Αρχειοθήκη ιστολογίου

Τρίτη 4 Μαΐου 2021

The mini incision approach to the facial artery as a recipient vessel in head and neck reconstruction

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J Plast Reconstr Aesthet Surg. 2021 Apr 18:S1748-6815(21)00173-X. doi: 10.1016/j.bjps.2021.03.072. Online ahead of print.

NO ABSTRACT

PMID:33941471 | DOI:10.1016/j.bjps.2021.03.072

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Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application

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J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00144-3. doi: 10.1016/j.bjps.2021.03.054. Online ahead of print.

ABSTRACT

The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the fo ot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF.

PMID:33941474 | DOI:10.1016/j.bjps.2021.03.054

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Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications

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J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00116-9. doi: 10.1016/j.bjps.2021.03.026. Online ahead of print.

ABSTRACT

BACKGROUND: Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism.

METHODS: We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, a nd shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression.

RESULTS: With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline.

CONCLUSIONS: Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases.

PMID: 33941472 | DOI:10.1016/j.bjps.2021.03.026

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A Rare Laryngeal Presentation of Stevens‐Johnson Syndrome

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Stevens‐Johnson syndrome (SJS) is a rare but severe mucocutaneous epidermolysis commonly triggered by medications. SJS is characterized by mucocutaneous lesions of the trunk, face, and limbs, as well as the oral cavity, gastrointestinal tract, and respiratory tract. Although uncommon, laryngeal involvement in SJS can lead to severe respiratory, phonatory and deglutitive complications. Providers caring for patients with SJS should maintain a high index of suspicion for laryngeal involvement and low threshold to solicit Otolaryngology consultation. Laryngeal complications can be more expediently managed when anticipated early in the course of disease. Laryngoscope, 2021

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Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki

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Objectives/Hypothesis

Facial functional restoration is one of the main goals in face transplantation. We report the oromyofacial function outcomes of two bimaxillary face transplantation (FT) patients in Helsinki.

Study design

Outcome Study.

Methods

Two male patients, aged 34 and 59, had severe functional facial disabilities following self‐inflicted gunshot injuries sustained to their mid and lower faces several years earlier. Both underwent tooth‐bearing maxillomandibular face transplantation in 2016 and 2018. We collected data regarding speech, swallowing, sensory recovery, motor recovery, and olfaction prior to transplantation. Patient charts were reviewed from the follow‐up period of 4 and 2 years, respectively.

Results

Speech intelligibility, acceptability, and articulation continued to improve during follow‐up for both patients. Voice quality and resonance were mainly normal at last follow‐up. Swallowing improved once lip occlusion was regained, with only minor aspiration evident on videofluorography. Both patients had significant improvement in facial mimic muscle function after FT. The first patient who only had buccal sensory nerves connected has only recovered protective facial sensation, whereas our second patient with buccal, infraorbital, and alveolar nerves connected has almost complete facial two‐point discrimination.

Conclusion

Both patients have regained satisfactory facial sensory and motor function. Sensory recovery seems to be faster and more precise if multiple sensory nerve coaptations are performed. Swallowing and speech have continued to improve over time although not reaching the level of the normal population. We demonstrate how speech‐corrective surgery can safely be performed in a FT patient and can improve speech recovery.

Level of Evidence

4 Laryngoscope, 2021

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Cholesterol Granuloma of the Sphenoid Sinus: An Insidious Entity

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Abstract

Pathology of sphenoid sinus is uncommon and may pose a diagnostic challenge in view of its vague symptoms together with its relatively inaccessible location at the skull base. Radiological imaging is of utmost importance in diagnosis. We present an insidious case of a sphenoid sinus cholesterol granuloma.

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Expression of VAChT and 5-HT in Ulcerative colitis dendritic cells

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Via histochem

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Acta Histochem. 2021 Apr 30;123(4):151715. doi: 10.1016/j.acthis.2021.151715. Online ahead of print.

ABSTRACT

Ulcerative colitis is a chronic inflammatory condition of the gastrointestinal tract that can affect people of worldwide. In contrast with Crohn's disease, that can relate the entire thickness of the bowel wall, the inflammation of ulcerative colitis is limited to the colonic mucosa. Immune cells including activated T cells, plasma cells, mast cells, macrophages, and dendritic cells (DCs) trigger the inflammation. Furthermore, dendritic cells are antigen presenting cells involved in maintaining intestinal immune homeostasis. It has been described an increment of number in DCs colonic mucosa of patients with ulcerative colitis. The immune cells such as antigen-presenting cells can act as autocrine or paracrine modulators. Recent studies showed that dendritic cells synthetized and released classical neurotransmitters as glutamate, dopamine, acetylcholine, and serotonin. Paraformaldehyde-fixed intestinal tissues, obtained from the stricture sites of ten patients with ulcerative colitis were analyzed by immunostaining for Langerin/CD207, serotonin and vesicular acetylcholine transporter. As controls, unaffected (normal) portions of five patients were also investigated. Aim of this study was to characterize for the first time the human gut dendritic cells of ulcerative colitis patients, with Langerin/CD207 that is a c-type lectin expressed by differ ent types of DCs and to colocalize in the same cells the expression of serotonin and vesicular acetylcholine transporter, showing the link between dendritic cells, gut enterochromaffin cells or autonomic nerves in immune activation and generation of intestinal inflammation.

