So-called gastric-type adenocarcinoma and related premalignant lesions have been characterized in the cervix, but similar lesions are not widely recognized in the vagina. We report a series of 11 vaginal glandular lesions exhibiting gastric differentiation, comprising 5 cases of adenocarcinoma and 6 of adenosis. All cases occurred in adults (aged 33 to 69) with no known history of diethylstilboestrol exposure. The vaginal adenocarcinomas exhibited morphologic features identical to gastric-type adenocarcinoma of the cervix, but 1 case additionally demonstrated basaloid and sarcomatoid components, which have not been previously reported in cervical gastric-type adenocarcinoma. Immunohistochemically, the adenocarcinomas were positive for MUC6 (4/5), PAX8 (3/5), CK7 (5/5), CK20 (1/5), CDX2 (5/5), CA19.9 (5/5), CEA (4/5), CA125 (5/5), and hepatocyte nuclear factor 1β (5/5). p16, estrogen receptor, and Napsin A were negative in all cases tested, whereas p53 exhibited mutation-type staining in 3/5 cases. In all 5 adenocarcinomas, a component of adenosis with benign or atypical nuclear features was identified; the adenosis displayed gastric morphology in 4 cases and tuboendometrial morphology in 1. The 6 cases of pure vaginal adenosis (without associated adenocarcinoma) all contained gastric-type mucinous glands together with tuboendometrial glands in 2 cases. There was focal intestinal differentiation with goblet cells in all 6 cases and neuroendocrine cells with eosinophilic granules in 3. Cytologic atypia was observed in 4/6 cases of pure vaginal adenosis. Immunohistochemically, the gastric-type adenosis (10 cases) was positive for MUC6 (10/10), estrogen receptor (5/10), PAX8 (8/10), CK7 (9/9), CK20 (2/9), CDX2 (5/9), CA19.9 (8/9), CEA (6/9), CA125 (6/9), hepatocyte nuclear factor 1β (10/10), and Napsin A (1/10). p53 exhibited wild-type immunoreactivity in all 10 cases, whereas p16 was negative in all cases tested. Scattered individual chromogranin-positive cells were present in all 5 cases of pure adenosis tested. Follow-up was available in 4 of the adenocarcinoma cases, with 3 patients dead of disease within 1 to 3 years and 1 patient alive with disease at 1 year. The morphologic and immunohistochemical findings in our study suggest a close relationship between vaginal gastric-type adenocarcinoma and adenosis exhibiting gastric differentiation. This probably represents a distinct pathway of vaginal gastric-type carcinogenesis analogous to that occurring in the cervix. We propose that gastric-type adenocarcinoma be recognized as a distinct histologic subtype of vaginal adenocarcinoma while vaginal adenosis of gastric-type represents a novel subtype of adenosis that requires further study to clarify its biological potential. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: W. Glenn McCluggage, FRCPath, Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT12 6BA, UK (e-mail: glenn.mccluggage@belfasttrust.hscni.net). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JUKgdZ
Τρίτη 17 Απριλίου 2018
Pretreatment neurocognitive function and self‐reported symptoms in patients with newly diagnosed head and neck cancer compared with noncancer cohort
Head &Neck, EarlyView.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2HKpzAQ
Effects of single- and double-layered resorbable membranes and platelet-rich fibrin on bone healing
Abstract
Objectives
Research has been ongoing on achieving optimum bone healing in the reconstruction of bone loss. Clinically, soft tissue migration into the already existing bone defects is the leading cause of unfavourable bone healing. Platelet-rich fibrin, a recent material that is used to promote bone healing, was compared with single- and double-layered resorbable collagen membranes to determine whether a healing protocol which increases patient comfort is possible.
Materials and methods
Sixty adult female Sprague-Dawley rats were used. The rats were divided into five main groups as a sacrification group, a control group, and three experimental groups. The bone defects experimental group 1 were covered with a single-layer collagen membrane, and experimental group 2 were covered with the double-layered collagen membrane. Defects on the experimental group 3 were covered with platelet-rich fibrin membranes which were derived from the sacrification group. The animals in the main groups were also divided into eight subgroups arranged by sacrification periods on day 7 and day 28.
Results
Statistical analysis of our study revealed that new bone formation in experimental group 3 was significantly higher than in other groups. Fibrosis was found to be lower in experimental group 3 than in any other group. No significant differences were found between experimental group 1 and the control group.
Conclusion
Platelet-rich fibrin, which can be used as an autologous membrane which promotes bone healing, yields better clinical result compared to collagen membranes.
Clinical relevance
Histopathologic evaluation has been carried out regarding the effect of platelet-rich fibrin and collagen membranes applied on bone recovery. Our objective is to contribute to barrier membrane studies that continue to guide and accelerate bone recovery.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2ETl7wh
Effect of bleaching agent extracts on murine macrophages
Abstract
Objectives
The aim of this study was to evaluate the cytotoxicity and the influence of bleaching agents on immunologically cell surface antigens of murine macrophages in vitro.
Materials and methods
RAW 264.7 cells were exposed to bleaching gel extracts (40% hydrogen peroxide or 20% carbamide peroxide) and different H2O2 concentrations after 1 and 24-h exposure periods and 1-h exposure and 23-h recovery. Tests were performed with and without N-acetyl cysteine (NAC) and buthionine sulfoximine (BSO). Cell viability was determined by MTT assay. The expression of surface markers CD14, CD40, and CD54 with and without LPS stimulation was detected by flow cytometry, while the production of TNF-α was measured by ELISA. Statistical analysis was performed using the Mann-Whitney U test (α = 0.05).
Results
Extracts of bleaching agents were cytotoxic for cells after a 1-h exposure; cells could not recover after 24 h. This effect can be mitigated by the antioxidant NAC and increased by BSO, an inhibitor of glutathione (GSH) synthesis. LPS stimulated expression of all surface markers and TNF-α production. Exposure to bleaching agent extracts and H2O2 leads to a reduction of TNF-α, CD14, and CD40 expression, while the expression of CD54 was upregulated at non-cytotoxic concentrations. Whereas NAC reduced this effect, it was increased in the presence of BSO.
Conclusions
Extracts of bleaching agents were irreversibly cytotoxic to macrophages after a 1-h exposure. Only the expression of CD54 was upregulated. The reactions are mediated by the non-enzymatic antioxidant GSH.
Clinical relevance
The addition of an antioxidant can downregulate unfavorable effects of dental bleaching.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JTVy1Z
Lack of association between ENAM gene polymorphism and dental caries in primary and permanent teeth in Czech children
Abstract
Objectives
The enamelin gene (ENAM) polymorphism (rs12640848) was recently associated with dental caries in primary teeth in Polish children. The aims of the present study were to prove this association in primary dentition and to find a possible effect of this variant on caries development in permanent dentition in Czech children.
Materials and methods
This study comprised 905 Czech children. Totally, 187 children aged 2–6 years with primary dentition [78 healthy subjects (with decayed/missing/filled teeth, dmft = 0) and 109 patients with early childhood caries (ECC; dmft ≥ 1)] were included in this case-control study. In addition, 177 subjects aged 13–15 years without caries (DMFT = 0) and 541 children with dental caries (DMFT ≥ 1) in permanent dentition were selected from the ELSPAC study. Genotype determination of the ENAM polymorphism (rs12640848) was based on the TaqMan method.
Results
No significant differences in the allele or genotype frequencies between the caries-free children and those affected by dental caries were observed in both primary and permanent dentitions.
Conclusions
Lack of association between the ENAM polymorphism (rs12640848) and dental caries in Czech children was detected.
