Head and Neck Diseases by Alexandros G.Sfakianakis: 05/19/17

Παρασκευή 19 Μαΐου 2017

Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study.

BACKGROUND: Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated. OBJECTIVE: We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery. DESIGN: Prospective randomised double-blind trial. SETTING: A tertiary teaching hospital. PATIENTS: In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor. INTERVENTIONS: Patients were randomly allocated to receive either 5 mg kg-1 of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 [mu]g kg-1 of neostigmine and 15 [mu]g kg-1 of atropine at the end of surgery. MAIN OUTCOME MEASURES: The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point. RESULTS: The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration. CONCLUSION: Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2q3a9Og

Anaesthesiology research in the European Union and the European Free Trade Association: An overview from 2001 to 2015.

BACKGROUND: Publication performance in anaesthesiology hints at research activity and attractiveness for a particular centre or country for anaesthetists. OBJECTIVE: The aim of this retrospective bibliographic study is to compare the publication performance of anaesthesiology departments within the countries of the European Union (EU) and European Free Trade Association (EFTA) combined. Outcome measures were the number of publications, the number of original articles, the average impact factor and the number of publications and average impact factor per million inhabitants. METHODS: Articles from anaesthesiology departments within the EU and EFTA countries published between 1 January 2001 and 31 December 2015 were included. Articles were electronically imported from Medline into a database and linked to anaesthesiology departments according to the authors' affiliations. Publication performance was assessed for 2001 to 2005, 2006 to 2010, 2011 to 2015 and 2001 to 2015. RESULTS: From 2001 to 2015, the absolute number of articles increased from 10 513 to 19 037 (+81%), whereas the number of original research articles decreased from 3786 to 1563 (-58%). Germany had the most publications (8948) with 1967 of these being original articles. Denmark achieved not only the highest average impact factor per million inhabitants (319.9) but also the most articles per anaesthesiologist (1.46), and per million habitants (105.7). Countries which moved up the income scale to a higher income class also increased the number of publications. DISCUSSION: In the EU and EFTA countries, the total number of publications increased from 2001 to 2015, but the number of original research articles fell by more than 50%. CONCLUSION: Between 2001 and 2015, in the EU and EFTA countries, the number of publications increased, whereas the number of original articles decreased. Germany published most, but Denmark had most publications per anaesthesiologist and per capita, and also achieved the highest impact factor per article. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2rnNjEO

Turning the tide: Clinical utility of PD-L1 expression in squamous cell carcinoma of the head and neck

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Astrid De Meulenaere, Tijl Vermassen, Sandrine Aspeslagh, Wouter Huvenne, Jo Van Dorpe, Liesbeth Ferdinande, Sylvie Rottey
The use of cytotoxic and/or targeted agents is the gold standard in first- and second-line treatment of metastatic head and neck cancer. Currently the focus of oncologic research is shifting to the implementation of immune checkpoint inhibitor regimens. Many trials are being performed evaluating the survival benefit of various PD-1/PD-L1 blocking antibodies in both solid and haematological malignancies. Also, evaluation of the predictive value of PD-L1 expression on tumour cells and immune cells is being explored.We first review the current knowledge and possible pitfalls for PD-L1 expression in squamous cell carcinoma of the head and neck. Next, we provide an update on the therapeutic use of PD-1/PD-L1 blocking antibodies as treatment modality for patients with squamous cell carcinoma of the head and neck and we assess the predictive value of tumour PD-L1 positivity. Finally, we elaborate on other promising predictive biomarkers of interest in this patient population.

http://ift.tt/2qDOiQD

Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study.

BACKGROUND: Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. OBJECTIVE: The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. DESIGN: A randomised, double-blinded, placebo-controlled trial. SETTING: ENT operating room, Menofia University Hospitals, Egypt. PATIENTS: A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds. INTERVENTIONS: Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg-1 in the first hour followed by 9 mg kg-1 h-1 until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 [mu]g kg-1 min-1. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively. PRIMARY OUTCOME: The incidence and severity of agitation measured 5 min after admission to the PACU. RESULTS: Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P

http://ift.tt/2rnOzYF

Integrating speech in time depends on temporal expectancies and attention

Publication date: Available online 19 May 2017
Source:Cortex
Author(s): Mathias Scharinger, Johanna Steinberg, Alessandro Tavano
Sensory information that unfolds in time, such as in speech perception, relies on efficient chunking mechanisms in order to yield optimally-sized units for further processing. Whether or not two successive acoustic events receive a one-unit or a two-unit interpretation seems to depend on the fit between their temporal extent and a stipulated temporal window of integration. However, there is ongoing debate on how flexible this temporal window of integration should be, especially for the processing of speech sounds. Furthermore, there is no direct evidence of whether attention may modulate the temporal constraints on the integration window. For this reason, we here examine how different word durations, which lead to different temporal separations of sound onsets, interact with attention. In an Electroencephalography (EEG) study, participants actively and passively listened to words where word-final consonants were occasionally omitted. Words had either a natural duration or were artificially prolonged in order to increase the separation of speech sound onsets. Omission responses to incomplete speech input, originating in left temporal cortex, decreased when the critical speech sound was separated from previous sounds by more than 250 ms, i.e. when the separation was larger than the stipulated temporal window of integration (125-150 ms). Attention, on the other hand, only increased omission responses for stimuli with natural durations. We complemented the event-related potential (ERP) analyses by a frequency-domain analysis on the stimulus presentation rate. Notably, power of stimulation frequency showed the same duration and attention effects than the omission responses. We interpret these findings on the background of existing research on temporal integration windows and further suggest that our findings may be accounted for within the framework of predictive coding.

http://ift.tt/2pVwtNX

Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: A randomised clinical trial.

BACKGROUND: Postoperative pharyngolaryngeal complications are commonly reported following laryngeal mask airway (LMA) insertion. After induction of anaesthesia, the airway structures fall backwards under the influence of gravity, and this may contribute to difficulty in placement of a LMA. External airway alignment by lifting the larynx during insertion of an airway may avoid collision of the airway with laryngeal structures. OBJECTIVE(S): To compare pharyngolaryngeal complications after either conventional airway insertion with or without cuff semi-inflation and a method, including an external larynx lift. DESIGN: Randomised controlled double blind clinical trial. SETTING: Ambulatory surgical operating rooms of a university hospital. PATIENTS: American Society of Anaesthesiologists class 1 to 3 patients undergoing ambulatory surgery scheduled to receive general anaesthesia for which a LMA was not contraindicated. INTERVENTIONS: Patients were randomised into three groups for LMA placement: G1, deflated airway; G2, pre-inflated cuff; G3, pre-inflated cuff with external lifting of the larynx. Assessment of pharyngolaryngeal complications (blinded assessor) was made at the time of LMA removal and again at 1, 2 and 24 h. MAIN OUTCOME MEASURES: A pharyngolaryngeal complication, defined as a composite of one or more of sore throat, dysphonia or dysphagia at any time point, or blood on the airway at removal. RESULTS: Of the 450 consecutive patients, 441 were studied. There were no differences in insertion times or number of insertion attempts among the groups. There was no difference in pharyngolaryngeal complications among the groups: G1, 57%; G2, 55%; G3, 52%, (P = 0.77). Blood on the airway was observed less frequently in G3 (9%) compared with G1 and G2 combined (17%): difference -8% (95% confidence interval of the difference -0.8 to -16%, P = 0.01). CONCLUSION: The external larynx lift technique was associated with a lower incidence of blood on the airway at removal, suggesting that the method may decrease trauma to the tissues of the upper airway during insertion. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01749033. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2q2IhKe

Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study.

