The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].:

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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Bilateral pedicled gracilis flap for scrotal reconstruction.

Bilateral pedicled gracilis flap for scrotal reconstruction.

J Plast Reconstr Aesthet Surg. 2016 Jun 2;

Authors: Daigeler A, Behr B, Mikhail BD, Lehnhardt M, Wallner C

Abstract
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes.

PMID: 27318782 [PubMed - as supplied by publisher]

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Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Int J Surg Case Rep. 2016 Apr 19;25:48-50

Authors: Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E

Abstract
INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy.
CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli.
CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

PMID: 27318859 [PubMed - as supplied by publisher]

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Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

J Plast Reconstr Aesthet Surg. 2016 Jun 10;

Authors: Lee YJ, Kim HY, Rha EY, Lee JY, Han HH

PMID: 27318783 [PubMed - as supplied by publisher]

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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

J Plast Reconstr Aesthet Surg. 2016 Jun 1;

Authors: Bella H, Kornmann NS, Hardwicke JT, Wallis KL, Wearn C, Su TL, Richard BM

Abstract
BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters.
METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing.
RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment.
CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

PMID: 27318781 [PubMed - as supplied by publisher]

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Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

J Plast Reconstr Aesthet Surg. 2016 May 10;

Authors: Zhu M, Xie Y, Zhu Y, Chai G, Li Q

PMID: 27318784 [PubMed - as supplied by publisher]

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Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Int J Surg Case Rep. 2016 May 24;25:51-54

Authors: Sahsamanis G, Samaras S, Basios A, Katis K, Dimitrakopoulos G

Abstract
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management.
PRESENTATION OF CASE: A 77year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.
DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.
CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

PMID: 27318860 [PubMed - as supplied by publisher]

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Left sympathetic cardiac denervation in managing electrical storm: acute outcome and long term follow up.

Left sympathetic cardiac denervation in managing electrical storm: acute outcome and long term follow up.

J Interv Card Electrophysiol. 2016 Jun 18;

Authors: Prabhu MA, Prasad SB, Abhilash SP, Thajudeen A, R BK, Namboodiri N

Abstract
PURPOSE: Left sympathetic cardiac denervation (LSCD) may be beneficial in treating electrical storm (ES) of varied aetiologies. The present study analyse the outcome and long term follow up of LSCD in treating ES.
METHODS: This is a retrospective study of patients with ES who underwent LSCD.
RESULTS: Nine patients (majority males (88.89 %), median age 52 years, IQR 50.5-56.5) underwent LSCD. Coronary artery disease was the commonest substrate (7 (77.78 %)). Five patients, who had hypotension and unstable hemodynamics, underwent percutaneous stellate ganglion blockade. Three of the survivors subsequently underwent surgical sympathectomy. In the remaining four, video assisted thoracoscopy (VATS) guided sympathectomy was performed. Five (55 %) and seven (77.78 %) had a >90 and 80 % reduction in ventricular arrhythmias (VA), respectively. LSCD was ineffective in one patient, who succumbed to ES. There was no difference in outcome between patients with monomorphic versus polymorphic VA (60 vs 70 %, respectively, p = 0.82). One (11.1 %) patient had sudden death on the fifth day after LSCD. The median hospital stay was 13 days (IQR 11-16). During median 34 months of (IQR 18-46) follow up, one patient died of heart failure, and another had recurrence of ES. There was sustained reduction in VA burden in others.
CONCLUSION: LSCD is effective in controlling ES and continues to reduce the incidence of VAs during long term follow up. Pharmacological LSCD needs particular emphasis, as it can be performed at bedside, and can be a bail-out procedure in centres where sophisticated procedures like VATS-guided LSCD or radiofrequency ablation are not readily available.

PMID: 27318998 [PubMed - as supplied by publisher]

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Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

J Plast Reconstr Aesthet Surg. 2016 May 10;

Authors: Zhu M, Xie Y, Zhu Y, Chai G, Li Q

PMID: 27318784 [PubMed - as supplied by publisher]

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Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles to treat melanoma.

Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles to treat melanoma.