Clinical relevance
Although ENAM is considered as a candidate gene for dental caries, the presence of the ENAM variant (rs12640848) cannot be used as a risk factor of this multifactorial disease in the Czech population.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EVN32w
Evaluation of the interface between gutta-percha and two types of sealers using scanning electron microscopy (SEM)
Abstract
Objectives
The aim of the present study was to evaluate the adaptation of a calcium silicate bioceramic (BC) sealer with either BC or conventional gutta-percha compared with that of AH Plus sealer in different root canal sections.
Materials and methods
Seventy-two extracted mandibular premolars were divided randomly into six groups. After standardised chemomechanical preparation, four groups were obturated with the BC sealer and BC gutta-percha or conventional gutta-percha, and the other two groups were obturated with AH Plus sealer and conventional gutta-percha either in lateral compaction or in a single cone technique. Each root was sectioned into three sections. An impression was made from each section, and replicas were then made for scanning electron microscopy (SEM) analysis. Areas and interfacial gaps were identified using image analysis software. In addition to descriptive and explorative data analyses, linear regression analysis was performed.
Results
All specimens had measurable interfacial gaps. Significantly fewer gaps were found between conventional gutta-percha and sealer compared to those observed when using the BC gutta-percha (p < 0.001). However, minor interfacial gaps between sealer and dentin were observed with the BC sealer (p = 0.04). The technique of obturation in different root canal sections did not significantly affect the sealer adaptability.
Conclusion
The type of gutta-percha as well as the sealer had a noticeable impact on the adaptability.
Clinical relevance
Different obturation techniques will result in similar outcomes. However, within the limitations of the study, there seems to be no advantage in using the BC gutta-percha.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JSGTEa
Prevention of coronal discoloration induced by regenerative endodontic treatment in an ex vivo model
Abstract
Objectives
The aim of this study was to assess the effect of sealing the pulp chamber walls with a dentin-bonding agent (DBA) on prevention of discoloration induced by regenerative endodontic procedures (REPs) in an ex vivo model.
Materials and methods
Ninety-six bovine incisors were prepared and randomly divided into two groups. In one group, the pulp chamber walls were sealed with DBA before placement of triple antibiotic paste (TAP) containing minocycline inside the root canals, but in the other group, DBA was not applied. After 4 weeks, the root canals were filled with human blood and each group was then randomly divided into four subgroups (n = 12) according to the endodontic cements placed over the blood clot (ProRoot MTA, OrthoMTA, RetroMTA, or Biodentine). The color changes (∆E) were measured at different steps. The data were analyzed using t test and two-way ANOVA.
Results
The specimens in which dentinal walls of pulp chamber were sealed with DBA showed significantly less coronal discoloration at each step of regenerative treatment (p < 0.001). However, application of DBA did not completely prevent the clinically perceptible coronal color change. Sealing the blood clot with different endodontic cements did not result in significant difference in coronal discoloration (p > 0.05).
Conclusions
Sealing the pulp chamber walls before insertion of TAP decreased coronal discoloration following REP using different endodontic cements but did not prevent it.
Clinical relevance
Discoloration of teeth undergoing REPs is an unfavorable outcome. Considering the significant contribution of TAP containing minocycline to the coronal tooth discoloration even after sealing the pulp chamber walls, the revision of current guidelines in relation to the use of TAP with minocycline might need to be revised.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EWkvWL
Development of a novel bioactive glass for air-abrasion to selectively remove orthodontic adhesives
Abstract
Objectives
To develop a novel, bioactive glass for removing residual orthodontic adhesive via air-abrasion, following bracket debonding, and to evaluate its effectiveness against a proprietary bioactive glass 45S5(Sylc™)-air-abrasion, and a slow-speed tungsten carbide (TC) bur.
Materials and methods
Three glasses were prepared and their bioactivity was proved. One novel glass (QMAT3) was selected due to its appropriate hardness, lower than that of enamel/45S5(Sylc™). Sixty extracted human premolars were randomly assigned to adhesive removal using: (a) QMAT3-air-abrasion, (b) 45S5(Sylc™)-air-abrasion, and (c) TC bur, which were further subdivided (n = 10) based on the adhesive used (Transbond XT™ or Fuji Ortho LC™). Enamel roughness was assessed using scanning electron microscopy (SEM) and non-contact profilometry before bracket bonding, after removing residual adhesive following bracket debonding and after polishing.
Results
QMAT3 formed apatite faster (6 h) than 45S5(Sylc™) (24 h) in Tris solution. QMAT3-air-abrasion gave the lowest enamel roughness (Ra) after removing the adhesives. SEM images showed a pitted, roughened enamel surface in the TC bur group and to a lesser extent with 45S5(Sylc™), while a virtually smooth surface without any damage was observed in the QMAT3-air-abrasion group. The time taken for adhesive removal with QMAT3 was comparable to 45S5(Sylc™) but was twice as long with the TC bur.
Conclusions
QMAT3-air-abrasion is a promising technique for selective removal of adhesives without inducing tangible enamel damage.
Clinical relevance
A novel bioactive glass has been developed as an alternative to the use of TC burs for orthodontic adhesive removal.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EVx9pc
Chemokine Receptor 5 Has No Major Role in the Severity of Hepatitis C Virus-Related Liver Damage
Viral Immunology, Ahead of Print.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2H88mnF
Building a Better Flu Vaccine
Viral Immunology, Ahead of Print.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2qHaUOt
Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers
Abstract
DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2H7hHw5
Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006–2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2qHaOq5
Effects of single- and double-layered resorbable membranes and platelet-rich fibrin on bone healing
Abstract
Objectives
Research has been ongoing on achieving optimum bone healing in the reconstruction of bone loss. Clinically, soft tissue migration into the already existing bone defects is the leading cause of unfavourable bone healing. Platelet-rich fibrin, a recent material that is used to promote bone healing, was compared with single- and double-layered resorbable collagen membranes to determine whether a healing protocol which increases patient comfort is possible.
Materials and methods
Sixty adult female Sprague-Dawley rats were used. The rats were divided into five main groups as a sacrification group, a control group, and three experimental groups. The bone defects experimental group 1 were covered with a single-layer collagen membrane, and experimental group 2 were covered with the double-layered collagen membrane. Defects on the experimental group 3 were covered with platelet-rich fibrin membranes which were derived from the sacrification group. The animals in the main groups were also divided into eight subgroups arranged by sacrification periods on day 7 and day 28.
Results
Statistical analysis of our study revealed that new bone formation in experimental group 3 was significantly higher than in other groups. Fibrosis was found to be lower in experimental group 3 than in any other group. No significant differences were found between experimental group 1 and the control group.
Conclusion
Platelet-rich fibrin, which can be used as an autologous membrane which promotes bone healing, yields better clinical result compared to collagen membranes.
Clinical relevance
Histopathologic evaluation has been carried out regarding the effect of platelet-rich fibrin and collagen membranes applied on bone recovery. Our objective is to contribute to barrier membrane studies that continue to guide and accelerate bone recovery.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2ETl7wh
Effect of bleaching agent extracts on murine macrophages
Abstract
Objectives
The aim of this study was to evaluate the cytotoxicity and the influence of bleaching agents on immunologically cell surface antigens of murine macrophages in vitro.
Materials and methods
RAW 264.7 cells were exposed to bleaching gel extracts (40% hydrogen peroxide or 20% carbamide peroxide) and different H2O2 concentrations after 1 and 24-h exposure periods and 1-h exposure and 23-h recovery. Tests were performed with and without N-acetyl cysteine (NAC) and buthionine sulfoximine (BSO). Cell viability was determined by MTT assay. The expression of surface markers CD14, CD40, and CD54 with and without LPS stimulation was detected by flow cytometry, while the production of TNF-α was measured by ELISA. Statistical analysis was performed using the Mann-Whitney U test (α = 0.05).
