OtoRhinoLaryngology News: 08/24/17

Πέμπτη 24 Αυγούστου 2017

Long-term Health-Related QoL After Breast Reconstruction

How do these four different methods of breast reconstruction impact health-related quality of life among breast cancer patients?
Plastic Reconstructive Surgery-Global Open (PRS Global Open)

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On assessing neurofeedback effects: should double-blind replace neurophysiological mechanisms?

Sir,

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Reply: On assessing neurofeedback effects: should double-blind replace neurophysiological mechanisms?

Sir,

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Evaluation of the RumiWatchSystem for measuring grazing behaviour of cows

Publication date: Available online 24 August 2017
Source:Journal of Neuroscience Methods
Author(s): J. Werner, L. Leso, C. Umstatter, J. Niederhauser, E. Kennedy, A. Geoghegan, L. Shalloo, M. Schick, B. O'Brien
Feeding behaviour is an important parameter of animal performance, health and welfare, as well as reflecting levels and quality of feed available. Previously, sensors were only used for measuring animal feeding behaviour in indoor housing systems. However, sensors such as the RumiWatchSystem can also monitor such behaviour continuously in pasture-based environments. Therefore, the aim of this study was to validate the RumiWatchSystem to record cow activity and feeding behaviour in a pasture-based system. The RumiWatchSystem was evaluated against visual observation across two different experiments. The time duration per hour at grazing, rumination, walking, standing and lying recorded by the RumiWatchSystem was compared to the visual observation data in Experiment 1. Concordance Correlation Coefficient (CCC) values of CCC=0.96 for grazing, CCC=0.99 for rumination, CCC=1.00 for standing and lying and CCC=0.92 for walking were obtained. The number of grazing and rumination bouts within one hour were also analysed resulting in Cohen's Kappa (κ)=0.62 and κ=0.86 for grazing and rumination bouts, respectively. Experiment 2 focused on the validation of grazing bites and rumination chews. The accordance between visual observation and automated measurement by the RumiWatchSystem was high with CCC=0.78 and CCC=0.94 for grazing bites and rumination chews, respectively. These results indicate that the RumiWatchSystem is a reliable sensor technology for observing cow activity and feeding behaviour in a pasture based milk production system, and may be used for research purposes in a grazing environment.

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Effects of a combination of 3,4-methylenedioxymeth amphetamine and caffeine on real time stimulated dopamine release in the rat striatum: studies using fast cyclic voltammetry

Publication date: Available online 24 August 2017
Source:Journal of Neuroscience Methods
Author(s): J.J. O'Connor, K.M. O'Boyle, J.P. Lowry
It is well documented that caffeine exacerbates the hyperthermia associated with acute exposure to 3,4-methylenedioxymethamphetamine (MDMA) in rats. Previous reports have also indicated that MDMA-related enhancement of dopamine release is exacerbated in the presence of caffeine. In the present study we have examined whether the effects of MDMA on real-time stimulated dopamine release in the absence of uptake inhibition are accentuated in the presence of caffeine. Isolated striatal slices from adult male Wistar rats were treated acutely with MDMA, caffeine, or a combination, and their effects on single and 5pulse stimulated dopamine release monitored using the technique of fast cyclic voltammetry. Caffeine at 10 or 100μM had no significant effect on single pulse stimulated dopamine release. However 100μM caffeine caused a significant peak increase in 5pulse stimulated dopamine release. Both 1 and 30μM MDMA gave rise to a significant increase in both single and 5-pulse dopamine release and reuptake. A combination of 100μM caffeine and 1 or 30μM MDMA did not significantly enhance the effects of MDMA on single or 5pulse dopamine release and reuptake when compared to that applied alone. Utilizing single action potential dependent dopamine release, these results do not demonstrate a caffeine-enhanced MDMA-induced dopamine release.

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Development of a head-mounted wireless microstimulator for deep brain stimulation in rats

Publication date: Available online 24 August 2017
Source:Journal of Neuroscience Methods
Author(s): Felix Fluri, Thomas Mützel, Michael K. Schuhmanna, Miloš Krstić, Heinz Endres, Jens Volkmann
BackgroundCommercial neurostimulators for clinical use are effective in patients; however they are too large and prohibitively expensive for preclinical studies. Thus, there is an urgent need of a small inexpensive and wireless microstimulator which is fully programmable in frequency, pulse width and amplitude for rodent experiments.New methodsRats were subjected to a photothrombotic stroke of the right sensorimotor cortex and a microelectrode was implanted in the right mesencephalic locomotor region. The microstimulator was connected with the head plug of the rat. Three different stimulation frequencies were applied and different stimulating amplitudes were chosen. Under these conditions, gait velocity and locomotor behavior of six rats were examined on a beam.ResultsThe head-mounted microstimulator allowed freedom in all motor activities performed spontaneously by the tested rats. Increasing either the frequency or the stimulating amplitude increased gait velocity and ameliorated locomotor behavior after stroke.Comparison with existing methodsOther devices for DBS in rodents must be implanted under the skin or worn in an animal jacket on the back by the tested rat. Some available systems require even a tethering of the tested animal via a cable to an external stimulation system, which limits the freedom of movement.ConclusionHere, we present a freely programmable microstimulator including DBS-typical stimulating parameters. The lightweight device is connected by a simple plug to the head allowing full freedom of movement and exchange of batteries for long-term experiments. The design of this stimulator is suitable for sophisticated behavior tests requiring balance and skilled walking.

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Effect of Transcranial Direct Current Stimulation on Severely Affected Arm-Hand Motor Function in Patients After an Acute Ischemic Stroke: A Pilot Randomized Control Trial.

Objective: The aim of this article was to determine whether cathodal transcranial direct current stimulation (c-tDCS) to unaffected primary motor cortex (PMC) plus conventional occupational therapy (OT) improves functional motor recovery of the affected arm hand in patients after an acute ischemic stroke compared with sham transcranial direct current stimulation plus conventional OT. Design: In this prospective, randomized, double-blinded, sham-controlled trial of 16 severe, acute ischemic stroke patients with severe arm-hand weakness were randomly assigned to either experimental (c-tDCS plus OT; n = 8) or control (sham transcranial direct current stimulation plus OT; n = 8) groups. All patients received a standard 3-hr in-patient rehabilitation therapy, plus an additional ten 30-min sessions of tDCS. During each session, 1 mA of cathodal stimulation to the unaffected PMC is performed followed by the patient's scheduled OT. The primary outcome measure was change in Action Research Arm Test (ARAT) total and subscores on discharge. Result: Application of c-tDCS to unaffected PMC resulted in a clinically relevant 10-point improvement in the affected arm-hand function based on ARAT total score compared with a 2-point improvement in the control group. Conclusions: Application of 30-min of c-tDCS to the unaffected PMC showed a 10-point improvement in the ARAT score. This corresponds to a large effect size in improvement of affected arm-hand function in patients with severe, acute ischemic stroke. Although not statistically significant, this suggests that larger studies, enrolling at least 25 patients in each group, and with a longer follow-up are warranted. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Striatal synapses, circuits, and Parkinson's disease

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): Shenyu Zhai, Asami Tanimura, Steven M Graves, Weixing Shen, D James Surmeier
The striatum is a hub in the basal ganglia circuitry controlling goal directed actions and habits. The loss of its dopaminergic (DAergic) innervation in Parkinson's disease (PD) disrupts the ability of the two principal striatal projection systems to respond appropriately to cortical and thalamic signals, resulting in the hypokinetic features of the disease. New tools to study brain circuitry have led to significant advances in our understanding of striatal circuits and how they adapt in PD models. This short review summarizes some of these recent studies and the gaps that remain to be filled.

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Parsing learning in networks using brain–machine interfaces

Publication date: October 2017
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Amy L Orsborn, Bijan Pesaran
Brain–machine interfaces (BMIs) define new ways to interact with our environment and hold great promise for clinical therapies. Motor BMIs, for instance, re-route neural activity to control movements of a new effector and could restore movement to people with paralysis. Increasing experience shows that interfacing with the brain inevitably changes the brain. BMIs engage and depend on a wide array of innate learning mechanisms to produce meaningful behavior. BMIs precisely define the information streams into and out of the brain, but engage wide-spread learning. We take a network perspective and review existing observations of learning in motor BMIs to show that BMIs engage multiple learning mechanisms distributed across neural networks. Recent studies demonstrate the advantages of BMI for parsing this learning and its underlying neural mechanisms. BMIs therefore provide a powerful tool for studying the neural mechanisms of learning that highlights the critical role of learning in engineered neural therapies.