Colloids Surf B Biointerfaces. 2016 Jun 3;146:188-197

Authors: Labala S, Jose A, Venuganti VV

Abstract
Overexpression of signal transducer and activator of transcription 3 (STAT3) protein prevents apoptosis and enhances proliferation of melanocytes. The aim of this study was to investigate the feasibility of using layer-by-layer assembled gold nanoparticles (LbL-AuNP) as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma. Chitosan coated AuNP (AuNP-CS) were prepared by direct reduction of HAuCl4 in the presence of chitosan. The AuNP-CS were then sequentially layered with siRNA and chitosan to form AuNP-CS/siRNA/CS. STAT3 siRNA replaced with scrambled siRNA or sodium alginate were used as controls. The average particle size and zeta-potential of the prepared LbL-AuNP were 150±10nm (PDI: 0.41±0.06) and 35±6mV, respectively. In vitro studies in B16F10 murine melanoma cells showed that AuNP-CS/siRNA/CS inhibited the cell growth by 49.0±0.6% and 66.0±0.2% at 0.25nM and 0.5nM STAT3 siRNA concentration, respectively. Fluorescence microscopy and flow cytometry studies showed a time dependent cell uptake of the LbL-AuNP up to 120min. Clathrin mediated endocytosis was found to be the predominant cell uptake mechanism for LbL-AuNP. STAT3 siRNA loaded LbL-AuNP reduced the STAT3 protein expression by 47.3% in B16F10 cells. Similarly, apoptosis assay showed 29% and 44% of early and late apoptotic events, respectively after treatment with STAT3 siRNA loaded LbL-AuNP. Confocal microscope and skin cryosections showed that application of 0.47mA/cm(2) of anodal iontophoresis enhanced the skin penetration of LbL-AuNP to reach viable epidermis. In conclusion, layer-by-layer chitosan coated AuNP can be developed as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma.

PMID: 27318964 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Int J Surg Case Rep. 2016 May 24;25:51-54

Authors: Sahsamanis G, Samaras S, Basios A, Katis K, Dimitrakopoulos G

Abstract
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management.
PRESENTATION OF CASE: A 77year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.
DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.
CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

PMID: 27318860 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].:

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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Bilateral pedicled gracilis flap for scrotal reconstruction.

Bilateral pedicled gracilis flap for scrotal reconstruction.

J Plast Reconstr Aesthet Surg. 2016 Jun 2;

Authors: Daigeler A, Behr B, Mikhail BD, Lehnhardt M, Wallner C

Abstract
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes.

PMID: 27318782 [PubMed - as supplied by publisher]

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Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Int J Surg Case Rep. 2016 Apr 19;25:48-50

Authors: Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E

Abstract
INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy.
CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli.
CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

PMID: 27318859 [PubMed - as supplied by publisher]

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Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

J Plast Reconstr Aesthet Surg. 2016 Jun 10;

Authors: Lee YJ, Kim HY, Rha EY, Lee JY, Han HH

PMID: 27318783 [PubMed - as supplied by publisher]

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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

J Plast Reconstr Aesthet Surg. 2016 Jun 1;

Authors: Bella H, Kornmann NS, Hardwicke JT, Wallis KL, Wearn C, Su TL, Richard BM

Abstract
BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters.
METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing.
RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment.
CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

PMID: 27318781 [PubMed - as supplied by publisher]

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Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

J Plast Reconstr Aesthet Surg. 2016 May 10;

Authors: Zhu M, Xie Y, Zhu Y, Chai G, Li Q

PMID: 27318784 [PubMed - as supplied by publisher]

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Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Int J Surg Case Rep. 2016 May 24;25:51-54

Authors: Sahsamanis G, Samaras S, Basios A, Katis K, Dimitrakopoulos G

Abstract
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management.
PRESENTATION OF CASE: A 77year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.
DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.
CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

PMID: 27318860 [PubMed - as supplied by publisher]

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Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Int J Surg Case Rep. 2016 Apr 19;25:48-50

Authors: Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E

Abstract
INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy.
CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli.
CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

PMID: 27318859 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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Bilateral pedicled gracilis flap for scrotal reconstruction.

Bilateral pedicled gracilis flap for scrotal reconstruction.

J Plast Reconstr Aesthet Surg. 2016 Jun 2;

Authors: Daigeler A, Behr B, Mikhail BD, Lehnhardt M, Wallner C

Abstract
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes.

PMID: 27318782 [PubMed - as supplied by publisher]

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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

J Plast Reconstr Aesthet Surg. 2016 Jun 1;

Authors: Bella H, Kornmann NS, Hardwicke JT, Wallis KL, Wearn C, Su TL, Richard BM

Abstract
BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters.
METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing.
RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment.
CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

PMID: 27318781 [PubMed - as supplied by publisher]

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Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

J Plast Reconstr Aesthet Surg. 2016 Jun 10;

Authors: Lee YJ, Kim HY, Rha EY, Lee JY, Han HH

PMID: 27318783 [PubMed - as supplied by publisher]

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Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles

 to treat melanoma.:

Colloids Surf B Biointerfaces. 2016 Jun;146:188-197

Authors: Labala S, Jose A, Venuganti VV

Abstract

Overexpression of signal transducer and activator of transcription 3 (STAT3) protein prevents apoptosis and enhances proliferation of melanocytes. The aim of this study was to investigate the feasibility of using layer-by-layer assembled gold nanoparticles (LbL-AuNP) as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma. Chitosan coated AuNP (AuNP-CS) were prepared by direct reduction of HAuCl4 in the presence of chitosan. The AuNP-CS were then sequentially layered with siRNA and chitosan to form AuNP-CS/siRNA/CS. STAT3 siRNA replaced with scrambled siRNA or sodium alginate were used as controls. The average particle size and zeta-potential of the prepared LbL-AuNP were 150±10nm (PDI: 0.41±0.06) and 35±6mV, respectively. In vitro studies in B16F10 murine melanoma cells showed that AuNP-CS/siRNA/CS inhibited the cell growth by 49.0±0.6% and 66.0±0.2% at 0.25nM and 0.5nM STAT3 siRNA concentration, respectively. Fluorescence microscopy and flow cytometry studies showed a time dependent cell uptake of the LbL-AuNP up to 120min. Clathrin mediated endocytosis was found to be the predominant cell uptake mechanism for LbL-AuNP. STAT3 siRNA loaded LbL-AuNP reduced the STAT3 protein expression by 47.3% in B16F10 cells. Similarly, apoptosis assay showed 29% and 44% of early and late apoptotic events, respectively after treatment with STAT3 siRNA loaded LbL-AuNP. Confocal microscope and skin cryosections showed that application of 0.47mA/cm(2) of anodal iontophoresis enhanced the skin penetration of LbL-AuNP to reach viable epidermis. In conclusion, layer-by-layer chitosan coated AuNP can be developed as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma.

PMID: 27318964 [PubMed - as supplied by publisher]

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Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles to treat melanoma.

Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles to treat melanoma.

Colloids Surf B Biointerfaces. 2016 Jun 3;146:188-197

Authors: Labala S, Jose A, Venuganti VV

Abstract
Overexpression of signal transducer and activator of transcription 3 (STAT3) protein prevents apoptosis and enhances proliferation of melanocytes. The aim of this study was to investigate the feasibility of using layer-by-layer assembled gold nanoparticles (LbL-AuNP) as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma. Chitosan coated AuNP (AuNP-CS) were prepared by direct reduction of HAuCl4 in the presence of chitosan. The AuNP-CS were then sequentially layered with siRNA and chitosan to form AuNP-CS/siRNA/CS. STAT3 siRNA replaced with scrambled siRNA or sodium alginate were used as controls. The average particle size and zeta-potential of the prepared LbL-AuNP were 150±10nm (PDI: 0.41±0.06) and 35±6mV, respectively. In vitro studies in B16F10 murine melanoma cells showed that AuNP-CS/siRNA/CS inhibited the cell growth by 49.0±0.6% and 66.0±0.2% at 0.25nM and 0.5nM STAT3 siRNA concentration, respectively. Fluorescence microscopy and flow cytometry studies showed a time dependent cell uptake of the LbL-AuNP up to 120min. Clathrin mediated endocytosis was found to be the predominant cell uptake mechanism for LbL-AuNP. STAT3 siRNA loaded LbL-AuNP reduced the STAT3 protein expression by 47.3% in B16F10 cells. Similarly, apoptosis assay showed 29% and 44% of early and late apoptotic events, respectively after treatment with STAT3 siRNA loaded LbL-AuNP. Confocal microscope and skin cryosections showed that application of 0.47mA/cm(2) of anodal iontophoresis enhanced the skin penetration of LbL-AuNP to reach viable epidermis. In conclusion, layer-by-layer chitosan coated AuNP can be developed as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma.

PMID: 27318964 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Int J Surg Case Rep. 2016 May 24;25:51-54

Authors: Sahsamanis G, Samaras S, Basios A, Katis K, Dimitrakopoulos G

Abstract
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management.
PRESENTATION OF CASE: A 77year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.
DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.
CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

PMID: 27318860 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].:

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Int J Surg Case Rep. 2016 Apr 19;25:48-50

Authors: Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E

Abstract
INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy.
CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli.
CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

PMID: 27318859 [PubMed - as supplied by publisher]

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Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

J Plast Reconstr Aesthet Surg. 2016 Jun 10;

Authors: Lee YJ, Kim HY, Rha EY, Lee JY, Han HH

PMID: 27318783 [PubMed - as supplied by publisher]

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Bilateral pedicled gracilis flap for scrotal reconstruction.

