Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ud9CiN

Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ud9CiN

Can radiation chemistry supply a highly efficient AO(R)P process for organics removal from drinking and waste water? A review

Abstract

The increasing role of chemistry in industrial production and its direct and indirect impacts in everyday life create the need for continuous search and efficiency improvement of new methods for decomposition/removal of different classes of waterborne anthropogenic pollutants. This review paper addresses a highly promising class of water treatment solutions, aimed at tackling the pressing problem of emerging contaminants in natural and drinking waters and wastewater discharges. Radiation processing, a technology originating from radiation chemistry studies, has shown encouraging results in the treatment of (mainly) organic water pollution. Radiation ("high energy") processing is an additive-free technology using short-lived reactive species formed by the radiolysis of water, both oxidative and reducing, to carry out decomposition of organic pollutants. The paper illustrates the basic principles of radiolytic treatment of organic pollutants in water and wastewaters and specifically of one of its most practical implementations (electron beam processing). Application examples, highlighting the technology's strong points and operational conditions are described, and a discussion on the possible future of this technology follows.

http://ift.tt/2wgmDFR

The Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome.

Objective: CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This study aims to describe a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess. Patients: Three children with profound hearing loss secondary to CHARGE syndrome. Intervention: Transcanal cochlear implantation with closure of the ear canal via a modified Rambo meatoplasty. Main Outcome Measure(s): Retrospective chart review of temporal bone anomalies associated with CHARGE syndrome, technical nuances of this transcanal approach, and cochlear implant outcomes. Results: The mean patient age was 2.5 years (range 1.5-3.8 yr). Two were male and two were left ears. All patients had a hypoplastic mastoid, semicircular canal aplasia, and had some degree of cochlear dysplasia. A full cochlear implant insertion was achieved in all cases, even in the presence of grossly abnormal middle ear and facial nerve anatomy. There were no intraoperative or postoperative complications. The mean follow-up was 12.4 months (range, 3.9-25.2 mo). All three patients use their device daily. Their guardians report improved vocalization and environmental awareness. Conclusions: The modified Rambo transcanal approach provides a safe corridor for cochlear implantation in patients with CHARGE syndrome. This approach minimizes the anatomical variations associated with the syndrome and may reduce the risk of electrode extrusion. Implant outcomes in this patient population remain highly variable based on the patient's global cognitive capacity. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

http://ift.tt/2vz1b0W

Rapamycin prolongs graft survival and induces CD4+IFN-[gamma]+IL-10+ regulatory type 1 cells in old recipient mice.

Background: Although the elderly represents a rapidly growing population among transplant recipients, age-specific aspects have not been considered sufficiently in clinical trials. Moreover, age-specific effects of immunosuppressive therapies remain poorly understood. Methods: Here, we assessed the impact of Rapamycin on alloimmune responses in old recipients using a fully MHC-mismatched murine transplantation model. Results: Old untreated recipients displayed a prolonged skin graft survival compared to their young counterparts, an observation that confirmed data of our previous experiments. Rapamycin led to a significant prolongation of graft survival in both, young and old recipients. However, graft survival was age-dependent and extended in old vs. young recipients (19 days vs. 12 days, p=0.004). This age-specific effect was not linked to changes in frequencies or subset composition of either CD8+ or CD4+ T cells. Moreover, antiproliferative effects of Rapamycin on CD8+ and CD4+ T cells as assessed by in vivo BrdU-incorporation were comparable and age-independent. In contrast, the systemic production of IL-10 was markedly elevated in old recipients treated with Rapamycin. In parallel to this shift in cytokine balance, IFN-[gamma]/IL-10 double-positive regulatory type 1 cells emerged during Th1-differentiation of old T helper cells in presence of Rapamycin. Similarly, CD4+IFN-[gamma]+IL-10+ cells expanded among Foxp3-negative cells after in vivo treatment of old recipients with Rapamycin. Conclusions: Our results highlight novel aspects of age-dependent immunosuppressive effects of Rapamycin, with relevance for age-specific immunosuppressive regimens. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2fh0tPT

Preventive effect of a vapocoolant spray on propofol-induced pain: a prospective, double-blind, randomized study

Abstract

Purpose

Propofol causes injection pain. Although lidocaine pre-treatment via venous occlusion is known to be the most effective way, it still has some inconvenience. We implemented this study to compare the effect of a vapocoolant spray with lidocaine pre-treatment.

Methods

Participants (n = 90) were randomized to one of three groups. Group V: after placebo injection and tourniquet, the vapocoolant spray was applied; group L: after lidocaine injection and tourniquet, the placebo spray was applied; group C: after placebo injection and tourniquet, the placebo spray was applied. The intensity of propofol-induced pain, the incidence of metallic taste, and the satisfaction were assessed.

Results

Propofol-induced pain was significantly lower in groups V and L than in group C [0.5 (0–2.25), 0.5 (0–1), and 5 (1–7), median (interquartile range), respectively, p < 0.001]. There was no significant difference in pain intensity between groups V and L. Group L showed a significantly higher incidence of metallic taste than groups V and C (23, 0, and 0%, respectively; p = 0.001). Groups V and L showed higher satisfaction scores than group C [5 (4–5), 4 (3.75–5), and 2 (2–3), respectively; p < 0.001], and there was a significant difference between groups V and L (p = 0.012).

Conclusion

Vapocoolant spray showed a similar effect to lidocaine in analgesia and lowered the incidence of a metallic taste. These resulted in greater satisfaction with the vapocoolant spray compared with lidocaine. Vapocoolant spray is an effective and convenient way to prevent propofol-induced pain.

http://ift.tt/2utyT3z

Pre-eclampsia and acute pulmonary embolism—the importance of making a differential diagnosis: a case report

Abstract

We describe the case of a 41-year-old pregnant patient who presented at 38 weeks of gestation for an urgent cesarean section, with new onset of pre-eclampsia as the initial diagnosis. The intraoperative course was complicated by seizures and hemodynamic collapse. Initially, the presentation of seizure pointed to pre-eclampsia/eclampsia; however, with careful consideration of each event as it occurred, the correct diagnosis was later determined to be pulmonary embolism and stroke. This case illustrates the importance of considering multiple possible etiologies, even when a particular diagnosis seems obvious.

http://ift.tt/2uctYZM