OtoRhinoLaryngology News: 12/06/17

Τετάρτη 6 Δεκεμβρίου 2017

Pedicled iliac crest bone flap transfer for the treatment of upper femoral shaft fracture nonunion: An anatomic study and clinical applications

Purpose

We present the results of a study on the anatomy of the ascending branch of the lateral circumflex femoral artery (AB-LCFA) and the use of the pedicled iliac bone flap transfer perfused by AB-LCFA combined with external fixation for the treatment of the nonunion of upper femoral shaft fractures.

Methods

The orientation, diameter, length, and distribution of the AB-LCFA from 40 lower limbs of adult cadavers were dissected and measured. From 2000 to 2012, 13 patients with nonunion of upper femoral shaft fractures underwent pedicled iliac bone flap transfer perfused by the AB-LCFA combined with external fixation. The time of bone fracture union was recorded based on X-ray examination. The functional results of the femoral shaft were evaluated by the Klemm classification.

Results

The lateral circumflex femoral artery (LCFA) divided into ascending, transverse, and descending branches in 32 specimens (80%). The diameter of the AB-LCFA at the origin was 3.15 ± 0.9 mm and the length of the AB-LCFA was 8.51 ± 3.06 cm. The postoperative course of the procedure was uneventful in all 13 patients. The average follow-up was 15 months. Bone union was achieved in all patients and the average union time was 5.3 months. 12 patients achieved excellent or good functional results based on the Klemm classification.

Conclusion

The AB-LCFA has a consistent orientation and abundant blood flow. The transfer of the iliac crest bone flap perfused by the AB-LCFA while combined with external fixation could be an option for treating the nonunion of upper femoral shaft fractures.

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Long-term stability of dental adhesive incorporated by boron nitride nanotubes

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Felipe Weidenbach Degrazia, Vicente Castelo Branco Leitune, Fernanda Visioli, Susana Maria Werner Samuel, Fabrício Mezzomo Collares
ObjectiveThe aim of this study was to evaluate physicochemical properties, long-term microtensile bond strength and cytotoxicity of methacrylate-based adhesive containing boron nitride nanotubes (BNNTs) as fillers.MethodsA dental adhesive was formulated using BisGMA/HEMA, 66/33wt% (control). Inorganic BNNT fillers were incorporated into the adhesive at different concentrations (0.05, 0.075, 0.1 and 0.15wt%). Analyses of degree of conversion (DC), polymerization rate [Rp.(s⁻¹)], contact angle (CA) on dentin, after 24h and 6 months microtensile bond strength (μTBS-24h and 6 months) were assessed. Cytotoxicity was performed through viability of fibroblast cells (%) by sulforhodamine B (SRB) colorimetry.ResultsDC and max. polymerization rate increased (p<0.05) after incorporating 0.075 and 0.1wt% BNNT. The contact angle on dentin increased (p<0.05) after incorporating 0.15wt% BNNT. The μTBS-24h showed no changes (p>0.05) after incorporating up to 0.15wt% BNNT comparing to control. After 6 months, μTBS decreased (p<0.05) for control and 0.15wt% BNNT and BNNT groups up to 0.15wt% showed higher μTBS than control (p<0.05). No difference of fibroblast growth was found among adhesives (p>0.05) and up to 19% of cell viability was found comparing 0.05wt% BNNT to positive control group (100%).SignificanceIncorporating boron nitride nanotubes up to 0.1wt% into dental adhesive increased the long-term stability to dentin without decreasing viability of fibroblast cell growth. Thus, the use of BNNTs as filler may decrease failure rate of current dentinal adhesives.

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Quantifying the prognostic significance in glioblastoma of seizure history at initial presentation: A systematic review and meta-analysis

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Victor M. Lu, Toni R. Jue, Kevin Phan, Kerrie L. McDonald
The role of prognostic factors in the management of glioblastoma (GBM) is very important given the stasis in improving its clinical outcomes. Patients who initially present with a positive seizure history at diagnosis have anecdotally experienced superior survival outcomes. The aim of this review was to perform a systematic review and meta-analysis to quantify the potential prognostic significance of positive seizure history in GBM patients. A search strategy was performed using the PRISMA guidelines for article identification, screening, eligibility and inclusion. Relevant articles were identified from six electronic databases from their inception to August 2017. These articles were screened against established criteria for inclusion into this study. Meta-analysis was conducted by pooling results with multivariate-adjusted hazard ratios (HRs). After screening, 6 relevant studies were included for analysis. There was a total cohort of 1836 GBM patients, of which 488 (27%) had a positive seizure history at initial presentation. There was a significant association found between positive seizure history in GBM patients and less mortality events, with an overall HR of 0.71 (95%CI=0.63–0.81, p<0.00001, I²=4%). Positive seizure history at initial presentation of GBM can be associated with improved prognosis. However, there are a number of variables that need to be considered further, including genetic profiling, lead time bias, and anti-epileptic drug (AED) therapy. This review represents the highest level of evidence to date, and its result will be validated by future, prospective study of larger cohorts.

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Practical prognostic score for predicting the extent of resection and neurological outcome of gliomas in the sensorimotor area

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Giannantonio Spena, Federico D'Agata, Pier Paolo Panciani, Luciano Buttolo, Michela Buglione di Monale Bastia, Marco Maria Fontanella
ObjectiveIn this prospective study, we assessed the utility of a novel prognostic score (PS) in guiding the surgical strategy of patients with sensorimotor area gliomas.Patients and methodsForm December 2012 to April 2016, we collected data from patients diagnosed with brain gliomas in the sensorimotor area. All the patients had intraoperatively confirmed contiguity or continuity with sensorimotor cortical and subcortical structures. Several clinical and radiological factors were analyzed to generate a PS for each patient (range 1–8). The end-points included the extent of resection (EOR) and neurological outcome (modified Rankin Score; mRS). We assessed the predictive power of the PS using different analyses. Crosstabs analyses and Fisher's exact test (Fet) were used to evaluate the possible predictive parameters, and for the classification of positive or negative outcomes for the chosen proxies; the significance threshold was set at p<0.05.ResultsUsing independent t-tests, we compared the mRS at different time points (pre, post, and at 6 months) for 2 subgroups from the total sample using a cut-off PS value of 4. For the EOR, a PS value of ≥5 was predictive of successful outcome, a value of 4 indicated an uncertain outcome, and a value of ≤3 predicted a worse outcome.ConclusionsThis PS value can be easily used in clinical settings to help predict the functional outcome and EOR in sensorimotor area tumors. Integration with information from fMRI, DTI, and TMS, along with MRI spectroscopy could further enhance the value of this PS.

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Clinical outcomes of primary intracranial malignant melanoma and metastatic intracranial malignant melanoma

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Joonho Byun, Eun Suk Park, Seok Ho Hong, Young Hyun Cho, Young-Hoon Kim, Chang Jin Kim, Jeong Hoon Kim, Seungjoo Lee
ObjectivesPrimary intracranial malignant melanoma (PIMM) is extremely rare central nervous system (CNS) tumor and known for only composed 0.07% of the CNS tumors. PIMM composed only 1% of malignant melanoma and accordingly their clinical behavior and prognosis are not well documented. So, herein, we report our experience of pathologically proven PIMM, and compared their clinical characteristics and outcome with metastatic intracranial malignant melanoma (MIMM).Patients and methodsOur institutional database was reviewed for patients who diagnosed as PIMM and MIMM pathologically between 1996–2016. As a result, a total of 6 patients of PIMM and 18 patients of MIMM were identified and analyzed. All these patients' clinical, radiological, histopathological and surgical records were obtained and reviewed.ResultsThe median age of PIMM patients at initial surgery was 54.5 years (range, 30–60 years). During the mean follow-up of 12.8 months (range: 9–21 months), tumor recurrence occurred in 5 patients (83.3%). The overall survival rates of PIMM at 6, 9, 12 and 18 months were 100%, 83%, 50% and 25%. The PFS rates of PIMM at 3,6,9 and 12 months were 66.7%, 50%, 16.7% and 16.7%. The overall survival rates and progression-free survival rate difference between PIMM and MIMM were not statistically significant. (p=0.723 and p=0.6, respectively).ConclusionAccording to our experience, PIMM is very aggressive malignant tumor. Its median survival was less than 1year. We suggest that maximal safe resection plus adjuvant RT and CTX for intracranial malignant melanoma considering highly aggressive clinical course of this tumors.

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Brain tumors associated with psychogenic non-epileptic seizures: Case series

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Catherine R. Garcia, Gulam Q. Khan, Amy M. Morrow, Priyanka Yadav, Donita D. Lightner, Frank G. Gilliam, John L. Villano
ObjectiveThe association of psychogenic non-epileptic seizures (PNES) with primary or secondary brain tumors has not been well described in the literature. We aim to discuss their association, and their impact in brain tumor treatment.Patients and methodsWe identified four patients retrospectively from our practice. The diagnosis of PNES was based on clinical suspicion and standard EEG, supplemented with video-EEG recording in 2 patients.ResultsThe initial diagnosis of brain tumor was associated with a new onset seizure prior to diagnosis. The majority of the patients presented with ES followed by recurrent PNES during the course of their disease. Patients were treated with multiple anti-epileptic drugs, requiring frequent schedule adjustments. The preferred tumor treatment modality was chemotherapy, followed by surgical resection. The patients were offered psychological consultation achieving partial control of their events. These patients manifested recurrent disabling clinical events that required multiple medical consultations. None of these patients presented clinical evidence of tumor progression at the time of PNES presentation.ConclusionA high index of suspicion and early psychological consultation referral will likely mitigate the quality of life impact of PNES in these patients.