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Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas.

Background: Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation. Methods: We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later. Results: No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery. Conclusions: Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus. (C) 2017 by North American Neuro-Ophthalmology Society

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Gorham-Stout Disease Presenting as Acute Unilateral Proptosis.

Gorham-Stout disease (GSD) is a rare angiomatous disorder characterized by osteolysis. We report the case of a 66-year-old woman who developed sudden left eye proptosis and facial pain. Neuroimaging demonstrated a destructive mass involving the roof and lateral wall of the left orbit with adjacent abnormal orbital soft tissue. An initial biopsy of the soft tissue was nondiagnostic; however, transcranial biopsy of the orbital roof revealed an intraosseous cavernous angioma, with infiltration of orbital fat by angiomatous tissue. Despite resection of the orbital roof and lateral wall, the orbital lesion continued to expand, leading to signs of a compressive optic neuropathy. The patient then reported severe back pain, prompting imaging that demonstrated disseminated bony involvement of the axial skeleton, eventually leading to the diagnosis of GSD. The patient was treated with a bisphosphonate and a vascular endothelial growth factor inhibitor with stabilization of disease. (C) 2017 by North American Neuro-Ophthalmology Society

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Evaluation of Touchscreen Chambers To Assess Cognition in Adult Mice: Effect of Training and Mild Traumatic Brain Injury

Journal of Neurotrauma Sep 2017, Vol. 34, No. 17: 2481-2494.

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NEAR-FALLS IN PEOPLE WITH PARKINSON'S DISEASE: CIRCUMSTANCES, CONTRIBUTING FACTORS AND ASSOCIATION WITH FALLING

Publication date: Available online 24 August 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Tatjana Gazibara, Darija Kisic Tepavcevic, Marina Svetel, Aleksandra Tomic, Iva Stankovic, Vladimir S. Kostic, Tatjana Pekmezovic
ObjectivesTo describe circumstances of near-falls among persons with Parkinson's disease (PD), assess factors associated with near-falling and assess whether near-falls in the first 6 months are associated with falling in the latter 6 months over one year of follow-up.Materials and MethodsIn the period August 2011-December 2012, 120 consecutive persons with PD, who denied having fallen in the past 6 months, were recruited at Clinical center of Serbia in Belgrade. Occurrence of falling and near-falls was followed for one year.ResultsA total of 31 persons with PD (25.8%) experienced near-falls, but did not fall. Of 42 fallers, 32 (76.2%) experienced near-falls. Tripping was the most common cause of near-falls among fallers, whereas postural instability was the most common in non-fallers. Regardless of falling experience, the most common manner to avoid fall was holding onto furniture or wall. After adjustment for multiple motor and non-motor PD features, more severe freezing of gait was associated with occurrence of near-falls over one year of follow-up (odds ratio [OR]=1.08, 95% confidence interval [CI] 1.01-1.16; p=0.043). Adjusted regression analysis did not show associations between near-falling in the first 6 months and falling in the latter 6 months of follow-up.ConclusionNear-falls commonly occur in persons with PD. More severe freezing of gait appears to predispose near-falling. Fall prevention programs focusing on balance maintenance when experiencing freezing of gait could potentially be useful in reduction of near-falls.

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Effects of microvascular decompression on depression and anxiety in trigeminal neuralgia: a prospective cohort study focused on risk factors and prognosis

Publication date: Available online 24 August 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Jian Cheng, Jiang Long, Xuhui Hui, Ding Lei, Heng Zhang
ObjectivePatients with trigeminal neuralgia (TN) often develop a terrible fear of triggering pain, which may lead to depression and anxiety, exerting a negative effect on their quality of life. This study aimed to investigate the prevalence and risk factors of depression and anxiety in TN patients, and further to investigate the effects of microvascular decompression (MVD) on these psychiatric disorders.Patients and MethodsA prospective cohort study was conducted, patients with TN who underwent MVD in our department between 2013 and 2015 were included. Visual analogue scale (VAS) score was used to measure the severity of pain. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate depression and anxiety disorders before and 6-month after MVD. The clinical data of these patients were collected prospectively and statistically analyzed.ResultsA total of 128 study subjects comprising 70 women and 58 men with a mean age of 47.5±11.2years were included in this study. The mean VAS score was 7.7±1.5. Eighty-three patients (64.8%) had depression and 24 patients (18.8%) suffered anxiety. Multivariate logistic regression analysis revealed that female gender (OR=2.4, P=0.036), high pain intensity (OR=3.25, P=0.027) and ineffective medicine treatment (OR=1.89, P=0.041) were associated with depression, and female gender (OR=3.45, P=0.034) and high pain intensity (OR=2.88, P=0.022) were also associated with anxiety. There were significant improvements in depression and anxiety symptoms between pre- and postoperative responses.ConclusionsDepression and anxiety are prevalent in patients with idiopathic TN. Female gender, high pain intensity and ineffective medicine treatment are risk factors. MVD not only provides high pain-relief rate, but also leads to significant improvements in the depression and anxiety symptoms.

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Establishing objective volume-outcome measures for anterior and posterior cervical spine fusion

Publication date: Available online 24 August 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Micah B. Blais, Sean Michael Rider, Daniel J. Sturgeon, Justin Blucher, Jay M. Zampini, James D. Kang, Andrew J. Schoenfeld
ObjectivesThere is a growing literature on the relationship between provider volume and patient outcomes, specifically within joint arthroplasty and lumbar spine surgery. Such benchmarks have yet to be established for many other spinal procedures, including cervical fusion. We sought to determine whether outcomes-based volume measures for both surgeons and hospitals can be established for cervical spine fusion procedures.Patients and methodsThis was a retrospective review of patient data in the Florida Statewide Inpatient Dataset (SID; 2011–14). Patients identified in the Florida SID who underwent either anterior or posterior cervical fusion were identified along with the operative surgeons and the hospitals where the procedures were performed. Socio-demographic data, as well as medical and surgical characteristics were obtained, as were the development of complications and readmissions up to 90days following hospital discharge. Surgeon and hospital volume were plotted separately against the number of complications and readmissions in an adjusted spline analysis. Multivariable logistic regression analysis was subsequently performed to assess the effect of surgeon and hospital volume on post-operative complications and readmissions.ResultsThere were 8960 patients with posterior cervical fusion and 57,108 anterior cervical fusions (total=66,068) identified for inclusion in the analysis. The patients of low-volume surgeons were found to have an increased (OR 1.83; 95% CI 1.65, 2.02) likelihood of complications following anterior and posterior (OR 1.45; 95% CI 1.24, 1.69) cervical fusion. Low-volume surgeons demonstrated increased likelihood of readmission, irrespective of anterior (OR 1.37; 95% CI 1.29, 1.47) or posterior (OR 1.31; 95% CI 1.16, 1.48) approach. No clinically meaningful differences in the likelihood of complications or readmissions were detected between high- and low-volume hospitals.ConclusionsThis study demonstrates objective volume-outcome measures for surgeons who perform anterior and posterior cervical fusions. Our results have immediate applicability to clinical practice and may be used to benchmark procedural volume. Findings with respect to hospitals speak against the need for healthcare regionalization in this specific clinical context.

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Evaluation of Touchscreen Chambers To Assess Cognition in Adult Mice: Effect of Training and Mild Traumatic Brain Injury

Journal of Neurotrauma Sep 2017, Vol. 34, No. 17: 2481-2494.

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N-Palmitoylethanolamine-Oxazoline (PEA-OXA) as a New Therapeutic Strategy to Control Neuroinflammation: Neuroprotective Effects in Experimental Models of Spinal Cord and Brain Injury

Journal of Neurotrauma , Vol. 0, No. 0.

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Mitteilungen der DGKFO

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Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma

Future Oncology, Ahead of Print.

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County level incidence rates of chronic lymphocytic leukemia are associated with residential radon levels

Future Oncology, Ahead of Print.

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Challenges faced when identifying patients for combination immunotherapy

Future Oncology, Ahead of Print.