Results
Extracts of bleaching agents were cytotoxic for cells after a 1-h exposure; cells could not recover after 24 h. This effect can be mitigated by the antioxidant NAC and increased by BSO, an inhibitor of glutathione (GSH) synthesis. LPS stimulated expression of all surface markers and TNF-α production. Exposure to bleaching agent extracts and H2O2 leads to a reduction of TNF-α, CD14, and CD40 expression, while the expression of CD54 was upregulated at non-cytotoxic concentrations. Whereas NAC reduced this effect, it was increased in the presence of BSO.
Conclusions
Extracts of bleaching agents were irreversibly cytotoxic to macrophages after a 1-h exposure. Only the expression of CD54 was upregulated. The reactions are mediated by the non-enzymatic antioxidant GSH.
Clinical relevance
The addition of an antioxidant can downregulate unfavorable effects of dental bleaching.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JTVy1Z
Lack of association between ENAM gene polymorphism and dental caries in primary and permanent teeth in Czech children
Abstract
Objectives
The enamelin gene (ENAM) polymorphism (rs12640848) was recently associated with dental caries in primary teeth in Polish children. The aims of the present study were to prove this association in primary dentition and to find a possible effect of this variant on caries development in permanent dentition in Czech children.
Materials and methods
This study comprised 905 Czech children. Totally, 187 children aged 2–6 years with primary dentition [78 healthy subjects (with decayed/missing/filled teeth, dmft = 0) and 109 patients with early childhood caries (ECC; dmft ≥ 1)] were included in this case-control study. In addition, 177 subjects aged 13–15 years without caries (DMFT = 0) and 541 children with dental caries (DMFT ≥ 1) in permanent dentition were selected from the ELSPAC study. Genotype determination of the ENAM polymorphism (rs12640848) was based on the TaqMan method.
Results
No significant differences in the allele or genotype frequencies between the caries-free children and those affected by dental caries were observed in both primary and permanent dentitions.
Conclusions
Lack of association between the ENAM polymorphism (rs12640848) and dental caries in Czech children was detected.
Clinical relevance
Although ENAM is considered as a candidate gene for dental caries, the presence of the ENAM variant (rs12640848) cannot be used as a risk factor of this multifactorial disease in the Czech population.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EVN32w
Evaluation of the interface between gutta-percha and two types of sealers using scanning electron microscopy (SEM)
Abstract
Objectives
The aim of the present study was to evaluate the adaptation of a calcium silicate bioceramic (BC) sealer with either BC or conventional gutta-percha compared with that of AH Plus sealer in different root canal sections.
Materials and methods
Seventy-two extracted mandibular premolars were divided randomly into six groups. After standardised chemomechanical preparation, four groups were obturated with the BC sealer and BC gutta-percha or conventional gutta-percha, and the other two groups were obturated with AH Plus sealer and conventional gutta-percha either in lateral compaction or in a single cone technique. Each root was sectioned into three sections. An impression was made from each section, and replicas were then made for scanning electron microscopy (SEM) analysis. Areas and interfacial gaps were identified using image analysis software. In addition to descriptive and explorative data analyses, linear regression analysis was performed.
Results
All specimens had measurable interfacial gaps. Significantly fewer gaps were found between conventional gutta-percha and sealer compared to those observed when using the BC gutta-percha (p < 0.001). However, minor interfacial gaps between sealer and dentin were observed with the BC sealer (p = 0.04). The technique of obturation in different root canal sections did not significantly affect the sealer adaptability.
Conclusion
The type of gutta-percha as well as the sealer had a noticeable impact on the adaptability.
Clinical relevance
Different obturation techniques will result in similar outcomes. However, within the limitations of the study, there seems to be no advantage in using the BC gutta-percha.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JSGTEa
Prevention of coronal discoloration induced by regenerative endodontic treatment in an ex vivo model
Abstract
Objectives
The aim of this study was to assess the effect of sealing the pulp chamber walls with a dentin-bonding agent (DBA) on prevention of discoloration induced by regenerative endodontic procedures (REPs) in an ex vivo model.
Materials and methods
Ninety-six bovine incisors were prepared and randomly divided into two groups. In one group, the pulp chamber walls were sealed with DBA before placement of triple antibiotic paste (TAP) containing minocycline inside the root canals, but in the other group, DBA was not applied. After 4 weeks, the root canals were filled with human blood and each group was then randomly divided into four subgroups (n = 12) according to the endodontic cements placed over the blood clot (ProRoot MTA, OrthoMTA, RetroMTA, or Biodentine). The color changes (∆E) were measured at different steps. The data were analyzed using t test and two-way ANOVA.
Results
The specimens in which dentinal walls of pulp chamber were sealed with DBA showed significantly less coronal discoloration at each step of regenerative treatment (p < 0.001). However, application of DBA did not completely prevent the clinically perceptible coronal color change. Sealing the blood clot with different endodontic cements did not result in significant difference in coronal discoloration (p > 0.05).
Conclusions
Sealing the pulp chamber walls before insertion of TAP decreased coronal discoloration following REP using different endodontic cements but did not prevent it.
Clinical relevance
Discoloration of teeth undergoing REPs is an unfavorable outcome. Considering the significant contribution of TAP containing minocycline to the coronal tooth discoloration even after sealing the pulp chamber walls, the revision of current guidelines in relation to the use of TAP with minocycline might need to be revised.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EWkvWL
Oral cancer radiotherapy affects enamel microhardness and associated indentation pattern morphology
Abstract
Objectives
The aim of this study is to determine the effects of in vitro and in vivo high-dose radiotherapy on microhardness and associated indentation pattern morphology of enamel.
Materials and methods
The inner, middle, and outer microhardness of enamel was evaluated using three experimental groups: control (non-radiated); in vitro irradiated; in vivo irradiated. In vitro specimens were exposed to simulated radiotherapy, and in vivo specimens were extracted teeth from oral cancer patients previously treated with radiotherapy. Indentations were measured via SEM images to calculate microhardness values and to assess the mechanomorphological properties of enamel before and after radiotherapy.
Results
Middle and outer regions of enamel demonstrated a significant decrease in microhardness after in vitro and in vivo irradiation compared to the control group (p < 0.05). Two indentation patterns were observed: pattern A—presence of microcracks around indent periphery, which represents local dissipation of deformation energy; pattern B—clean, sharp indents. The percentage of clean microindentation patterns, compared to controls, was significantly higher following in vitro and in vivo irradiation in all enamel regions. The highest percentage of clean microindentations (65%) was observed in the in vivo irradiated group in the inner region of enamel near the dentin-enamel junction.
Conclusions
For the first time, this study shows that in vitro and in vivo irradiation alters enamel microhardness. Likewise, the indentation pattern differences suggest that enamel may become more brittle following in vitro and in vivo irradiation.
Clinical relevance
The mechanomorphological property changes of enamel following radiation may be a contributory component of pathologic enamel delamination following oral cancer radiotherapy.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2JSfh22
Development of a novel bioactive glass for air-abrasion to selectively remove orthodontic adhesives
Abstract
Objectives
To develop a novel, bioactive glass for removing residual orthodontic adhesive via air-abrasion, following bracket debonding, and to evaluate its effectiveness against a proprietary bioactive glass 45S5(Sylc™)-air-abrasion, and a slow-speed tungsten carbide (TC) bur.