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A right amygdalohippocampectomy: A diagnostic challenge

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Frank Jonker, Cees Jonker, Laura Bronzwaer, Erik Scherder
ObjectiveAmygdalohippocampectomy (AHE) is the resective surgery for medically intractable mesial temporal lobe epilepsy. To date no study has investigated a wide range of neuropsychiatric symptoms in right AHE outpatients.Patients and methodsThree patients with right AHE participated in this study. The control group are patients with cognitive complaints with no history of epilepsy or neurological impairment and no structural abnormalities on the MRI/CT. We expected no difference in verbal memory compared to the controls. Concerning affective Theory of Mind (ToM) we expect a difference between controls and AHE patients. In terms of behavior it is expected that coping and behavioral questionnaires do not significantly differ between AHE and controls, but that proxies of AHE patients do report more behavioral/psychiatric symptoms.ResultsNo significant difference was found between groups concerning the cognitive functions. For affective ToM we did find a significant difference (p=0.044). A significant difference for the use of more reassuring thoughts (p=0.006) and a trend for less passive reactions on the coping questionnaire, suggesting an 'active coping style'. Overall, AHE patients report fewer problems the self- reported questionnaires. Proxies of the AHE patients reported a trend for more behavioral disinhibition compared to proxy ratings of the control group.ConclusionRight AHE patients underestimate their behavioral and emotional changes due to self-awareness deficits. Ratings of significant others are of immense importance for the detection of psychiatric and behavioral problems. Lesions in the amygdala- orbitofrontal cortex connection disrupt the emotional network, which might explain our results.

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Trends in peri-operative performance status following resection of high grade glioma and brain metastases: The impact on survival

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Chirag K. Patel, Ravi Vemaraju, James Glasby, Joanne Shires, Tessa Northmore, Malik Zaben, Caroline Hayhurst
ObjectivesMaximal surgical resection of high grade brain tumours is associated with improved overall survival (OS). It carries the risk of neurological deterioration leading to worsening performance status (PS), which may affect overall survival and preclude patients from adjuvant therapy. We aim to review the changes in performance status of patients undergoing resection of high grade tumours and metastases and the impact of changes on overall survival.Patients and methodsA prospective study of the perioperative performance status of 75 patients who underwent primary resection of malignant primary brain tumour or solitary metastasis in a single centre. Data on patients' demographics, tumour histology and overall survival were also collected. WHO performance status was recorded pre-operatively and at intervals following surgery.ResultsOf the 75 patients (35 males, 40 females, median age 61 years at diagnosis), 50 had primary malignant brain tumours, 25 had metastasis. Although PS dropped at postoperative day 1 in 14 patients (18.7%), 28% improved by day 5 and there was significant improvement by day 14 (41%, p=0.02). The number of patients with PS 3 or worse changed from 4% pre-operatively (n=3) to 8% (n=6). Overall survival is better in those whose PS remained improved or unchanged at 2 weeks after surgery compared to those whose PS deteriorated; high grade glioma median survival 15.67 vs. 2.4 months (p=0.005) and metastasis median survival 8.53 vs.2.33 months (p=0.001).ConclusionOur data demonstrates that although PS may deteriorate immediately after surgery, the majority of patients regain their baseline PS or improve by 2 weeks postoperatively; decisions on fitness for adjuvant treatment should therefore be delayed until then. In those patients whose PS declines following surgery overall survival is poor.

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Spinal muscular atrophy with progressive myoclonic epilepsy linked to mutations in ASAH1

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Edibe Pembegül Yildiz, Gözde Yesil, Gonca Bektas, Mine Caliskan, Burak Tatlı, Nur Aydinli, Meral Ozmen
Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME), a rare disorder caused by mutation in the ASAH1 gene, is characterized by progressive muscle weakness and intractable epilepsy. The literature about SMA-PME is very rare and most of the time limited to case reports. Mutation in the ASAH1 gene is also found in another rare syndrome which is Farber disease. We report a case of a 13.5-year-old girl with SMA-PME associated with ASAH1 gene mutation. She presented with progressive muscle weakness, tremor, seizure, and cognitive impairment. Clinical features and electrophysiological investigations revealed a motor neuron disease and generalized epilepsy. The marked difference in disease manifestations may explain why Farber and SMA-PME diseases were not suspected of being allelic conditions. SMA-PME cases with ASAH1 mutation could be treated using therapeutic studies regarding Farber disease. In patients with undefined PME or lower motor neuron disease cases, ASAH1 mutation scans should be studied.

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Circadian rhythm in idiopathic normal pressure hydrocephalus

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Andreas Eleftheriou, Martin Ulander, Fredrik Lundin
ObjectivesThe pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) takes place in structures close to the cerebral ventricular system. Suprachiasmatic nucleus (SCN), situated close to the third ventricle, is involved in circadian rhythm. Diurnal disturbances are well-known in demented patients. The cognitive decline in iNPH is potentially reversible after a shunt operation. Diurnal rhythm has never been studied in iNPH. We hypothesize that there is a disturbance of circadian rhythm in iNPH-patients and the aim was to study any changes of the diurnal rhythm (mesor and circadian period) as well as any changes of the diurnal amplitude and acrophase of the activity in iNPH-patients before and after a shunt operation.Patients and methodsTwenty consecutive iNPH-patients fulfilling the criteria of the American iNPH-guidelines, 9 males and 11 females, mean age 73 (49–81) years were included. The patients underwent a pre-operative clinical work-up including 10m walk time (w10mt) steps (w10ms), TUG-time (TUGt) and steps (TUGs) and for cognitive function an MMSE score was measured. In order to receive circadian rhythm data actigraphic recordings were performed using the SenseWear 2 (BodyMedia Inc Pittsburgh, PA, USA) actigraph. Cosinor analyses of accelerometry data were performed in "R" using non-linear regression with Levenburg- Marquardt estimation. Pre- and post-operative data regarding mesor, amplitude and circadian period were compared using Wilcoxon-Mann-Whitney test for paired data.ResultsTwenty patients were evaluated before and three month post-operatively. Motor function (w10mt, w10ms, TUGt, TUGs) was significantly improved while MMSE was not significantly changed. Actigraphic measurements (mesor, amplitude and circadian period) showed no significant changes after shunt operation.ConclusionThis is the first systematic study of circadian rhythm in iNPH-patients. We found no significant changes in circadian rhythm after shunt surgery. The conceptual idea of diurnal rhythm changes in hydrocephalus is still interesting from a theoretical standpoint and warrants further studies that could include a combination of better designed actigraphic studies in combination with neuroendocrine markers and imaging methods

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Bilateral facial nerve palsies secondary to chronic inflammatory demyelinating polyneuropathy following adalimumab treatment

Publication date: January 2018
Source:Clinical Neurology and Neurosurgery, Volume 164
Author(s): Anthony Yao, Helen Chan, Richard A.L. Macdonell, Neil Shuey, Jwu Jin Khong
PurposeChronic Inflammatory Demyelinating Polyneuropathy (CIDP) presents uncommonly with cranial nerve involvement with ophthalmological implications.MethodsWe report the case of a 37year-old man who developed CIDP which manifested as progressive and relapsing bilateral facial nerve palsy with lagophthalmos and exposure keratopathy, in the setting of treatment of Crohn's disease with the anti-TNF-alpha agent adalimumab.ResultsSymptoms gradually improved over the course of several months following withdrawal of adalimumab and treatment with intravenous immunoglobulin (IVIg) and oral prednisolone.ConclusionBilateral facial nerve involvement occurs uncommonly as a feature of CIDP in its classic form. The prognosis is good for recovery of facial nerve function with discontinuation of anti-TNF-alpha therapy and concurrent use of steroid and intravenous immunoglobulin in this case.