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Validation of Immunohistochemical Assays for Integral Biomarkers in the NCI-MATCH EAY131 Clinical Trial

Biomarkers that guide therapy selection are gaining unprecedented importance as targeted therapy options increase in scope and complexity. In conjunction with high-throughput molecular techniques, therapy-guiding biomarker assays based upon immunohistochemistry (IHC) have a critical role in cancer care in that they inform about the presence of a protein target. Here, we describe the validation procedures for four clinically available IHC biomarker assays - PTEN, RB, MLH1 and MSH2 - for use as integral biomarkers in the nationwide NCI-MATCH (Molecular Analysis for Therapy Choice) EAY131 clinical trial. Validation procedures were developed through an iterative process based on collective experience and adaptation of broad guidelines from the United State Food and Drug Administration (FDA). The steps included primary antibody selection, assay optimization, development of assay interpretation criteria incorporating biological considerations and expected staining patterns, including indeterminate results, orthogonal validation, and tissue validation. Following assay lockdown, patient samples and cell lines were used for analytical and clinical validation. The assays were then approved as laboratory developed tests and used for clinical trial decisions for treatment selection. Calculations of sensitivity and specificity were undertaken using various definitions of gold standard references, and external validation was required for the PTEN IHC assay. In conclusion, validation of IHC biomarker assays critical for guiding therapy in clinical trials is feasible using comprehensive pre-analytical, analytical and post-analytical steps. Implementation of standardized guidelines provides a useful framework for validating IHC biomarker assays that allow for reproducibility across institutions for routine clinical use.

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Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma

Future Oncology, Ahead of Print.

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County level incidence rates of chronic lymphocytic leukemia are associated with residential radon levels

Future Oncology, Ahead of Print.

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Coagulopathy in Children With Liver Disease.

It was thought that a high International Normalized Ratio (INR) predicted bleeding in patients with chronic liver disease (CLD) and patients were 'autoanticoagulated'. Contrary to this belief, while patients with CLD experienced bleeding, they also developed thromboses. In the last decade, the prevailing literature challenged the idea that an elevated INR increased bleeding risk. The global assays of coagulation such as: thromboelastography (TEG)/rotational thromboelastometry (ROTEM) and thrombin generation assays (TGA) provide additional insight into coagulation processes. It has become apparent that a parallel reduction of procoagulant and anticoagulant factors leave patients in a new 'balanced' state, albeit a fragile one, where the balance can be easily disrupted. The inherent differences in coagulation between children and adults such as differences in levels of procoagulant and anticoagulant factors, underlying liver disease and the paucity of studies in children make extrapolation of these findings to the pediatric population problematic. Ultimately, this is an area that requires further investigation to avoid inappropriate use of blood products and medication. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clinical Report: Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation (IR) programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. IR programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications and learning from the accumulated patient databases. Quality assurance and research collaboration among centers is also a goal of many of these programs. The combined and coordinated talents and skills of multiple types of healthcare practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Every Other Day Dosing of Oral Viscous Budesonide is not Effective in the Management of Eosinophlic Esophagitis.

Introduction: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized histologically by esophageal eosinophilia. Oral viscous budesonide (OVB) is an effective treatment with remission rates reported between 55 and 87%; however, topical corticosteroids are associated with increased risk of candidal esophagitis and adrenal suppression. Attempts to decrease the daily dose of topical steroids have resulted in disease relapse. The objective of this study was to determine whether or not reducing the frequency of OVB administration would be effective in controlling esophageal eosinophilia in children and adolescents. Methods: Data were obtained by retrospective chart review of patients at Boston Children's Hospital diagnosed with EoE, based on endoscopic findings of >15 eosinophils per high power field (eos/HPF) on esophageal biopsies while on acid blockade. Patients with histologic evidence of response (

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A Rare Phenotype of Alpha-1-Antitrypsin Deficiency due to PI*IS in a Newborn With Liver Disease.

No abstract available

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Use of Fully Covered Self-Expanding Metal Biliary Stents in Pediatrics: A Case Series.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been utilized in this population for obstructive lesions and bile leaks, however they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. However, their use in pediatrics has not been defined. The aim of this study is to describe our experience with FCSEMS at our institution. Methods: We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including three adolescents and one young adult with complex medical needs. Results: Patient age range was 12-24 years and the weight ranged between 36-75 kg. All patients underwent previous ERCP and one or more rounds of plastic stenting without adequate clinical response prior to consideration of FCSEMS placement. Indications included: 1) Recalcitrant biliary anastomotic stricture post liver transplant, 2) Persistent bile leak after needle perforation, 3) Recurrent obstructive choledocholithiasis after cholecystectomy, and 4) Malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6-8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal. Conclusions: FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Functional Gastrointestinal Disorders and Joint Hypermobility. A School-based Study.

Objectives: To assess the prevalence of JH among school-children with and without FGIDs. Methods: School-children completed validated Rome III questionnaires to diagnose FGID. Each child diagnosed with a FGID was matched for age and gender with a healthy control. The prevalence of JH in both groups was compared. Results: 654 school-children participated in the study. One hundred and forty-eight (22.6%) children were diagnosed with a FGID. Data from 136 FGIDs and 136 healthy controls was analyzed. Joint laxity was assessed to establish the Beighton score (>= 4 was considered JH). There was no significant difference in JH between children with and without diagnoses of FGIDs OR 1.03 (95% CI: 0.59-1.81, p = 0.89). Multivariate analysis showed that younger age OR 2.31 (95% CI: 1.30-4.10, p = 0.004) and female gender OR 2.27 (95% CI: 1.22-4.24, p = 0.009) were significantly associated with JH. Conclusions: JH is equally prevalent in school-children with and without FGIDs. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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The Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report from the NASPGHAN Pancreas Committee.

Background: While the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. Methods: The NASPGHAN Pancreas committee performed a MEDLINE review using several pre-selected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. Results: The diagnosis of pediatric AP should follow the published INSPPIRE definitions (by meeting at least two out of three criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values >=3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 h. Analgesia may include opioid medications when opioid-sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, anti-oxidants, probiotics, and protease inhibitors. Esophago-gastro-duodenoscopy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications as well as recurrent attacks of AP. Conclusions: This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multi-center pediatric studies to further validate these recommendations and optimize care for children with AP. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Prospective Study of Gastrointestinal Symptoms in School Children of South-America.

Objectives: To establish the prevalence of abdominal pain (AP) in school-children in Pasto (Colombia) and determine the impact of AP on their daily activities; and compare the prevalence of AP and other gastrointestinal symptoms between school-children from Pasto and Chicago. Methods: Fourth and fifth-grade students from a public school and a private school in Colombia were invited to participate in a prospective study using the same methods and questionnaires (Spanish version) as a previous study conducted in Chicago schools. Children completed weekly confidential surveys for eight consecutive weeks. Results: A total of 332 children participated in the study (40% girls, mean age 9.97 years, median 10, range 8-12 years): public school (288), private school (44). A total of 2425 surveys were analyzed. Out of 2656 possible weekly surveys (332 children x 8 weeks), 91.3% were completed. Overall weekly prevalence of gastrointestinal symptoms: AP (39%), nausea (29.5%), constipation (14%), diarrhea (10.5%), vomiting (9%). Children with AP reported interference with activities: gym (21.9%), school (17.3%), difficulty sleeping (13.7%), and social activities (12.6%). Out of all children, 8.4% sought medical attention for AP during the study period. Conclusions: Gastrointestinal symptoms are common in school-aged children in Colombia and interfere with both daily activities and school attendance. The prevalence of AP, diarrhea and vomiting found in this study were similar to published prevalence of American children using similar methods. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Fatal Central Nervous System Post-Transplant Lymphoproliferative Disease in a Patient Who Underwent Liver Transplantation for Hepatoblastoma.

No abstract available

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Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas.

Gorham-Stout Disease Presenting as Acute Unilateral Proptosis.

Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study.

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Flap necrosis after palatoplasty in irradiated patient and its reconstruction with tunnelized-facial artery myomucosal island flap

Abstract

Background

Tunneled transposition of the facial artery myomucosal (FAMM) island flap on the lingual side of the mandible has been reported for intraoral as well as oropharyngeal reconstruction. This modified technique overcomes the limitations of short range and dentition and further confirms the flexibility of the flap. This paper presents a case of reconstructing secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in irradiated patient with lingually transposed facial artery myomucosal island flap.

Case presentation

The authors successfully reconstructed secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in an irradiated 59-year-old female patient with tunnelized-facial artery myomucosal island flap (t-FAMMIF).

Conclusions

Islanding and tunneling modification extends the versatility of the FAMM flap in the reconstruction of soft palatal defects post tumor excision and even after radiation, giving a great range of rotation and eliminating the need for revision in a second stage procedure. The authors thus highly recommend this versatile flap for the reconstruction of small and medium-sized oral defects.

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Validation of a new three-dimensional imaging system using comparative craniofacial anthropometry

Abstract

Background

The aim of this study is to validate a new three-dimensional craniofacial stereophotogrammetry imaging system (3dMDface) through comparison with manual facial surface anthropometry. The null hypothesis was that there is no difference between craniofacial measurements using anthropometry vs. the 3dMDface system.