Materials and methods
Three glasses were prepared and their bioactivity was proved. One novel glass (QMAT3) was selected due to its appropriate hardness, lower than that of enamel/45S5(Sylc™). Sixty extracted human premolars were randomly assigned to adhesive removal using: (a) QMAT3-air-abrasion, (b) 45S5(Sylc™)-air-abrasion, and (c) TC bur, which were further subdivided (n = 10) based on the adhesive used (Transbond XT™ or Fuji Ortho LC™). Enamel roughness was assessed using scanning electron microscopy (SEM) and non-contact profilometry before bracket bonding, after removing residual adhesive following bracket debonding and after polishing.
Results
QMAT3 formed apatite faster (6 h) than 45S5(Sylc™) (24 h) in Tris solution. QMAT3-air-abrasion gave the lowest enamel roughness (Ra) after removing the adhesives. SEM images showed a pitted, roughened enamel surface in the TC bur group and to a lesser extent with 45S5(Sylc™), while a virtually smooth surface without any damage was observed in the QMAT3-air-abrasion group. The time taken for adhesive removal with QMAT3 was comparable to 45S5(Sylc™) but was twice as long with the TC bur.
Conclusions
QMAT3-air-abrasion is a promising technique for selective removal of adhesives without inducing tangible enamel damage.
Clinical relevance
A novel bioactive glass has been developed as an alternative to the use of TC burs for orthodontic adhesive removal.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2EVx9pc
c‐Src inhibitor selectively inhibits triple‐negative breast cancer overexpressed Vimentin in vitro and in vivo
Cancer Science, EarlyView.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2H851VF
Hispidulin suppresses cell growth and metastasis by targeting PIM1 through JAK2/STAT3 signaling in colorectal cancer
Cancer Science, EarlyView.
from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2qGPm4D
Sternocleidomastoid Flap in Parotid Surgery: A Case Series
Abstract
Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.
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Issue Information
Journal of Cutaneous Pathology, Volume 45, Issue 5, May 2018.
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Cutaneous Pyoderma Gangrenosum of the Hand
What can this case tell us about the presentation, diagnosis, and management of cutaneous pyoderma gangrenosum?
ePlasty, Open Access Journal of Plastic Surgery
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Adjuvant chemotherapy in patients with operable granulosa cell tumors of the ovary: a surveillance, epidemiology, and end results cohort study
Cancer Medicine, EarlyView.
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Dimethyl Fumarate Attenuates Neuroinflammation and Neurobehavioral Deficits Induced by Experimental Traumatic Brain Injury
Journal of Neurotrauma, Ahead of Print.
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Early Predictors of Global Functional Outcome After Traumatic Spinal Cord Injury: A Systematic Review
Journal of Neurotrauma, Ahead of Print.
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Central Infusion of Insulin-Like Growth Factor-1 Increases Hippocampal Neurogenesis and Improves Neurobehavioral Function after Traumatic Brain Injury
Journal of Neurotrauma, Ahead of Print.
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Chronic respiratory rhinitis
Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): R. Jankowski, P. Gallet, D.T. Nguyen, C. Rumeau
The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.
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Maxillofacial brown tumours: Series of 5 cases
Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Antin, D. Bakhos, F. Jegoux, M. Merkouza, L. Laccourreye
ObjectivesBrown tumours are benign bone tumours secondary to hyperparathyroidism. The authors describe the various clinical features, diagnostic methods and treatment modalities for maxillofacial brown tumours.Material and methodsThis multicentre retrospective study comprised 5 patients (four women and one man, between the ages of 29 and 70 years) with one or several maxillofacial brown tumours observed over a 16-year period from January 2000 to December 2016.ResultsFour patients presented secondary hyperparathyroidism in a context of chronic renal failure, one patient presented primary hyperparathyroidism due to parathyroid adenoma. Three patients presented a mandibular brown tumour, and two patients presented a maxillary brown tumour. The diagnosis was based on histological examination and laboratory tests. Brown tumours were treated either surgically or conservatively. A favourable outcome was observed in all cases.ConclusionBrown tumours are rare lesions. This diagnosis must be considered in a context of giant cell tumour associated with hyperparathyroidism. Brown tumours should be treated conservatively.
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Dimethyl Fumarate Attenuates Neuroinflammation and Neurobehavioral Deficits Induced by Experimental Traumatic Brain Injury
Journal of Neurotrauma, Ahead of Print.
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Early Predictors of Global Functional Outcome After Traumatic Spinal Cord Injury: A Systematic Review
Journal of Neurotrauma, Ahead of Print.
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Central Infusion of Insulin-Like Growth Factor-1 Increases Hippocampal Neurogenesis and Improves Neurobehavioral Function after Traumatic Brain Injury
Journal of Neurotrauma, Ahead of Print.
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Optimising intratumoral treatment of head and neck squamous cell carcinoma models with the diterpene ester Tigilanol tiglate
Summary
The five-year survival rate for patients with head and neck squamous cell carcinoma (HNSCC) has remained at ~50% for the past 30 years despite advances in treatment. Tigilanol tiglate (TT, also known as EBC-46) is a novel diterpene ester that induces cell death in HNSCC in vitro and in mouse models, and has recently completed Phase I human clinical trials. The aim of this study was to optimise efficacy of TT treatment by altering different administration parameters. The tongue SCC cell line (SCC-15) was identified as the line with the lowest efficacy to treatment. Subcutaneous xenografts of SCC-15 cells were grown in BALB/c Foxn1nu and NOD/SCID mice and treated with intratumoral injection of 30 μg TT or a vehicle only control (40% propylene glycol (PG)). Greater efficacy of TT treatment was found in the BALB/c Foxn1nu mice compared to NOD/SCID mice. Immunohistochemical analysis indicated a potential role of the host's innate immune system in this difference, specifically neutrophil infiltration. Neither fractionated doses of TT nor the use of a different excipiant led to significantly increased efficacy. This study confirmed that TT in 40% PG given intratumorally as a single bolus dose was the most efficacious treatment for a tongue SCC mouse model.
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Two phase I, pharmacokinetic, and pharmacodynamic studies of DFP-10917, a novel nucleoside analog with 14-day and 7-day continuous infusion schedules
Summary
Purpose DFP-10917 is a novel deoxycytidine analog with a unique mechanism of action. Brief exposure to high concentrations of DFP-10917 inhibits DNA polymerase resulting in S-phase arrest, while prolonged exposure to DFP-10917 at low concentration causes DNA fragmentation, G2/M-phase arrest, and apoptosis. DFP-10917 demonstrated activity in tumor xenografts resistant to other deoxycytidine analogs. Experimental design Two phase I studies assessed the safety, pharmacokinetic, pharmacodynamic and preliminary efficacy of DFP-10917. Patients with refractory solid tumors received DFP-10917 continuous infusion 14-day on/7-day off and 7-day on/7-day off. Enrollment required age > 18 years, ECOG Performance Status 0–2 and adequate organ function. Results 29 patients were dosed in both studies. In 14-day infusion, dose-limiting toxicities (DLT) consisting of febrile neutropenia and thrombocytopenia occurred at 4.0 mg/m2/day. At 3.0 mg/m2/day, 3 patients experienced neutropenia in cycle 2. The dose of 2.0 mg/m2/day was well tolerated in 6 patients. In 7-day infusion, grade 4 neutropenia was DLT at 4.0 mg/m2/day. The maximum tolerated dose was 3 mg/m2/day. Other toxicities included nausea, vomiting, diarrhea, neutropenia, and alopecia. Eight patients had stable disease for >12 weeks. Paired comet assays performed for 7 patients showed an increase in DNA strand breaks at day 8. Pharmacokinetic data showed dose-proportionality for steady-state concentration and AUC of DFP-10917 and its primary metabolite. Conclusion Continuous infusion of DFP-10917 is feasible and well tolerated with myelosuppression as main DLT. The recommended doses are 2.0 mg/m2/day and 3.0 mg/m2/day on the 14-day and 7-day continuous infusion schedules, respectively. Preliminary activity was suggested. Pharmacodynamic data demonstrate biological activity at the tested doses.