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery: A retrospective review.

BACKGROUND: Vocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur. OBJECTIVE: To evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors. DESIGN: Single-centre retrospective review of adult patients. SETTING: Osaka University Hospital, Suita, Japan, from January 2013 to August 2015. PATIENTS: We included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases. MAIN OUTCOME MEASURES: The incidence and severity of VCP after extubation. RESULTS: The incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P

http://ift.tt/2rnKWSG

Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study.

Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial.

BACKGROUND: Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD. OBJECTIVE: The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD. DESIGN: Randomised controlled study. SETTING: Single university teaching hospital, from March 2015 to January 2016. PATIENTS: A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses. INTERVENTION: Patients were randomised to receive a single intravenous bolus of 0.1 mg kg-1 dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery. MAIN OUTCOME MEASURES: The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100[beta] protein levels. RESULTS: Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P

http://ift.tt/2q2DNmQ

Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: A randomised clinical trial.

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery: A retrospective review.

Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial.

Anaesthesiology research in the European Union and the European Free Trade Association: An overview from 2001 to 2015.

Subcellular Energetics and Metabolism: Potential Therapeutic Applications

Part I of this review discussed the similarities between embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1 [HIF-1]), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, and it focused on the common characteristics that allow cells and organisms to survive in these states. Part II of this review describes techniques by which researchers gain insight into subcellular energetics and identify potential future tools for clinicians. In particular, P31 nuclear magnetic resonance to measure high-energy phosphates, serum lactate measurements, the use of near-infrared spectroscopy to measure the oxidation state of cytochrome aa3, and the ability of the protoporphyrin IX-triplet state lifetime technique to measure mitochondrial oxygen tension are discussed. In addition, this review discusses novel treatment strategies such as hyperbaric oxygen, preconditioning, exercise training, therapeutic gases, as well as inhibitors of HIF-1, HIF prolyl hydroxylase, and peroxisome proliferator-activated receptors.

http://ift.tt/2rnvWnz

Zika Virus: Obstetric and Pediatric Anesthesia Considerations

As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million. Similar to Dengue and Chikungunya viruses, ZIKV is spread to humans by infected Aedes aegypti mosquitoes, through travel-associated local transmission, via sexual contact, and through blood transfusions. South Florida is an epicenter for ZIKV infection in the United States and the year-round warm climate along with an abundance of mosquito vectors that can harbor the flavivirus raise health care concerns. ZIKV infection is generally mild with clinical manifestations of fever, rash, conjunctivitis, and arthralgia. Of greatest concern, however, is growing evidence for the relationship between ZIKV infection of pregnant women and increased incidence of abnormal pregnancies and congenital abnormalities in the newborn, now medically termed ZIKA Congenital Syndrome. Federal health officials are observing 899 confirmed Zika-positive pregnancies and the FDH is currently monitoring 110 pregnant women with evidence of Zika infection. The University of Miami/Jackson Memorial Hospital is uniquely positioned just north of downtown Miami and within the vicinity of Liberty City, Little Haiti, and Miami Beach, which are currently "hot spots" for Zika virus exposure and transmissions. As the FDH works fervently to prevent a Zika epidemic in the region, health care providers at the University of Miami and Jackson Memorial Hospital prepare for the clinical spectrum of ZIKV effects as well as the safe perioperative care of the parturients and their affected newborns. In an effort to meet anesthetic preparedness for the care of potential Zika-positive patients and perinatal management of babies born with ZIKA Congenital Syndrome, this review highlights the interim guidelines from the Centers for Disease Control and Prevention and also suggest anesthetic implications and recommendations. In addition, this article reviews guidance for the evaluation and anesthetic management of infants with congenital ZIKV infection. To better manage the perioperative care of affected newborns, this article also reviews the comparative anesthetic implications of babies born with related congenital malformations.

http://ift.tt/2rnWDsm

Coming to a Patient Near You: The Zika Virus and Anesthetic Implications

No abstract available

http://ift.tt/2rnFOh8

Subcellular Hypoxia: A Survival Guide

No abstract available

http://ift.tt/2rnHgjH

Subcellular Energetics and Metabolism: A Cross-Species Framework

Although it is generally believed that oxidative phosphorylation and adequate oxygenation are essential for life, human development occurs in a profoundly hypoxic environment and "normal" levels of oxygen during embryogenesis are even harmful. The ability of embryos not only to survive but also to thrive in such an environment is made possible by adaptations related to metabolic pathways. Similarly, cancerous cells are able not only to survive but also to grow and spread in environments that would typically be fatal for healthy adult cells. Many biological states, both normal and pathological, share underlying similarities related to metabolism, the electron transport chain, and reactive species. The purpose of Part I of this review is to review the similarities among embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, with a particular focus on the common characteristics that allow cells and organisms to survive in these states.

http://ift.tt/2rnvXrD

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):160-167

Authors: Capaccio P, Canzi P, Gaffuri M, Occhini A, Benazzo M, Ottaviani F, Pignataro L

Abstract
Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.

PMID: 28516980 [PubMed - in process]

http://ift.tt/2qZebv3

Botulinum toxin therapy: functional silencing of salivary disorders.

Botulinum toxin therapy: functional silencing of salivary disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):168-171

Authors: Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R

Abstract
Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulae that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulae after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey's syndrome), and could be considered the gold standard treatment for this neurological disorder.

