orthodontic therapy.

https://ift.tt/2EkbsnK

Chirurgische Therapie im Stadium I und II des nichtkleinzelligen Lungenkarzinoms

Zusammenfassung

Hintergrund

In den vergangenen Jahrzehnten hat sich die Prognose des Lungenkarzinoms trotz moderner Diagnostik und multimodaler Therapiestrategien kaum verbessert. Ein großer Anteil der Patienten mit einem nichtkleinzelligen Lungenkarzinom (NSCLC; 57 %) haben zum Zeitpunkt der Diagnose Fernmetastasen und nur etwa 40 % der Patienten sind in einem potenziell operablen Tumorstadium.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie eigenen Erfahrungen zum Thema des Artikels.

Ergebnisse

Für Patienten in einem frühen Tumorstadium, Stadium I und II nach der Klassifikation der Tumorstadien in der 8. Ausgabe der Union for International Cancer Control (UICC), ist die chirurgische anatomische Tumorresektion in Kombination mit einer systematischen mediastinalen und hilären Lymphknotendissektion das Therapieverfahren der Wahl. Mit dem klassischen Resektionsverfahren der Lobektomie (Bilobektomie, Pneumonektomie) in Verbindung mit einer systematischen Lymphadenektomie lassen sich Fünfjahresüberlebensraten von über 80 % im Frühstadium IA bzw. 48 % im Stadium II erzielen. Neben der offenen chirurgischen Resektion konnten weltweit minimal-invasive, videoassistierte thorakoskopische Resektionsverfahren (VATS, „video-assisted thoracic surgery") im Stadium I und II erfolgreich etabliert werden. Im Stadium II kann eine adjuvante Chemotherapie das Überleben positiv beeinflussen.

Diskussion

Ob zielgerichtete Krebstherapien (sog. „targeted therapies") oder eine Immuntherapie im neoadjuvanten oder adjuvanten Therapiekonzept beim NSCLC im Frühstadium das Überleben der Patienten verbessern, wird momentan in Studien untersucht.

https://ift.tt/2AcKHxg

Lebensqualität und Depression bei Hörminderung

Zusammenfassung

Hintergrund

Hörbehinderungen können zu einer verminderten Lebensqualität führen und somit einen Vulnerabilitätsfaktor für psychische Störungen darstellen.

Ziel der Arbeit

Diese Studie stellt die erste grundlegende Analyse subjektiver Lebensqualität und depressiver Symptome bei Hörbehinderung in Deutschland aus psychiatrischer Perspektive dar.

Material und Methoden

Die Patientengruppe umfasste 30 hörbehinderte Probanden (27 Frauen, 3 Männer), die eine aktuelle oder vergangene psychische Erkrankung und/oder eine psychiatrisch-psychotherapeutische Behandlung vorwiesen (Alter: Mittelwert [M] = 49,67 Jahre, Standardabweichung [SD] = 13,54). Die Kontrollgruppe bestand aus 22 hörbehinderten Probanden (16 Frauen, 6 Männer), die weder eine psychische Störung noch eine dementsprechende Behandlung angaben (Alter M = 52,41 Jahre, SD = 17,30). Neben soziodemografischen Daten wurden der Beginn/Grad der Hörbehinderung sowie die Versorgung mit Hörsystemen erfasst. Testdiagnostisch wurden die subjektiv wahrgenommene Funktionsbeeinträchtigung (Sheehan Disability Scale [SDS]) und die gesundheitsbezogene Lebensqualität (Fragebogen zum Gesundheitszustand, SF-36) ermittelt. Zudem erfolgte eine Erhebung depressiver Symptome (Beck-Depressions-Inventar, BDI-II).

Ergebnisse

Die Gruppen unterschieden sich nicht signifikant bzgl. Alter, Geschlecht und Intelligenz. Teilnehmer der Patientengruppe wiesen eine signifikant höhere subjektive Beeinträchtigung, niedrigere Lebensqualität und stärkere depressive Symptome auf. Als potenzielle Vulnerabilitätsfaktoren auf seelische Gesundheit innerhalb dieser Gruppe erscheinen insbesondere das Ausmaß der Invasivität der Hörhilfe (d. h. Cochlea-Implantat) sowie Entwicklungszeitpunkt der Hörminderung (postlingual) plausibel.

Schlussfolgerung

Die Ergebnisse dieser Studie bedeuten für den Behandler, dass dieser neben einer qualitativ hochwertigen akustischen Versorgung die psychosoziale Behandlungsbedürftigkeit der psychischen Folgen, bedingt durch den Verlust der Lebensqualität, kontinuierlich prüfen sollte. Die Entwicklung eines spezifischen psychotherapeutischen Angebots für Menschen mit einer Hörminderung bedarf zusätzlicher Erforschung von Schutz- und Vulnerabilitätsfaktoren, die für die Entwicklung psychischer Störungen bei Hörminderung von Bedeutung sein können.

https://ift.tt/2OWX5d2

Recovery of positional nystagmus after benign paroxysmal positional vertigo fatigue

Abstract

Purpose

In benign paroxysmal positional vertigo (BPPV), positional nystagmus is generally weaker when the Dix–Hallpike test is repeated. This phenomenon is known as BPPV fatigue. The positional nystagmus induced by the Dix–Hallpike test can be observed again when time has passed. There has been no study regarding the length of time required to recover the positional nystagmus. The purpose of this study was to examine whether positional nystagmus recovers within 30 min after the disappearance of the nystagmus by BPPV fatigue.

Methods

This was a prospective observational study. Twenty patients with posterior canal type of BPPV (canalolithiasis of the posterior canal) were included. Dix–Hallpike tests were performed three times for each patient. A second Dix–Hallpike test was performed immediately after the first Dix–Hallpike test. A third Dix–Hallpike test was performed 30 min after the second Dix–Hallpike test. We recorded positional nystagmus induced by the Dix–Hallpike tests and analyzed maximum slow-phase eye velocity (SPEV) of the positional nystagmus.

Results

The average maximum SPEV of positional nystagmus induced by the second Dix–Hallpike test (4.8°/s) was statistically lower than that induced by the first Dix–Hallpike test (48.0°/s); this decrease was caused by BPPV fatigue. There was no statistical difference between average maximum SPEV of positional nystagmus induced by the first Dix–Hallpike test and that induced by the third Dix–Hallpike test (41.6°/s); this indicates that the effect of BPPV fatigue disappeared. The effect of BPPV fatigue disappears within 30 min.