Bilateral pedicled gracilis flap for scrotal reconstruction.

J Plast Reconstr Aesthet Surg. 2016 Jun 2;

Authors: Daigeler A, Behr B, Mikhail BD, Lehnhardt M, Wallner C

Abstract
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes.

PMID: 27318782 [PubMed - as supplied by publisher]

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Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

J Plast Reconstr Aesthet Surg. 2016 May 10;

Authors: Zhu M, Xie Y, Zhu Y, Chai G, Li Q

PMID: 27318784 [PubMed - as supplied by publisher]

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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

J Plast Reconstr Aesthet Surg. 2016 Jun 1;

Authors: Bella H, Kornmann NS, Hardwicke JT, Wallis KL, Wearn C, Su TL, Richard BM

Abstract
BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters.
METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing.
RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment.
CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

PMID: 27318781 [PubMed - as supplied by publisher]

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Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

Response to comment on: A novel noninvasive three-dimensional volumetric analysis for fat-graft survival in facial recontouring using the 3L and 3M technique.

J Plast Reconstr Aesthet Surg. 2016 May 10;

Authors: Zhu M, Xie Y, Zhu Y, Chai G, Li Q

PMID: 27318784 [PubMed - as supplied by publisher]

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Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Treatment of a half century year old giant inguinoscrotal hernia. A case report.

Int J Surg Case Rep. 2016 May 24;25:51-54

Authors: Sahsamanis G, Samaras S, Basios A, Katis K, Dimitrakopoulos G

Abstract
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management.
PRESENTATION OF CASE: A 77year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.
DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.
CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.

PMID: 27318860 [PubMed - as supplied by publisher]

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Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.

Int J Surg Case Rep. 2016 Apr 19;25:48-50

Authors: Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, Gianetta E

Abstract
INTRODUCTION: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy.
CASE PRESENTATION: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli.
CONCLUSION: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy.

PMID: 27318859 [PubMed - as supplied by publisher]

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[Renovascular effects of antiangiogenic drugs].

[Renovascular effects of antiangiogenic drugs].

Bull Cancer. 2016 Jun 15;

Authors: Deray G, Janus N, Aloy B, Launay-Vacher V

Abstract
During the last decade, inhibitors of the vascular endothelial growth factor (VEGF) were developed for the treatment of cancer. Many anti-VEGF are available but the issue is still the same: to inhibit the effect of the VEGF on their receptors. There are two main classes, depending on the mechanism of action by blocking the binding of the ligand on the receptor (VEGF trap or monoclonal antibody) or by affecting directly the receptor (tyrosine kinase inhibitor [TKI], monoclonal antibody directed against the VEGF receptor). These selective agents are safe. Nevertheless, side effects were described, in particular renal and vascular effects. In this article, we analyze the frequency of these renovascular complications, their clinical aspects and the interest of these indexes as a marker of treatment efficacy.

PMID: 27318610 [PubMed - as supplied by publisher]

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Bilateral pedicled gracilis flap for scrotal reconstruction.

Bilateral pedicled gracilis flap for scrotal reconstruction.

J Plast Reconstr Aesthet Surg. 2016 Jun 2;

Authors: Daigeler A, Behr B, Mikhail BD, Lehnhardt M, Wallner C

Abstract
Trauma, infection and cancer can cause severe scrotal defects. The demand to a definitive reconstruction in terms of aesthetics and function is high. Primary closure, skin grafts and local fasciocutaneous flaps do not meet these high demands in most cases. The authors treated a series of patients requiring scrotal reconstruction with bilateral pedicled gracilis muscle flaps and split thickness skin grafts, resulting in satisfying aesthetic and functional outcomes.

PMID: 27318782 [PubMed - as supplied by publisher]

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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment.

J Plast Reconstr Aesthet Surg. 2016 Jun 1;

Authors: Bella H, Kornmann NS, Hardwicke JT, Wallis KL, Wearn C, Su TL, Richard BM

Abstract
BACKGROUND AND AIM: The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive, and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after unilateral cleft lip and palate (UCLP) repair using a novel web-based rating platform with an extended panel of surgeon raters.
METHODS: Cropped images of 5-year-old UCLP patients were arranged in a randomly generated sequence within a web-based aesthetic scoring tool as part of an agreement/reliability study. Assessors rated the appearances of patients using a five-point Likert-type scale on two occasions. A mixed-effect statistical model was adopted to analyse the effects of rater, image and timing.
RESULTS: Images of 76 patients were scored by 29 UK-based cleft surgeons. Intra-rater variability was found, and the linear weighted kappa was 0.56. This allowed identification of the most and least consistent raters. The random image effect (p < 0.001) suggested that a broad range of aesthetic outcomes were included in the current study. Surgeon raters in this study were likely to score the images more preferably at the second assessment.
CONCLUSIONS: A web-based scoring system provides extended data capture, and mixed-effect statistical modelling reveals the effect that time, image and rater have on the scorings. The selection and training of raters, in combination with an exemplary yardstick, might improve inter- and intra-rater agreement. The development of objective measures based upon digital facial recognition can replace the highly variable subjective human influence on rating the aesthetic outcome.