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Cerebral Arterio-Venous Malformations in the Paediatric Population: Angiographic Characteristics, Multimodal Treatment Strategies and Outcome

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Klaus-Peter Stein, Bernd-Otto Huetter, Sophia Goericke, Neriman Oezkan, Rebecca Leyrer, I. Erol Sandalcioglu, Michael Forsting, Ulrich Sure, Oliver Mueller
ObjectivesCerebral arterio-venous malformations (AVM) are considered congenital lesions, emerging as an important cause of haemorrhagic stroke in children. The potential influence of age on clinical presentation and angio-architecture have been analysed extensively in the last years. Yet, comparative studies comprising ascending age groups may be limited in their conclusions, especially when comparing young children and adults. It is the aim of this study to evaluate characteristic clinical and angiographic features of AVM within a paediatric subgroup and their correlation to age at presentation.Patients and MethodsBetween 1990–2015, 46 children harbouring AVMs were treated at our institution. Clinical presentation, radiological data, treatment strategies and outcome were evaluated retrospectively.ResultsOf 46 consecutive patients, 18 were male and 28 female patients. Mean age was 11.6±4.3years, ranging from 2–17 years. 35 patients (76%) presented with haemorrhage. Seizures were found in 6 patients (13%) and progressive or transient focal neurological deficits in 4 individuals (9%). There was one incidental patient, only. Mean age of children presenting with haemorrhage was significantly lower as compared to those without a history of intracranial bleeding (p=0.1). The size of the AVM was small (n=27, 59%), corresponding a grade I AVM in the majority of patients (N=28, 61%). 41 patients (89%) underwent treatment of their AVM by an interdisciplinary approach achieving complete elimination of the lesion in 34 patients (83%). 34 patients (83%) showed at least a favourable outcome (mRS≤2) at last follow-up. An excellent recovery (mRS 0-1) was noted in 28 patients (68%).ConclusionFrom our data we suggest that patients' age impacts the clinical presentation. Particularly young children seem to bear a higher risk for haemorrhage from their AVM. Treatment of paediatric AVMs can be achieved safely in experienced hands with a high rate of complete elimination and good clinical outcome.

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Quantitative texture analysis in the prediction of IDH status in low-grade gliomas

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Asgeir Store Jakola, Yi-Hua Zhang, Anne J. Skjulsvik, Ole Solheim, Hans Kristian Bø, Erik Magnus Berntsen, Ingerid Reinertsen, Sasha Gulati, Petter Förander, Torkel B. Brismar
ObjectivesMolecular markers provide valuable information about treatment response and prognosis in patients with low-grade gliomas (LGG). In order to make this important information available prior to surgery the aim of this study was to explore if molecular status in LGG can be discriminated by preoperative magnetic resonance imaging (MRI).Patients and MethodsAll patients with histopathologically confirmed LGG with available molecular status who had undergone a preoperative standard clinical MRI protocol using a 3T Siemens Skyra scanner during 2008-2015 were retrospectively identified. Based on Haralick texture parameters and the segmented LGG FLAIR volume we explored if it was possible to predict molecular status.ResultsIn total 25 patients (nine women, average age 44) fulfilled the inclusion parameters. The textural parameter homogeneity could discriminate between LGG patients with IDH mutation (0.12, IQR 0.10-0.15) and IDH wild type (0.07, IQR 0.06-0.09, p=0.005). None of the other four analyzed texture parameters (energy, entropy, correlation and inertia) were associated with molecular status. Using ROC curves, the area under curve for predicting IDH mutation was 0.905 for homogeneity, 0.840 for tumor volume and 0.940 for the combined parameters of tumor volume and homogeneity. We could not predict molecular status using the four other chosen texture parameters (energy, entropy, correlation and inertia). Further, we could not separate LGG with IDH mutation with or without 1p19q codeletion.ConclusionsIn this preliminary study using Haralick texture parameters based on preoperative clinical FLAIR sequence, the homogeneity parameter could separate IDH mutated LGG from IDH wild type LGG. Combined with tumor volume, these diagnostic properties seem promising.

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Clinical and radiographic comparison of cervical disc arthroplasty with Prestige-LP Disc and anterior cervical fusion: a minimum 6-year follow-up study

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Junfeng Zeng, Hao Liu, Beiyu Wang, Yuxiao Deng, Chen Ding, Hua Chen, Yi Yang, Ying Hong, Ning Ning
ObjectivesTo retrospectively compare the long-term clinical and radiographic outcomes of cervical disc arthroplasty (CDA) with Prestige-LP Disc and anterior cervical discectomy and fusion (ACDF) for single-level cervical degenerative disc disease.Patients and MethodsNinety-eight patients (45 CDA and 53 ACDF) with a minimum 6-year follow-up were included. Clinical evaluations included Japanese Orthopedic Association (JOA), visual analogue scale (VAS), and Neck Disability Index (NDI) scores. Radiographic evaluations included sagittal alignment, range of motion (ROM) at the index and adjacent level, adjacent segment degeneration (ASD), and heterotopic ossification (HO).ResultsAt the final follow-up, there were no significant differences in JOA, VAS neck, and VAS arm scores between the two groups. However, NDI scores improved more in the CDA group than in the ACDF group. The sagittal alignment was maintained in both groups. The ROM at the index level in the CDA group was decreased from 9.6±4.3° at baseline to 7.8±4.7° at the final follow-up. The ROM at the cranial adjacent level in the ACDF group was increased. The incidence of ASD was lower in the CDA group than in the ACDF group (26.7% vs 49.1%, p=0.023). HO was observed in 46.7% of the patients but did not influence the clinical outcome.ConclusionBoth CDA with Prestige-LP Disc and ACDF showed good clinical outcomes at a minimum 6-year follow-up. Compared with ACDF, CDA preserved the motion and reduced the incidence of ASD.

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Prediction of Persistent Hemodynamic Depression after Carotid Angioplasty and Stenting using Artificial Neural Network Model

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Jin Pyeong Jeon, Chulho Kim, Byoung-Doo Oh, Sun Jeong Kim, Yu-Seop Kim
ObjectivesTo assess and compare predictive factors for persistent hemodynamic depression (PHD) after carotid artery angioplasty and stenting (CAS) using artificial neural network (ANN) and multiple logistic regression (MLR) or support vector machines (SVM) models.Patients and MethodsA retrospective data set of patients (n=76) who underwent CAS from 2007 to 2014 was used as input (training cohort) to a back-propagation ANN using TensorFlow platform. PHD was defined when systolic blood pressure was less than 90mmHg or heart rate was less 50 beats/min that lasted for more than one hour. The resulting ANN was prospectively tested in 33 patients (test cohort) and compared with MLR or SVM models according to accuracy and receiver operating characteristics (ROC) curve analysis.ResultsNo significant difference in baseline characteristics between the training cohort and the test cohort was observed. PHD was observed in 21 (27.6%) patients in the training cohort and 10 (30.3%) patients in the test cohort. In the training cohort, the accuracy of ANN for the prediction of PHD was 98.7% and the area under the ROC curve (AUROC) was 0.961. In the test cohort, the number of correctly classified instances was 32 (97.0%) using the ANN model. In contrast, the accuracy rate of MLR or SVM model was both 75.8%. ANN (AUROC: 0.950; 95% CI [confidence interval]: 0.813–0.996) showed superior predictive performance compared to MLR model (AUROC: 0.796; 95% CI: 0.620–0.915, p<0.001) or SVM model (AUROC: 0.885; 95% CI: 0.725-0.969, p<0.001).ConclusionsThe ANN model seems to have more powerful prediction capabilities than MLR or SVM model for persistent hemodynamic depression after CAS. External validation with a large cohort is needed to confirm our results.

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Comparison of dynamic cervical implant versus anterior cervical discectomy and fusion for the treatment of single-level cervical degenerative disc disease: a five-year follow-up

Publication date: Available online 5 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Ce Zhu, Xi Yang, Lei Wang, Bo-wen Hu, Li-min Liu, Lin-nan Wang, Hao Liu, Yue-ming Song
ObjectiveTo compare clinical and radiographic outcomes of dynamic cervical implant(DCI) with anterior cervical discectomy and fusion(ACDF) in the treatment of single-level cervical degenerative disc disease (CDDD) 5 years after surgery.Patients and MethodsForty-three patients with DCI were matched one-to-one with patients with ACDF based on age, gender, and operative segment in this retrospective study. All patients had been followed up for more than 5 years. Radiological assessments included heterotopic ossification(HO), adjacent segment degeneration (ASD), intervertebral height (IH), range of motion (ROM) at C2-7, the implanted level and adjacent levels. Clinical parameters included Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) and Short Form-36 scores(SF-36). Patients were also asked to rate their postoperative satisfaction at final follow-up.ResultsThe postoperative ROM of C2-7 and ROM at the implanted level in the DCI group were higher than those in the ACDF group. The ROM at the implanted level in the DCI group was maintained at 2 years postoperatively but decreased at final follow-up (10.7° vs 4.5°). The rate of HO in the DCI group was 46.5% (20/43). The rate of ASD was comparable between the two groups (16.3% vs 20.9%). The JOA, VAS, NDI, and SF-36 scores were comparable between two groups and improved postoperatively. However, the proportion of patients who reported their level of satisfaction as being very satisfied, or somewhat satisfied was larger in the ACDF group than that in the DCI group (95.3% vs 79.1%).ConclusionsDCI resulted in better ROM of C2-7 and the implanted level than ACDF did. The clinical outcomes were similar between two groups. However, the ROM at the implanted level decreased at final follow-up in the DCI group, which may contribute to patient dissatisfaction. The long-term outcomes were not that satisfactory especially due to the deviation from its original intention as a non-fusion technique. As such, we have not used DCI in the past 2 years.