PMID: 28516981 [PubMed - in process]

http://ift.tt/2rnZFx0

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):155-159

Authors: Canzi P, Cacciola S, Capaccio P, Pagella F, Occhini A, Pignataro L, Benazzo M

Abstract
Salivary gland toxicity is a common adverse effect of radioactive iodine ((131)I) for the treatment of thyroid cancers with a prevalence ranging from 2% to 67% of the (131)I exposed population. Recently, sialendoscopy has been introduced as an attractive diagnostic and therapeutic tool for management of patients with radioiodine-induced sialadenitis that is unresponsive to standard medical treatments. The objective of the current review was to assess the impact of this procedure on outcomes in patients suffering from radioiodine sialadenitis. Overall, eight studies were included and 122 patients underwent 264 sialendoscopic procedures. Duct stenosis and mucous plugs were observed in 85.7% of endoscopic findings, supporting the role of ductal obstruction in the pathophysiology of radioiodine sialadenitis. In total, 89.3% of patients experienced complete or partial resolution of sialadenitis recurrences without any major adverse events, and parotidectomy was advocated in only 1 case. However, outcomes mainly concerned subjective reports and only two clinical experiences evaluated objective measurement with dissimilar results. Limited to few studies, xerostomia and obstructive symptoms responded differently after sialendoscopy. The optimal timing of salivary gland videoendoscopy needs to be further analysed in order to define the best management of radioiodine-induced obstructive sialadenitis.

PMID: 28516979 [PubMed - in process]

http://ift.tt/2qAdU0T

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):148-154

Authors: Gallo A, Martellucci S, Fusconi M, Pagliuca G, Greco A, De Virgilio A, De Vincentiis M

Abstract
Autoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

PMID: 28516978 [PubMed - in process]

http://ift.tt/2q2FLU3

Complications of traditional and modern therapeutic salivary approaches.

Complications of traditional and modern therapeutic salivary approaches.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):142-147

Authors: Nahlieli O

Abstract
The morbidity following traditional surgery of the salivary glands is well documented and includes postsurgical complications such as the Frey's syndrome, complete or partial facial nerve damage, facial scarring, greater auricular nerve numbness, sialocoeles and salivary fistula. The avulsion of the salivary duct, secondary strictures, gland swelling, salivary fistulas and perforations (false rout), traumatic ranulas, and the lingual nerve paraesthesia are the main endoscopy-related complications. In general, the rate of postsurgical complications after modern advanced minimally invasive surgical interventions is significantly lower compared with traditional surgery of the salivary glands. However, such comparisons cannot be performed because up-to-date traditional and minimally invasive surgical techniques are applied to different salivary disorders. Combinations of various minimally invasive techniques are also possible. There is no clear borderline between "traditional" and "modern" surgery of the salivary glands. It is appropriate to write about gradual replacement of old techniques with newer ones, and this process has no traffic lights.

PMID: 28516977 [PubMed - in process]

http://ift.tt/2q2BFeV

Salivary duct stenosis: diagnosis and treatment.

Salivary duct stenosis: diagnosis and treatment.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):132-141

Authors: Koch M, Iro H

Abstract
The management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.

PMID: 28516976 [PubMed - in process]

http://ift.tt/2ryEXrm

Sialendoscopy-assisted transfacial removal of parotid calculi.

Sialendoscopy-assisted transfacial removal of parotid calculi.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):128-131

Authors: Hills AJ, Holden AM, McGurk M

Abstract
Superficial parotidectomy has significant morbidity, and minimally invasive techniques have therefore been developed, including those involving sialendoscopy, to remove sialoliths and preserve the gland along with its function. The size, mobility and location of the sialolith, alongside the presence of strictures, all dictate management. We outline basic treatment paradigms and describe two sialoendoscopyassisted surgical procedures developed for treating stones, one intraoral and one extraoral.

PMID: 28516975 [PubMed - in process]

http://ift.tt/2rnZEcq

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):231-236

Authors: Alessandrini M, Micarelli A, Viziano A, Pavone I, Costantini G, Casali D, Paolizzo F, Saggio G

Abstract
Since changes in vestibular function may be one cause of disequilibrium, major advances in measuring postural control and sensory integration in vestibular impairments have been achieved by using posturography. However, in order to overcome problems related to this type of technology, body-worn accelerometers (ACC) have been proposed as a portable, low-cost alternative to posturography for measurements of postural sway in a friendly and ecologic environment. Due to the fact that no study to date has shown the experimental validity of ACC-based measures of body sway with respect to posturography for subjects with vestibular deficits, the aim of the present study was: i) to develop and validate a practical tool that can allow clinicians to measure postural sway derangements in an otoneurological setting by ACC, and ii) to provide reliable, sensitive and accurate automatic analysis of sway that could help in discriminating unilateral vestibular failure (UVF) patients. Thus, a group of 13 patients (seven females, 6 males; mean age 48.6 ± 6.4 years) affected for at least 6 months by UVF and 13 matched healthy subjects were instructed to maintain an upright position during a static forceplate-based posturography (FBP) acquisition while wearing a Movit® sensor (by Captiks) with 3-D accelerometers mounted on the posterior trunk near the body centre of mass. Pearson product moment correlation demonstrated a high level of correspondence of four time-domain and three frequency-domain measures extracted by ACC and FBP testing; in addition, t-test demonstrated that two ACC-based time- and frequency-domain parameters were reliable measures in discriminating UVF subjects. These aspects, overall, should further highlight the attention of clinicians and researchers to this kind of sway recording technique in the field of otoneurological disorders by considering the possibility to enrich the amount of quantitative and qualitative information useful for discrimination, diagnosis and treatment of UVF. In conclusion, we believe the present ACC-based measurement of sway offers a patient-friendly, reliable, inexpensive and efficient alternative recording technique that is useful - together with clinical balance and mobility tests - in various circumstances, as well as in outcome studies involving diagnosis, follow-up and rehabilitation of UVF patients.

PMID: 28516967 [PubMed - in process]

http://ift.tt/2q2BDDP

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):122-127

Authors: Capaccio P, Gaffuri M, Rossi V, Pignataro L

Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.

PMID: 28516974 [PubMed - in process]

http://ift.tt/2rnQdtv

Salivary lithotripsy in the era of sialendoscopy.

Salivary lithotripsy in the era of sialendoscopy.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):113-121

Authors: Capaccio P, Torretta S, Pignataro L, Koch M

Abstract
The traditional management of obstructive salivary disorders has been replaced by minimally-invasive gland-preserving techniques including shock-wave lithotripsy, sialendoscopy, interventional radiology and endoscopically video-assisted trans-oral and cervical stone retrieval, of which sialendoscopy is considered to be the method of first choice. Primary endoscopically controlled stone extraction without prior fragmentation is only possible in 15-20% of cases; in more than 80%, fragmentation is necessary because of the size, impactation and location of the stone, or an alternative treatment such as transoral duct surgery or combined approaches are required. Moreover, about 10-20% of all stones cannot be adequately accessed by means of a sialendoscope or any alternative surgical method and, in such cases, extra-corporeal shock wave lithotripsy (ESWL) is the treatment of choice. However, in endoscopically accessible stones, ESWL is being gradually replaced by endoscopically assisted intra-corporeal techniques, including endoscopically guided laser and pneumatic intracorporeal lithotripsy. We describe the currently most widely used techniques for salivary lithotripsy, including ESWL, and endoscopically guided laser, electrohydraulic, electrokinetic and pneumatic intra-corporeal lithotripsy, and discuss their indications given the widespread use of advanced rehabilitative sialendoscopy and combined therapeutic approaches.