Methods

Facial images using the new 3dMDface system were taken from six randomly selected subjects, sitting in natural head position, on six separate occasions each 1 week apart, repeated twice at each sitting. Exclusion criteria were excess facial hair, facial piercings and undergoing current dentofacial treatment. 3dMDvultus software allowed facial landmarks to be marked and measurements recorded. The same measurements were taken using manual anthropometry, using soluble eyeliner to pinpoint landmarks, and sliding and spreading callipers and measuring tape to measure distances. The setting for the investigation was a dental teaching hospital and regional (secondary and tertiary care) cleft centre. The main outcome measure was comparison of the craniofacial measurements using the two aforementioned techniques.

Results

The results showed good agreement between craniofacial measurements using the 3dMDface system compared with manual anthropometry. For all measurements, except chin height and labial fissure width, there was a greater variability with the manual method compared to 3D assessment. Overall, there was a significantly greater variability in manual compared with 3D assessments (p < 0.02).

Conclusions

The 3dMDface system is validated for craniofacial measurements.

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Flap necrosis after palatoplasty in irradiated patient and its reconstruction with tunnelized-facial artery myomucosal island flap

Abstract

Background

Case presentation

Conclusions

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Validation of a new three-dimensional imaging system using comparative craniofacial anthropometry

Abstract

Background

Methods

Results

Conclusions

The 3dMDface system is validated for craniofacial measurements.

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Re: Mandibular wing osteotomy: technical modification

Publication date: Available online 24 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. Brusco

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Customised instrument to retract alveolar subperiosteal flap during the placement of dental implants: new technique

Publication date: Available online 24 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ashwant Kumar Vadepally

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Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

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Cancer Self-Defense: An Immune Stealth

Abstract The hurdles in realizing immunotherapy success for cure stem from the fact that cancer patients are either refractory to immune response and/or develop resistance. Here, we propose that these phenomena are due, in part, to the deployment of a 'decoy flare' i.e., release or secretion of anomalous cancer-associated antigens. The cancer secretome, that resembles the parent cell make up, is composed of soluble macromolecules (proteins, glycans, lipids, DNAs, RNAs etc.) and insoluble vesicles (exosomes), thus hindering cancer detection/recognition by immunotherapeutic agents resulting in a 'cancer-stealth' effect. A clinical evaluation of tumor-derived secretome and specific autoantibodies may change the therapeutic landscape

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Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

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T790M-selective EGFR-TKI combined with dasatinib as an optimal strategy for overcoming EGFR-TKI resistance in T790M-positive non-small cell lung cancer

T790M mutation-selective epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have demonstrated clinical benefits in non-small cell lung cancer (NSCLC) patients harboring T790M mutation, which is the major cause of resistance to EGFR-TKI. However, their efficacy is limited, possibly due to the emergence of apoptosis resistance in T790M-positive NSCLC. We previously identified Src family kinases as co-oncogenic drivers along with T790M and found that the Src inhibitor dasatinib combined with an irreversible or a preclinical T790M-selective EGFR-TKI enhanced anti-tumor activity in T790M-positive cells. In the current study, we evaluated the efficacy of dasatinib combined with the clinically relevant T790M-selective EGFR-TKI or osimertinib in EGFR mutation-positive NSCLC with or without T790M mutation. A cell viability assay revealed that dasatinib had synergistic effects with these TKIs in T790M-positive cells, and simultaneously inhibited Src, Akt, and Erk, which remained activated upon single-agent treatment. Dasatinib also increased the rate of apoptosis in T790M-positive cells induced by T790M-selective EGFR-TKIs, as determined by the annexin-V binding assay; this was associated with downregulation of the anti-apoptotic Bcl-2 family member Bcl-xL, a finding that was confirmed in mice bearing T790M-positive xenografts. Our results suggest that Bcl-xL plays a key role in the apoptosis resistance of T790M-positive NSCLC, and that dasatinib combined with clinically relevant T790M-selective EGFR-TKIs is potentially effective in overcoming resistance to first-generation EGFR-TKIs in NSCLC patients with acquired T790M.

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Lack of constitutively active DNA repair sensitizes glioblastomas to Akt inhibition and induces synthetic lethality with radiation treatment in a p53-dependentmanner

Treatment refractory glioblastoma (GBM) remains a major clinical problem globally and targeted therapies in GBM have not been promising to date. TCGA integrative analysis of GBM reported the striking finding of genetic alterations in the p53 and PI3K pathways in over 80% of GBMs. Given the role of these pathways in making cell-fate decisions and responding to genotoxic stress, we investigated the reliance of these two pathways in mediating radiation-resistance. We selected a panel of GBM cell lines and glioma stem cells (GSC) with wild-type TP53 (p53-wt) and mutant TP53, mutations known to interfere with p53 functionality (p53-mt). Cell lines were treated with a brain permeable inhibitor of P-Akt (ser473), phosphatidylinositol ether lipid analogue (PIA), with and without radiation treatment. Sensitivity to treatment was measured using Annexin-V/PI flow cytometry and western blot analysis for the markers of apoptotic signaling, alkaline COMET assay. All results were verified in p53 isogenic cell lines. p53-mt cell lines were selectively radiosensitized by PIA. This radiosensitization effect corresponded with an increase in DNA damage and a decrease in DNA-PKcs levels. TP53 silencing in p53-wt cells showed a similar response as the p53-mt cells. Additionally, the radiosensitization effects of Akt inhibition were not observed in normal human astrocytes suggesting this treatment strategy could have limited off-target effects. We demonstrate that the inhibition of the PI3K/Akt pathway by PIA radiosensitizes p53-mt cells by antagonizing DNA repair. In principle, this strategy could provide a large therapeutic window for the treatment of TP53 mutant tumors.

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Animacroxam, a novel dual-mode compound targeting histone deacetylases and cytoskeletal integrity of testicular germ cell cancer cells

Novel approaches for the medical treatment of advanced solid tumors including testicular germ cell tumors (TGCT) are desperately needed. Especially, TGCT patients not responding to cisplatin-based therapy need therapeutic alternatives, as there is no effective medical treatment available for this particular subgroup. Here, we studied the suitability of the novel dual mode compound animacroxam for TGCT treatment. Animacroxam consists of a HDAC-inhibitory hydroxamate moiety coupled to a 4,5-diarylimidazole with inherent cytoskeleton disrupting potency. Animacroxam revealed pronounced antiproliferative, cell cycle arresting, and apoptosis inducing effects in TGCT cell lines with different cisplatin sensitivities. The IC50 values of animacroxam ranged from 0.22 to 0.42 µM and were not correlated to the cisplatin sensitivity of the tumor cells. No unspecific cytotoxicity of animacroxam was observed in either cisplatin sensitive or resistant TGCT cells - even at doses as high as 10 µM. Furthermore, animacroxam induced the formation of actin stress fibers in cancer cells thereby confirming the cytoskeleton disrupting and antimigratory properties of its imidazole moiety. When compared with the clinically established HDAC-inhibitor vorinostat, the novel dual mode compound animacroxam exhibited superior antitumoral efficacy in vitro. Animacroxam also reduced the tumor size of TGCT tumors in vivo, as evidenced by performing xenograft experiments on tumor bearing chorio-allantoic membranes of fertilizes chicken eggs (CAM assay). The in vivo experiments also revealed a very good tolerability of the compound and hence, aniamcroxam may be a promising candidate for innovative treatment of TGCT in general and the more so for platinum-insensitive or -refractory TGCT.

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The Neddylation Inhibitor Pevonedistat (MLN4924) Suppresses and Radiosensitizes Head and Neck Squamous Carcinoma Cells and Tumors

The cullin RING E3 ubiquitin ligase 4 (CRL4) with its substrate receptor CDT2 (CRL4-CDT2) is emerging as a critical regulator of DNA replication through targeting CDT1, SET8 and p21 for ubiquitin-dependent proteolysis. The aberrant increased stability of these proteins in cells with inactivated CRL4-CDT2 results in DNA rereplication, which is deleterious to cells due to the accumulation of replication intermediates and stalled replication forks. Here, we demonstrate that CDT2 is overexpressed in head and neck squamous cell carcinoma (HNSCC) and its depletion by siRNA inhibits the proliferation of human papilloma virus negative (HPV-ve) HNSCC cells primarily through the induction of rereplication. Treatment of HNSCC with the NEDD8-activating enzyme (NAE) inhibitor pevonedistat (MLN4924), which inhibits all cullin-based ligases, induces significant rereplication and inhibits HNSCC cell proliferation in culture and HNSCC xenografts in mice. Pevonedistat additionally sensitizes HNSCC cells to ionizing radiation (IR) and enhances IR-induced suppression of xenografts in mice. Induction of rereplication via CDT2 depletion, or via the stabilization or activation of CDT1, also radiosensitizes HNSCC cells. Collectively, these results demonstrate that induction of rereplication represents a novel approach to treating radioresistant HNSCC tumors and suggest that pevonedistat may be considered as an adjuvant for IR-based treatments.