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SMART coils for intracranial aneurysm embolization: Initial outcomes

Publication date: Available online 2 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Adeel Ilyas, Thomas J. Buell, Ching-Jen Chen, Dale Ding, Daniel Raper, Davis G. Taylor, Jennifer D. Sokolowski, Kenneth C. Liu
ObjectivesEndovascular technology for the treatment of intracranial aneurysms continues to rapidly evolve. The SMART coil (Penumbra Inc., Alameda, CA, USA) is a novel microcoil designed to enhance deliverability. The aim of this single-center, retrospective cohort study is to assess the initial outcomes after aneurysm embolization using SMART coils.Patients and methodsWe reviewed consecutive patients with intracranial aneurysms who underwent endovascular embolization using SMART coils from June 2016 to January 2017. Baseline and initial outcomes data were analyzed.ResultsThe study cohort was comprised of 32 patients with 33 aneurysms. The mean age was 55.8 years. The majority (85%) of aneurysms were located in the anterior circulation. The mean aneurysm maximum diameter and neck width were 6.0mm and 3.1mm, respectively. Dome irregularity and fusiform aneurysm morphology were noted in 33% and 9% of aneurysms, respectively, and 15% presented with subarachnoid hemorrhage. No serious procedural complications occurred, including microcatheter prolapse, intraprocedural aneurysm rupture, or thromboembolism. Device malfunction occurred in one case (3%). The mean packing density was 25%, and the degree of immediate post-embolization aneurysm occlusion was a modified Raymond-Roy grade I, II, IIIa, and IIIb in 48%, 27%, 18%, and 6%, respectively.ConclusionOur preliminary findings suggest that the SMART coil has a favorable initial risk to benefit profile for the embolization of appropriately selected aneurysms. Additional studies of larger cohorts are necessary to determine the mid-term and long-term clinical and angiographic outcomes of aneurysm patients treated with the SMART coil.

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Intraventricular hemorrhage related to AVM rupture: description, outcomes and impact of intraventricular fibrinolysis

Publication date: Available online 2 December 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Vianney Gilard, Thomas Metayer, Clement Gakuba, Olivier Langlois, François Proust, Evelyne Emery, Thomas Gaberel
ObjectivesArteriovenous malformation (AVM) rupture could lead to intraventricular hemorrhage (IVH), a particularly severe form of intracranial bleeding. The epidemiology, presentation, management and outcomes of IVH related to AVM rupture have not been clearly addressed yet. The aim of the present study was to investigate the characteristics of IVH related to AVM rupture, with particular attention paid to functional outcomes and to the impact of intraventricular fibrinolysis (IVF).Patients and MethodsBetween 2011 and 2015, all patients suffering from IVH admitted in two tertiary neurosurgical centers were included in a prospective register. Patient with IVH related to AVM rupture were identified (n=29) and their data retrospectively collected. Particular attention was paid on patients who received IVF. We also compared them to 29 apparied aneurysmal IVH.ResultsIVH related to AVM rupture often occurred in young patients. In most cases, intracerebral hemorrhage was associated to IVH. 17% of the patients died, and functional outcome at 6 months was similar to those with aneurysmal IVH. Interestingly, 5 patients received IVF and none experienced any rebleeding.ConclusionIVH related to AVM rupture is a severe form of hemorrhagic stroke, with a poor neurologic prognosis. IVF seems to be safe and may be considered in this particular form of IVH.

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Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern India

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Ishwar Chandra Behera, Mahesh Chandra Sahu
BackgroundPrimary sinonasal tuberculosis is an extremely rare clinical entity. Often the clinician fail to diagnose the primary sinonasal tuberculosis, so treatment is frequently delayed and leading to complications.ObjectiveTo evaluate the clinical profile, diagnostic tools, treatment and outcome of primary sinonasal tuberculosis.Materials and MethodsRetrospective studies of six cases of primary sinonasal tuberculosis were done over period of five years. The detail clinical profile, diagnosis, treatment and outcome were studied in these patients.ResultsOut of the six cases of primary sinonasal tuberculosis, four cases were female and two were male. The mean age during the time of diagnosis was 35 years (16–67 years). The most common clinical presentations were chronic nasal obstruction, epistaxis and ulcerations at the nasal vestibule and nasal cavity. Diagnosis was confirmed by Histopathological diagnosis in all six cases. All cases received antitubercular therapy for 6–9 months. All six patients successfully responded to antitubercular therapy. Two year follow up showed no relapse, dissemination and death.ConclusionPrimary sinonasal tuberculosis is a rare clinical entity. It is always suspected among the patients with nasal obstruction, epistaxis and ulcerations at nasal vestibule and nasal cavity in the region with high prevalence of Tuberculosis.

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The role of Mannose-binding lectin 2 (MBL2) gene polymorphisms in adenoid hypertrophy among young children

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Husam Majeed Hameed, Ali S. Dawood
ObjectiveIs to determine the role of Mannose binding lectin (MBL) 2 (SNP 49 C/T rs#5030737) gene polymorphism among patients with adenoidal hypertrophy in Iraqi population.MethodsFrom July through December 2015, a total of 60 adenoid hypertrophy (study group) young child patients (35 males and 25 females) with an age between (4 and 12) years old, were enrolled in this study according to selection criteria. A second group of otherwise healthy young child who did not have any symptoms or signs of adenoid hypertrophy were considered to be a control group. Confirmation of adenoid hypertrophy was achieved by: clinical examination, radiological assessment of postnasal space and an endoscopic nasopharyngoscopy. Blood samples were collected from both groups and genotyping of MBL-2 gene polymorphism was performed using traditional PCR and allele-specific technique.ResultsMBL2 gene polymorphism and allele frequencies among adenoid hypertrophy patients and their control were studied and the results showed that CC = 40 (66.7%), TT = 13(21.7%), and CT = 7 (11.6) in study group, while in control group CC = 5(8.3), TT = 9 (15%).CT = 46 (67.7%). The P-value of genotypes (CC, TT and CT) in study groups versus the control group were P < 0.001 (highly significant), P = 0.435 (non-significant) and P < 0.001 (highly significant) respectively.ConclusionThe difference between the MBL2 (SNP 49 C/T rs#5030737) gene polymorphism among adenoid hypertrophy patients and healthy people may indicate it could be used as an early predictive factor for children whom will be prone to adenoid hypertrophy. The genotype CC could be considered as a risk factor while CT genotype could be considered a protective factor against adenoid hypertrophy in the current study. A further study needed to evaluate the use of the above mentioned polymorphism as a prognostic value foradenoid hypertrophy.

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Surgical strategy for frontal sinus inverted papilloma

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): A.A. Ibrahim, Haitham Morsi, Mohamed Hassab, Mohamed Eid, Samy Elwany
Inverted papilloma (IP) is a benign tumor with a local aggressive nature and has a tendency to recur after excision. Despite the evolution of endoscopic techniques in the management of IP, external approaches still play a crucial role in frontal sinus involvement.ObjectiveThe present study aimed at planning a strategy for managing IP arising in or involving the frontal recess and/or frontal sinus.Patients and methodsTen patients with frontal sinus IP were enrolled in the present study. The type of surgical procedure was tailored according to the site of origin and extent of the tumor.ResultsFive combined surgeries and five extended endoscopic surgeries were performed in 1 year and 4 months with a follow up period of 2 years. Complete resection of the tumor was achieved in all the cases and no recurrences were reported at the end of the follow up period.ConclusionsThe exact approach to frontal sinus IP differ from one case to the other. Endoscopic frontal surgery is the mainstay in treatment of frontal sinus IP. External or combined approaches still remain a valid option for lesions affecting the mucosa of the frontal sinus extensively or extending far lateral.

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Intracranial metastasis of follicular thyroid carcinoma mimicking cerebellopontine angle tumour

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Li Yun Lim, Jamuneswary Selvarajoo, Norhafiza Mat Lazim, Ing Ping Tang
Cerebellopontine angle (CPA) tumour is most commonly associated acoustic neuroma. The occurrence of metastatic brain tumour at CPA is rare. Follicular thyroid carcinoma is second most common well differentiated thyroid malignancy and brain metastasis is unusual. We would like to report an unusual presentation of follicular thyroid carcinoma with brain metastasis at the CPA region. A 60 year old gentleman presented with occipital headache, slurred speech with positive cerebellar signs and multiple cranial nerve palsies with no neurological deficit to upper and lower limbs. No other significant findings noted on examination. Imaging investigations revealed a CPA tumour. Transnasal transphenoidal tumour debulking was done and biopsy revealed a metastasis of follicular thyroid carcinoma. After total thyroidectomy, the patient was scheduled for radioactive iodine ablation. Metastasis brain tumour with high vascular supply can contribute to difficult tumour debulking. Embolisation and stereotactic therapy are the supporting and alternative method of treatment.

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Atypical multiple metastasis of recurrent pleomorphic adenoma

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Darshini Nagarajah, Irfan Mohamad, Norhafiza Mat Lazim, Sharifah Emilia Tuan Sharif, Nur Hidayati Mohamad Pakarul Razy
Pleomorphic adenoma is the commonest benign neoplasm of the parotid gland and minor salivary glands. It is composed of epithelial and myoepithelial cells arranged in various morphological patterns. The concrete reasons contributing to a recurrent disease are obvious or attempts of accidental tumor spillage, enucleation with rupture and incomplete excision during operation. The other solid reasons that could contribute to recurrence are known incomplete pseudocapsule, extracapsular extensions, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule matrix. Most recurrent pleomorphic adenoma are multinodular with different recurrent sites and time duration. We describe a case of 55-year-old lady who underwent left superficial parotidectomy for pleomorphic adenoma 14 years prior to current presentation. After 8 years, she presented with ipsilateral level II lymph node, in which excision showed pleomorphic adenoma. Within 2 years after excision, she experienced another multiple small neck swellings at the level II-III, in which histopathology examination of the excised masses were consistent with pleomorphic adenoma, without evidence of lymph node background to suggest metastasis.

