Anaesthesia and Perioperative Care for Transoral Robotic Surgery

Minimally invasive surgical techniques have gained increasing interest in recent years for their conferred recovery and postoperative advantages. Robot-assisted surgery requires special consideration for anaesthetic and perioperative management. The introduction of robot- assisted intra-oral surgery has important implications on anaesthesia provision, airway management and patient safety. Due to its relatively novel use we explore these considerations alongside our own experience in this field.
ORL 2018;80:125–133

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Pediatric Head and Neck Fibrosarcomas: A Demographical, Treatment, and Survival Review and Review of a Rare Case

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tyler A. Janz, Ramamoorthy Nagasubramanian, Julie L. Wei

Abstract

Objective

To examine pediatric head and neck fibrosarcoma cases and review the demographics, management, and survival for these patients.

Methods

Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973-2014 based on a diagnosis of a head and neck fibrosarcoma using ICD-O-3 head and neck primary sites and histology codes. Patients were included from ages 0-18 years. Additionally, a pediatric case of a head and neck infantile fibrosarcoma treated at the Nemours Children's hospital in Orlando, Florida is presented.

Results

One hundred-thirteen pediatric head and neck fibrosarcomas were identified within the SEER database over the study period. The mean age at diagnosis was 9.8 years (SD: 6.2, range: 0.0-18.0). The mean age at diagnosis for infantile fibrosarcomas was 1.7 years (SD: 3.2, range: 0.0-12.0). Fifty-one (45.1%) patients were female. A majority (N=67, 59.3%) of patients had dermatofibrosarcoma followed by 18 (15.9%) who had infantile fibrosarcomas. Nearly all patients (N=107, 94.7%) received surgical intervention. 27.5% of patients with an infantile fibrosarcoma received chemotherapy as a part of their care compared to 1.5% of patients with a dermatofibrosaroma (p=.004). The 5-year disease-specific survival was 97%.

Conclusions

and Relevance: Pediatric patients with head and neck fibrosarcomas are most likely to present in Caucasian males or female during late childhood or early adolescence. Infantile fibrosarcomas present in pediatric patients at a much earlier age. Surgical management is common for pediatric head and neck fibrosarcomas. Additionally, chemotherapy may be used for infantile fibrosarcomas of the head and neck. Survival rates for pediatric patients with a head and neck fibrosarcoma are excellent.

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Endoscopic Cricopharyngeal Myotomy in Infants

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Keith J. Basler, Catherine Swanson, Steven M. Andreoli

Abstract

Cricopharyngeal achalasia is a rare cause of dysphagia in young children. Conservative treatments involve medical therapy and serial dilations or injections. Definitive cure can be achieved with cricopharyngeal myotomy. We report two cases of young children, each less than one year of age, who underwent endoscopic laser-assisted cricopharyngeal myotomy. Following surgery, both infants were able to advance to age appropriate diets prior to discharge. Post-operative modified barium swallow demonstrated complete resolution of achalasia in both patients. To the best of our knowledge, this is the first case series of infants undergoing successful endoscopic cricopharyngeal myotomy.

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Autologous Cartilage Microtia Reconstruction: Complications and Risk Factors

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yao-yao Fu, Chen-long Li, Jun-li Zhang, Tian-yu Zhang

Abstract

Background

The Brent or Nagata techniques of microtia reconstruction and their modifications involve complicated frameworks; therefore, complications are inevitable. The authors aimed to provide comprehensive knowledge regarding the occurrence, development, prognosis, risk factors, and treatment of complications.

Methods

This study was a retrospective review of patients who underwent autologous cartilage microtia reconstruction at a single auricular plastic and reconstructive center between March 2005 and June 2016. Custom database software was used to process data from patients with microtia. Details of postoperative complications were collected during follow-up for analysis.

Results

A total of 470 procedures (stage I) were performed on 429 patients. The mean (±SD) age at surgery was 12.27±5.01 years (range, 6–32 years). The mean time to follow-up was 3.67±2.45 years (range, 1–11 years). The complication rate was 2.98% (4/134) with the Brent technique and 12.2% (38/311) with the Nagata technique. A multivariate logistic regression analysis of complications of microtia reconstruction revealed that age, sex, and laterality were not associated with postoperative complications (p > 0.05). Surgical technique affected the incidence of complications. The Nagata technique resulted in a higher risk for complications (OR 6.14 [95% CI 1.63–23.19]; p < 0.01).