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Short and Long-Term Outcomes of Titanium Clip Ossiculoplasty
Objective: To report short (∼4 mo) and long-term (>12 mo) audiometric outcomes following ossiculoplasty using a titanium clip partial ossicular reconstruction prosthesis. Methods: Case series at a single tertiary referral center reviewing 130 pediatric and adult patients with conductive hearing loss (CHL) secondary to chronic otitis media (n = 121, 93%) or traumatic ossicular disruption (n = 9, 7%) who underwent partial ossiculoplasty from January 2005 to December 2015 with the CliP prosthesis. Results: At both short and long-term follow-up, postoperative air-bone gap (ABG) was significantly improved (18 dB HL, IQ range 13–26, p
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Active Transcutaneous Bone Conduction Implant: Middle Fossa Placement Technique in Children With Bilateral Microtia and External Auditory Canal Atresia
Aim: The aim of this study is to present the middle fossa technique (MFT) as an alternative for patients who cannot undergo traditional surgery for active transcutaneous bone conduction implants (ATBCI) due to their altered anatomy or desire for future aesthetic reconstruction. Design: A case series descriptive study was designed. The MFT was developed. Preoperative and postoperative information from 24 patients with external auditory canal atresia (EACA) and implanted with ATBCI was reviewed. Results: A total of 24 children with bilateral EACA received implants in the middle cranial fossa. Their average age was 12. Of these patients, eight had an associated congenital disorder: Goldenhar Syndrome, Treacher Collins Syndrome or the Pierre Robin Sequence. The average follow-up was at 17 months (ranging from between 2– and 36 mo) and there were no major complications. Four patients showed skin erythema at the processor site after turn on, which was solved by lowering the magnet strength. One patient had a scalp hematoma that required puncture drainage. The hearing thresholds went down on average from 66.5 to 25.2 dB 1 month after turn on. Speech recognition improved respectively from 29.4% without and 78.9% with a bone conduction hearing aid to 96.4%. Conclusion: MFT placement of the ATBCI was proven to be safe and effective and a viable option for treating pediatric patients with EACA who cannot receive implants at the sinodural angle or in the retrosigmoidal position because of their altered anatomy and/or desire for future aesthetic reconstruction. Address correspondence and reprint requests to Carolina Der, M.D., Ph.D., Otorhinolaryngology Department, Hospital Luis Calvo Mackenna, Antonio Varas #360 Avenue, Providencia, Santiago 7500539, Chile; E-mail: cdercder@gmail.com The source of funding for the implant program is the National School and Scholarship Assistance Council (JUNAEB for its acronym in Spanish). The authors disclose no conflicts of interest. Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
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Vestibular Manifestations in Subjects With Enlarged Vestibular Aqueduct
Objective: To describe the results of a thorough evaluation in a large series of patients with an enlarged vestibular aqueduct (EVA), focusing on vestibular manifestations with etiological considerations. Study Design: Retrospective chart review of patients with EVA. Setting: Tertiary referral center. Patients: A total of 22 EVA patients with a median age of 8 years (6 mo–35 yr) who underwent both audiovestibular and radiologic examinations. Main Outcome Measures: Patient demographics, radiologic findings, audiologic results, vestibular symptoms, findings of neurotologic examinations, and laboratory evaluations were collected and analyzed. Standard descriptive statistics were used to summarize patient characteristics. Subjects who had a history of vertigo attack were categorized as "vestibulopathy group," while subjects without any history of vertigo as "non-vestibulopathy group." Results: Of the 41 ears included, 37 (90.2%) had hearing loss on initial audiometric evaluations. Among the 22 patients, 14 (63.6%) complained of dizziness. Of the 14 vertiginous patients, seven had recurrent episodes, five had a history of single attack, and two presented with postural imbalances. There were no significant differences between vestibulopathy and non-vestibulopathy groups with regard to the relationship between the development of vestibular symptoms and aqueductal size, hearing threshold, or age at first visit. Four of the 22 (18.2%) patients developed secondary benign paroxysmal positional vertigo (BPPV) and all patients complained of simultaneous decreases in hearing. Conclusions: Our results demonstrate that patients may develop vestibular symptoms during their clinical course, and all patients with an enlarged vestibular aqueduct should be cautioned regarding the potential development of vestibular pathology. Moreover, the non-negligible incidence of secondary BPPV mandates positional tests when evaluating EVA patients with vertigo. Address correspondence and reprint requests to Ja-Won Koo, M.D., Ph.D., Department of Otorhinolaryngology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-Gu, Gyeonggi-Do, 13620, Republic of Korea; E-mail: jwkoo99@snu.ac.kr This work was supported by the SNUBH research fund (No. 02–2014–037) and National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No.2016R1C1B2007911). The authors disclose no conflicts of interest. Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
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Long-term Hearing Outcome of Canaloplasty With Partial Ossicular Replacement in Congenital Aural Atresia
Objective: The aim of this study was to correlate the postoperative hearing outcomes with regard to the length of prosthesis of the partial ossicular replacement prosthesis (PORP) in patients with congenital aural atresia. Study Design: Retrospective review of medical records. Setting, Patients, Intervention, Main Outcome Measure: The medical records of 131 patients (132 ears) who underwent canaloplasty with PORP by a single surgeon from 2011 to 2016 were reviewed for demographic data, Jahrsdoerfer score, grade of microtia, length of prosthesis, and audiometric outcomes. Air conduction, bone conduction threshold, and air-bone gap were measured preoperatively and at 3-, 6-, 12-, and 24-months of follow-up. Patients were divided into two groups according to the postoperative hearing outcomes, and the length of PORP was compared between the two groups. Univariable and multivariable generalized estimating equations were used to investigate other favorable prognostic factors for long-term postoperative hearing results. Results: When the improvement of the air-bone gap within 30 dB was defined as successful hearing outcome, no significant differences were observed for prosthesis length between two groups at 3, 6, and 12 months postoperatively. However, at 2-year follow-up, mean length of prosthesis was significantly shorter (p = 0.006) for the success group (2.30 ± 0.53 mm) than for the nonsuccess group (2.77 ± 0.73 mm). Generalized estimating equations revealed PORP length as the only factor significantly associated with favorable long-term hearing results. Conclusion: Long-term hearing outcome of canaloplasty with PORP is likely to be affected by prosthesis length. For that reason, making the neo-annulus as medial as possible to shorten the length of the appropriate prosthesis is important for successful long-term hearing outcomes. Address correspondence and reprint requests to Yang-Sun Cho, M.D., Ph.D., Department of Otorhinolaryngology—Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, 06351 Seoul, Korea; E-mail: yscho@skku.edu The authors disclose no conflicts of interest. Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
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Association Between Voice Handicap Index and Praat Voice Analysis in Patients with Benign Vocal Cord Lesion Before and After Microscopic Laryngeal Surgery
Abstract
Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson's correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p < 0.05). We found no correlation between VHI score and Praat voice analysis in patients with benign vocal cord lesion before and after surgery, except correlation between VHI functional subscale with HNR and VHI total score with jitter.