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Radiosensitisation in vivo by histone deacetylase inhibition with no increase in early normal tissue radiation toxicity

As the population ages, more elderly patients require radiotherapy-based treatment for their pelvic malignancies, including muscle-invasive bladder cancer, as they are unfit for major surgery. Therefore, there is an urgent need to find radiosensitising agents minimally toxic to normal tissues, including bowel and bladder, for such patients. We developed methods to determine normal tissue toxicity severity in intestine and bladder in vivo, using novel radiotherapy techniques on a small animal radiation research platform (SARRP). The effects of panobinostat (PAN) on in vivo tumour growth delay were evaluated using subcutaneous xenografts in athymic nude mice. PAN concentration levels in xenografts, plasma and normal tissues were measured in CD1-nude mice. CD1-nude mice were treated with drug/irradiation combinations to assess acute normal tissue effects in small intestine using the intestinal crypt assay, and later effects in small and large intestine at 11 weeks by stool assessment and at 12 weeks by histological examination. In vitro effects of PAN were assessed by qPCR and of PAN, TMP195 and mocetinostat by clonogenic assay, and western blot. PAN resulted in growth delay in RT112 bladder cancer xenografts but did not significantly increase acute (3.75 days) or 12 weeks' normal tissue radiation toxicity. Radiosensitisation by PAN was effective in hypoxic bladder cancer cells and associated with class I HDAC inhibition, and protein downregulation of HDAC2 and MRE11. Pan-HDAC inhibition is a promising strategy for radiosensitisation, but more selective agents may be more useful radiosensitisers clinically, resulting in fewer systemic side effects.

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Mitteilungen der DGKFO

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Persistent perineal sinus after abdominoperineal resection

Abstract

Background and aims

Persistent perineal sinus (PPS) defined as a perineal wound remaining unhealed more than 6 months after abdominoperineal resection (APR) is a well-known complication. The aim of our study was (1) to evaluate the incidence of PPS after APR for Crohn's disease (CD) in the era of biotherapy, (2) to determine long-term outcome of PPS, (3) to study risk factors associated with delayed perineal healing, and (4) to compare the results in this CD patient group with patients without CD.

Methods

From 1997 to 2013, the records of patients who underwent APR for CD and for non-CD rectal cancer with or without radiochemotherapy at two French university hospitals were studied retrospectively. Perineal healing was evaluated by clinical examination at 1, 6, and 12 months after surgery.

Results

The cumulative probability of perineal wound unhealed at 6 and 12 months after surgery was 85 and 48%, respectively, for 81 patients who underwent APR for CD patients in contrast to 21 and 13%, respectively, for 25 non-CD patients with rectal cancer. Eight patients with CD (10%) remained with PPS after a median follow up of 4 years and spontaneous perineal healing occurred with time for all non-CD patients. Factors associated with delayed perineal healing in CD included age at surgery < 49 years (p = 0.001) and colonic-only Crohn's disease location (p = 0.045). Medical treatments had no significant impact on perineal healing.

Conclusions

PPS beyond 6 months post-APR remains a frequent complication but mostly resolves over time. CD is a risk factor for developing PPS and factors associated with higher incidence of PPS were age at surgery < 49 years and colonic-only Crohn's disease location. Prevention of PPS in this population with muscle flap during APR deserves to be evaluated.

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Rooted in the Community: Assessing the Reintegration Impacts of Agriculture on Rural Veterans

Publication date: Available online 24 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Karen Besterman-Dahan, Margeaux Chavez, Eni Njoh
ObjectiveTo assess the impact of a Veteran-oriented community agricultural initiative (CAI) on transitioning rural Veterans.DesignConvergent mixed-method program evaluation.SettingA Veteran-oriented farm-to-market CAI in rural Washington State.ParticipantsVeterans who were members of the CAI.Main Outcome MeasuresHealth, well-being, and reintegration were assessed by self-reported data from interview, demographic survey, validated health quality of life measure (Veterans RAND-12 -VR-12), validated reintegration measure (Military to Civilian Questionnaire -M2C-Q), and general satisfaction survey.ResultsVeteran participants were primarily Caucasian (88.4%, n=38) and male (74.4%, n=32) and most had a service-connected disability rating (58.2%, n=25). Qualitative and quantitative data revealed that the veterans participating in this CAI experienced health and reintegration benefits. Results on the M2C-Q, VR-12, and the satisfaction survey suggest that participating in this CAI contributed to improved mental, physical, and emotional health and vocational skills, community connectedness, and interpersonal communication. Qualitative interviews supported quantitative findings and revealed that participating in the CAI provided Veterans with a sense of satisfaction, belonging, and helped decrease the stigma surrounding their Veteran status.ConclusionsVeterans who participate in this CAI reported general improvements in physical and mental health, including improvements in sleep, nutrition, exercise, and decreases in anxiety, pain, depression and medication and substance use, all known factors which impact Veteran reintegration.

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Low-dose-rate prostate brachytherapy: 4–8 week postimplant prostate-specific antigen a novel predictor of biochemical failure-free survival

Publication date: Available online 24 August 2017
Source:Brachytherapy
Author(s): Cameron M. Callaghan, Lin Wang, Abhishek Alluri, Andrew Lauve, Cynthia Boyer, William Russell
PurposeThe purpose of this study was to determine the relationship between patient, disease, and treatment variables and biochemical failure-free survival (bFFS) following low-dose-rate prostate brachytherapy (LDR-BT).Methods and MaterialsData from 624 consecutive patients who received LDR-BT for localized prostate cancer between 2002 and 2012 at a single institution were collected for various patient, disease, and treatment characteristics including a 4–8 week postimplant PSA (4–8wkPSA). Subgroup analysis was stratified by risk category and treatment regimen. Analysis was performed using Kaplan–Meier survival curves, Cox proportional hazard ratios (HRs), and receiver-operator characteristic curves.ResultsA total of 624 consecutive patients were included with followup time of 4.0 ± 3.1 years. Predictors of bFFS included PSA nadir and 4–8wkPSA (HR = 2.48, p = 0.000 and HR = 1.24, p = 0.000, respectively) for total population. Diabetes mellitus (p = 0.026), chronic obstructive pulmonary disease (p = 0.000), alcohol use (p = 0.024), and age (p = 0.002) were predictors for specific subgroups. Receiver-operator characteristic curves 4–8wkPSA were found to be significant (p = 0.036).Conclusion4–8wkPSA is a novel predictor of bFFS for patients receiving LDR-BT across several risk categories and treatment regimens with potential clinical utility as a prognostic indicator. Certain comorbidities and exposure histories also demonstrated significant relationships with bFFS including chronic obstructive pulmonary disease, diabetes mellitus, age, alcohol history, proton pump inhibitor use, PSA nadir, and PSA density.

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Clinical implementation of a novel Double-Balloon single-entry breast brachytherapy applicator

Publication date: Available online 24 August 2017
Source:Brachytherapy
Author(s): Bethany M. Anderson, Charles R. Wallace, Anna-Maria A. De Costa, Rupak K. Das
PurposeThe purpose of the study was to describe the clinical utilization of a novel Double-Balloon applicator for accelerated partial breast irradiation (APBI).Methods and MaterialsThe Double-Balloon single-entry breast applicator contains a single central treatment catheter, as well as four peripheral catheters that can be differentially loaded to customize radiation dose coverage. An inner balloon is filled with up to 7–30 cm³ of saline to increase separation between the peripheral catheters, and an outer balloon is filled with up to 37–115 cm³ of saline to displace breast tissue from the peripheral catheters. Treatment planning objectives include coverage of the breast planning target volume to a minimum of V90 > 90%, limiting dose heterogeneity such that V200 < 10 cm³ and V150 < 50 cm³, and limiting maximum dose to skin (<100% of prescription dose) and ribs (<145% of prescription dose).ResultsHigh-dose-rate APBI was delivered to 11 women using this device (34 Gy in 10 twice daily fractions). The mean V90 was 98.2% (range 94.2–99.4%). The mean skin Dmax with the Double-Balloon applicator was 83.3% (range 75.6–99.5%). The mean breast V200 was 5.8 cm³ (range 2.3–10.2 cm³), and the mean breast V150 was 32.9 cm³ (range 25.0–41.7 cm³). Pretreatment quality assurance was performed using CT prior to each morning fraction and ultrasound prior to each afternoon fraction.ConclusionsThe Double-Balloon applicator can be easily introduced into a previously existing brachytherapy program. APBI plans created with this applicator achieve excellent planning target volume coverage, while limiting skin dose and maintaining breast V200 < 10 cm³.