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Venous thromboembolism events after breast reconstructions with DIEP free flaps in 192 consecutive case

Publication date: Available online 6 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): A. Modarressi, A.-V. Schettini, E.M. Rüegg, B. Pittet-Cuénod
BackgroundPatient candidates for breast reconstruction with free deep inferior epigastric perforator flap (DIEP) may present several risk factors for venous thromboembolism (VTE). Risk identification is essential for appropriate VTE prophylaxis measures to be put in place. This study aims to investigate VTE incidence after DIEP flap breast reconstruction and to assess the accuracy of the Caprini Risk Assessment Model (RAM), which is the unique score validated to assess the VTE risk for plastic surgery procedures and identify patients at high VTE risk.MethodsA chart review was conducted of 192 consecutive patients who underwent breast reconstruction with a DIEP flap from 1999 to 2016. VTE rate was assessed and the Caprini score was calculated for each patient and correlated with the VTE incidence.ResultsDuring the 90 post-operative days, four patients presented a pulmonary embolism (2.1%) and two patients (1%) had deep venous thrombosis (overall VTE incidence of 3.1%). Most patients (92.2%) were assessed as high-risk (Caprini score >5) and all VTE occurred among this group. Apart from the Caprini score, no specific single risk factor could be identified for VTE.ConclusionsOur data confirm that the Caprini RAM is a valuable assessment tool for VTE risk measurement among all patients undergoing autologous breast reconstruction. As most candidates for DIEP flap belong to the high-risk group, combined anticoagulation prophylaxis methods are required for most cases, particularly chemoprophylaxis up to four weeks postoperatively.

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Génioplasties d’augmentation prothétiques et osseuses, à visée esthétique : revue de littérature et actualisation des connaissances

Publication date: Available online 6 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): A. Baus, K. Rem, M. Revol, S. Cristofari
La génioplastie d'augmentation est un geste chirurgical couramment pratiqué, que ce soit dans le traitement des microgénies, dans le cadre d'une chirurgie orthognatique ou à visée esthétique. Le choix de la technique diffère selon les spécialités chirurgicales qui la pratiquent. Il existe un grand nombre de publications sur le sujet, permettant de comparer les différentes méthodes chirurgicales, leurs indications et leurs complications. Le but de cette étude était de réaliser une revue de littérature avec actualisation des connaissances, ainsi qu'une synthèse des indications préférentielles de génioplasties osseuses et prothétiques à visée esthétique.ConclusionMalgré la généralisation des implants « modernes » en France, la génioplastie prothétique reste plus fréquemment pourvoyeuse de complications graves (infections, extrusions, érosions osseuses). De même, cette technique possède des indications bien plus limitées que la génioplastie osseuse, qui a l'avantage d'une meilleure longévité. Dans une logique d'augmentation mentonnière à visée esthétique, la génioplastie osseuse devrait donc être réalisée plus facilement et plus fréquemment par les chirurgiens, toutes spécialités confondues.Chin augmentation is commonly practiced, whether in microgenia treatment, in cases of orthognathic or cosmetic surgery. Located at the crossroads of many specialties, the technique choice still differs according to the surgeon specialiy. A large number of publications on the subject are available. A comparaison between different surgical methods is therefore possible concerning their indications and their complication. The purpose of this study was to carry out a literature review, with updating knowledge, as well as a synthesis indication regarding aesthetic osseous and alloplastic genioplasty. Despite the generalization of "modern" implants in France, prosthetic genioplasty remains more frequently the source of serious complications (infections, extrusions, bone erosions). Similarly, this technique has much more limited indications than osseous genioplasty, which has the advantage of a better longevity. In order to increase the aesthetic appearance of the chin, osseous genioplasty should be performed more easily and more frequently by surgeons on all sides.

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Le lambeau médial sural perforant : bases anatomiques, technique chirurgicale et indications en reconstruction cervicofaciale

Publication date: Available online 6 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): S. Struk, J.-B. Schaff, Q. Qassemyar
IntroductionLe lambeau médial sural perforant (medial sural artery perforator [MSAP] flap) est un lambeau cutanéo-graisseux, fin et malléable, prélevé aux dépens de la face médiale de la jambe. Ce lambeau est encore peu utilisé en France. L'objectif de ce travail, effectué à partir de dissections sur sujets anatomiques, est de rappeler les bases anatomiques et la technique chirurgicale de ce lambeau, et de proposer des indications en reconstruction cervicofaciale.Matériel et méthodesNous avons disséqué 10 lambeaux MSAP sur 5 sujets anatomiques différents. Dans chaque cas, le nombre et la localisation des perforantes issues de l'artère surale médiale étaient enregistrés. Pour chaque lambeau, nous avons rapporté la longueur du pédicule, le calibre des vaisseaux à l'origine du pédicule ainsi que l'épaisseur du lambeau. Enfin, nous avons réalisé un cas clinique pour un trismus post-thérapeutique.RésultatsUn total de 23 perforantes de calibre supérieur à 1mm a été identifié sur les 10 jambes disséquées. L'artère surale médiale donnait 1 à 4 perforantes musculocutanées. Les perforantes étaient localisées en moyenne à 10,3cm±2cm du creux poplité et à 3,6cm±1cm de la ligne médiane du mollet. La longueur moyenne du pédicule était de 12,1cm±2,5cm. À l'origine du pédicule, l'artère mesurait en moyenne 1,8mm±0,25mm et les veines mesuraient en moyenne 2,45mm±0,9mm. Le cas clinique s'est déroulé sans complication avec le prélèvement d'un lambeau perforant sural médial droit.DiscussionCette étude confirme la constance de l'anatomie du lambeau médial sural perforant. Le lambeau MSAP est fin, malléable et particulièrement adaptée à la reconstruction des pertes de substance muqueuses de la cavité orale ou pour le « resurfaçage » de la face ou des extrémités. Les séquelles au niveau du site donneur sont moindres qu'avec le lambeau antébrachial radial pour des résultats fonctionnels équivalents en reconstruction cervicofaciale.IntroductionThe medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery.Material and methodsWe harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap.ResultsA total of 23 perforators with a diameter superior than 1mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3cm±2cm from the popliteal fossa and at 3.6cm±1cm from the median line of the calf. The mean pedicle length was 12.1cm±2.5cm. At its origin, the source artery diameter was 1.8mm±0.25mm and source veins diameters were 2.45mm±0.9mm in average. There was no complication in our clinical application.DiscussionThis study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results.

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Author Index: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Editorial Board

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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BMP-2 plasmid DNA-loaded chitosan films – A new strategy for bone engineering

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12
Author(s): Juan Li, Jun Lin, Wenke Yu, Xiaojia Song, Qiaoling Hu, Jing-Hong Xu, Huiming Wang, Christian Mehl
ObjectivesBone defects are common in every area of medicine and remain a clinical challenge. Tissue engineering has led to promising new strategies in accelerating bone repair. Bone morphogenetic proteins (BMPs) play crucial roles in bone regeneration, but are required in supra-physiological doses, which are expensive and produce severe side effects.MethodsTo address these issues, we prepared BMP-2 plasmid DNA-loaded chitosan films, and examined their effects on mouse osteoblast-like MC3T3-E1 cell morphology, proliferation, and runt-related transcription factor 2 (RUNX2) expression. In vivo testing was performed using calvarial critical-sized defects and histomorphometry in 36 Sprague–Dawley rats. Unloaded chitosan films and empty defects served as controls.ResultsIn contrast to the controls, cells grown on BMP-2 plasmid DNA-loaded chitosan films had well established filopodia and lamellipodia, significantly higher proliferation 2, 4, and 6 days post-seeding (P ≤ 0.05), and higher nuclear RUNX2 expression. In vivo, new bone growth was significantly greater in the BMP-2 group than in the control groups at 4, 8, and 12 weeks (P ≤ 0.01).ConclusionsBased on our study findings, BMP-2 plasmid DNA-loaded chitosan films provide an effective strategy for GBR, combining cellular compatibility with biocapability in vivo.