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Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant disease derived from nasopharyngeal epithelial cells that have a higher tendency for invasion and metastasis to the cervical lymph nodes than other head–neck malignancies. NPC patients with the same stages often show different progressions and prognoses. This suggests that clinical stages are not sufficient to predict progressivity, so biomarkers are required to provide better progression predictions. Some literature shows that the development and progression of NPC is a complex mechanism involving various components of signal paths, it plays a role in regulating the process of proliferation, angiogenesis and apoptosis. One of the most studied is β-catenin protein that is a key component of the canonical Wnt signal pathway. The β-catenin protein is reported to have roles in increasing the proliferative pathway of c-Myc and cyclin D1, increasing the expression of IL-8 proangiogenesis factor, decreasing expression of RASSF1A tumor suppressor and inhibiting apoptosis through the barriers of caspace-9 activity. To determine the association of β-catenin expression and staging in nasopharyngeal carcinoma patients. The research design used was analytic observational research with cross sectional approach. Samples were enrolled using consecutive sampling. The β-catenin expression was examined from the NPC tissue paraffin block with the immunohistochemical cracking technique, using an anti-β-catenin rabbit polyclonal antibody from Boster Biotechnology, California, USA. The β-catenin expression was assessed visually using a binocular light microscope and a scoring method according to the Allred scale index by an Anatomical Pathology consultant. Statistical analysis was performed using Spearman's test to determine the association between β-catenin expression and staging in NPC patients. The significance level was α = 0.05. The study was conducted from May to December 2015 at Otolaryngology Unit of Dr. Soetomo General Soetomo, Surabaya. There were 40 patients who fulfilled the inclusion criteria. Spearman test results obtained p value = 0.060. The correlation of β-catenin expression with staging in NPC patients was found to be non-significant (p > 0.05). There was no correlation between β-catenin expression and staging in NPC patients.
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Issue Information
Clinical Oral Implants Research, Volume 29, Issue 4, Page i-ii, April 2018.
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Identification of specific sources of airborne particles emitted from within a complex industrial (steelworks) site
Source:Atmospheric Environment, Volume 183
Author(s): D.C.S. Beddows, Roy M. Harrison
A case study is provided of the development and application of methods to identify and quantify specific sources of emissions from within a large complex industrial site. Methods include directional analysis of concentrations, chemical source tracers and correlations with gaseous emissions. Extensive measurements of PM10, PM2.5, trace gases, particulate elements and single particle mass spectra were made at sites around the Port Talbot steelworks in 2012. By using wind direction data in conjunction with real-time or hourly-average pollutant concentration measurements, it has been possible to locate areas within the steelworks associated with enhanced pollutant emissions. Directional analysis highlights the Slag Handling area of the works as the most substantial source of elevated PM10 concentrations during the measurement period. Chemical analyses of air sampled from relevant wind directions is consistent with the anticipated composition of slags, as are single particle mass spectra. Elevated concentrations of PM10 are related to inverse distance from the Slag Handling area, and concentrations increase with increased wind speed, consistent with a wind-driven resuspension source. There also appears to be a lesser source associated with Sinter Plant emissions affecting PM10 concentrations at the Fire Station monitoring site. The results are compared with a ME2 study using some of the same data, and shown to give a clearer view of the location and characteristics of emission sources, including fugitive dusts.
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The role of ketogenic diets in the therapeutic management of adult and paediatric gliomas: a systematic review
CNS Oncology, Ahead of Print.
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Realidad nacional de los programas de detección auditiva temprana con miras a la cobertura universal
ABSTRACT Introduction: 50% of hearing-impared newborns do not have any associated risk factors; so early universal detection programs can change the prognosis of these patients. Universal newborn hearing screening consists in studying all newborns in a particular area, regardless of the presence of risk factors. Aim: Describe and analyze the presence of universal newborn hearing screening programs in Chile and its characteristics. Material and method: We identify establishments that have universal newborn hearing screening programs and sent them An electronic survey focusing on the structure of each program. Results: 34 hospitals have universal newborn hearing screening. Of these, 31 answered the survey. 73% begun the program after 2010. The Ministry of Health provides financing in 46%. Audiologists and medical technicians majoring in otolariyngology are in charge of the vast majority of the programs. Available screening methods are distortion product otoacoustic emissions (90%) and automated Brainsteam evoked response audiometry (67.8%). As for the definitive diagnosis, 71% use Brainsteam evoked response audiometry click plus impedanciometry. Conclusion: 50% of the hospitals with maternities have universal hearing screening; most of them are in Chile's central area. Even though some hospitals show interest and have made advances in this regard, there is still much to be done, being universal coverage the main objective.
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Carcinoma adenoide quístico de cavidad nasal y senos paranasales: Experiencia de 5 años en Clínica Las Condes de Santiago de Chile
ABSTRACT Introduction: Adenoid Cystic Carcinoma is a neoplasm originating in exocrine glands throughout the body, mainly in the major salivary glands. In the nasal cavity and paranasal sinuses is rare and characterized by a high frequency of recurrence and distant metastasis after remission and despite its treatment. Aim: To describe characteristics of a series of patients with operated adenoid cystic carcinoma of the nasal cavity and paranasal sinuses. Material and method: Descriptive-retrospective study. Period January 2012 and January 2017. The information was obtained from the electronic tabs of the Las Condes Clinic. It describes origin, age and sex, clinical characteristics, anatomopathological findings, diagnostic methods, treatment, evolution. Results: Total 5 patients operated, 3 women and 2 men. The average age was 63 years, ranging from 33 years to 90 years of age. 100% of the cases without associated factors. The most frequent clinical presentation was unilateral nasal obstruction, followed by facial pain. 2 patients presented with initial diagnosis, 2 due to recurrence and 1 due to persistence. In 3 cases the tumor originates from the maxillary sinus and in 2 in the ethmoidal sinus. All had advanced disease, stage IV and III. 3 patients were histologically low grade and 2 high grade. In all 5 cases, the primary treatment was surgical, 60% endoscopic, 20% open and 20% combined. In 4 cases, postoperative radiotherapy was used and in 3 of this concomitant chemotherapy. All are without signs of tumor recurrence in the last control. Conclusion: Adenoid Cystic Carcinoma of the nasal cavity and paranasal sinuses is quite infrequent; its incidence is less than 1/100,000 cases per year. It is more common in women between 40 and 50 years. It is identified more with its origin in the maxillary sinus (50%) and cribriform pattern. Clinically it presents in advanced stages since at an early stage, it is asymptomatic or it presents nonspecific inflammatory clinic. Diagnosis is performed with biopsy supplemented with imaging. The most commonly used treatment is endoscopic or open surgery associated with postoperative radiotherapy, despite which, they present with high recurrence in the long term.
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Estudio clínico y micológico de otomicosis en diabéticos: Una serie de 17 casos
ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.
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Hábitos auditivos recreacionales y umbral tonal en la frecuencia audiométrica 6.000 Hz en jóvenes universitarios
ABSTRACT Introduction: Noise exposure is one of most common causes of hearing loss according to the World Health Organization (WHO). The use of personal music players is one of the sources of this harmful noise, which has been demonstrated to constitute a risky habit. Previous studies have found hearing loss produced by noise in users of music players compared to subjects who do not used them. Aim: The present study aimed to investigate the relationship between recreational hearing habits and hearing performance at 6000 Hz frequency in university students. Material and method: Fifty subjects (age range of 18-26 years), without history of otologic disorders were assessed. The CHAR questionnaire and an air conduction pure tone audiometry (125 Hz-8000 Hz) were administered to each participant. Results: Findings from pure tone audiometry demonstrated the presence of hearing scotoma at 6000 Hz frequency in fifty-two percent of subjects. Moreover, statistically significant differences were found when comparing subjects with normal threshold and subjects with threshold greater than 20 dB at 6000 Hz. This was related to years and intensity of noise exposure. Conclusion: Recreational noise exposure may cause hearing loss in early stages of lifespan. Prevention strategies to avoid early hearing loss in young subjects are required.