Conclusions

A second Dix–Hallpike test should be performed at least 30 min after the first.

https://ift.tt/2ChtQuG

Prevention of Dermatitis in Epoxy Exposed Workers

Conditions:   Contact Dermatitis;   Sensitization Dermatitis
Intervention:   Device: Fluorescence visualization (feedback)
Sponsors:   Aarhus University Hospital;   Arbejdsmiljøforskningsfonden;   Vestas Wind Power;   Siemens Gamesa Renewable Energy;   Skane University Hospital;   Herning Hospital;   National Research Centre for the Working Environment, Denmark;   Aalborg Universitetshospital
Not yet recruiting

https://ift.tt/2yeM8Kc

Effects of Mobilization and Perceptive Rehabilitation on Patients With Fibromyalgia Syndrome

Condition:   Fibromyalgia
Interventions:   Other: Perceptive Rehabilitation;   Other: Mobilisation Techniques
Sponsor:   European University of Lefke
Not yet recruiting

https://ift.tt/2yHtLNg

Comparison of diagnostic effects of infrared imaging and bitewing radiography in proximal caries of permanent teeth

Abstract

This study aimed to compare the diagnostic efficacy of VistaCam iX intraoral camera system using infrared light and bitewing radiography for detection of proximal caries in permanent teeth. This in vitro study was performed on 108 teeth. The proximal surfaces of the teeth were examined for caries using ICDAS II criteria, bitewing radiography, and the Proxi head of VistaCam iX. The teeth were then sectioned and histologically analyzed (gold standard). Data were analyzed using SPSS version 25 via the correlation test at P < 0.05 level of significance. The overall and segmental sensitivity and specificity values were calculated for (1) the contact area and higher regions, (2) below the contact area to the cementoenamel junction (CEJ), and (3) below the CEJ. Radiography had the highest specificity. VistaCam had the highest overall and segmental sensitivity for enamel caries. Radiography had the highest segmental sensitivity for dentin. In region 1, VistaCam had the highest sensitivity and lowest specificity, and radiography and ICDAS II had the highest specificity and lowest sensitivity. In region 2, radiography showed the highest sensitivity and specificity. VistaCam had the lowest sensitivity and ICDAS II had the lowest specificity in this region. In region 3, VistaCam did not detect any caries and radiography had a better performance than ICDAS II. The specificity value was equal for both methods. VistaCam had the highest diagnostic efficacy among the three methods for caries in region 1; however, bitewing radiography had a superior efficacy in regions 2 and 3.

https://ift.tt/2AatPXT

Japanese familial anetoderma: A report of two cases and review of the published work

The Journal of Dermatology, EarlyView.


https://ift.tt/2OqEoix

Extracellular proteoglycan decorin maintains human hair follicle stem cells

The Journal of Dermatology, EarlyView.


https://ift.tt/2yICMFU

Indeterminate dendritic cell neoplasm accompanied by eosinophilic pneumonia successfully treated by systemic steroid therapy: Report of the first case with muscular and parotid involvement and review of published work

The Journal of Dermatology, EarlyView.


https://ift.tt/2yICOO2

Cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis in a Japanese patient with cardiac sarcoidosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2OqEtCR

Sexuell übertragbare Infektionen in den Tropen

Zusammenfassung

Sexuell übertragbare Infektionen (STI) sind weltweit häufig; allein die Inzidenz für Chlamydien-Infektionen, Gonorrhö, Syphilis und Trichomoniasis wird auf 500 Mio. Fälle/Jahr geschätzt. Drei Viertel dieser Infektionen entfallen auf tropische Länder in Lateinamerika, Subsahara-Afrika sowie Süd- bzw. Südostasien. Unter „tropischen Geschlechtskrankheiten" werden die bakteriellen Infektionen Ulcus molle, Lymphogranuloma venereum und Granuloma inguinale zusammengefasst. Diese treten vornehmlich in den Ländern zwischen den Wendekreisen auf – Regionen, die zum einen durch ein feucht-heißes Klima, zum anderen vielfach durch Armut und Unterentwicklung gekennzeichnet sind. Die 3 Erkrankungen gehen primär mit Ulzera einher; ihr Vorliegen stellt daher ein erhöhtes Risiko für die Übertragung von HIV und anderen STI dar. Wie bei allen STI gilt auch für die Tropeninfektionen, dass Risikominimierung durch Verzicht auf riskante Sexualpraktiken und Kondombenutzung essenziell sind.

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Monitoring treatment response in patients affected by actinic keratosis: dermoscopic assessment and metalloproteinases evaluation after piroxicam 0.8% and sunfilter cream

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OqCVJ2

Recent advances in the histological and molecular classification of endometrial stromal neoplasms

Abstract

This review addresses known features and recent developments in the histological, immunohistochemical, and molecular characterization of endometrial stromal neoplasms. We discuss the spectrum of these tumors, from the benign endometrial stromal nodule to low-grade endometrial stromal sarcoma to uterine undifferentiated sarcomas with a special emphasis on the expanding group of high-grade stromal sarcomas, recently added to the 2014 WHO classification, not only discussing the well-established YWHAE-FAM22 tumors but also two new groups, presenting with BCOR alterations including those with BCOR tandem internal duplications or NTRK fusions. It is likely that this high-grade category of endometrial stromal tumors will expand as increasing molecular data is available.

https://ift.tt/2Ck0dsu

Heated humidified high-flow nasal oxygen prevents intraoperative body temperature decrease in non-intubated thoracoscopy

Abstract

Purpose

In patients receiving non-intubated video-assisted thoracic surgery (NIVATS), transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has been applied instead of oxygen mask for better oxygenation. However, the THRIVE effects on intraoperative temperature decrease have not been investigated.

Methods

Pre- and postoperative temperatures, measured by an infrared tympanic ear thermometer, taken before sending patients to the operation room and immediately upon their arrival in the postoperative anesthesia unit, were collected from medical records of patients who received NIVATS either with oxygen mask or THRIVE. Intraoperative temperature decrease, calculated by preoperative temperature minus postoperative temperature, was compared between different groups. Multiple linear regression analysis was performed to determine factors associated with intraoperative temperature decrease.