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Corrigendum to “The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis – A randomized controlled preclinical study” [J Cranio-Maxillo-Facial Surg 45 (2017) 1190–1196]

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12
Author(s): Tobias Moest, Jan Wrede, Christian Martin Schmitt, Melanie Stamp, Friedrich Wilhelm Neukam, Karl Andreas Schlegel

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EACMFS Awards

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Keyword index: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Contents: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12
Author(s): Srinivas M. Susarla, Gerhard S. Mundinger, Hitesh Kapadia, Mark Fisher, James Smartt, Christopher Derderian, Amir Dorafshar, Richard A. Hopper
PurposeObstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement.MethodsThis was a retrospective evaluation of patients with achondroplasia who underwent facial skeletal advancement for obstructive sleep apnea. Patients were treated with either an isolated Le Fort III distraction (LF3) or Le Fort II distraction with or without subsequent Le Fort I and bilateral sagittal split osteotomies (LF2 ± LF1/BSSO). Demographic, cephalometric, volumetric, and polysomnographic variables were recorded pre- and postoperatively.ResultsSix patients with achondroplasia underwent midface advancement for treatment of OSA (2 LF2 + LF1/BSSO, 2 LF2, 2 LF3). Patients undergoing LF2 + LF1/BSSO had consistent volumetric improvements at the nasopharyngeal and oropharyngeal levels (Δ ≥ +347% and ≥+253%, respectively). Patients undergoing LF2 alone had consistent improvement in the nasopharyngeal airway alone (Δ ≥ +214%). Patients undergoing LF3 alone had consistent, but less dramatic, changes in nasopharyngeal volume (Δ ≥ +97.1%). All patients undergoing LF2 distraction (with or without LF1/BSSO) had a ≥50% reduction in the apnea–hypopnea index (AHI) postoperatively; there was no improvement in AHI with LF3 alone.ConclusionIn patients with achondroplasia-associated OSA there are variable improvements in airway volume. This preliminary report suggests that LF2 distraction, with or without subsequent LF1/BSSO, may provide consistent reductions in AHI relative to LF3 distraction.

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Announcements

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Author Index: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Editorial Board

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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BMP-2 plasmid DNA-loaded chitosan films – A new strategy for bone engineering

Corrigendum to “The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis – A randomized controlled preclinical study” [J Cranio-Maxillo-Facial Surg 45 (2017) 1190–1196]

EACMFS Awards

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Keyword index: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Contents: Volume 45

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia

Announcements

Publication date: December 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 12

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Issue Information - TOC

No abstract is available for this article.

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Issue Information - Journal Info page

No abstract is available for this article.

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Wrist accelerometry for physical activity measurement in individuals with spinal cord injury – a need for individually calibrated cut-points

Publication date: Available online 6 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Laura A. McCracken, Jasmin K. Ma, Christine Voss, Franco H.N. Chan, Kathleen A. Martin Ginis, Christopher R. West
ObjectiveTo create and compare individual and group-based cut-points for wrist-accelerometry that corresponds to moderate-to-vigorous physical activity (MVPA) in people with spinal cord injury (SCI).DesignParticipants completed a graded treadmill-wheeling test while being assessed for oxygen consumption, wrist-acceleration vector magnitude, and spoke acceleration. Oxygen consumption was converted to SCI metabolic equivalents (SCI METS) and linear regression was applied to determine an individualized vector magnitude cut-point (counts per minute, VM-CPM) corresponding with MVPA (≥3 SCI METS). Multilevel linear regression was applied to determine a group MVPA cut-point. Participants then completed a 6-day monitoring period while wearing the accelerometers.SettingA local SCI research centre.ParticipantsTwenty manual wheelchair users (30-64yrs, C5-L1) with chronic (>1 year) SCI.InterventionsNot applicable.Main outcome measuresMean total daily MVPA, wheeled MVPA, and non-wheeled MVPA were calculated using both the individual and group cut-points. Agreement on measures of min/day of MVPA between the individual and group mean cut-point method was compared using Bland-Altman plots.ResultsIndividual cut-points for MVPA ranged from 6040 to 21540 VM-CPM, with a group cut-point of 11652 (CI 7395 – 15909). For total daily MVPA, Bland-Altman analysis revealed a bias of 0.22 ± 33.0 minutes, with 95% limits of agreement from -64.5 to 64.9 minutes, suggesting a large discrepancy between total MVPA calculated from individual and group-mean cut-points.ConclusionsIndividual calibration of wrist-worn accelerometry is recommended for effective habitual PA monitoring in this population.

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Limitations in learning: How treatment verifications fail and what to do about it?

Publication date: Available online 6 December 2017
Source:Brachytherapy
Author(s): Susan Richardson, Bruce Thomadsen
PurposeThe purposes of this study were: to provide dialog on why classic incident learning systems have been insufficient for patient safety improvements, discuss failures in treatment verification, and to provide context to the reasons and lessons that can be learned from these failures.Methods and MaterialsHistorically, incident learning in brachytherapy is performed via database mining which might include reading of event reports and incidents followed by incorporating verification procedures to prevent similar incidents. A description of both classic event reporting databases and current incident learning and reporting systems is given. Real examples of treatment failures based on firsthand knowledge are presented to evaluate the effectiveness of verification. These failures will be described and analyzed by outlining potential pitfalls and problems based on firsthand knowledge.ResultsDatabases and incident learning systems can be limited in value and fail to provide enough detail for physicists seeking process improvement. Four examples of treatment verification failures experienced firsthand by experienced brachytherapy physicists are described. These include both underverification and oververification of various treatment processes.ConclusionsDatabase mining is an insufficient method to affect substantial improvements in the practice of brachytherapy. New incident learning systems are still immature and being tested. Instead, a new method of shared learning and implementation of changes must be created.

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Treatment planning considerations for permanent breast seed implant

Publication date: Available online 6 December 2017
Source:Brachytherapy
Author(s): Amy Frederick, Tyler Meyer, Michael Roumeliotis
PurposeTo determine an optimal planning strategy for permanent breast seed implant that minimizes dose heterogeneity without degrading coverage and conformity.Methods and MaterialsA simple model was developed to investigate planning strategies incorporating a range of ¹⁰³Pd seed activities, needle and seed spacings, and implants in which seed positions are either restricted to or permitted outside of spherical planning target volumes (PTVs). To address more realistic target geometries, model parameters were used to retrospectively replan a 10-patient cohort in MIM Symphony.ResultsWe confirm that the current clinical modified uniform implantation pattern provides the most favorable dose distributions, given the resolution of the template grid and spacer length. We show that needle and seed counts for replans with seed placement permitted 0.3 cm outside of the PTV are most comparable to clinical preplans, but offer a 13 ± 11% average reduction in the VPTV150%. Replans produced with seed placement 0.5 cm outside of the PTV provide the largest improvement in dose homogeneity, at the cost of a slight increase in irradiated volume and an increase in the number of needles and seeds.ConclusionsImplanting seeds beyond the PTV within a 0.3–0.5 cm margin, and optimizing seed activity on a per patient basis, allows for improvement in dose homogeneity. However, these plans require higher needle and seed counts and result in a small increase in irradiated volume. Before planning recommendations can be made, the implications of these changes must be investigated in the context of clinical outcome for permanent breast seed implant.

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The mechanism study of miR-125b in occurrence and progression of multiple myeloma

Abstract

Although many efforts have contributed to improve our knowledge of molecular pathogenesis about multiple myeloma (MM), the role and significance of microRNAs and long noncoding RNAs in MM cells, along with the core mechanism remains virtually absent. The mRNA levels of miR-125b and MALAT1 in MM cell lines were detected by qRT-PCR. The influence of Lenti-Sh-miR-125b on cell viability and the Notch-1 pathway-related proteins were assessed by MTT method and western blot, respectively. We also investigated the regulation effect between MALAT1 and Notch1 pathway. Moreover, the connection between Notch1 signaling and MM cell growth was discussed in-depth. The reverse effect of pcDNA-Notch1 on the cell viability and Notch-1 pathway proteins induced by Si-MALAT1 was also studied. Furthermore, miR-125b overexpressing MM cell lines were injected subcutaneously into nude mice. MiR-125b and MALAT1 were inversely expressed in MM cell lines. Lenti-Sh-miR-125b inhibited the expression of MALAT1 and Notch-1 protein. Binding sites were confirmed between miR-125b and MALAT1, and silencing MALAT1 did not alter the expression of Notch-1. The apoptosis rate was increased and the survival rate was decreased obviously in GSI XII (targeted cleavage of Notch-1 receptor) group, along with the inhibited Notch1 and HES1 proteins. Moreover, the decreased cell viability and Notch-1 pathway proteins induced by Si-MALAT1 could be reversed by pcDNA-Notch1. Lenti-Sh-miR-125b promoted survival and decreased Notch1 and HES1 proteins levels, while this effect was reversed by si -MALAT1. MiR-125b regulated MALAT1 expression via Notch1 signaling pathway to regulate cell growth, thus participating in the occurrence and progression of MM, which functioned as a therapeutic target for tracking MM.

To investigate the mechanism of long noncoding RNA MALAT1 and miR-125b in the progression of multiple myeloma (MM), through our current study, we found that loss of miR-125b contributes to lncRNA MALAT1 expression through Notch-1 pathway, further regulating cell growth. Therefore, the current findings not only provide new insight in clarifying the complex molecular mechanisms of specific miR-125b and MALAT1 but also facilitate the development.