PMID: 28516973 [PubMed - in process]

http://ift.tt/2rniRuM

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):102-112

Authors: Carta F, Farneti P, Cantore S, Macrì G, Chuchueva N, Cuffaro L, Pasquini E, Puxeddu R

Abstract
Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.

PMID: 28516972 [PubMed - in process]

http://ift.tt/2rnKWC1

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):94-101

Authors: Castagnola M, Scarano E, Passali GC, Messana I, Cabras T, Iavarone F, Di Cintio G, Fiorita A, De Corso E, Paludetti G

Abstract
Saliva testing is a non-invasive and inexpensive test that can serve as a source of information useful for diagnosis of disease. As we enter the era of genomic technologies and -omic research, collection of saliva has increased. Recent proteomic platforms have analysed the human salivary proteome and characterised about 3000 differentially expressed proteins and peptides: in saliva, more than 90% of proteins in weight are derived from the secretion of three couples of "major" glands; all the other components are derived from minor glands, gingival crevicular fluid, mucosal exudates and oral microflora. The most common aim of proteomic analysis is to discriminate between physiological and pathological conditions. A proteomic protocol to analyze the whole saliva proteome is not currently available. It is possible distinguish two type of proteomic platforms: top-down proteomics investigates intact naturally-occurring structure of a protein under examination; bottom-up proteomics analyses peptide fragments after pre-digestion (typically with trypsin). Because of this heterogeneity, many different biomarkers may be proposed for the same pathology. The salivary proteome has been characterised in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease Sjögren's syndrome and other autoimmune disorders such as SAPHO, schizophrenia and bipolar disorder, and genetic diseases like Down's Syndrome and Wilson disease. The results of research reported herein suggest that in the near future human saliva will be a relevant diagnostic fluid for clinical diagnosis and prognosis.

PMID: 28516971 [PubMed - in process]

http://ift.tt/2qZbr0Q

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):83-93

Authors: Ugga L, Ravanelli M, Pallottino AA, Farina D, Maroldi R

Abstract
Inflammatory and obstructive disorders of the salivary glands are caused by very different pathological conditions affecting the gland tissue and/or the excretory system. The clinical setting is essential to address the appropriate diagnostic imaging work-up. According to history and physical examination, four main clinical scenarios can be recognised: (1) acute generalised swelling of major salivary glands; (2) acute swelling of a single major salivary gland; (3) chronic generalised swelling of major salivary glands, associated or not with "dry mouth"; (4) chronic or prolonged swelling of a single major salivary gland. The algorithm for imaging salivary glands depends on the scenario with which the patient presents to the clinician. Imaging is essential to confirm clinical diagnosis, define the extent of the disease and identify complications. Imaging techniques include ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with MR sialography.

PMID: 28516970 [PubMed - in process]

http://ift.tt/2q2BD6N

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):242-244

Authors: Tulli M, Bondi S, Bussi M

Abstract
Laryngeal schwannomas are extremely uncommon. We present a case of bulky supraglottic schwannoma with involvement of the preepiglottic and superior paraglottic spaces. Clinical findings, computed tomography and magnetic resonance images are presented. These characteristics are typical, however not specific to schwannomas. For definitive diagnosis, histology and immunohistochemistry are necessary. We present an external mini-invasive approach that allowed us to both obtain diagnosis and provide definitive treatment for this kind of voluminous laryngeal tumour.

PMID: 28516969 [PubMed - in process]

http://ift.tt/2qZrnAi

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):237-241

Authors: Rigante M, La Rocca G, Lauretti L, D'Alessandris GQ, Mangiola A, Anile C, Olivi A, Paludetti G

Abstract
During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan). Two screens are used, one 31" Monitor - (LMD-X310S) and one main ultra-HD 55" screen optimised for UHD image reproduction (LMD-X550S). In selected cases, we used a navigation system (Stealthstation S7, Medtronic, Minneapolis, MN, US). We evaluated 22 pituitary adenomas (86.3% macroadenomas; 13.7% microadenomas). 50% were not functional (NF), 22.8% GH, 18.2% ACTH, 9% PRL-secreting. Three of 22 were recurrences. In 91% of cases we achieved total removal, while in 9% near total resection. A mean follow-up of 187 days and average length of hospitalisation was 3.09 ± 0.61 days. Surgical duration was 128.18± 30.74 minutes. We experienced only 1 case of intraoperative low flow fistula with no further complications. None of the cases required any post- or intraoperative blood transfusion. The visualisation and high resolution of the operative field provided a very detailed view of all anatomical structures and pathologies allowing an improvement in safety and efficacy of the surgical procedure. The operative time was similar to the standard 2D HD and 3D procedures and the physical strain was also comparable to others in terms of ergonomics and weight.

PMID: 28516968 [PubMed - in process]

http://ift.tt/2rle3pu

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):224-230

Authors: Presutti L, Bonali M, Marchioni D, Pavesi G, Feletti A, Anschuetz L, Alicandri-Ciufelli M

Abstract
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle. In addition, thorough skeletonisation of the carotid artery and the jugular bulb were necessary for the same purpose. In conclusion, ExpTTA appeared to be successful to access the internal auditory canal and cerebellopontine angle region. Potential extensive and routine application of this type of approach in lateral skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among otolaryngologists and neurosurgical community.

PMID: 28516966 [PubMed - in process]

http://ift.tt/2pScAqL

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):218-223

Authors: Lee JM, Jeon JH, Moon IS, Choi JY

Abstract
In this retrospective chart review we compared the subjective and objective benefits of active middle ear implants (AMEIs) with conventional hearing aids (HAs) in patients with sloping high tone hearing loss. Thirty-four patients with sensorineural hearing loss were treated with AMEIs. Of these, six had sloping high tone hearing loss and had worn an HA for more than 6 months. Objective assessments, a pure-tone audiogram, as well as a word recognition test, and the Korean version of the Hearing in Noise Test (K-HINT), and a subjective assessment, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, were performed. Tests were conducted under three circumstances: 1) the unaided state before surgery; 2) the HA-aided state before surgery; and 3) the AMEI-aided state 3 months after surgery. The average high-frequency hearing gain (≥ 2 kHz) was significantly better with AMEIs than with HAs. Although the result had no statistical significance, AMEIs showed a superior word recognition score (WRS) compared to HAs. However, the most comfortable hearing level at which the WRS was tested was significantly decreased with an AMEI compared to an HA. In the K-HINT, patients with an AMEI showed greater recognition than those fitted with an HA under both quiet and noisy conditions. The APAHB scores revealed that patients were more satisfied with an AMEI rather than an HA on all subscales. The use of vibroplasty in patients with sloping high tone loss resulted in positive hearing outcomes when compared to conventional HAs. Based on the data from this study, AMEIs provided better objective and subjective results and could, therefore, be a better alternative for the treatment of sloping hearing loss.