PMID:33940317 | DOI:10.1016/j.acthis.2021.151715

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Septal Extension Graft in Increasing Nasal Tip Projection

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Abstract

To study the use of septal extension graft for increasing nasal tip projection in cases of an under-projected nasal tip and to evaluate post-operative aesthetic and functional outcomes associated with it. 28 patients of underprojected tip underwent rhinoplasty with use of Direct caudal type of Septal extension graft with a minimum follow up of 12 months, operated between January 2018 to January 2020. ROE questionnaire and photographic evaluation were used for the assessment of post-operative functional and aesthetic outcomes. Significant improvement was seen in both aesthetic and functional outcomes with a mean ROE questionnaire score of 30.5 pre-operatively to 79.5 post-operatively. Pre-operative and post-operative photographic evaluation showed significant improvement in aesthetic outcome. None of the patients reported any postoperative complication. Septal extension graft can be used in patients with nasal tip deformity, Binder's syndrome, caudal septal disl ocation, drooping tip,/ retracted columella and short nose with good post-operative aesthetic and functional outcomes and hence is an important technique for grafting. Owing to its rigid fixation with nasal septum, anterior nasal spine and lower alar cartilage, long term results for the control of nasal tip projection and rotation are remarkable.

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Title-Optical Forceps: The Real Boon for Surgeon, Residents and Patients with Foreign Body Aspiration

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Abstract

Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16 year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1–5 year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic inserti on and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.

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Novel dopamine receptor 3 antagonists inhibit the growth of primary and temozolomide resistant glioblastoma cells

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by Sarah E. Williford, Catherine J. Libby, Adetokunbo Ayokanmbi, Arphaxad Otamias, Juan J. Gordillo, Emily R. Gordon, Sara J. Cooper, Matthew Redmann, Yanjie Li, Corinne Griguer, Jianhua Zhang, Marek Napierala, Subramaniam Ananthan, Anita B. Hjelmeland

Treatment for the lethal primary adult brain tumor glioblastoma (GBM) includes the chemotherapy temozolomide (TMZ), but TMZ resistance is common and correlates with promoter methylation of the DNA repair enzyme O-6-methylguanine-DNA methyltransferase (MGMT). To improve treatment of GBMs, including those resistant to TMZ, we explored the potential of targeting dopamine receptor signaling. We found that dopamine receptor 3 (DRD3) is expressed in GBM and is also a previously unexplored target for therapy. We identified novel antagonists of DRD3 that decreased the growth of GBM xenograft-derived neurosphere cultures with minimal toxicity against human astrocytes and/or induced pluripotent stem cell-derived neurons. Among a set of DRD3 antagonists, we identified two compounds, SRI-21979 and SRI-30052, that were brain penetrant and displayed a favorable therapeutic window analysis of The Cancer Genome Atlas data demonstrated that higher levels of DRD3 (but not DRD2 or DRD4) were associated with worse prognosis in primary, MGMT unmethylated tumors. These data suggested that DRD3 antagonists may remain efficacious in TMZ-resistant GBMs. Indeed, SRI-21979, but not haloperidol, significantly reduced the growth of TMZ-resistant GBM cells. Together our data suggest that DRD3 antagonist-based therapies may provide a novel therapeutic option for the treatment of GBM.
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Smell impairment in patients with chronic rhinosinusitis: a real-life study

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Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06848-9. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequently occurring condition involving type 2 inflammation. It has a global prevalence of approximately 4% and has a major effect on the quality of life of those affected by it. CRSwNP is a complex condition for otorhinolaryngologists to manage, since its precise pathogenic basis has not been established, treatment is challenging and the condition often recurs. It is common to find abnormalities in smelling in those with CRSwNP.

MATERIALS AND METHODS: This cross-sectional study enrolled patients suffering from CRS. Three groups were compared: 1812 patients with CRS, 571 with CRSwNP, and 120 with CRSwNP treated by FESS. The Sniffin' Sticks® olfactory test was used to measure olfactory function in all patients.

RESULTS: Olfactory dysfunction was a common symptom in patients with CRS, ranging in frequency from 56 to 74%. In patients with CRSwNP, impairment of sense of smell affected 64% of subjects (42% with anosmia, 10% with hyposmia, and 12% with cacosmia). After surgery, there was a significant improvement in the ability to smell normally.

CONCLUSION: The present study confirms that impairment of smell is a common symptom in patients with chronic rhinosinusitis, mainly in subjects with nasal polyps. FESS reduces the prevalence of olfactory dysfunction.

PMID:33942122 | DOI:10.1007/s00405-021-06848-9

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