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Mortality and its Causes in a German Cohort with Diabetes Mellitus Type 1 after 20 Years of Follow-Up: The JEVIN Trial

04-2017-0143-dia_10-1055-s-0043-113452-1

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-113452

Background The JEVIN trial started as a cross-sectional study in 1989/90 in Jena. After a follow-up of more than 20 years, the mortality incidence of JEVIN participants with type 1 diabetes was surveyed. Methods 103 (78.6%) of the 131 JEVIN patients participating at baseline could be examined. 38 persons (36.9%) had deceased. All JEVIN survey data and routine examinations documented in the electronic patient record EMIL® of surviving and deceased participants were used for analyses. We compared the data of the surviving with the deceased participants (follow-up time: 2,166 person-years). Results The incidence rate of death was 1.75/100 person-years. Median observation time for all patients was 23.1 years (range 0.61–26.6 years). Mean age at death was 58.5 years (34.2–78.4 years), and diabetes duration 35 years (3.5–68.5 years). Most frequent causes of death were: cardiovascular diseases (48.2%, n=13) and infections (25.9%, n=7). There were no differences in age (p=0.302), diabetes duration (p=0.371), BMI (p=0.535), blood pressure (p=0.622/0.820), gender (p=0.566), and smoking status (p=0.709) between surviving and deceased persons. The mean HbA1c of the last year before death or last visit was higher in the deceased than surviving persons (7.5% vs. 7.0%; p=0.010). 57.4% of the surviving and 87.0% of the deceased participants had nephropathy (p=0.012), 79.7% vs. 89.7% retinopathy (p=0.241) and 61.4% vs. 63.3% neuropathy (p=0.860), but only nephropathy was significantly associated with increased mortality risk (HR=4.208, CI:1.226-14.440; HR=2.360, CI:0.696-8.004; HR=0.944, CI:0.436-2.043). Conclusions In the JEVIN population with diabetes mellitus type 1 only, diabetic nephropathy was associated with higher mortality risk.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Characterization of FaDu-R, a radioresistant head and neck cancer cell line, and cancer stem cells

Publication date: Available online 24 August 2017
Source:Auris Nasus Larynx
Author(s): Kwang-Jae Cho, Eun-Ji Park, Min-Sik Kim, Young-Hoon Joo
ObjectivesThe aim of this study was to evaluate the impact of CSC on insensitivity to radiotherapy in HNSCC.MethodsA radioresistant cell line, FaDu-R, was established using fractionated ionizing radiation. Cells with high and low CD44/ALDH activity were isolated.ResultsFaDu-R cells demonstrated significantly increased cell viability after radiation exposure compared with parental cells. CD44^high/ALDH^high FaDu-R cells demonstrated significantly faster wound closure (p<0.05) and more efficient invasion (p<0.05) compared to the CD44^high/ALDH^high FaDu cells or the CD44^low/ALDH^low FaDu-R cells. There was a significant difference in tumor volume between the CD44^high/ALDH^high FaDu-R cells and the CD44^high/ALDH^high FaDu cells (p<0.05) as well as the CD44^low/ALDH^low FaDu-R cells (p<0.05).ConclusionCancer stem cells (CSC) were associated with invasion and tumorigenesis in a radioresistant head and neck squamous cell carcinoma (HNSCC) cell line. This concept might help to improve the understanding of these mechanisms and to develop drugs that can overcome radioresistance during radiotherapy.

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Risk factors for the occurrence of epistaxis: Prospective study

Publication date: Available online 24 August 2017
Source:Auris Nasus Larynx
Author(s): Filipa Camacho Côrte, Tiago Orfao, Cláudia Camila Dias, Carla Pinto Moura, Margarida Santos
ObjectiveAnalyse and compare the characteristics of patients with epistaxis admitted to the otolaryngology emergency department with those provided by a control group. Establish a model to identify epistaxis predictive factors.MethodsProspective analysis of 283 consecutive adults, admitted to the otolaryngology emergency department of a tertiary referral centre between 25 January and 25 February 2014. Comparison of gender, age, co-morbidities, usual medication, history of epistaxis or nasal trauma, presence of septal deviation and blood pressure value on admission, between the elements that were admitted to the emergency due to epistaxis (group 1) and a group composed of patients with other symptoms (group 2). Intergroup variations were analyzed using t student and chi-square tests. Multivariate logistic regression and a receiver operating characteristic curve were used to establish a predictive model and test its suitability.ResultsMale gender (OR=2.57, 95% CI 1.1–6.0, p=0.029), older age (OR=1.03, 95% CI 1.0–1.1, p=0.002), existence of peripheral vascular disease (OR=13.47, 95% CI 1.9–95.3, p=0.009), cardiovascular disease (OR=3.91, 95% CI 1.6–9.7, p=0.003) and previous history of epistaxis (OR=5.53, 95% CI 2.5–12.1, p<0.001) were predictors of epistaxis when adjusted for the presence of elevated blood pressure, history of hypertension, cerebrovascular disease and chronic use of anticoagulants or antiplatelet drugs. The model revealed a good applicability (area under the curve of 0.852).ConclusionsThe only predictive factors of admission to the emergency department due to epistaxis were male gender, older age, peripheral vascular disease, cardiovascular disease and history of epistaxis.

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A case of ectopic salivary gland of the larynx

Publication date: Available online 24 August 2017
Source:Auris Nasus Larynx
Author(s): Shori Tajima, Kouichi Yamauchi, Ryuzaburo Higo, Katsuhisa Ikeda
A 46-year-old man presented with sore throat. Laryngoscopic findings revealed a smooth yellow mass occupying the anterior portion of the false vocal fold on the left side. The authors performed biopsy under general anesthesia. The histopathological diagnosis was ectopic salivary gland. Because salivary glands are usually not found under the false vocal fold mucosa, ectopic salivary gland of the larynx was diagnosed.It is necessary to consider the possibility of ectopic salivary gland for mass lesions if swelling of the provisional vocal cord is found.

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Characterization of FaDu-R, a radioresistant head and neck cancer cell line, and cancer stem cells

The aim of this study was to evaluate the impact of CSC on insensitivity to radiotherapy in HNSCC.

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Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients

Abstract

Background

Laparoscopic inguinal hernia repair is preferred over an open technique because of reduced recovery time, favorable cost effectiveness, and less chronic postoperative inguinal pain. Nevertheless, some patients develop a nociceptive inguinal pain syndrome possibly related to the presence of the mesh. This is the first study describing feasibility, safety, and effectiveness of laparoscopic mesh removal in patients with chronic pain after endoscopic hernia repair.

Methods

Pre- and intraoperative data of chronic pain patients scheduled for endoscopic mesh removal were prospectively collected by a standard evaluation form. Long-term efficacy was determined using pain scores, patient satisfaction, and quality of life questionnaire. A Wilcoxon signed-rank test was used to determine significant differences between pre- and postoperative pain scores.

Results

Fourteen patients were studied (11 males, median 52 years). Median operating time was 103 min. Conversion to open surgery was not required. One intraoperatively recognized bladder laceration was laparoscopically closed. Otherwise, no intraoperative or postoperative complications occurred. Eight months postoperatively (median), pain scores had dropped from eight to four (p < 0.01). Satisfaction was good or excellent in ten patients. A recurrent hernia developed in two patients requiring an open mesh repair in one.

Conclusions

Laparoscopic mesh removal is a feasible, safe, and effective option in selected patients with chronic groin pain after endoscopic hernia repair in the hands of an experienced surgeon.

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Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator

Abstract

Objective

To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS).

Methods

15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups.

Results

Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p = 0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score.

Conclusion

Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills.

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Automated anesthesia delivery systems in cardiac surgical patients with left ventricular dysfunction: All systems go?

The interest in the use of automated drug infusion systems to deliver anesthesia has grown amongst both clinicians and researchers since their inception decades ago. Presently, two major types of automated anesthesia delivery systems exist, both of which have been used predominantly to deliver intravenous medications as part of a general anesthetic.