PMID: 28516965 [PubMed - in process]

http://ift.tt/2rnmQaC

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):214-217

Authors: Vicini C, Meccariello G, Cammaroto G, Rashwan M, Montevecchi F

Abstract
The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.

PMID: 28516964 [PubMed - in process]

http://ift.tt/2rnVIbn

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):201-206

Authors: Farneti D, Fattori B, Bastiani L

Abstract
Oral FEES (O-FEES) is an endoscopic procedure conceived to directly visualise the oral phase of swallowing. In the perspective of clinical use, the feasibility, safety and acceptability of O-FEES has been evaluated. Subsequently, the procedure was compared with the radiological gold standard. The acceptability of O-FEES was compared to that of FEES using a 10 point questionnaire submitted to a sample of 52 outpatients complaining of swallowing disorders. Repeated measure analysis of variance (rm-ANOVA) models were used to test the mean difference of acceptability in the same subjects after FEES and O-FEES. Subsequently, another sample of 8 male outpatients underwent a simultaneous O-FEES and videofluoroscopic study (VFSS). The inter-rater reliability using 10 radiological landmarks, compared to O-FEES, was blindly determined between two raters. Inter-rater agreement between the two judges for O-FEES and VFSS scores was assessed with the single score intra-class correlation coefficient (ICC). Differences between FEES and O-FEES answers for each question and among all the items considered overall were statistically significant (rm-ANOVA; F-statistic p < 0.001). The inter-rater agreement concerning endoscopic and radiological evaluations between the two raters showed strong values of intra-class correlation coefficient (ICC) (95% confidence interval): 0.875 (0.373-0.979) and 0.921 (0.542-0.986), respectively. The Bland-Altman test showed a bias of -0.24 (95% limits of agreement; -1.77 to +1.19), which suggests that both methods produced almost identical results. In clinical practice and compared with FEES, O-FEES is a well tolerated and safe procedure. Compared with the radiological gold standard, O-FEES offers reliable information about oral preparation and oral propulsion of the bolus.

PMID: 28516963 [PubMed - in process]

http://ift.tt/2pSEfrG

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):195-200

Authors: Tarsitano A, Battaglia S, Sandi A, Marchetti C

Abstract
The gold standard for mandibular reconstruction is universally recognised and consists of the replacement of the bony part of the mandible with a bony microvascular free flap supported by a reconstructive plate. Although this procedure is feasible and reproducible in most patients, at times poor oncological prognosis or poor performance status force surgeons to consider other reconstructive solutions. In these cases, the main alternative in reconstructing a mandibular defect is represented by bridging plates combined with soft tissue flaps. However, repairing a mandibular defect with a reconstructive plate only can lead to a series of diverse complications. The most frequent complications reported are rupture and oral exposure of the plate. In this paper, we describe a new method for mandibular reconstruction using a customised bridging mandibular prosthesis (CBMP) without bone free flap.

PMID: 28516962 [PubMed - in process]

http://ift.tt/2ryEO74

Nanoparticle switches off blood vessel growth

Publication date: Available online 19 May 2017
Source:Nano Today

http://ift.tt/2rBWfTA

Extra- and intra-cellular fate of nanocarriers under dynamic interactions with biology

Publication date: Available online 19 May 2017
Source:Nano Today
Author(s): Seog-Jin Seo, Meiwan Chen, Hongxia Wang, Min Sil Kang, Kam W. Leong, Hae-Won Kim
Synthetic nanocarriers continue to play an important role in nanomedicine as the next generation of therapeutics demands effective intracellular delivery. Better understanding of the extra- and intra-cellular fate of the nanocarriers in relation with biological environments in vitro and in vivo is essential for the progress of nanocarrier-based therapeutics. As nanocarriers come into contact with biological fluid, interactions with various biomolecules alter their initial physicochemical status. Such dynamic modifications influence their interactions with cells and the subsequent endocytic process. Upon cellular uptake, intracellular machineries control their trafficking, release and degradation of cargoes, and exocytosis. In this Review, we highlight the navigation of nanocarriers through various extra- and intra-cellular barriers, with an emphasis on how dynamic interactions with biological components alter their fate and performance.

Graphical abstract

http://ift.tt/2qDHVwR

Self-assembly and morphological control of three-dimensional macroporous architectures built of two-dimensional materials

Publication date: Available online 19 May 2017
Source:Nano Today
Author(s): Ji-Eun Kim, Jung-Hwan Oh, Moumita Kotal, Nikhil Koratkar, Il-Kwon Oh
The three-dimensional (3D) macroscopic assembly of tailored porous architectures built of graphene derivatives or other two-dimensional (2D) materials has attracted great attention in both academia and industry. The reason being that such 3D assemblies with controlled morphology can provide ultra-large accessible surface areas and interconnected networks, as well as preventing the undesirable re-stacking phenomena of 2D materials. Herein, we review the synthetic routes and formation mechanism of bulk gel and interface mediated 3D architectures made of diverse 2D materials encompassing both graphene derivatives and non-graphene 2D materials. We also suggest universal strategies that can provide useful insight into application-oriented architecture design. The gelation mechanism is explained in detail; it involves controlled destabilization of the suspension involving a delicate balance between attractive and repulsive interactions. Further, interface mediated self-assembly processes between liquid-solid, liquid-liquid, liquid-gas, and ice-water phases are discussed with a view to tailoring 3D layered and interconnected morphologies. Finally, we highlight the demand for future applications of 2D material-based 3D macroporous architectures. Despite recent progress, more precise control strategies for tuning surface area, pore size distribution, orientation/interconnectivity of pores, density of architectures, and mechanical stability, remain as key scientific and technological barriers that must be addressed to enable practical applications. Further, an important frontier area for future research will involve multilateral hybridization, involving diverse combinations of materials, morphologies, and assembly methods This will provide researchers a multi-dimensional toolbox to access hitherto unavailable properties of 2D material-based 3D architectures for a whole host of applications.

Graphical abstract

http://ift.tt/2qDI0Rb

Neural interfaces engineered via micro- and nanostructured coatings

Publication date: Available online 19 May 2017
Source:Nano Today
Author(s): Nuan Chen, Lingling Tian, Anoop C. Patil, Shengjie Peng, In Hong Yang, Nitish V. Thakor, Seeram Ramakrishna
During the past decade, neural interfaces have attracted great interest due to their potential of body-machine communication for disease diagnosis and therapy. Considering the significant material mismatch between the electrode implants and the native tissue, a thin coating is employed on the electrode sites as an intermediate layer to bridge the material differences and has been proved to play an important role in the promotion of neural cell attachment and signal transmission. Micro- and nanostructured coating materials, together with surface functionalization such as biological cues, provide not only high surface areas for signal transduction but also a biomimetic platform for the cells. In this paper, we review the performance of different kinds of micro- and nanostructured coating materials including metallic materials, carbon materials, conducting polymeric materials and composite materials and then complement the discussion with the influence of the fabrication process on the performance of the coatings. The coating could be functionalized by various advanced techniques, which are also reviewed. The existing challenge and future research directions of electrode coatings are briefly discussed at the end of the review.