Conclusion

The development of complications was a dynamic process. There was a learning curve associated with autologous cartilage microtia reconstruction. Orthopedists or otologists aspiring to master microtia reconstruction should have a fundamental understanding of the procedure and be aware of possible complications.

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Versatility of iron-rich steel waste for the removal of high arsenic and sulfate concentrations in water

Abstract

The aim of this work is to evaluate the application of a steel waste, basic oxygen furnace sludge (BOFS), rich in iron, to treat water contaminated with elevated arsenic and sulfate concentrations. In the first step, three doses (10, 60, and 80 g L⁻¹) of BOFS were tested to investigate the removal of As(III) and As(V) (67 mg L⁻¹) and sulfate (3700 mg L⁻¹) separately from an aqueous solution. In the second step, the efficacies of BOFS (10 g L⁻¹) and commercial ZVI (5 g L⁻¹) were compared to simultaneously remove arsenic and sulfate. The pH of the feed solution was adjusted to 2.5 and monitored during the experiment. The use of BOFS achieved arsenic removal up to 92% and sulfate removal of nearly 40% after 72 h of contact time. Use of BOFS also increased the solution pH to 12. Similar removal levels were achieved with both BOFS and ZVI. These results confirm the potential application of BOFS to remove high arsenic and sulfate concentrations from acidic solutions. The data obtained here should be used as a basis for further studies on the remediation of acid mine drainage with high concentrations of arsenic and sulfate using an abundant and low-cost steel waste.

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NMR characterizing mixed wettability under intermediate-wet condition

Publication date: Available online 2 October 2018

Source: Magnetic Resonance Imaging

Author(s): Jie Wang, Lizhi Xiao, Guangzhi Liao, Yan Zhang, Yushi Cui, Zhe Sun, Yu Dong, Lin Hu

Abstract

Applying the concept of effective relaxivity to characterize wettability is based on the configuration of fluid distributions in porous media. However, in mixed-wet porous media with intermediate-wet patches (homogeneous wetting region), effective surface relaxivity cannot fully characterize wettability because fluid distributions are not directly corresponding to wetting patch distributions. Patches with different wettability interact with the same fluid differently, which leads to different surface relaxivity. The distribution of this kind surface relaxivity from porous media saturated with single fluid matches mixed wettability distribution. Here, we apply decay due to diffusion in internal field plus Carr-Purcell-Meiboom-Gill (DDIF-CPMG) method to obtain T₂ and the pore size distribution correlation. The variation of surface relaxivity obtained from the correlation map is used to characterize wettability distributions of mixed-wet porous media. In this paper, we also redefine a parameter based on surface relaxivity distribution to evaluate mixed wettability under intermediate-wet condition. The experiment results with limestones show that, after wettability alteration of the sample, the distribution of the surface relaxivity is changed and closely correlated with pore size distribution, which demonstrates the features of mixed wettability under intermediate-wet conditions.

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Dynamics of ionic liquids in poly(vinyl alcohol) porous scaffold. Low field NMR study

Publication date: Available online 1 October 2018

Source: Magnetic Resonance Imaging

Author(s): Carlos Mattea, Bulat Gizatullin, Siegfried Stapf

Abstract

In this study molecular dynamics of ionic liquids in poly(vinyl alcohol) scaffolds were investigated. The binary poly(vinyl alcohol) – ionic liquid (PVA-IL) compound was prepared from initial solutions of water, ionic liquid (IL) and poly(vinyl alcohol) (PVA) at different concentrations. Subsequently water was evaporated under open conditions, leaving the scaffold/IL system of interest. Low field nuclear magnetic resonance (NMR) relaxation and diffusion measurements, as well as 2D T₁-T₂ correlated NMR experiments were performed to determine specific local and translational dynamics properties at different time scales. Data suggest that during water evaporation, partial demixing of IL from the polymeric matrix leaves the remaining solvent confined in the porous structure formed by the PVA polymer. The results show that the translational diffusion, as well as the local rotational molecular dynamics is comparable to the bulk liquid state. Moreover, in partial saturation conditions, diffusion shows enhancements relative to the bulk.

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