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Manejo endoscópico del meningoencefalocele de base de cráneo anterior
ABSTRACT Endoscopic management of anterior skull base meningoencephalocele. The cerebrospinal fluid leak (CSF) is an abnormal communication between the subaracnoid space and the pneumatic portion of the anterior cranial base which is related to the paranasal cavities. The persistent leak requires surgery due to the potential complications such as meningitis, cerebral abscess or pneumoencephalus. Extracranial endoscopic approach is the gold standard procedure. One of the most important risk of the surgery is to damage noble intracranial structures. This situation can be ameliorated by using image guided surgery. We present two cases of CSF in anterior cranial base associated with meningoencephalocele that were treated in our center using nasal image guided endoscopic surgery.
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Cirugía endoscópica de oído para el manejo del colesteatoma atical
ABSTRACT The cholesteatoma is the presence of keratinized squamous epithelium in pneumatized areas of the temporal bone, its most frequent location is the attic. In the 1990s the development of the ear endoscopic surgery begins, offering a new perspective for cholesteatoma treatment. Two clinical cases of patients who present attic cholestatoma are described. A transcanal endoscopic approach with complete macroscopic resection was accomplished. Post-surgical audiometry shows improvement of the conductive hearing loss.
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Telangiectasia hemorrágica hereditaria: A propósito de un caso clínico
ABSTRACT Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.
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Amiloidosis laríngea: A propósito de un caso
ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.
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Actualización en abuso de drogas por vía nasal
RESUMEN La vía nasal, ya sea mediante la inhalación o aspiración, se ha convertido en una ruta atractiva para quienes abusan de sustancias, principalmente por la fácil accesibilidad y la rápida absorción sistémica, además de evitar las consecuencias asociadas al uso de drogas intravenosas (enfermedades de transmisión). El objetivo de esta revisión es presentar una actualización de diversas sustancias que son utilizadas por esta vía, enfocándose en aquellas en las que se ha documentado daños en la anatomía nasal.
ABSTRACT The nasal route, either by inhalation or aspiration, has become an attractive route for substances abusers, mainly because of its easy accessibility, rapid systemic absorption and also to avoid the consequences associated with intravenous drug use (transmitted diseases). The objective of this review is to present an update of various substances that are used by this route, focusing on those in which damage to the nasal anatomy has been documented.
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Abordaje endoscópico transeptal de tumores benignos de cavidades paranasales
ABSTRACT Endoscopic sinus surgery is a frequent procedure in Otorhinolaryngology practice, in the last decade new techniques have been introduced to help the resection of tumors in regions traditionally considered of difficult access. One of these techniques is the trans-septal approach, which allows the approach of the anterior and lateral wall of the maxillary sinus, as well as four-handed work for approach of these tumors. The aim of this review is to describe the transeptal endoscopic approach as a complementary technique in the endoscopic surgery of benign nasal tumors, specifically inverted papilloma and juvenile nasopharyngeal angiofibroma.
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Mecanismos de comunicación en pacientes laringectomizados
RESUMEN El cáncer laríngeo representa el 25% de las neoplasias de cabeza y cuello. Para los carcinomas laríngeos T1 tratados con radioterapia o cirugía láser, no existe diferencia significativa en cuanto a la calidad de voz percibida por el paciente entre ambas formas terapéuticas. La laringectomía total sigue siendo utilizada como la alternativa terapéutica en carcinomas avanzados. La pérdida de la capacidad de fonación es una consecuencia de esta cirugía, por lo que existe un variado abanico de mecanismos de comunicación que ofrecerle al paciente. Las alternativas clásicas comprenden: erigmofonación, laringe electrónica y válvula traqueoesofágica. Dentro de este escenario, han surgido nuevas alternativas en los últimos años como son conversión estadística de voz GMM (Gaussian Mixture Model), proyecto SWARA y el proyecto "Mi propia voz".
ABSTRACT Laryngeal cancer accounts for 25% of head and neck cancers. For T1 laryngeal carcinomas treated with radiotherapy or laser surgery, there is no significant difference in terms of quality of voice perceived by the patient between both therapeutic forms. The total laryngectomy is still used as the therapeutic alternative in advanced carcinomas. The loss of the phonation ability is a consequence of the surgery, so there is a diverse range of communication mechanisms to offer to the patient. Classical approaches include: esophageal speech, electrolarynx and tracheoesophageal valve. In this scenario, new alternatives have emerged: statistical voice conversion GMM (Gaussian Mixture Model), SWARA project and "Mi propia voz" project.
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Tiroides ectópica dual hiperfuncionante: Abordaje quirúrgico dual
RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.
ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.
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Sub-lethal ultraviolet B irradiation and Poly I:C treatment synergistically induced apoptosis of HaCaT cells through NF-κB pathway
Source:Molecular Immunology, Volume 99
Author(s): Wuxiyar Otkur, Weiwei Liu, Jinda Wang, Xingfan Jia, Dianchao Huang, Fang Wang, Toshihiko Hayashi, Shin-ichi Tashiro, Satoshi Onodera, Takashi Ikejima
Ultraviolet B (UVB) irradiation exerts multiple effects on skin cells, inducing apoptosis, senescence and carcinogenesis. Toll-like receptor 3, a member of pattern recognition receptors, is reported to initiate inflammation by recognizing double-strand RNA (dsRNA) released from UVB-irradiated cells. It has not been studied, however, whether apoptosis induction in UVB irradiation is attributed to TLR3 activation. Here, we report on the pro-apoptotic role of TLR3 in UVB-irradiated epidermal cells. Poly I:C, an analogue of dsRNA that activates TLR3, was used in combination with sub-lethal UVB (4.8 mJ/cm2) irradiation for investigating the effects of TLR3 activation on human immortalized keratinocyte HaCaT cells. Although sub-lethal dose of either Poly I:C or UVB alone did not induce cell death, UVB-Poly I:C co-treatment synergistically induced cell death by activation of caspase-3 and cleavages of ICAD and PARP, with apoptotic features when stained with Annexin V/PI or Hoechst 33342. Treatment with pan-caspase inhibitor, Z-VAD, attenuated UVB-Poly I:C-induced cell death. Silencing TLR3 by siRNA rescued HaCaT cells from UVB-Poly I:C-induced apoptosis. NF-κB, a major downstream component of TLR3 pathway, that usually negatively regulates the classical TLR3 apoptotic pathway, was analyzed by western blotting and immunofluorescence confocal microscopy. The results indicate to our surprise that NF-κB is translocated to nucleus in the cells co-treated with UVB-Poly I:C. The nuclear translocation of NF-κB is attenuated by TLR3 silencing. Treatment with BAY, an inhibitor of NF-κB pathway, blocked UVB-Poly I:C-induced apoptosis. Therefore, we conclude that NF-κB pathway plays a cytotoxic role in UVB-Poly I:C-treated HaCaT cells, mediating TLR3-related apoptosis.