Graphical abstract

http://ift.tt/2qDC8HB

3D nanoparticle structures emerge from the fog

Publication date: Available online 19 May 2017
Source:Nano Today

http://ift.tt/2qDCaPJ

Tethered nanoparticles charge ahead

Publication date: Available online 19 May 2017
Source:Nano Today

http://ift.tt/2rCcr7c

Primary Central Nervous System Vasculitis Mimicking a Cortical Brain Tumor: A Case Report.

Primary Central Nervous System Vasculitis Mimicking a Cortical Brain Tumor: A Case Report.

Brain Tumor Res Treat. 2017 Apr;5(1):30-33

Authors: Lee JS, Jung TY, Lee KH, Kim SK

Abstract
We report a case of primary central nervous system vasculitis (PCNSV) mimicking a cortical brain tumor. A 25-year-old woman presented with a 2-week history of headache and transient right hemiparesis. Brain magnetic resonance imaging (MRI) revealed a cortical-involving lesion on the left frontal lobe. The 6-cm sized lesion showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The lesion had continual linear enhancement on the subcortical white matter and leptomeninges. There was no evidence of hemorrhage on susceptibility-weighted images and no diffusion restriction on diffusion-weighted images. The regional cerebral blood volume was decreased on the MR perfusion images, and spectroscopy showed increased lactate and lipid peaks. The symptoms were aggravated by fever and seizures. Biopsy was performed to rule out tumorous or inflammatory lesions. Pathologically, lymphocytes were infiltrated on the vessels, and the arachnoid membrane was thickened with inflammatory cells. The patient did not have any underlying diseases, including immune disorders. After high-dose steroid administration, her symptoms improved. Two months later, brain MRI showed a reduction in the infiltration of the T2 hyperintensity lesion with subtle subcortical enhancement. We present a case of PCNSV involving the left frontal lobe, showing vasogenic edema, mass effect, and subcortical linear contrast enhancement without hemorrhage or infarction.

PMID: 28516076 [PubMed]

http://ift.tt/2rBaOaJ

Fourth Ventricle Neurenteric Cyst Mimicking Hemangioblastoma.

Fourth Ventricle Neurenteric Cyst Mimicking Hemangioblastoma.

Brain Tumor Res Treat. 2017 Apr;5(1):42-44

Authors: Choe E, Hwang K, Choe G, Kim CY

Abstract
This report presents a case of fourth ventricle neurenteric cyst (NE cyst) mimicking hemangioblastoma, which developed in a 50-year-old woman. A tiny enhancing mural portion of the fourth ventricle in MRI suggested that the cyst was hemangioblastoma, but pathological evidence showed that the cyst was in fact NE cyst in the fourth ventricle. In order to make proper decision on to what extent of surgical resection should be done, considering every possibility in differential diagnosis might be helpful. This case reports an unusual pathology in 4th ventricle, considering the patient's age, and demonstrates that a rarer disease may share radiological features of a common disease.

PMID: 28516079 [PubMed]

http://ift.tt/2rBzdxc

Subependymal Giant Cell Astrocytoma Presenting with Tumoral Bleeding: A Case Report.

Subependymal Giant Cell Astrocytoma Presenting with Tumoral Bleeding: A Case Report.

Brain Tumor Res Treat. 2017 Apr;5(1):37-41

Authors: Kim JY, Jung TY, Lee KH, Kim SK

Abstract
We report a rare case of subependymal giant cell astrocytoma (SEGA) associated with tumoral bleeding in a pediatric patient without tuberous sclerosis complex (TSC). A 10-year-old girl presented with a 2-week history of an increasingly aggravating headache. Brain magnetic resonance imaging revealed an approximately 3.6-cm, well-defined, heterogeneously enhancing mass with multistage hemorrhages on the right-sided foramen of Monro. The tumor was completely resected using a transcallosal approach. Intraoperatively, the mass presented as a gray-colored firm tumor associated with acute and subacute hemorrhages. The origin of the mass was identified as the ventricular septum adjacent to the foramen of Monro. A pathological analysis revealed pleomorphic multinucleated eosinophilic tumor cells with abundant cytoplasm. These cells showed positive staining for the glial fibrillary acidic protein and S100 protein. A diagnosis of SEGA was established. The patient recovered without any neurological symptoms. There was no evidence of TSC. The radiological follow-up showed no recurrence for 2 years. This was a case of SEGA with intratumoral hemorrhage, for which a favorable outcome was achieved, without any neurological deficit after tumoral resection.

PMID: 28516078 [PubMed]

http://ift.tt/2rBzbp4

A Case of Coincidental Intrasellar Chordoma and Pituitary Adenoma.

A Case of Coincidental Intrasellar Chordoma and Pituitary Adenoma.

Brain Tumor Res Treat. 2017 Apr;5(1):49-52

Authors: Park S, Kim HS, Park KS, Nam TK, Park YS, Kwon JT, Kim KT

Abstract
Although chordomas are midline tumors, primarily intrasellar chordomas are extremely rare. In this report, the authors describe the case of a 68-year-old female with partial abducens nerve palsy in the right eye due to the intrasellar cystic tumor. After endonasal trans-sphenoidal surgery, intraoperative and histopathological findings confirmed the co-occurrence of an entirely intrasellar chordoma and pituitary adenoma. To our knowledge, the present case is the third reported case of an intrasellar chordoma with a pituitary adenoma.

PMID: 28516081 [PubMed]

http://ift.tt/2rBj5eL

Cutaneous Anaplastic Large T-Cell Lymphoma with Invasion of the Central Nervous System: A Case Report.

Cutaneous Anaplastic Large T-Cell Lymphoma with Invasion of the Central Nervous System: A Case Report.

Brain Tumor Res Treat. 2017 Apr;5(1):45-48

Authors: Seo HN, Seo JH, Lee CY, Song J, Kim JH, Kim HW

Abstract
Anaplastic large T-cell lymphoma (ALCL) encompasses different clinical entities that can be aggressive or localized. Scalp anaplastic lymphoma kinase (ALK)-negative ALCL is considered a localized lymphoma, and usually extends to the regional lymph nodes; intracranial invasion is rare. A 74-year-old woman was diagnosed with scalp ALK-negative ALCL, but did not exhibit invasion of the lymph nodes. Computed tomography and magnetic resonance imaging revealed intracranial masses with bony erosions. We treated the patient using CHOP chemotherapy and achieved short-term regression of the scalp and intracranial lesions. However, the patients ultimately died of pneumonia during the pancytopenic period. Therefore, caution must be exercised when treating scalp ALK-negative ALCL with intracranial invasion.