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Asymmetrical Arterial Diameters

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Wolfgang G. Mouton, André Wyss

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Re: “Management of Atherosclerotic Carotid and Vertebral Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)”

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Karl Sörelius

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Floating Aortic Thrombus in a Non-aneurysmal and Non-atherosclerotic Aorta

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): C. Sosa, F. Zuccarino

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Response to “Re. Management of Atherosclerotic Carotid and Vertebral Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)”

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): A Ross Naylor, Jean-Baptiste Ricco

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Double Banana Technique: A Fruity Solution for Treating Iliac Aneurysms After Aortic Surgery

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Lucie Salomon du Mont, Simon Rinckenbach

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Efficient Differentiation of Bone Marrow Mesenchymal Stem Cells into Endothelial Cells in Vitro

Publication date: Available online 6 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Chengen Wang, Yuan Li, Min Yang, Yinghua Zou, Huihui Liu, Zeyin Liang, Yue Yin, Guochen Niu, Ziguang Yan, Bihui Zhang
ObjectiveEndothelial cells (ECs) play an important role in neovascularisation, but are too limited in number for adequate therapeutic applications. Mesenchymal stem cells (MSCs) have the potential to differentiate into endothelial lineage cells, which makes them attractive candidates for therapeutic angiogenesis. The aim of this study was to investigate efficient differentiation of MSCs into ECs by inducing medium in vitro.MethodsMSCs were isolated from bone marrow by density gradient centrifugation. The characterisation of the MSCs was determined by their cluster of differentiation (CD) marker profile. Inducing medium containing vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), insulin like growth factor (IGF), epidermal growth factor (EGF), ascorbic acid, and heparin was applied to differentiate the MSCs into ECs. Endothelial differentiation was quantitatively evaluated using flow cytometry. Real time quantitative PCR (qRT-PCR) was used to analyse mRNA expression of endothelial markers. Tube formation assay was further performed to examine the functional status of the differentiated MSCs.ResultsFlow cytometry analysis demonstrated that CD31⁺ and CD34⁺ cells increased steadily from 12% at 3 days, to 40% at 7 days, and to 60% at 14 days. Immunofluorescence staining further confirmed the expression of CD31 and CD34. qRT-PCR showed that expression of von Willebrand factor (vWF), vascular endothelial cadherin (VE-cadherin) and vascular endothelial growth factor receptor-2 (VEGFR-2) were significantly higher in the induced MSCs group compared with the uninduced MSCs group. The functional behavior of the differentiated cells was tested by tube formation assay in vitro on matrigel. Induced MSCs were capable of developing capillary networks, and progressive formation of vessel like structures was associated with increased EC population.ConclusionsThese results provide a method to efficiently promote differentiation of MSCs into ECs in vitro for potential application in the treatment of peripheral arterial disease.

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Widespread enlarged perivascular spaces associated with dementia and focal brain dysfunction: case report

Enlarged perivascular spaces (PVS) are common magnetic resonance imaging (MRI) findings, whereas widespread enlarged PVS are extremely rare. Although most patients with widespread enlarged PVS remain asymptoma...

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The underlying physiological basis of the desert rodent Meriones shawi's survival to prolonged water deprivation: Central vasopressin regulation on peripheral kidney water channels AQPs-2

Publication date: Available online 6 December 2017
Source:Acta Histochemica
Author(s): A. Elgot, O. El Hiba, M. Belkouch, H. Gamrani
Meriones shawi (M. shawi) is a particular semi-desert rodent known by its resistance to long periods of thirst. The aim of the present investigation is to clarify the underlying mechanisms allowing M. shawi to resist to hard conditions of dehydration. For this reason we used two different approaches: i) a morphometric study, which consists in measuring the effect of dehydration on body and kidneys weights as well as the report kidney weight/body weight, ii) By immunohistochemistry, we proceed to study the effect of dehydration on the immunoreactivity of central vasopressin (AVP) and the kidney aquaporin-2 (AQP-2) which is a channel protein that allows water to permeate across cell membranes. Our results showed both a body mass decrease accompanied by a remarkable kidneys hypertrophy. The immunohistochemical study showed a significant increase of AQP-2 immunoreactivity in the medullar part of Meriones kidneys allowing probably to Meriones a great ability to water retention. Consistently, we demonstrate that the increased AQP-2 expression occurred together with an increase in vasopressin (AVP) expression in both hypothalamic supraoptic (SON) and paraventricular nucleus (PVN), which are a major hub in the osmotic control circuitry.These various changes seen either in body weight and kidneys or at the cellular level might be the basis of peripheral control of body water homeostasis, providing to M. shawia strong resistance against chronic dehydration.

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Development of a Web-Based Psychosocial Intervention for Adolescent and Young Adult Survivors of Pediatric Brain Tumor

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.

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Reply

Publication date: Available online 6 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Fernando Sergio Leitao Filho, Seung Won Ra, Andre Mattman, Robert S. Schellenberg, Don D. Sin

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Chronic obstructive pulmonary disease exacerbation frequency and serum IgG levels

Publication date: Available online 6 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Juthaporn Cowan, Sunita Mulpuru, Gonzalo Alvarez, Vicente Corrales-Medina, Donald W. Cameron

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HER2 copy number of circulating tumour DNA functions as a biomarker to predict and monitor trastuzumab efficacy in advanced gastric cancer

Publication date: January 2018
Source:European Journal of Cancer, Volume 88
Author(s): Haixing Wang, Beifang Li, Zhentao Liu, Jifang Gong, Lin Shao, Jun Ren, Yunyun Niu, Shiping Bo, Zhongwu Li, Yumei Lai, Sijia Lu, Jing Gao, Lin Shen
BackgroundHER2 status is significant to trastuzumab therapy; however, it is difficult to determine HER2 status accurately with few pieces of biopsies from advanced gastric cancer (AGC) due to highly heterogeneity and invasive behaviour, which will be investigated in this study.MethodsFifty-six patients with AGC were included in this study. Primary tumour tissues and matched plasmas before medication from 36 patients were retrospectively collected, and the other 20 patients with primary tumour tissues and paired plasmas were prospectively collected. HER2 expression and amplification in 56 tumour tissues were determined by immunohistochemistry (IHC) and dual in situ hybridisation (DISH), and HER2 copy number in 135 circulating tumour DNAs (ctDNAs) was judged by next-generation sequencing.ResultsFor tumour tissues, HER2 amplification by DISH was most commonly found in patients with HER2 score 3+by IHC. For plasmas, HER2 amplification defined as HER2 copy number >2.22 was identified in 26 of 56 patients. There was a high concordance of HER2 amplification between ctDNA and tumour tissues, suggesting that ctDNA could function as an alternative to screen HER2-targeted population. Moreover, the changes of HER2 copy number in ctDNA could efficiently monitor trastuzumab efficacy, the power of which was superior to commonly used markers carcinoembryonic antigen (CEA) and CA199, suggesting its potential role in clinical practice.ConclusionctDNA for HER2 analysis was strongly recommended to serve as a surrogate to screen trastuzumab-suitable population and monitor trastuzumab efficacy.

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The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data

Publication date: January 2018
Source:European Journal of Cancer, Volume 88
Author(s): Magdalena Lycken, Linda Drevin, Hans Garmo, Pär Stattin, Jan Adolfsson, Ingela Franck Lissbrant, Lars Holmberg, Anna Bill-Axelson
BackgroundSymptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.MethodsThis Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.ResultsWe included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47–0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66–0.92 for unmarried without children versus married with children).ConclusionOur results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.

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Improved stratification of pT1 melanoma according to the 8th American Joint Committee on Cancer staging edition criteria: A Dutch population-based study

Publication date: Available online 5 December 2017
Source:European Journal of Cancer
Author(s): D. Verver, W.J. Louwman, S. Koljenović, C. Verhoef, D.J. Grünhagen, A.C.J. van Akkooi
IntroductionThe 8th American Joint Committee on Cancer (AJCC) staging edition includes revisions regarding pT1 melanomas. We aimed to evaluate the expected impact of this edition on staging and survival in the Dutch pT1 melanoma population.MethodsIn total, 32,935 pT1 melanoma patients, whose data were retrieved from the Netherlands Cancer Registry between 2003 and 2015, were included in the study. Patients were stratified by the 6th AJCC edition (cohort 1: 2003–2009) and 7th edition (cohort 2: 2010–2015) and all reclassified according to the 8th edition. Stage migration, sentinel lymph node biopsy (SLNB) positivity rates and relative survival were analysed. Agreement between staging systems was calculated by Cohen's kappa coefficient.ResultsIn cohort 2, restaging according to the 8th edition led to an increase of 7% in the total number of patients staged pT1b. The kappa score for agreement between the 6th and 8th edition was 0.15 and 0.25 for agreement between 7th and 8th edition. Restaging according to the 8th edition resulted in a higher SLNB positivity rate for pT1b patients than pT1a patients (8% versus 5%, p = 0.08). Relative survival curves were predominantly similar between the staging editions.ConclusionsImplementation of the 8th AJCC staging edition will presumably not have major impact on the total number of Dutch pT1b patients. Consequently, the number of patients eligible for SLNB would roughly remain similar. In terms of SLNB positivity, the selection of high-risk pT1 melanoma patients is likely to improve. In addition, the 8th edition criteria for pT1 melanoma seem more workable for pathologists.