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Molecular pathways for antigenic peptide generation by ER aminopeptidase 1
Source:Molecular Immunology
Author(s): Anastasia Mpakali, Zachary Maben, Lawrence J. Stern, Efstratios Stratikos
Endoplasmic Reticulum aminopeptidase 1 (ERAP1) is an intracellular enzyme that can generate or destroy potential peptide ligands for MHC class I molecules. ERAP1 activity influences the cell-surface immunopeptidome and epitope immunodominance patterns but in complex and poorly understood manners. Two main distinct pathways have been proposed to account for ERAP1's effects on the nature and quantity of MHCI-bound peptides: i) ERAP1 trims peptides in solution, generating the correct length for binding to MHCI or overtrimming peptides so that they are too short to bind, and ii) ERAP1 trims peptides while they are partially bound onto MHCI in manner that leaves the peptide amino terminus accessible. For both pathways, once an appropriate length peptide is generated it could bind conventionally to MHCI, competing with further trimming by ERAP1. The two pathways, although not necessarily mutually exclusive, provide distinct vantage points for understanding of the rules behind the generation of the immunopeptidome. Resolution of the mechanistic details of ERAP1-mediated antigenic peptide generation can have important consequences for pharmacological efforts to regulate the immunopeptidome for therapeutic applications, and for understanding association of ERAP1 alleles with susceptibility to autoimmune disease and cancer. We review current evidence in support of these two pathways and discuss their relative importance and potential complementarity.
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Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.
| Related Articles |
Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.
Ann Ital Chir. 2018;89:70-74
Authors: Marella GL, De Dominicis E, Paliani GB, Santeusanio G, Marsella LT, Potenza S
Abstract
Necrotizing fasciitis is one of the most dangerous complication of an abscess and it is still a disease with a high mortality. In this work, we decided to consider two cases: the first one concerns a male subject, aged 66, deceased because of a fatal necrotizing fasciitis associated to a cervical descending mediastinitis, which evolved from a primary peritonsillar abscess; the second is about a 50-year-old woman with a perineal abscess, then evolved into necrotizing fasciitis associated to a fatal septis shock. After a systematic consideration of necrotizing fasciitis as pathology and an analysis of the possible related risks to a diagnostic or therapeutic delay, we analyzed the particular history of both cases to underline the possible critical issues in professional behavior of the medical staff intervened.
KEY WORDS: Abscess, Medical malpractice, Mortality, Necrotizing fasciitis, Professional liability.
PMID: 29629889 [PubMed - in process]
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Trends in Gender-affirming Surgery in Insured Patients in the United States
Background: An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population. Methods: The Truven MarketScan Database, containing data from 2009 to 2015, was utilized, and a sample set was created using the Gender Identity Disorder diagnosis code. Basic demographic information and utilization of gender-affirming procedures was tabulated. Results: We identified 7,905 transgender patients, 1,047 of which underwent surgical procedures from 2009 to 2015. Our demographic results were consistent with previous survey-based studies, suggesting transgender patients are on average young adults (average age = 29.8), and geographically diverse. The most common procedure from 2009 to 2015 was mastectomy. Complications of all gender-affirming procedures was 5.8%, with the highest rate of complications occurring with phalloplasty. There was a marked year-by-year increase in utilization of surgical services. Conclusion: Transgender care and gender confirming surgery are an increasing component of health care in the United States. The data contained in existing databases can provide demographic, utilization, and outcomes data relevant to providers caring for the transgender patient population. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication November 28, 2017; accepted February 7, 2018. Ms. Lane and Mr. Ives contributed equally to this work. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Supplemental digital content is available for this article. Clickable URL citations appear in the text. William M. Kuzon, MD, PhD, Division of Plastic Surgery, University of Michigan, 1201 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, E-mail: wkuzon@med.umich.edu Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.
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Mucinous Adenocarcinoma of the Scalp: Primary Cutaneous Neoplasm Versus Underlying Metastatic Disease
Summary: Primary cutaneous mucinous carcinoma (PCMC) is a rare mucin-producing malignancy derived from epithelial glandular structures. The literature regarding this topic is mostly in the form of case reports and case series. PCMC tends to present in the elderly with predilection for the head and neck and on initial assessment it can be easily mistaken for a simple inclusion cyst. Although PCMC is often indolent in nature, in rare instances it can metastasize and should remain a differential diagnosis in a selected population. The significance in identifying PCMC is reliably differentiating it from metastatic mucinous adenocarcinoma. We present a review of literature and case of PCMC on the scalp of a 67-year-old female. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication November 28, 2017; accepted March 1, 2018. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Ciara A. Brown, BS, Plastic Surgery, HSC-S, PO Box 9238, Morgantown, WV 26506, E-mail: cebrown2@mix.wvu.edu Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.
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A Simple Positioning Technique for Surgery on an Isolated Digit
Buried Versus Exposed Kirschner Wires Following Fixation of Hand Fractures: l Clinician and Patient Surveys
Background: Fractures of the metacarpals and phalanges are common. Placement of Kirschner wires (K-wires) is the most common form of surgical fixation. After placement, a key decision is whether to bury the end of a K-wire or leave it protruding from the skin (exposed). A recent systematic review found no evidence to support either approach. The aim of study was to investigate current clinical practice, understand the key factors influencing clinician decision-making, and explore patient preferences to inform the design of a randomized clinical trial. Methods: The steering group developed surveys for hand surgeons, hand therapists, and patients. Following piloting, they were distributed across the United Kingdom hand surgery units using the Reconstructive Surgery Trials Network. Results: A total of 423 hand surgeons, 187 hand therapists, and 187 patients completed the surveys. Plastic surgeons and junior surgical trainees preferred to leave K-wires not buried. Ease of removal correlated with a decision to leave wires exposed, whereas perceived risk of infection correlated with burying wires. Cost did not affect the decision. Hand therapists were primarily concerned about infection and patient-related outcomes. Patients were most concerned about wire-related problems and pain. Conclusion: This national survey provides a new understanding of the use of K-wires to manage hand fractures in the United Kingdom. A number of nonevidence-based factors seem to influence the decision to bury or leave K-wires exposed. The choice has important clinical and health economic implications that justify a randomized controlled trial. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication January 10, 2018; accepted February 13, 2018. Presented at the British Society of Surgery for the Hand (BSSH), Autumn Scientific Meeting 2016 in Cardiff, Wales. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by a grant from the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Matthew D. Gardiner, MA, PhD, FRCS(Plast), Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Old Road Campus, Oxford, OX3 7FY, E-mail: matthew.gardiner@kennedy.ox.ac.uk Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.
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Neoumbilicoplasty with a Superiorly Based Abdominal Skin Flap
Summary: We propose a neoumbilicoplasty technique that can be applied when the umbilical stalk becomes disrupted during an abdominoplasty. This case used surgical concepts that involved progressive thinning of the flap in a 3-cm radius around the neoumbilicus, with increased thinning toward the neoumbilical position. This was followed with suture tacking of the thinned abdominal flap to create a concavity around the neoumbilicus. A longer "U" shaped incision was created and also sutured down to abdominal wall to recreate an umbilical "floor" with the adjacent skin sutured to the superior-based flap to construct the walls of the neoumbilicus. An aesthetically pleasing umbilicus resulted with high patient satisfaction and a lack of postoperative complications. There were no additional scars extending beyond the umbilical region. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication January 22, 2018; accepted March 1, 2018. Ethical Disclosure: All aspects of this study conform to the Helsinki Declaration. Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. Oren Tessler, MD, MBA, LSUHSC Department of Surgery, Division of Plastic & Reconstructive Surgery, 1542 Tulane Ave, Rm 734, New Orleans, LA 70112, E-mail: otessl@lsuhsc.edu Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.
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