PMID: 28516080 [PubMed]

http://ift.tt/2qAaRFM

Toxoplasmic Encephalitis in Patient with Acquired Immunodeficiency Syndrome.

Toxoplasmic Encephalitis in Patient with Acquired Immunodeficiency Syndrome.

Brain Tumor Res Treat. 2017 Apr;5(1):34-36

Authors: Lee SB, Lee TG

Abstract
Toxoplasmic encephalitis (TE) is an opportunistic infection found in immunocompromised patients and TE related cerebral mass lesion is often reported in acquired immunodeficiency acquired immunodeficiency syndrome (AIDS) patients. However, incidence of TE related AIDS in Korea is still rare and is unfamiliar to neurosurgeons. Differential diagnosis is needed to rule out other brain lesions. A 39-year-old man visited the emergency room with rapid progressive left hemiparesis. Magnetic resonance imaging showed a ring-enhanced mass lesion in his right frontal lobe. Human immunodeficiency virus and Toxoplasma gondii immunoglobulin G were tested positive by a serologic test. We report here a rare case of patient with TE related AIDS.

PMID: 28516077 [PubMed]

http://ift.tt/2rB3trZ

Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

Brain Tumor Res Treat. 2017 Apr;5(1):24-29

Authors: Khan MN, Poulin A, Essig M

Abstract
Over the course of five years, a total of ten cases were collected of glioma patients in whom a distant lesion at the fourth ventricle was noted. A 'distant lesion' was defined as a lesion with a normal appearing tissue bridge at imaging between the primary and secondary locations. Previous imaging of these patients was reviewed along with clinical history, course of therapy, and available histology. A review of the literature was performed with respect to present knowledge on patterns of glioma proliferation and dissemination. This case series is the first to describe the fourth ventricle as a location that may be prone to secondary lesions in glioma patients. Further investigation on this subject may yield deeper insights into the mechanisms by which glial tumors spread within the brain, with the hope of developing or improving therapeutic targets.

PMID: 28516075 [PubMed]

http://ift.tt/2rBfI7E

An Updated Nationwide Epidemiology of Primary Brain Tumors in Republic of Korea, 2013.

An Updated Nationwide Epidemiology of Primary Brain Tumors in Republic of Korea, 2013.

Brain Tumor Res Treat. 2017 Apr;5(1):16-23

Authors: Dho YS, Jung KW, Ha J, Seo Y, Park CK, Won YJ, Yoo H

Abstract
BACKGROUND: This report aims to provide accurate nationwide epidemiologic data on primary brain and central nervous system (CNS) tumors in the Republic of Korea. We updated the data by analyzing primary brain and CNS tumors diagnosed in 2013 using the data from the national cancer incidence database.
METHODS: Data on primary brain and CNS tumors diagnosed in 2013 were collected from the Korean Central Cancer Registry. Crude and age-standardized rates were calculated in terms of gender, age, and histological type.
RESULTS: A total of 11,827 patients were diagnosed with primary brain and CNS tumors in 2013. Brain and CNS tumors occurred in females more often than in males (female:male, 1.70:1). The most common tumor was meningioma (37.3%). Pituitary tumors (18.0%), gliomas (12.7%), and nerve sheath tumors (12.3%) followed in incidence. Glioblastomas accounted for 41.8% of all gliomas. In children (<19 years), sellar region tumors (pituitary and craniopharyngioma), embryonal/primitive/medulloblastoma, and germ cell tumors were the most common tumors.
CONCLUSION: This study should provide valuable information regarding the primary brain tumor epidemiology in Republic of Korea.

PMID: 28516074 [PubMed]

http://ift.tt/2rBdQvS

Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma.

Systematic Analysis of Clinical Outcomes Following Stereotactic Radiosurgery for Central Neurocytoma.

Brain Tumor Res Treat. 2017 Apr;5(1):10-15

Authors: Bui TT, Lagman C, Chung LK, Tenn S, Lee P, Chin RK, Kaprealian T, Yang I

Abstract
Central neurocytoma (CN) typically presents as an intraventricular mass causing obstructive hydrocephalus. The first line of treatment is surgical resection with adjuvant conventional radiotherapy. Stereotactic radiosurgery (SRS) was proposed as an alternative therapy for CN because of its lower risk profile. The objective of this systematic analysis is to assess the efficacy of SRS for CN. A systematic analysis for CN treated with SRS was conducted in PubMed. Baseline patient characteristics and outcomes data were extracted. Heterogeneity and publication bias were also assessed. Univariate and multivariate linear regressions were used to test for correlations to the primary outcome: local control (LC). The estimated cumulative rate of LC was 92.2% (95% confidence interval: 86.5-95.7%, p<0.001). Mean follow-up time was 62.4 months (range 3-149 months). Heterogeneity and publication bias were insignificant. The univariate linear regression models for both mean tumor volume and mean dose were significantly correlated with improved LC (p<0.001). Our data suggests that SRS may be an effective and safe therapy for CN. However, the rarity of CN still limits the efficacy of a quantitative analysis. Future multi-institutional, randomized trials of CN patients should be considered to further elucidate this therapy.

PMID: 28516073 [PubMed]

http://ift.tt/2ryrJuu

Bevacizumab in Recurrent Glioma: Patterns of Treatment Failure and Implications.

Bevacizumab in Recurrent Glioma: Patterns of Treatment Failure and Implications.

Brain Tumor Res Treat. 2017 Apr;5(1):1-9

Authors: Li Y, Ali S, Clarke J, Cha S

Abstract
Glioblastoma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, has increasingly been used in the treatment of recurrent glioblastoma. It has achieved excellent rates of radiographic response, but most patients will progress after only a few months. Upon recurrence, tumors may not enhance, secondary to vascular normalization. We describe four patterns of radiographic progression commonly associated with Bevacizumab failure: 1) Distant enhancing tumor, 2) Local tumor progression without enhancement, 3) Diffuse gliomatosis-like infiltration, and 4) Local or multifocal progression, with enhancement. Some have noted an increased incidence of distant or diffuse disease upon recurrence, suggestive of a transition to a more aggressive phenotype, but a review of the literature suggests there is no conclusive evidence that Bevacizumab treatment is associated with an increased rate of distant or diffuse recurrence.

PMID: 28516072 [PubMed]

http://ift.tt/2rB6I2r

Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis.

Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):82-87

Authors: Mammen S, Keshava SN, Moses V, Aaron S, Ahmed M, Chiramel GK, Mani SE, Alexander M

Abstract
BACKGROUND: In dural venous sinus thrombosis (DVST), the mortality ranges 5-30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST.
MATERIALS AND METHODS: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System(®). In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year.
RESULTS: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period.
CONCLUSION: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.