Results

Records of 256 adult patients with forced-air warming were retrospectively analyzed. 172 patients of them received THRIVE and 84 patients received oxygen mask. Preoperative temperatures were comparable between groups (THRIVE: 36.25 ± 0.46 °C; mask: 36.30 ± 0.39 °C, p = 0.43). Postoperative temperatures were significantly higher in patients using THRIVE than those using oxygen masks (36.05 ± 0.59 vs 35.87 ± 0.62 °C, p = 0.025). Significantly less intraoperative temperature decrease was shown in THRIVE group (THRIVE: 0.20 ± 0.69 °C; mask: 0.43 ± 0.69 °C, p = 0.04). According to the multiple linear regression analysis, significant temperature decrease was associated with the advanced age (β_age = 0.01) but not the anesthetic duration. Using THRIVE was correlated with significantly less body temperature decrease (β_TRIVE = − 0.24).

Conclusions

THRIVE effectively prevents intraoperative temperature decrease during NIVATS, especially in old patients.

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Clinical Use of the Pictorial Baxter Retching Faces Scale for the Measurement of Postoperative Nausea in Children

BACKGROUND: Because nausea is difficult to evaluate in children, vomiting is used as the objective clinical end point in managing pediatric postoperative nausea and vomiting and postdischarge nausea and vomiting (PDNV). The recently developed pictorial Baxter Retching Faces (BARF) scale has content, construct, and convergent validity in quantifying pediatric nausea intensity. We determined its clinical usefulness in assessing pediatric postoperative nausea and vomiting and PDNV, establishing the lowest age associated with consistently reliable use, the score at which patients identify a need for therapy, and the minimum clinically relevant change in scores, and examined its test–retest reliability. METHODS: We obtained subject ratings of the severity of their nausea using the BARF and visual analog scales in the preoperative, postanesthesia care unit and postdischarge phases. Changes in nausea were rated on a 5-point Likert scale, along with responses to queries of a need for rescue antiemetics at these time points. RESULTS: Children ≥6 years of age had a consistently reliable ability to use the BARF scale (132/132 [100%] vs 59/76 [77.6%] for children ≥6 and 6) in 13 (6.7%). Emesis occurred in 8 (4.1%). Rescue antiemetics were administered to 16 (8.3%), including 2 with severe emesis (≥3 episodes) but in only 2 of 11 (18.2%) with severe nausea without vomiting. PDNV was reported in 39 of the 99 who returned diaries (39.4%), with nausea in 34 (34.3%), severe nausea in 15 (15.2 %), and emesis in 16 (16.2%). CONCLUSIONS: The pictorial BARF scale is easy to use in the clinical setting by children ≥6 years of age, has a minimum clinically relevant difference of 1.47, with scores of 4 or higher associated with a patient-identified need for rescue antiemetics. Assessment of postoperative nausea by the BARF scale has shown that clinically significant nausea occurs frequently in children but is not always treated unless accompanied by vomiting. Accepted for publication September 5, 2018. Funding: This work was supported by internal funding from the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, and Baylor College of Medicine, Houston, TX. The authors declare no conflicts of interest. Clinical trials registration: The trial was registered before patient enrollment at clinicaltrials.gov (NCT 02421952, principal investigator: S.A.B.; date of registration: April 21, 2015). Reprints will not be available from the authors. Address correspondence to Mehernoor F. Watcha, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, 6621 Fannin St, Suite A 3300, Houston, TX 77030. Address e-mail to mwatcha@gmail.com. © 2018 International Anesthesia Research Society

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Anesthesia in Enhanced Recovery Pathways for Hip and Knee Arthroplasty: Where Is the Evidence?

No abstract available

https://ift.tt/2CM8l6v

Rapid Titration of Intravenous Treprostinil to Treat Severe Pulmonary Arterial Hypertension Postpartum: A Retrospective Observational Case Series Study

BACKGROUND: Pulmonary hypertension during pregnancy carries high mortality rate. The relatively long-acting, specific pulmonary vasodilator treprostinil has been used to improve survival in these parturients. Slow uptitration is performed in most cases, and rapid titration has not been reported in the postpartum period. METHODS: We retrospectively reviewed 17 pregnant patients with severe pulmonary arterial hypertension who were treated with intravenous treprostinil in our institution between 2014 and 2016. Patients' demographic characteristics, etiology, functional status, mode of delivery, anesthetic administration, medical therapy, echocardiographic and hemodynamic measurements, subsequent clinical course, and maternal–fetal outcomes were assessed. The a priori primary outcome is maternal mortality in this study. RESULTS: Rapid titration of intravenous treprostinil was initiated at 1.25 ng/kg/min and increased to effective dose of 10 ng/kg/min by 1.25–2.5 ng/kg/min every 3 hours. In the next 24 hours, we adjusted the dosage to a median maximum dose of 15 ng/kg/min (interquartile range, 15–20 ng/kg/min) over a median uptitration period of 34 hours (interquartile range, 24–41 hours) for 17 parturients with severe pulmonary hypertension. Treprostinil was weaned off by 0.50–1.25 ng/kg/min every 3 hours in 94.3 ± 42.4 hours. Fifteen patients survived to discharge, and only 2 patients died of pulmonary hypertensive crisis (maternal mortality rate, 11.7%). No treprostinil infusion-related postpartum complication was observed. CONCLUSIONS: Our experience suggested that rapid uptitration of intravenous treprostinil combined with oral sildenafil in the postpartum period may be a safe and effective approach for these very sick parturients with severe pulmonary hypertension. Accepted for publication August 23, 2018. Funding: None. The authors declare no conflicts 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 website (https://ift.tt/KegmMq). T. Wang and J. Lu contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Jiapeng Huang, MD, PhD, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 200 Abraham Flexner Way, Louisville, KY 40202. Address e-mail to jiapenghuang@yahoo.com; and Jinglan Zhang, MD, Department of Surgical Intensive Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing AnZhen Hospital, Capital Medical University, No. 2 AnZhen Rd, Chaoyang District, Beijing 100029, People's Republic of China. Address e-mail to jinglanzhang2006@163.com. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Electronic Audit and Feedback With Positive Rewards Improve Anesthesia Provider Compliance With a Barcode-Based Drug Safety System