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C-statistic: A brief explanation of its construction, interpretation and limitations

Publication date: Available online 5 December 2017
Source:European Journal of Cancer
Author(s): S.J. Caetano, G. Sonpavde, G.R. Pond

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Toxocara species exposure, symptoms of asthma, and fractional exhaled nitric oxide in the US population

Asthma is a major cause of morbidity in the United States.1 Toxocariasis is caused by exposure to the eggs of the nematodes Toxocara canis and Toxocara cati.2,3 Clinic-based studies have reported the association of Toxocara species with asthma. A study using data from the Third National Health and Nutrition Examination Survey (NHANES III) of 1988 to 1994 examined the association between Toxocara species infection and lung function in the United States.4 Infection was negatively associated with forced expiratory volume in 1 second.

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Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice

Since the legalization of medical marijuana (MJ) and recreational MJ in certain states, an increasing number of patients with allergy are presenting from MJ exposure. Most have substantial exposure from industrial cultivation or are heavy consumers, indicating that cannabis is a mild allergen.

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Could calcium channel blockers treat 2 illnesses with 1 pill?

Ever since Middleton's1 suggestion that excessive permeability of airway cells to calcium ions might play a role in the underlying mechanism of bronchial hyperresponsiveness (BHR) and asthma, researchers have questioned whether calcium channel blockers (CCBs) might be efficacious in the treatment of this illness. Their potential utility makes a great deal of sense, because cytoplasmic calcium is involved in bronchoconstriction, mast cell mediator release, vagal reflex stimulation, airway mucous gland secretion, chemotaxis of eosinophils, and possibly even smooth muscle remodeling.

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Editorial Board

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Innate lymphoid cells and allergic disease

Allergic diseases, including asthma, atopic dermatitis, and allergic rhinitis, are substantial causes of morbidity and mortality in developing and developed countries. An expansive set of cellular mediators and mechanisms have been identified that contribute to the initiation or exacerbation of allergic disease. During the past decade, the discovery of a new subset of leukocytes known as innate lymphoid cells (ILCs) has great expanded our understanding of the pathogenesis of allergic disease.

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Instructions for Authors

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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO

The Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (PROSPERO) study was designed to better understand the types of patients who are begun on omalizumab in the real-world setting, including asthma burden, comorbidities, and biomarker profiles, and to evaluate what clinical parameters might be associated with better outcomes with the use of this biologic agent. In this month's issue of the Annals, Griffin et al1 report on the first of these 2 outcomes.

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Burden of skin pain in atopic dermatitis

Atopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.

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Author Index to Volume 119, 2017

Abraham T, [Letters] 558

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Information for Readers

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Increasing our knowledge base of asthma

During the past decade, there has been an explosion in our knowledge of asthma. There are new descriptions of phenotypes, endotypes, and even genotypes. New approaches to management have been and continue to be developed. The realization and characterization of a spectrum of overlap with chronic obstructive pulmonary disease (COPD) in many patients with asthma have been reported in detail and approaches to management of patients with severe asthma continue on the forefront. These and other aspects of asthma are well represented in the more than 200 articles published on asthma since 2015 in the Annals of Allergy, Asthma and Immunology.

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The clinical role of fractional exhaled nitric oxide in asthma control

The potential role and characteristics of fractional exhaled nitric oxide (FeNO) remain unclear in the treatment of asthma.

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Restrictive surgical approach to palliate angina in a patient with coronary three vessel disease and biventricular metastatic hepatocellular carcinoma

Abstract

Background

Metastatic cardiac tumors may cause different symptoms including angina, symptoms of heart failure and/or arrhythmia. In patients with concomitant coronary artery disease, it may be difficult to distinguish between angina caused by metastases to the heart, for example, by stealing perfusion from the coronary arteries, and angina caused by coronary stenosis. Identifying the origin of the symptoms is, however, essential for designing appropriate surgical strategies.

Case presentation

A 69-year-old male with multifocal recurrence of a hepatocellular carcinoma (HCC) presented with increasing ventricular arrhythmia and angina several weeks after posterior myocardial infarction and PCI of the RCA culprit lesion during which two further lesions present in the distal RCX and a posterolateral branch, and a chronically occluded LAD had not been addressed. MRI showed a large metastatic tumor infiltrating the walls of both ventricles as well as the interventricular septum. His debilitating symptoms were attributed to steal phenomena and/or perivascular compression caused by the metastatic tumor rather than the remaining coronary lesions, and he was offered a restrictive surgical approach consisting of debulking of the metastasis with an option for subsequent coronary intervention. The palliative surgical procedure resulted in a reduction of the tumor mass by half and sufficiently reduced the patient's symptoms so that further coronary intervention was not required.

Conclusions

Palliative surgery for metastases to the heart may benefit patients, provided that the origin of symptoms is identified correctly. It goes without saying that in a palliative setting, surgery should be limited to treating symptoms rather than performing extensive procedures addressing, for example, coronary artery or valve disease. Interventional cardiac procedures addressing not only CAD but also valve disease may supplement palliative tumor surgery.

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Contents: Volume 45

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Keyword index: Volume 45

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Announcements

Dear Colleagues,

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EACMFS Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Author Index: Volume 45

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Editorial Board

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Diagnostic and treatment effects of sialendoscopy for patients with swelling of the parotid gland when sialoliths are undetected with computed tomography

Publication date: Available online 6 December 2017
Source:Auris Nasus Larynx
Author(s): Norio Kondo, Toshio Yoshihara, Yukie Yamamura, Kaoru Kusama, Eri Sakitani, Yukako Seo, Mayako Tachikawa, Keiko Kujirai, Erika Ono, Yasuyo Maeda, Tomohito Nojima, Akiko Tamiya, Emiri Sato, Manabu Nonaka
Between August 2009 and May 2016, 74 patients underwent sialoendoscopic surgery. 32 patients had parotid gland disease and 9 patients had intermittent swelling of the parotid gland and sialoliths were not detected with CT imaging. 4 patients were diagnosed with idiopathic Stensen's duct stenosis. Sialendoscopy directly confirmed Stensen's duct stenosis in 2 patients. However, the sialendoscope was unable to be inserted in the other 2 patients, who had stenosis of the orifice of the Stensen's duct. Balloon expansion of the duct was performed in these 2 patients and a steroid drug was injected into the duct in one patient. Complete remission was archived in one patient treated with sialendoscopy. Three patients had sialolithiasis. Microsialoliths and/or white floating matter was observed and removed using sialendoscopy. All patients experienced complete remission. In cases of Sjögren syndrome and recurrent parotitis, sialendoscopic surgery was performed, but the symptoms showed no improvement. For patients with microsialoliths, sialendoscopy may be most useful for diagnosis and treatment when the sialoliths are not detected with CT imaging. At present, sialendoscopic surgery have limitation in the treatment of Stensen's duct stenosis and may similarly have limitation in the treatment of Sjögren's syndrome and recurrent parotitis.

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Factors influencing recurrent emergency department visits for epistaxis in the elderly

Publication date: Available online 6 December 2017
Source:Auris Nasus Larynx
Author(s): Mohamad R. Chaaban, Dong Zhang, Vicente Resto, James S. Goodwin
ObjectiveOur objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.MethodsWe used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities.ResultsOut of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities.ConclusionAdditional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.

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Cannabinoids for epilepsy: What do we know and where do we go?

Summary

Over the past decade there has been an increasing interest in using cannabinoids to treat a range of epilepsy syndromes following reports of some remarkable responses in individual patients. The situation is complicated by the fact that these agents do not appear to work via their attachment to endogenous cannabinoid receptors. Their pharmacokinetics are complex, and bioavailability is variable, resulting in difficulty in developing a suitable formulation for oral delivery. Drug interactions also represent another complication in their everyday use. Nevertheless, recent randomized, placebo-controlled trials with cannabidiol support its efficacy in Dravet and Lennox-Gastaut syndromes. Further placebo-controlled studies are underway in adults with focal epilepsy using cannabidivarin. The many unanswered questions in the use of cannabinoids to treat epileptic seizures are briefly summarized in the conclusion.

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Electroencephalography and behavior patterns during experimental status epilepticus

Summary

Objective

To characterize the evolution of behavioral and electrographic seizures in an experimental electrical stimulation-based model of status epilepticus (SE) in C57Bl/6 mice, and to relate SE to various outcomes, including death and epileptogenesis.

Methods

SE was induced by continuous hippocampal stimulation and was evaluated by review of electroencephalographic recordings, spectral display, and behavior.

Results

Seizures were initially locked to the electrical trains but later became independent of them. Following the end of stimulation, autonomous seizures continued for >5 minutes in 85% of the animals. There was ongoing 2-3-Hz rhythmic, high-amplitude, slow spike-wave discharges (HASDs) associated with purposeless, repetitive, continuously circling and exploratory behavior. There were high-amplitude fast discharges (HAFDs) associated with worsening of behavioral seizures that were interspersed with the ongoing HASDs. Death during SE occurred in 23% of the animals, and it was preceded by a stage 5 behavioral seizure. In the waning stage of SE, severe seizures and HAFDs dissipated, HASDs slowed down, and normal behavior was restored in most animals. Epilepsy developed in 33% of the animals monitored after SE.

Significance

The electrical stimulation model of SE can be used to study mechanisms of SE and its adverse consequences, including death and epileptogenesis.

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Αρχειοθήκη ιστολογίου

Τετάρτη 6 Δεκεμβρίου 2017

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