PMID: 28515593 [PubMed - in process]

http://ift.tt/2rBlDJX

Prenatal diagnosis of a rare aortic arch anomaly with left aortic arch and right ductus arteriosus: Cross ribbon sign.

Prenatal diagnosis of a rare aortic arch anomaly with left aortic arch and right ductus arteriosus: Cross ribbon sign.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):70-72

Authors: Vijayaraghavan SB, Senthil S, Latha K

Abstract
Here, we report a fetus with a rare aortic arch anomaly with left aortic arch and right ductus arteriosus, which has not been reported so far. In this condition, the aorta extends to the left of the trachea as in normal, while the ductus arteriosus extends to the right of the trachea and joins the descending aorta posterior to the trachea, with a cross-ribbon sign.

PMID: 28515590 [PubMed - in process]

http://ift.tt/2rBmISg

A novel presentation of tubular adenoma of the breast as an intraductal mass: Diagnostic considerations and pathologic correlation.

A novel presentation of tubular adenoma of the breast as an intraductal mass: Diagnostic considerations and pathologic correlation.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):112-114

Authors: Smith Iorfido SM, Shah M, Zaidi SY, Iorfido S

PMID: 28515600 [PubMed - in process]

http://ift.tt/2rBeUjc

Author's reply.

Author's reply.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):111

Authors: Putta T, Irodi A, Thangakunam B, Oliver A

PMID: 28515599 [PubMed - in process]

http://ift.tt/2rBy88y

Gorham's syndrome vs generalized lymphagiomatosis: A close call.

Gorham's syndrome vs generalized lymphagiomatosis: A close call.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):110

Authors: Ray A

PMID: 28515598 [PubMed - in process]

http://ift.tt/2rBiiuj

Tibial periosteal ganglion cyst: The ganglion in disguise.

Tibial periosteal ganglion cyst: The ganglion in disguise.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):105-109

Authors: Reghunath A, Mittal MK, Khanna G, Anil V

Abstract
Soft tissue ganglions are commonly encountered cystic lesions around the wrist presumed to arise from myxomatous degeneration of periarticular connective tissue. Lesions with similar pathology in subchondral location close to joints, and often simulating a geode, is the less common entity called intraosseous ganglion. Rarer still is a lesion produced by mucoid degeneration and cyst formation of the periostium of long bones, rightly called the periosteal ganglion. They are mostly found in the lower extremities at the region of pes anserinus, typically limited to the periosteum and outer cortex without any intramedullary component. We report the case of a 62 year-old male who presented with a tender swelling on the mid shaft of the left tibia, which radiologically suggested a juxtacortical lesion extending to the soft tissue or a soft tissue neoplasm eroding the bony cortex of tibia. It was later diagnosed definitively as a periosteal ganglion in an atypical location, on further radiologic work-up and histopathological correlation.

PMID: 28515597 [PubMed - in process]

http://ift.tt/2rBwALG

Balloon occluded retrograde transvenous obliteration for bleeding gastric varices: Eyes see what the mind knows.

Balloon occluded retrograde transvenous obliteration for bleeding gastric varices: Eyes see what the mind knows.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):100-104

Authors: Khera PS, Myungsu L, Joonsung C

Abstract
Approximately one in six patients with portal hypertension who develop varices at sites of portosystemic venous collaterals has gastric varices due to hepatofugal flow into the gastric veins. Bleeding from gastric varices, though less common, has a higher mortality and morbidity compared to bleeding esophageal varices, which are easier to manage endoscopically. The efferent channel for gastric varices is mostly the gastrorenal shunt (GRS) which opens into the left renal vein. Balloon-occluded transvenous obliteration (BRTO) involves accessing the GRS with an aim to temporarily occlude its outflow using a balloon catheter and at the same time injecting sclerosant mixture within the varix so as to cause its thrombosis and thereby obliteration. BRTO is one of the mainstays of minimally invasive treatment for bleeding gastric varices. In the minority of cases where the GRS is absent, conventional BRTO is technically not possible. However, accessing the small alternate shunt from the inferior phrenic vein may be possible if one is aware of its existence.

PMID: 28515596 [PubMed - in process]

http://ift.tt/2rB2Qi7

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients.

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):92-99

Authors: Kulkarni CB, Prabhu NK, Kader NP, Rajeshkannan R, Pullara SK, Moorthy S

Abstract
AIM: To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients.
MATERIALS AND METHODS: We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study. The technical and clinical success of the percutaneous management was analyzed.
RESULTS: Anastomotic strictures associated with leak were found in 12/17 patients (70.6%). Ten out of 12 (83.3%) patients associated with leak had more than one duct-duct anastomoses (range, 2-3). The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6%) and clinical success was achieved in 13/17 (76.5%) of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4%) died (two acute rejections, one metabolic acidosis, and two sepsis).
CONCLUSIONS: Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.

PMID: 28515595 [PubMed - in process]

http://ift.tt/2rBeSb4

Radiofrequency ablation of osteoid osteoma in common and technically challenging locations in pediatric population.

Radiofrequency ablation of osteoid osteoma in common and technically challenging locations in pediatric population.

Indian J Radiol Imaging. 2017 Jan-Mar;27(1):88-91

Authors: Garge S, Keshava SN, Moses V, Chiramel GK, Ahmed M, Mammen S, Madhuri V

Abstract
CONTEXT: Percutaneous radiofrequency ablation (RFA) of osteoid osteoma has a high technical and clinical success rate. However, there is limited data on its use in the pediatric population, especially in technically challenging locations.
OBJECTIVE: To assess the safety and efficacy of computed tomography (CT)-guided percutaneous RFA of osteoid osteoma in pediatric population.
PATIENTS AND METHODS: From June 2009 to May 2014, 30 patients with osteoid osteoma were treated with CT-guided RFA in common (25 cases) and technically challenging (five cases: four near articular surface and one in sacrum) locations. Therapy was performed under general anesthesia with a three-array expandable RF probe for 6 min at 90°C and power of 60-100 W. The patients were discharged next day under instruction. The treatment success was evaluated in terms of pain relief before and after (1 day, 1 month, and 6 months) treatment.
RESULTS: Technical success was achieved in all patients (100%). Primary clinical success was 96.66% (29 of total 30 patients), despite the pediatric population and atypical location. One patient had persistent pain after 1 month and was treated successfully with a second procedure (secondary success rate was 100%). One patient had immediate complication of weakness of right hand and fingers extension. No delayed complications were observed.
CONCLUSIONS: CT-guided RFA is relatively safe and highly effective for treatment of osteoid osteoma in pediatric population, even in technically difficult locations.

PMID: 28515594 [PubMed - in process]

http://ift.tt/2rlssSS

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 19 Μαΐου 2017

Graphical abstract

Graphical abstract

Graphical abstract

Αρχειοθήκη ιστολογίου