BACKGROUND: We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an implementation intervention intended to increase the rate of scanning. METHODS: Using our Anesthesia Information Management System and Smart Anesthesia Manager software, we quantified syringe drug administrations by anesthesia providers with and without barcode scanning. We use an anesthesia team model in which an attending anesthesiologist is paired with a certified registered nurse anesthetist (CRNA) or a resident. Our system identified the pair of providers associated with a particular drug administration, but did not distinguish which providers actually administered the drug. Therefore, the rate of barcode scanning for a particular case was assigned to both providers equally. A baseline rate of scanning was established over a period of 17 months. An audit and feedback intervention was then performed that consisted of monthly performance reports sent by email to individual providers along with coffee gift card awards for top performers. The coffee gift cards were awarded in only the first 2 months of the intervention, while the email performance reports continued on a monthly basis. The coffee card awards were made public. The monthly emails reported the individual provider's rank order of performance relative to other providers, but was otherwise anonymous. The baseline rate of scanning was compared to the rate of scanning after the intervention for a period of 7 months. RESULTS: From November 2014 to March 2017, we accumulated 60,197 cases performed by 88 attending anesthesiologists, 65 CRNAs, and 148 residents. The total number of syringe drug administrations was 653,355. Average scanning performance improved from 8.7% of syringe barcodes scanned during the baseline period from November 2014 to February 2016 to 64.4% scanned during the period September 2016 to March 2017 (P

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In Response

No abstract available

https://ift.tt/2Cf0hK9

Improving outcomes in ambulatory anesthesia by identifying high risk patients

Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstructive sleep apnea, and obesity. Frailty has recently been linked to increased complications in ambulatory surgery as well. Newer ambulatory procedures such as spine and total joint arthroplasty require careful patient selection. Summary Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery. Correspondence to Michael T. Walsh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +507 284 9700; fax: +507 284 0120; e-mail: walsh.michael1@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2IXRde2

Hepatic Critical Care

No abstract available

https://ift.tt/2CKNvEa

Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients

BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65–90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible,

https://ift.tt/2CgwfFV

Attenuation of Unevoked Mechanical and Cold Pain Hypersensitivities Associated With Experimental Neuropathy in Mice by Angiotensin II Type-2 Receptor Antagonism

Recent findings from a phase II clinical trial showed analgesic effects of an angiotensin II type-2 receptor (AT2R) antagonist in postherpetic neuralgia patients. This study aimed to investigate whether AT2R antagonism could provide effective analgesia in voluntary measures of unevoked/ongoing pain-like behaviors in mice with experimental neuropathy. Mice were subjected to spared nerve injury to induce neuropathy and tested in 2 operant behavioral tests to measure ongoing mechanical and cold pain hypersensitivities. Systemic administration of an AT2R antagonist provided effective analgesia in these behavioral measures of mechanical and cold pain in spared nerve injury mice, suggesting its effectiveness in neuropathic pain. Accepted for publication September 6, 2018. Funding: This study was supported by a pilot and feasibility grant from the Washington University Nutrition Obesity Research Center National Institutes of Health grant P30DK056341 (to A.J.S.) and by start-up funds from the Department of Anesthesiology, Washington University Pain Center and Washington University School of Medicine (to D.P.M.). The authors declare no conflicts 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 website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Andrew J. Shepherd, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to a.shepherd@wustl.edu; and Durga P. Mohapatra, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to d.p.mohapatra@wustl.edu. © 2018 International Anesthesia Research Society

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Initial results of ixekizumab efficacy and safety in real‐world plaque psoriasis patients: A multicenter retrospective study

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2CfZ05C

Picosecond laser for atrophic surgical scars treatment: in vivo monitoring of results by means of reflectance confocal microscopy

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Aa5660

Long‐term efficacy and safety of ixekizumab in Japanese patients with erythrodermic or generalized pustular psoriasis: Subgroup analyses of an open‐label, phase 3 study (UNCOVER‐J)

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2AaLNcV

Association between psoriasis, psoriatic arthritis and gout: A nationwide population‐based study

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Ci1RLz

Systemic corticosteroid use in psoriasis: a national survey of board‐certified dermatologists

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Ab66qA

Response to critical appraisal of LIBERTY AD CHRONOS

British Journal of Dermatology, EarlyView.


https://ift.tt/2OnCzCS

Response to Critical appraisal of LIBERTY AD CHRONOS: reply from authors

British Journal of Dermatology, EarlyView.


https://ift.tt/2IXQCcn

Noncaseating suppurative granulomatous lymphadenitis in adult onset Still’s disease – a diagnostic dilemma in a tuberculosis-endemic region: a case report

Lymphadenopathy is not an uncommon presentation of adult onset Still's disease: it is present in up to two thirds of patients with adult onset Still's disease. The characteristic appearance of lymphadenopathy ...

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The effectiveness of hyperbaric oxygen in patients with idiopathic sudden sensorineural hearing loss: a systematic review

Abstract

Objective

To evaluate the effectiveness of hyperbaric oxygen in the treatment of patients with idiopathic sudden sensorineural hearing loss (ISSHL).

Data sources

An Embase, MEDLINE and Cochrane search were utilised to identify various clinical trials on the treatment of ISSHL. Studies that were published between 2002 and 2018 and written in the English, Dutch or German language were included. Search terms included synonyms for idiopathic sudden hearing loss.

Data synthesis

A total of 16 articles were identified regarding hyperbaric oxygen therapy. All patients were evaluated with pure-tone audiometry. A major part of the cases presented with unilateral hearing loss(bilateral hearing loss less than 5%). In several studies, the average of the mean hearing gain at five contiguous frequencies was significantly higher in the hyperbaric oxygen (HBO) therapy and systemic steroid (SS) group in patients with severe or profound hearing impairment. They recorded a significant treatment effect (p = 0.005) of HBO + SS therapy on patients with an initial hearing loss of ≥ 81 dB.

