Force measurements during posterior calvarial vault osteodistraction: a novel measurement method

Publication date: Available online 2 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): A. Ritvanen, M. Savolainen, D. Nowinski, D. Saiepour, M. Paulasto-Kröckel, J. Hukki, E. Tukiainen, J. Leikola
Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse.In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices.We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four syndromic craniosynostosis patients during PCVO.We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre-distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions.



http://ift.tt/2m2LIzg

Periosteal fasciitis in a 7-year old girl: a diagnostic dilemma

Publication date: Available online 2 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Lääveri, K. Heikinheimo, D. Baumhoer, P.J. Slootweg, R.-P. Happonen
Periosteal fasciitis, considered a subtype of nodular fasciitis, is a rare benign soft tissue mass often misdiagnosed as a malignant lesion due to its fast and infiltrative growth pattern and histological features. Nodular fasciitis is usually found in the upper extremities in adults and in the head and neck region in children. Incorrect diagnosis may lead to overtreatment, potentially causing disturbed orofacial development in growing children. A rapidly growing asymptomatic mass, initially suspected to be a malignant bone tumour, was found in the left angle area of the mandible in a healthy 7-year-old girl. Radiographic examination revealed an exophytic, expansile and destructive nodule arising from the periosteal region. A diagnosis of periosteal fasciitis was established based on histological findings in an open biopsy specimen and the lesion was subsequently enucleated. Fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement and confirmed the diagnosis molecularly. Due to the aggressive growth pattern without external trauma and the results of the gene rearrangement test, it is suggested that nodular fasciitis be regarded as a benign neoplasm rather than as a reactive process. The patient remains free of disease at 3 years after surgery.



http://ift.tt/2mSODtD

First signs of late-presenting cervical lymph node metastasis in oral cancers during follow-up

Publication date: Available online 2 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Sumino, N. Uzawa, Y. Ohyama, Y. Michi, A. Kawamata, M. Mizutani, M. Yamashiro
One of the most important prognostic factors in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastasis. Therefore, the early detection of late-presenting cervical lymph node metastasis is important. Although many studies have assessed diagnostic modalities for detecting metastatic cervical lymph nodes, no study has evaluated the process, especially first signs, for detecting late-presenting cervical lymph node metastasis. A retrospective analysis comparing methods for detecting the first signs of late-presenting lymph node metastasis was performed. A total of 65 OSCC patients were assessed. These patients were identified retrospectively as having presented late metastasis during follow-up after initial treatment with curative intent. The findings of four detection methods were analyzed: palpation, ultrasonography, computed tomography, and subjective symptoms. The numbers of cases identified by each method were as follows: palpation, 31 (47.7%); ultrasonography, 17 (26.1%); computed tomography, 12 (18.5%); and subjective symptoms, 5 (7.7%). Palpation played a major role in the discovery of late-presenting lymph node metastasis. In contrast, metastatic lymph nodes were detected by other methods in about half of the cases. The results suggest a possible stratification of the various methods used for metastatic lymph node detection, depending on the characteristics of individual cases.



http://ift.tt/2lloQOv

Biologic Response Modifiers: Indications, Implications and Insights

Publication date: Available online 2 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Benjamin P. Davis, Zuhair K. Ballas
The field of biologic immune-modulators is currently mushrooming at a dizzying pace. While most of these biologics are tested and approved for one or a few indications, their un-anticipated side effects and their off-label use have contributed significantly to our understanding of basic immune mechanisms, of the involvement of cytokines in several apparently non-immunologic diseases, and of the importance of compartmentalized immune responses. In this review, we attempt to give a bird's-eye view of the major biologics and to highlight insights and implications derived from their secondary effects and adverse reactions.



http://ift.tt/2mNqANh

Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis.

Background and Objectives: Dexamethasone is a useful adjuvant in regional anesthesia that is used to prolong the duration of analgesia for peripheral nerve blocks. Recent randomized controlled trials (RCTs) have demonstrated conflicting results as to whether perineural versus intravenous (IV) administration is superior in this regard, and the perineural use of dexamethasone remains off-label. Therefore, we sought to perform a systematic review and meta-analysis of RCTs. Methods: In accordance with PRISMA guidelines, we performed a random-effects meta-analysis of RCTs comparing perineural versus IV dexamethasone with duration of analgesia as the primary outcome. Results: Eleven RCTs met the inclusion criteria with a total of 1076 subjects. Perineural dexamethasone prolonged the duration of analgesia by 3.77 hours (95% confidence interval [CI], 1.87-5.68 hours; P

http://ift.tt/2mSurrZ

Ipilimumab has efficacy in metastatic Merkel Cell Carcinoma: a case series of five patients

Abstract

Immunotherapy with immune checkpoint blockers such as the CTLA-4 antibody ipilimumab and PD-1 antibodies has revolutionized oncological treatment options¹. MCC is an immunogenic tumor and the efficacy of PD-1 blockade has recently been demonstrated^2,3,4. Here, we present a retrospective analysis of five patients with metastatic MCC individually treated with ipilimumab between 2012 and 2015. Administration of four cycles (3 mg/kg every three weeks) was planned. Informed consent was obtained from all patients. Patient characteristics are depicted in table 1. All patients had received previous surgical and radiation therapy before initiation of ipilimumab.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mhu2SM

One more step towards a clinically applicable tolerance induction protocol in solid organ transplantation?.

No abstract available

http://ift.tt/2mkQD0W