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Idiopathic Rem Sleep Behavior Disorder In The Elderly Spanish Community: A Primary Care Center Study With A Two-Stage Design Using Video-Polysomnography

To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers.

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Response to “GHB concentration in breast milk of narcoleptic women treated with sodium oxybate. How important it is to be careful when interpreting values.” (Letter to the Editor by Busardò PB and Pichini S)

We thank Drs. Busardò and Pichini for their letter and points regarding our recent manuscript entitled "GHB levels in breast milk of women with narcolepsy with cataplexy treated with sodium oxybate". We agree and acknowledge, within the manuscript, that the data collected by ours and others' laboratories should be corroborated by larger prospective studies with appropriate controls. In the absence of sufficient clinical trial data, however, we submit that small studies such as these can be helpful to physicians and patients in making decisions regarding medications during the perinatal period.

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Investigation of the Leaching Behaviour of a Novel Cement-Polyurethane Hybrid Material for Waterproofing Purpose

Abstract

A novel cement-polyurethane hybrid material invented to stop massive water ingress during e.g. tunnel construction is presented in this study. A special emphasis is put on the leaching behaviour and the environmental impact of the material. For this purpose, a batch test as worst-case scenario and a tank leaching test were used to compare different material combinations. Besides sum parameters like pH value, major elements from cement and organic species were analysed in the leachates. Simulations about the release behaviour of ionic species as well as the total organic carbon were performed. Release was governed by surface wash-off effects for all species except for Al which was controlled by diffusion. Leaching of major elements correlated with the amount of ground granulated blast furnace slag added to substitute ordinary Portland cement. Total organic carbon content was measured, and the cumulative value was in the range of 83 to 49 mmol/m² after 64 days of leaching. All investigated parameters were below the threshold values governed by German authorities. In addition, ecotoxicological tests with earthworm species (Enchytraeus albidus) have been performed to explore the impact of the leachates on the environment. While in pure eluate tests the early age leachates showed toxic effects, in soil and sand tests the buffering function plays a key role to prevent possible hazardous effects.

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A Single-Operator Learning Curve Analysis for the Endoscopic Sleeve Gastroplasty

Endoscopic sleeve gastroplasty (ESG) is a novel, incisionless technique for gastric volume reduction to promote weight loss. Our aim was to describe the learning curve for performing ESG using a prospective case series.

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Effectiveness of endoscopic treatments for colonic diverticular bleeding

Several endoscopic modalities have been used for the treatment of colonic diverticular bleeding (CDB). The aim of this study was to evaluate the effectiveness of endoscopic treatment for CDB.

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Otolaryngic manifestations of Cushing disease

Edward C. Kuan, MD, MBA; Kevin A. Peng, MD; Jeffrey D. Suh, MD; Marvin Bergsneider, MD; Marilene B. Wang, MD

Abstract

Cushing disease is a relatively rare cause of Cushing syndrome secondary to a hyperfunctioning pituitary adenoma. In addition to signs and symptoms of hypercortisolism, Cushing disease may present with diverse otolaryngic manifestations, which may guide diagnosis and management. We performed a retrospective chart review of patients who were found to have Cushing disease and who underwent transnasal transsphenoidal surgery for pituitary adenomas between January 1, 2007, and July 1, 2014, at a tertiary academic medical center. There were 37 consecutive patients in this series with Cushing disease caused by a pituitary adenoma. Fifteen (41%) patients complained of visual changes. Five (14%) patients suffered from obstructive sleep apnea. Four (11%) patients had thyroid disease. Other symptoms included hearing loss, vertigo, tinnitus, epistaxis, dysphagia, and salivary gland swelling. Although Cushing disease traditionally presents with classic "Cushingoid" systemic features, it also may present with various otolaryngic manifestations. A thorough workup by otolaryngologists is critical in the comprehensive management of these patients.

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Use of sialendoscopy as an aid to identify a large retained foreign body

Christopher J. Britt, MD; David Hyman, MD; Gregory K. Hartig, MD

Abstract

We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.

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A clinicopathologic and epidemiologic study of chronic white lesions in the oral mucosa

Sampurna Ghosh, MS; Sudipta Pal, MS; Soumya Ghatak, MS; Somnath Saha, MS; Surajit Biswas, MD; Prabha Srivastava, MD

Abstract

Invasive oral squamous cell carcinoma is often preceded by the presence of clinically identifiable premalignant changes of the oral mucosa, including white lesions. We conducted a cross-sectional, observational study to assess the clinicopathologic and epidemiologic aspects of chronic oral mucosal white lesions to determine the necessity of early biopsy in these cases. Our study population was made up of 77 patients-50 males and 27 females, aged 15 to 70 years (mean: 42.9)-who presented with white lesions persisting for at least 4 weeks. All but 3 patients underwent a biopsy; the 3 exceptions were diagnosed with smear-proven candidiasis. Patients with moderate or severe dysplasia underwent an excision biopsy. The buccal mucosa was the single most common site of white lesions, occurring in 15 patients (19.5%), although 21 patients (27.3%) exhibited a diffuse involvement of the oral mucosa. Of the 77 patients, 59 (76.6%) had concerning findings: premalignant lesions in 45 patients (58.4%) and malignant lesions in 14 (18.2%). Also, dysplasia was seen in 8 patients (10.4%), all of whom had premalignant lesions. Tobacco chewing (p = 0.008) and betel quid chewing (p = 0.029) were significantly associated with the development of premalignant and malignant lesions; a longer duration of tobacco chewing (≥10 yr) was significantly associated with a higher risk of malignant but not premalignant lesions (p = 0.031). Finally, illiteracy was a significant risk factor for premalignant and malignant lesions (p = 0.03). Our findings support the necessity of biopsy in every case. Early detection of oral carcinoma by biopsy of all oral white lesions would not only prevent patients from undergoing disfiguring surgery and chemoradiation, but it also would increase the 5-year survival rate.

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25 years of powered endoscopic transnasal sphenoidotomy

Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS

Endoscopic transnasal sphenoidotomy requires good hemostasis in the operative field.

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Paresis podule on a paralyzed vocal fold

Karthik S. Shastri, MD; Aaron J. Jaworek, MD; Robert T. Sataloff, MD, DMA, FACS

Paresis podules are localized areas of Reinke edema that can develop on paretic or paralyzed vocal folds, or on the contralateral vocal fold.

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Modified two-handed transnasal endoscopic surgery: Innovative instrument design and an experimental canine study

Guodong Feng, MD; Zhiqiang Gao, MD; Xu Tian, MD; Yuan Zhuang, MD; Wei Lv, MD

Abstract

This study was conducted to design new instruments to solve the current issues of one-hand control and the obscuring of the endoscope by blood during transnasal endoscopic surgery. An endoscope holder and an electronically controlled irrigation-suction system were designed and manufactured. The feasibility and effectiveness of the designed instruments and operation models were verified in a model transnasal endoscopic surgery procedure performed on a mongrel dog. During the operation, one hand was used to perform the operation and move the endoscope, and the other hand was used for irrigation and suction to keep the surgical field and the endoscope clear. The combined use of an endoscope holder and an electronically controlled irrigation-suction system facilitates single-surgeon bimanual transnasal endoscopic surgery in a model surgical procedure. The clinical value of this technique warrants further research.

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Cornelia de Lange syndrome: What every otolaryngologist should know

Michael J. Eliason, MD, USN, LCDR; Jonathan M. Melzer, MD, USN, LCDR; Thomas Q. Gallagher, DO, USN, CDR

Abstract

Cornelia de Lange Syndrome (CdLS) can be expressed in multiple organ systems requiring a variety of specialists, including pediatric otolaryngology. We present the case of a 20-month-old boy with CdLS actively managed by an aerodigestive team consisting of pediatric otolaryngology, pediatric pulmonology, pediatric gastroenterology, with support staff from audiology, speech, and nutrition. His presentation included mixed hearing loss, dysphagia, microaspiration, gastroesophageal reflux, and failure to thrive. We submit this challenging case of CdLS with a review of the literature to focus specific attention on the otolaryngic manifestations of the syndrome and to discuss the benefits of a multidisciplinary approach to these unique patients.

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Nasal cavity tumefactive fibroinflammatory lesion mimicking recurrent mucoepidermoid carcinoma

Daniel Thomas Ginat, MD, MS; Elizabeth Blair, MD

The diagnostic imaging features of tumefactive fibroinflammatory lesions can mimic those of neoplasms.