Conclusions

On the whole group of ISSHL patients, no significant difference was demonstrated between the intervention and control group. However, in severe or profound hearing-impaired ISSHL patients, significant benefit was observed in the intervention group. These results likely indicate that adding HBO to steroid therapies might be of benefit in cases of severe and profound hearing impairment.

https://ift.tt/2AaCcTe

The Use of a Double Suture and Conjunctival Cuts in the Lateral Tarsal Strip: A New Approach to Involutional Ectropion

Purpose: To describe the use of a double suture and conjunctival cuts in the lateral tarsal strip (LTS) and to evaluate postsurgical outcome in patients with severe involutional ectropion. Methods: A prospective randomized study was conducted on 16 eyelids of 8 patients with symptomatic severe involutional ectropion. The 8 patients were between 62 and 79 years. They were distributed into 2 groups consisting of 4 patients each. The control group was treated with a conventional lateral tarsal strip (C-LTS), the second group underwent a modified lateral tarsal strip (M-LTS). The mean follow-up was 18 months. Success was defined as relief in lid laxity. The recurrence rate was also evaluated. Results: Patients treated with M-LTS showed lower horizontal laxity (3.5 ± 0.2) than patients treated with C-LTS (5.7 ± 0.2). During the 18-month follow-up, a statistically significant difference was found between the 2 groups with P value

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Early Surgical Treatment in Anterior Synostotic Plagiocephaly: Is This the Best Choice?

At the end of craniofacial growth, in anterior synostotic plagiocephaly, some aesthetical deficiencies may still be evident. This can depend on an inadequate initial correction or on altered postoperative growth or even on the combination of the 2 factors. Aesthetic alterations can result from various factors that could potentially affect the skeleton, the skin, subcutaneous, and muscular tissues. The pathological changes in the cutaneous and subcutaneous tissues are greater in patients who have undergone multiple surgical treatments of the frontoorbital area. The aim of this observational cohort study is to assess the residual aesthetic and functional impairment at the end of skeletal growth, in patients affected by anterior synostotic plagiocephaly who have undergone surgery at an early age. The purpose is to investigate whether early surgery can still be considered unavoidable in patients with this malformation. Between July 2012 and February 2015, patient's data were retrieved from our archives among the patients referred to our department from 2003 to 2012 for Anterior Synostotic Plagiocephaly at an early age. The authors studied this patient with CT scans and photographic documentation. On CT scans, the authors have assessed skeletal alterations, soft tissues alterations, and muscular tissue alterations. With photographic documentation, the authors have studied the perception of the malformation among external subjects. From this study it was possible to demonstrate that is many esthetical alterations are to still to be found in patients treated with an early surgical approach; for this reason in children without early complications, the authors suggest that surgical treatment should be delayed after the end of craniofacial growth. Address correspondence and reprint requests to Paolo De Angelis, DDS, Via Vittorio Emanuele 28, Ascoli Piceno (63100). Italy; E-mail: dr.paolodeangelis@gmail.com Received 6 May, 2018 Accepted 21 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Ex Vivo Time of Fresh Autologous Cartilage Before Transplantation and Cartilage Absorption Degree

Objective: This study aims to determine the relationship between the time of autogenous cartilage in vitro and the degree of absorption in animal experiments. Methods: New Zealand white rabbits were randomly divided into 3 groups according to the time of cartilage in vitro: 1-hour group, 2-hour group, and 3-hour group. A volume of ear cartilage was taken and transplanted into the back, according to the group. After 1 month, the volume was taken out and remeasured. Then, these were compared by scanning electron microscopy and hematoxylin and eosin staining. Results: The cartilage bulk absorption level of different groups is different (P 

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Success Rate and Complications of Cerebrospinal Fluid Rhinorrhea Treated with a Transcranial Approach

The aim of this study was to evaluate the clinical outcomes of cerebrospinal fluid (CSF) rhinorrhea in patients treated with transcranial surgery. Here, we retrospectively reviewed 23 patients with CSF rhinorrhea between 2008 and 2015 at our university hospital. Nine (39.1%) patients were treated conservatively, whereas 12 (52.2%) patients were treated with a transcranial approach. Our results showed that 7 (30.4%), 11 (47.8%), and 5 (21.7%) patients had spontaneous, traumatic, and iatrogenic CSF leakage, respectively. In our study, the cribriform plate was the most common site of leakage, and it was found to be involved in 5 (21.7%) patients. The mean diameter defect of the fistula was 130.40 ± 190.47 mm2 and there was no significant difference between this defect and the different etiology types. In our study, meningitis, third nerve palsy, and vasospasm were the main complications that arose during the treatment of CSF rhinorrhea. Moreover, 6 (26.1%) of 7 (30.4%) patients had spontaneous CSF leaks that were treated with surgery. Notably, spontaneous CSF leaks did not stop when treated with conservative measures. In addition, there were no significant differences between etiology types and CSF leaks. The primary surgical repair rate was 78.3% and the secondary surgery repair rate was 91.6%. Importantly, as we preferred using this type of transcranial surgery in our clinic, there has been a higher success rate with endoscopic treatments and fewer major complications from CSF rhinorrhea in the literature. Address correspondence and reprint requests to Ceren Kizmazoglu, MD, Dokuz Eylul University School of Medicine, Department of Neurosurgery, 35340 Balçova, Izmir/Turkey; E-mail: ceren.kizmazoglu@gmail.com Received 27 May, 2018 Accepted 16 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Reconstruction of Major Dehiscence After Bilateral Cleft Lip Repair

Repair of complete bilateral cleft lip with protruding premaxilla is challenging, and postoperative dehiscence was common. Re-repair is usually suggested for the dehisced lip, but other methods might be needed in unique situations. Evaluation was performed to check the presence of prolabial skin, wound scarring, and the position of premaxilla. Reconstruction plan was made to restore the anatomical components as possible and to repair under minimal tension. Two patients with major dehiscence were reported. In the first case, separation from the columella base and tissue destruction in central lip were noted. Repeated complete dehiscence on one side was reported in the second case before he was referred to our center. The premaxilla was protruding in both cases. Abbe flap was performed as delayed procedure in the first case. Reposition of the premaxilla in conjunction with lip repair was required in the second case. In both cases, adequate muscle approximation plus subcutaneous retention sutures were used to cope with the tension, and satisfactory healing was achieved. It is concluded that additional methods could be required for the reconstruction of major dehiscence after bilateral cleft lip repair. Careful planning and surgical execution ensured successful outcome. Address correspondence and reprint requests to Lun-Jou Lo, MD, Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kwei Shan, Taoyuan 333, Taiwan; E-mail: lunjoulo@cgmh.org.tw Received 30 April, 2018 Accepted 27 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2RPmzaL