PMID: 27318781 [PubMed - as supplied by publisher]

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Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

Esthetically successful fingertip reconstruction using a second toe pulp free flap with a split thickness skin graft and tattoo.

J Plast Reconstr Aesthet Surg. 2016 Jun 10;

Authors: Lee YJ, Kim HY, Rha EY, Lee JY, Han HH

PMID: 27318783 [PubMed - as supplied by publisher]

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Transcutaneous iontophoretic delivery of STAT3 siRNA using layer-by-layer chitosan coated gold nanoparticles

 to treat melanoma.:

Colloids Surf B Biointerfaces. 2016 Jun;146:188-197

Authors: Labala S, Jose A, Venuganti VV

Abstract

Overexpression of signal transducer and activator of transcription 3 (STAT3) protein prevents apoptosis and enhances proliferation of melanocytes. The aim of this study was to investigate the feasibility of using layer-by-layer assembled gold nanoparticles (LbL-AuNP) as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma. Chitosan coated AuNP (AuNP-CS) were prepared by direct reduction of HAuCl4 in the presence of chitosan. The AuNP-CS were then sequentially layered with siRNA and chitosan to form AuNP-CS/siRNA/CS. STAT3 siRNA replaced with scrambled siRNA or sodium alginate were used as controls. The average particle size and zeta-potential of the prepared LbL-AuNP were 150±10nm (PDI: 0.41±0.06) and 35±6mV, respectively. In vitro studies in B16F10 murine melanoma cells showed that AuNP-CS/siRNA/CS inhibited the cell growth by 49.0±0.6% and 66.0±0.2% at 0.25nM and 0.5nM STAT3 siRNA concentration, respectively. Fluorescence microscopy and flow cytometry studies showed a time dependent cell uptake of the LbL-AuNP up to 120min. Clathrin mediated endocytosis was found to be the predominant cell uptake mechanism for LbL-AuNP. STAT3 siRNA loaded LbL-AuNP reduced the STAT3 protein expression by 47.3% in B16F10 cells. Similarly, apoptosis assay showed 29% and 44% of early and late apoptotic events, respectively after treatment with STAT3 siRNA loaded LbL-AuNP. Confocal microscope and skin cryosections showed that application of 0.47mA/cm(2) of anodal iontophoresis enhanced the skin penetration of LbL-AuNP to reach viable epidermis. In conclusion, layer-by-layer chitosan coated AuNP can be developed as a carrier for iontophoretic delivery of STAT3 siRNA to treat melanoma.

PMID: 27318964 [PubMed - as supplied by publisher]

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Preventive Effects of Houttuynia cordata Extract for Oral Infectious Diseases

Preventive Effects of Houttuynia cordata Extract for Oral Infectious Diseases: Houttuynia cordata (HC) (Saururaceae) has been used internally and externally as a traditional medicine and as an herbal tea for healthcare in Japan. Our recent survey showed that HC poultice (HCP) prepared from smothering fresh leaves of HC had been frequently used for the treatment of purulent skin diseases with high effectiveness. Our experimental study also demonstrated that ethanol extract of HCP (eHCP) has antibacterial, antibiofilm, and anti-inflammatory effects against S. aureus which caused purulent skin diseases. In this study, we focused on novel effects of HCP against oral infectious diseases, such as periodontal disease and dental caries. We determined the antimicrobial and antibiofilm effects of water solution of HCP ethanol extract (wHCP) against important oral pathogens and investigated its cytotoxicity and anti-inflammatory effects on human oral epithelial cells. wHCP had moderate antimicrobial effects against some oral microorganisms and profound antibiofilm effects against Fusobacterium nucleatum, Streptococcus mutans, and Candida albicans. In addition, wHCP had no cytotoxic effects and could inhibit interleukin-8 and CCL20 productions by Porphyromonas gingivalis lipopolysaccharide-stimulated human oral keratinocytes. Our findings suggested that wHCP may be clinically useful for preventing oral infectious diseases as a mouthwash for oral care.

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