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An incidental thyroid nodule

John P. Flynn, MD; Peter A. Morawiecki, MD; Marco A. Ayala, MD

Preoperative diagnosis of intrathyroidal parathyroid adenomas is essential to determining correct surgical management

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Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis.

http:--production.springer.de-OnlineReso

Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis.

Surg Endosc. 2017 Mar;31(3):1032-1044

Authors: Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y, Chen J

Abstract
BACKGROUND: The efficacy of transoral incisionless fundoplication (TIF) performed with the EsophyX device (Redmond, Washington, USA) and its long-term outcomes in gastresophageal reflux disease (GERD) are debated. We, therefore, performed a systematic review with meta-analysis of studies evaluating the role of TIF in GERD.
METHODS: A systematic search of EMBASE, SCOPUS, PubMed, and the Cochrane Library Central was performed. All original studies reporting outcomes in GERD patients who underwent TIF were identified. Only randomized controlled trials (RCTs) evaluating the efficacy of TIF, and prospective observational studies reporting outcomes after TIF were included.
RESULTS: A total of 18 studies (963 patients) published between 2007 and 2015 were identified, including five RCTs and 13 prospective observational studies. The pooled relative risk of response rate to TIF versus PPIs/sham was 2.44 (95 % CI 1.25-4.79, p = 0.0009) in RCTs in the intention-to-treat analysis. The total number of refluxes was reduced after TIF compared with the PPIs/sham group. The esophageal acid exposure time and acid reflux episodes after TIF were not significantly improved. Proton-pump inhibitors (PPIs) usage increased with time and most of the patients resumed PPIs treatment at reduced dosage during the long-term follow-up. The total satisfaction rate after TIF was about 69.15 % in 6 months. The incidence of severe adverse events consisting of gastrointestinal perforation and bleeding was 2.4 %.
CONCLUSIONS: TIF is an alternative intervention in controlling GERD-related symptoms with comparable short-term patient satisfaction. Long-term results showed decreased efficacy with time. Patients often resume PPIs at reduced doses in the near future.

PMID: 27495332 [PubMed - indexed for MEDLINE]

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The Voiced Oral High-frequency Oscillation Technique's Immediate Effect on Individuals With Dysphonic and Normal Voices

The aim of this study was to verify the effect of the voiced oral high-frequency oscillation (VOHFO) on voice quality in acoustic voice symptoms and self-reported sensations in individuals with voice complaints and dysphonic voices, and in individuals with normal voices.

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Laryngeal Manual Therapies for Behavioral Dysphonia: A Systematic Review and Meta-analysis

The aim of this study was to review systematically the literature and to analyze the effectiveness of laryngeal manual therapy in addressing the overall severity of vocal deviation, the intensity of vocal and laryngeal symptoms, and musculoskeletal pain in adults with behavioral dysphonia.

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Use and Perceptions of Electronic Cigarettes Among Caregivers of Infants and Children with Bronchopulmonary Dysplasia

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

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Surgeries for Patients with Tandem Spinal Stenosis in Cervical and Thoracic Spine: Combined or Staged Surgeries?

Publication date: November 2017
Source:World Neurosurgery, Volume 107
Author(s): Pan-pan Hu, Miao Yu, Xiao-guang Liu, Zhong-jun Liu, Liang Jiang
BackgroundCervical and thoracic tandem spinal stenosis (ct-TSS) is a rare yet challenging degenerative disease. When the diagnosis is made, surgical decompression is indicated for both lesions. However, literature about the surgical approaches and prognosis of this disease is lacking.MethodsFrom March 2005 to April 2013, 30 patients with ct-TSS and a mean age of 49.8 years were recruited. We outlined 2 types of ct-TSS lesions—adjacent and skip lesions. The surgical approach for ct-TSS with adjacent lesions was combined cervical and thoracic decompression via a single posterior incision; the approach for skip lesions was 2-stage sequential cervical and thoracic decompressions. Neurologic status was evaluated with the Japanese Orthopaedic Association scale for cervical myelopathy.ResultsSeventeen patients underwent 1-stage surgery, and 13 patients underwent the 2-stage procedure. After surgery, 27 patients (90%) experienced improvement. Main complications included transient neurologic deterioration in 7 patients, dural tears in 14 patients, and new radiculopathy in 4 patients. Combined and staged groups were comparable in terms of total length of decompression, occurrence of perioperative complications, and recovery rate (P > 0.05). The average Japanese Orthopaedic Association score increased significantly from 9.8 ± 1.9 to 13.7 ± 3.0 (P < 0.05), and the average recovery rate was 54.4%.ConclusionsThe types of stenotic lesions should be considered when planning surgery for patients with ct-TSS. One-stage decompression is suitable for patients with adjacent stenotic lesions; staged procedures should be considered for other patients.

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Forgotten? Not Yet. Cardiogenic Brain Abscess in Children: A Case Series–Based Review

Publication date: November 2017
Source:World Neurosurgery, Volume 107
Author(s): Suhas Udayakumaran, Chiazor U. Onyia, R. Krishna Kumar
BackgroundBrain abscess is a significant cause of morbidity in patients with uncorrected or partially palliated congenital cyanotic heart disease (CCHD). Unfortunately, in the developing world, the majority of patients with CCHD remain either uncorrected or only partially palliated. Furthermore, a risk of this feared complication also exists even among those undergoing staged corrective operations in the interval in between operations. There have been no recent articles in the literature on the outcomes of surgical management of cardiogenic brain abscess in children. In this study, we aimed to describe the clinical and demographic profile of patients with cardiogenic cerebral abscess and to highlight the fact that uncorrected or palliated CCHD continue to be at risk for brain abscess.MethodsThis study was a retrospective analysis of 26 children (age <19 years) being managed for CCHD who were diagnosed with cerebral abscess managed surgically (26 of 39 of cases cerebral abscess in children), at Amrita Institute of Medical Sciences and Research Centre, Kochi, India between December 2000 and January 2014. Data collected retrospectively included demographic information, modes of presentation, diagnosis, location of abscess, details of the underlying heart disease, management of the cerebral abscess, and outcomes of management.ResultsThe patient cohort comprised 26 patients (16 males and 10 females), with a mean age of 7.19 years (range, 1.5–19 years). Ten of the 26 patients (38%) required reaspiration after the initial surgery. On follow-up, all the patients had improved symptomatically and demonstrated no signs of cerebral abscess.ConclusionsCardiogenic origin of cerebral abscess is the most common cause of cerebral abscess in children. Unresolved CCHD is a risk factor for the occurrence, persistence, and recurrence of cerebral abscess.

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The Likelihood of Remnant Nonfunctioning Pituitary Adenomas Shrinking Is Associated with the Lesion's Blood Supply Pattern

Publication date: November 2017
Source:World Neurosurgery, Volume 107
Author(s): Miiko Ito, Atushi Kuge, Ken-ichiro Matsuda, Shinya Sato, Takamasa Kayama, Yukihiko Sonoda
ObjectiveNonfunctioning pituitary adenomas (NFPA) often shrink after transsphenoidal surgery. However, little is known about the predictors of spontaneous NFPA regression. The aim of this study was to determine whether the blood supply pattern of remnant NFPA lesions was associated with the likelihood of such lesions shrinking.MethodsA total of 37 remnant tumors in 31 patients who were treated at the Department of Neurosurgery, Yamagata University Hospital, were included in this study. All patients underwent preoperative dynamic 3.0T magnetic resonance imaging (MRI) to evaluate their tumors' arterial blood supplies, followed by endoscopic transsphenoidal surgery and intraoperative 1.5T MRI. Follow-up MRI scans were obtained at 1–2 weeks and 3–6 postoperative months.ResultsWe detected tumor shrinkage in 15 of 37 (40.5%) remnant tumors on follow-up MRI scans obtained at 3–6 postoperative months. Remnant tumors were found in rostral and caudal locations in 21 and 16 cases, respectively. Rostral remnant tumors were significantly more likely to shrink (P < 0.0001). The tumors were classified into 3 groups according to their blood supply patterns (23 ascending, 6 descending, and 2 monophasic). The ascending blood supply pattern was found to be a positive predictor of tumor shrinkage (P = 0.002). Furthermore, no remnant tumors with rich blood supplies underwent spontaneous regression (P < 0.0001).ConclusionsEvaluations of the blood supplies of remnant NFPA via preoperative dynamic MRI and the locations of the remnant tumors could be useful for predicting postoperative tumor shrinkage.

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Αρχειοθήκη ιστολογίου

Πέμπτη 24 Αυγούστου 2017

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