A New Approach to Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate and Severe Cleft Width

The aim of this study was to describe a new approach to the presurgical orthopedic treatment of unilateral cleft lip and palate patients with severe cleft width. Modified nostril retainers manufactured from soft acrylic were used for the nasal molding. This technique enables the separation of the nasal molding without having to reduce the cleft width to 5 mm. Nasal molding with the modified nostril retainer resulted in the patient and the physician experiencing a more comfortable treatment period. Address correspondence and reprint requests to Serap Titiz, MS, Department of Orthodontics, Faculty of Dentistry, Usak University, Izmir, Turkey; E-mail: dtseraptitiz79@hotmail.com Received 30 November, 2017 Accepted 3 August, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Vagus Nerve Schwannoma Mimicking a Lateral Neck Cyst

Schwannomas are benign tumors originating from Schwann cells of the myelin sheath. The cystic appearance of a cervical vagal schwannoma is an extremely rare finding, with few patients reported in the literature. A 60-year-old female patient was seen at our service for a slow-growing, 9 × 6 cm left-sided cystic neck mass. Preoperative clinical and computed tomography evaluation suggested a diagnosis of a lateral neck cyst. The surgical exploration through the lateral cervicotomy revealed a large cystic mass and clearly identified that the tumor was originating from the left vagal nerve. The histopathologic analysis confirmed the diagnosis of schwannoma. Although uncommon, vagal schwannoma with pronounced cystic component should be included in the differential diagnosis of the cystic neck swellings. Address correspondence and reprint requests to Ognjen Cukic, MD, Department of Otorhinolaryngology With Maxillofacial and Cervical Pathology, Clinical Hospital Centre Zemun, Vukova 9, 11080 Zemun, Serbia; E-mail: ognjen.cukic.bg@gmail.com Received 3 July, 2018 Accepted 30 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Year Follow-Up of a Patient With Unilateral Cleft Lip and Palate Treated With Maxillary Protraction and Alveolar Bone Grafting: An Approach Exploring the Potential Power of Growth

Clinically, patients with operated unilateral cleft lip and palate always present with a concave profile, depressed midface, maxillary hypoplasia, narrow upper dental arch, and class III malocclusion. In this clinical report, the authors describe the successful orthodontic treatment of a patient with unilateral cleft lip and palate. A boy, 7 years 11 months of age, with a history of unilateral cleft lip and cleft palate presented with a Class I malocclusion on Skeletal Class III base. A satisfactory occlusion and a favorable lateral profile were achieved after maxillary protraction (face mask) combined with fixed appliance treatment, including alveolar bone grafting surgery. An acceptable occlusion and facial proportion were maintained after a 3-year retention period. These results suggest orthodontic treatment with growth interference is an effective option for a patient with cleft lip and palate. Address correspondence and reprint requests to Dr Zhenqi Chen, PhD, Department of Orthodontics, Shanghai Ninth People's Hospital, School of Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai 200011, China; E-mail: zqchen@shsmu.edu.cn Received 3 January, 2018 Accepted 2 July, 2018 This study was supported by grants from National Key R&D Program of China (2017YFC0840100, 2017YFC0840110). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2IXHZyq

Bilateral Antrochoanal Polyp in a Child

No abstract available

https://ift.tt/2EksKAV

Clinical Outcomes Between Atrophic and Nonatrophic Mandibular Fracture in Elderly Patients

The number of elderly patients with mandibular fracture is rapidly increasing. To improve outcome, it is important to understand the age-related characteristics of mandibular fracture. Thus, the aim of this study is to analyze the impact of atrophic change on mandibular fracture in elderly patients. The retrospective study was conducted in patients aged ≥65 years old, who underwent surgery for the treatment of mandibular fracture in our hospital from March 2006 until March 2015. Patient characteristics, such as age and gender, causes of injury, anatomic location of fracture, height of mandibular body, extent of atrophy, location of surgical sites, postoperative outcomes, and the follow-up period, were examined. Descriptive statistics were compared between atrophic and nonatrophic mandibles. The patients included 17 males and 12 females and the mean age was 71.9 years old. The average follow-up period was 6.06 months. Regarding occlusion and complications, there were no statistical differences between the atrophic and nonatrophic mandibular fractures. As major complications, nonunion occurred in 2 patients and malunion in 1 patient. There was no mortality associated with anesthesia or surgery. Atrophic and nonatrophic mandibular fractures in elderly patients can be treated successfully with surgery. There was no significant difference with respect to major complications between patients with atrophic and nonatrophic mandibular fractures. Address correspondence and reprint requests to Kyu Jin Chung, MD, PhD, Department of Plastic and Reconstructive surgery, College of Medicine, Yeungnam University Hospital, 170 Hyeonchung-ro, Postal code 42415, Namgu, Daegu, Korea; E-mail: chungkj@ynu.ac.kr Received 31 October, 2017 Accepted 2 July, 2018 This work was supported by the 2017 Yeungnam University Research Grant. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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The Periangular Approach to the Posterior Mandible: A Novel Approach and Technique

There exist 2 classic extraoral approaches to the posterior aspect of the mandible, namely the submandibular or Risdon approach, and the retromandibular approach. Despite their widespread use, there still exist concerns of damage to surrounding structures, in particular cranial nerve VII, as well as vascular structures and salivary glands. Evidence of facial nerve palsy has been shown to be as high as 48% in the patient with the Risdon approach, and as high as 30% in the retromandibular approach. The authors wish to propose a more conservative, technically easier, and less time-consuming approach to the posterior mandible, with less risk of damage to the branches of the facial nerve, as well as other structures such as the facial vessels and the parotid gland. Address correspondence and reprint requests to Neel Patel, MD, DMD, Resident, Oral and Maxillofacial Surgery, University at Buffalo, The State University of New York, 3435 Main St, 112 Squire Hall, Buffalo, NY 14214; E-mail: neel.patel@hotmail.com Received 18 February, 2018 Accepted 14 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Three-Dimensional Analysis of the Correlation Between Soft Tissue and Bone of the Lower Face Using Three-Dimensional Facial Laser Scan

Background: The prime aims of this study were to establish cephalometric linear and angular normative values of the lower face using a three-dimensional (3D) analysis in Korean individuals, and validate whether the linear and angular measurements using 3D laser scanner are comparable with measurements using 3D computed tomography (CT). Methods: In this study, 40 Korean individuals aged between 18 and 60 years were enrolled. Using 3D CT scan and 3D laser scanner, linear and angular values of the lower face were measured and recorded. Statistical analysis was carried out to verify the concordance and correlation between two 3D imaging modalities. Results: The 40 samples consisted of 11 women with a mean age of 40.8 ± 14.5 years and 29 men with a mean age of 29.7 ± 15.0 years. The results demonstrated the difference between sex and the tendency of asymmetry on both sides. Among different methods of measuring angular values, the gonial angle (GA) between tragion' (Tr')-gonion' (Go')-menton' (Me') from 3D laser scanning and between articulate-gonion-menton from CT scan demonstrated a good concordance and a high correlation. Conclusions: The GA measured between Tr'-Go'-Me' using a 3D facial laser scan was comparable with values from 3D CT scan. The reference points and the GA, which we assessed here for 3D laser scanning, can be a reliable alternative method evaluating mandibular angles for assessing patients and surgical planning in plastic and orthognathic surgery. Address correspondence and reprint requests to Ho Seong Shin, MD, PhD, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, 170 Jomaru-ro, Bucheon 14584, Korea; E-mail: psshin@schmc.ac.kr Received 19 October, 2017 Accepted 29 May, 2018 This work was financially supported by the Soonchunhyang University Research Fund. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Rhinogenic Headache: Standardization of Terminologies Used for Headaches Arising From Problems in the Nose and Nasal Cavity

Objective: The use of different expressions between physicians frequently results in confusion in the process of diagnosis and treatment of patients with headaches due to problems in the nose and nasal cavity. The aim of this study was to assess the terminologies that have been used most frequently to standardize these terminologies. Methods: Terminologies that are most frequently used in general, including rhinogenic migraine, sinus headache, rhinogenic contact point headache, middle turbinate headache syndrome, and rhinogenic headache, were found by searching PubMed, Web of Science, and Google Scholar. These terminologies were objectively assessed on the basis of existing research and definitions and the range of diagnoses by organizations with public credibility. Results: There were many terminologies in use for headache related to nose; however, these were not logical expressions and only partly explained the phenomenon. Among the terms, "rhinogenic headache" was most appropriate in expressing and describing the related symptoms. Conclusion: The results indicated that the term "rhinogenic headache" is most appropriate for describing pain in the nose and eyes in patients with deformation within the nose or the nasal cavity due to external injuries or underlying diseases related to nose as observed on computed tomography. Address correspondence and reprint requests to Daniel Seungyoul Han, MD, PhD, DH Plastic Surgery Clinic (5–8th floor), 21, Gaya-daero 784 beon-gil, Busanjin-gu, Busan, Republic of Korea; E-mail: doc6029@naver.com Received 26 May, 2018 Accepted 12 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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An Unusual Case of Schwannoma in the Infraorbital Region

Schwannoma is usually an uncommon benign encapsulated slow-growing neural tumor that originates from Schwann cells of peripheral, cranial, and autonomic nerves. It constitutes 1% to 8% of all head and neck neoplasms. Extracranial schwannoma are very rarely seen originating from the infraorbital nerve. Most of the schwannomas are usually solitary and not associated with NF1. The typical presentation is a slow-growing soft-tissue mass. Treatment of schwannoma is surgical resection. Address correspondence and reprint requests to Berhan Pirimoglu, MD, Department of Radiology, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey; E-mail: berhan.dr@gmail.com Received 26 May, 2018 Accepted 18 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Place of Sterotactic Radiotherapy in Treatment of Extramedullary Plasmocytoma

In conclusion, extramedullary plasmacytoma (EMPs) initially develop as localized disease. These tumors are quite sensitive to radiotherapy (RT) and the response is often complete recovery after RT. In addition, highly sensitive, conformal radiosurgery can be preferred to conventional RT; however, further studies are needed to define indications and therapeutic fractions in stereotactic RT of plasmacytoma since guidelines and clinical trials are lacking. Although general principles are valid, radiosurgery may be planned based on anatomical localization of EMP. Address correspondence and reprint requests to Yasemin Benderli Cihan, MD, Kayseri Education and Research Hospital, Department of Radiation Oncology 38010 Kayseri, Turkey; E-mail: cihany@erciyes.edu.tr Received 27 May, 2018 Accepted 16 June, 2018 The author reports no conflicts of interest. Ethical approval: This article does not contain any studies with human participants performed by any of the author. © 2018 by Mutaz B. Habal, MD.

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Approach to Half-Nose and Proboscis Lateralis

Half-nose or heminasal aplasia is an extremely rare congenital malformation, which has a withering effect both on the patient and the family. Proboscis lateralis is a rare facial anomaly resulting in the incomplete development of one side of the nose, which was first defined in 1861 by Forster in his monograph. Proboscis lateralis, cleft nose, and nasal agenesis are rare anomalies; however, half-nose is also an extremely rare condition. In the formation of half-nose deformities, either a facial cleft or nasal dysplasia is the assumed theories of embryological origin. In the reconstruction of proboscis lateralis tissue, local flaps and forehead flaps can be used for a functional and esthetically acceptable structure. The expanded forehead flap has become commonly used in recent years. Estimating the cosmetic result of surgery is an extreme challenge because of the accompanying nasal growth of the transferred tissue and the nose. In this study, the authors report on the reconstruction of half-nose and proboscis lateralis deformity with clinical results. Address correspondence and reprint requests to Ugur Horoz, MD, Dr Ersin Arslan Training and Research Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic, Gaziantep, Turkey; E-mail: ugur_horoz@hotmail.com. Received 15 January, 2018 Accepted 3 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Does Glossopharyngeal Neuralgia Need Rhizotomy in Neurovascular Decompression Surgery?

Objective: To evaluate and compare the long-term efficacy and safety of microvascular decompression (MVD) and glossopharyngeal nerve roots rhizotomy (GNR) in the treatment of glossopharyngeal neuralgia (GN). Patients and Methods: The data of 37 patients with glossopharyngeal neuralgia undergoing MVD alone and MVD + GNR from July 2004 to March 2017 were analyzed retrospectively. Among them, 22 were MVD alone and 15 were MVD + GNR. All patients underwent preoperative cocaine experiments to verify diagnoses, preoperative magnetic resonance imaging examinations to detect compressing vessels near the root entry zone of the glossopharyngeal nerve. Operation via retrosigmoid approach, keyhole craniotomy, and postoperative efficacy was followed up. Results: Efficacy: In the 22 patients with MVD alone, 19 patients were cured and 3 patients improved. In the 15 patients with MVD + GNR, 14 patients were cured and 1 patient improved. There was no significant difference between the 2 groups (χ2 test, P > 0.05). Complications: Postoperative complications in MVD group: 2 patients had short-term hoarseness and drinking cough, 1 patient with cerebrospinal fluid leakage, 1 patient with intracranial infection, 1 patient with ipsilateral hearing loss, and no deaths; postoperative complications in MVD + GNR group: permanent hoarseness in 2 patients, short-term drinking cough and hoarseness in 4 patients, ipsilateral facial paralysis in 1 patient, 1 patient with cerebrospinal fluid leakage, no intracranial infection and death. The incidence of postoperative hoarseness and drinking cough in MVD + GNR group was higher than that in MVD group (χ2 test, P 

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Sphenoid Sinus in Relation to Age, Gender, and Cephalometric Indices

The sphenoid sinus is located in the center of the cranial base and is surrounded by numerous neurovascular structures. The aim of this study was to determine sphenoid sinus types and subtypes, dimensions of the sinus and cranium, and the relations of these to age and gender. Computed tomography data was obtained from 144 patients to determine right sphenoidal volume (sphVOLR), left sphenoidal volume (sphVOLL), total sphenoidal volume (sphVOLT), anteroposterior length of the sphenoid sinus (sphAP), laterolateral length of the sphenoid sinus (sphLL), head circumference (crHC), fronto-occipital length (crFO), and biparietal length (crBP), with OSIRIX software. The patients' ages ranged between 9 and 83 years (mean age 38 ± 15.5 years). The study included 89 males (mean age 39 ± 15.5 years) and 55 females (mean age 38 ± 15.6 years). Conchal (1.4%), presellar (8.3%), sellar (23.6%), and postsellar (66.7%) type sphenoid sinuses were determined based on the extension of pneumatization around the sella turcica. Each type of sphenoid sinus was classified into the following 5 types based on the direction of pneumatization: body, full lateral, pterygoid, lesser wing, and greater wing subtypes. Mean sphAP was determined as 29.72 mm and mean sphLL as 37.73 mm. In 5 patients only (3.4%), the sphenoid sinus was not divided into right and left by the intersphenoidal septum. The variations in the extensions of pneumatization of the sphenoid sinus and its dimensions might be used to estimate the selection of a surgical approach to lesions bordering the sinus. Address correspondence and reprint requests to Çağatay Barut, MD, PhD, Department of Anatomy, Faculty of Medicine, Bahçeşehir University, Sahrayicedit Mah. Batman Sokak No: 66–68, Göztepe, Istanbul, Turkey; E-mail: cagbarut@yahoo.com Received 2 February, 2018 Accepted 2 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Assessment of Neurologic Disorders and Rare Intracranial Anomalies Associated With Cleft Lip and Palate

Accompanying neurologic disorders directly affect psychosocial development of cleft lip and/or cleft palate (CLP) patients and make it difficult for their family to look after them properly. The aim of this study was to investigate the diversity and the incidence of additional neurologic malformations in children with CLP and to evaluate their effects on cleft care. All patients who applied to our Cleft and Craniofacial Center between July 2014 and July 2017 were included in the study. Demographic and perioperative data such as gender, cleft type, syndromic status of the patient, associated neurologic anomalies, timing and duration of operation, hospitalization period, and follow-up period in the intensive care unit are all recorded. All patients received an interdisciplinary evaluation including pediatric neurology specialists in terms of mental and/or motor developmental delay, epilepsy, and other neurologic disorders. After detailed neurologic examination, 83 (3.8%) out of 2190 were reported as having a neurologic defect. The most leading neurologic disorder was found to be mental-motor retardation in 57 children followed by epileptiform disorders detected in 36 children. In 22 patients, rare intracranial pathologies were detected on magnetic resonance imaging. According to our results, having a neurologic pathology increases the need for intensive care unit stay by 5 times in these patients. There was statistically significant relationship between hospitalization period, age of cleft surgery, and neurologic pathologies in these patients. Neurologic disorders could complicate cleft care, cause delays in the planned surgery schedule, and increase perioperative and postoperative morbidity. Address correspondence and reprint requests to Mert Calis, MD, FEBOPRAS, Department of Plastic Reconstructive and Aesthetic Surgery and Hacettepe Cleft and Craniofacial Center, Hacettepe University Faculty of Medicine, Angora Evleri F11 Blok D:32 Beysukent, Çankaya, Ankara, Turkey; E-mail: mertcalis@gmail.com Received 22 March, 2018 Accepted 17 June, 2018 This study has been presented at the 4th International Meeting of Turkish Society of Cleft Lip and Palate in Izmir, Turkey. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Isolated Congenital Cleft of the Nose

The intrauterine growth of the face is formed by appropriate fusion of frontonasal, maxillary, and mandibular protrusions. These anomalies are very rare and there may be differences between individuals according to cleft types. In this article, a very rare condition of isolated alar cleft and its treatment method were presented. A 14-year-old female patient applied to our clinic with complaint of congenital nasal deformity. On physical examination, a full thickness defect was observed on distal 1/3 of right alar wing, and the right alar cartilage was found as malpositioned of 2 cm more cranially than it should have supposed to be. The patient was diagnosed as isolated nasal cleft and repaired with rotation and transposition flaps. In the technique described earlier, it was observed that the rotation and transposition flaps not only correct the incomplete units but also facilitating the correction of the nostril malposition. One must consider full-layer repair to obtain a more acceptable image in terms of aesthetic and functional results. According to authors, this technique is advantageous as it provides both excellent color and texture harmony. Address correspondence and reprint requests to Fatma Bilgen, MD, School of Medicine, Plastic, Reconstructive and Aesthetic Surgery, Kahramanmaraş Sütçüimam University, Kahramanmaraş, Turkey; E-mail: fatmabilgen81@gmail.com Received 23 March, 2018 Accepted 17 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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