Medicine by Sfakianakis G. Alexandros: November 2018

Friday, November 30, 2018

Application of indocyanine green in the parathyroid detection and protection: Report of 3 cases.

Application of indocyanine green in the parathyroid detection and protection: Report of 3 cases.

Am J Otolaryngol. 2018 Nov 07;:

Authors: Jin H, Fan J, Yang J, Liao K, He Z, Cui M

Abstract
BACKGROUND: It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid.
CASE PRESENTATION: From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism.
CONCLUSIONS: This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.

PMID: 30482405 [PubMed - as supplied by publisher]

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Vascular malformation of the sphenoid and temporal bone: A diagnostic dilemma.

Vascular malformation of the sphenoid and temporal bone: A diagnostic dilemma.

Am J Otolaryngol. 2018 Sep 18;:

Authors: Nagy CZ, Cantrell S, Wu X, Arturo Solares C

Abstract
We present a rare case of a vascular anomaly of the sphenoid and temporal bones causing an expandable mass of the temporal region with dependent patient positioning and characteristic osseous changes on imaging. Initial diagnosis considerations included multiple myeloma (MM), fibrous dysplasia (FD), Paget's disease, lymphoma, meningoencephalocele (MEC), and vascular malformation (VaM). VaMs of the head and neck are rare and typically arise in the mandible and maxilla. However, this case demonstrates a unique finding of a VaM of the sphenoid and temporal bones with important radiological features to distinguish the diagnosis of vascular anomaly from other etiologies.

PMID: 30482404 [PubMed - as supplied by publisher]

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Journal of Cancer Research and Therapeutics[jo]; +55 new citations

55 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

Journal of Cancer Research and Therapeutics[jo]

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PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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E-poster Presentations.

E-poster Presentations.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S59-S72

Authors:

Abstract

PMID: 30487343 [PubMed]

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Best Paper Award Abstracts.

Best Paper Award Abstracts.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S20

Authors:

Abstract

PMID: 30487341 [PubMed - in process]

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KC Basu Mallick Abstracts.

KC Basu Mallick Abstracts.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S18-S19

Authors:

Abstract

PMID: 30487340 [PubMed - in process]

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List of Poster Abstracts 2018.

List of Poster Abstracts 2018.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S14-S17

Authors:

Abstract

PMID: 30487339 [PubMed - in process]

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List of E-Poster Abstracts 2018.

List of E-Poster Abstracts 2018.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S11-S13

Authors:

Abstract

PMID: 30487338 [PubMed - in process]

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List of Oral Abstracts 2018.

List of Oral Abstracts 2018.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S2-S10

Authors:

Abstract

PMID: 30487337 [PubMed - in process]

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List of KC Basu Mallick Abstracts 2018.

List of KC Basu Mallick Abstracts 2018.

Indian J Pathol Microbiol. 2018 Nov;61(Supplement):S1

Authors:

Abstract

PMID: 30487336 [PubMed - in process]

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Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial.

Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial.

J Neurosurg. 2018 Oct 01;:1-7

Authors:

Abstract
OBJECTIVEBased on a null hypothesis that the use of short-term lumbar drainage (LD) after endoscopic endonasal surgery (EES) for intradural pathology does not prevent postoperative CSF leaks, a trial was conducted to assess the effect of postoperative LD on postoperative CSF leak following standard reconstruction.METHODSA prospective, randomized controlled trial of lumbar drain placement after endoscopic endonasal skull base surgery was performed from February 2011 to March 2015. All patients had 3-month follow-up data. Surgeons were blinded to which patients would or would not receive the drain until after closure was completed. An a priori power analysis calculation assuming 80% of power, 5% postoperative CSF leak rate in the no-LD group, and 16% in the LD group determined a planned sample size of 186 patients. A routine data and safety check was performed with every 50 patients being recruited to ensure the efficacy of randomization and safety. These interim tests were run by a statistician who was not blinded to the arms they were evaluating. This study accrued 230 consecutive adult patients with skull base pathology who were eligible for endoscopic endonasal resection. Inclusion criteria (high-flow leak) were dural defect greater than 1 cm2 (mandatory), extensive arachnoid dissection, and/or dissection into a ventricle or cistern. Sixty patients were excluded because they did not meet the inclusion criteria. One hundred seventy patients were randomized to either receive or not receive a lumbar drain.RESULTSOne hundred seventy patients were randomized, with a mean age of 51.6 years (range 19-86 years) and 38% were male. The mean BMI for the entire cohort was 28.1 kg/m2. The experimental cohort with postoperative LD had an 8.2% rate of CSF leak compared to a 21.2% rate in the control group (odds ratio 3.0, 95% confidence interval 1.2-7.6, p = 0.017). In 106 patients in whom defect size was measured intraoperatively, a larger defect was associated with postoperative CSF leak (6.2 vs 2.9 cm2, p = 0.03). No significant difference was identified in BMI between those with (mean 28.4 ± 4.3 kg/m2) and without (mean 28.1 ± 5.6 kg/m2) postoperative CSF leak (p = 0.79). Furthermore, when patients were grouped based on BMI < 25, 25-29.9, and > 30 kg/m2, no difference was noted in the rates of CSF fistula (p = 0.97).CONCLUSIONSAmong patients undergoing intradural EES judged to be at high risk for CSF leak as defined by the study's inclusion criteria, perioperative LD used in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.Clinical trial registration no.: NCT03163134 (clinicaltrials.gov).

PMID: 30485224 [PubMed - as supplied by publisher]

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"J Cancer Res Ther"[jour]; +55 new citations

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"J Cancer Res Ther"[jour]

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Laryngeal Vibration Increases Spontaneous Swallowing Rates in Chronic Oropharyngeal Dysphagia: A Proof-of-Principle Pilot Study.

Laryngeal Vibration Increases Spontaneous Swallowing Rates in Chronic Oropharyngeal Dysphagia: A Proof-of-Principle Pilot Study.

Dysphagia. 2018 Nov 28;:

Authors: Kamarunas E, Wong SM, Ludlow CL

Abstract
Previously, vibratory stimulation increased spontaneous swallowing rates in healthy volunteers indicating that sensory stimulation excited the neural control of swallowing. Here, we studied patients with severe chronic dysphagia following brain injury or radiation for head and neck cancer to determine if sensory stimulation could excite an impaired swallowing system. We examined (1) if laryngeal vibratory stimulation increased spontaneous swallowing rates over sham (no stimulation); (2) the optimal rate of vibration, device contact pressure, and vibratory mode for increasing swallowing rates; and (3) if vibration altered participants' urge to swallow, neck comfort, and swallow initiation latency. Vibration was applied to the skin overlying the thyroid lamina bilaterally in thirteen participants to compare vibratory rates 30, 70, 110, 150, or 70 + 110 Hz, different devices to neck pressures (2, 4, or 6 kilopascals), and pulsed versus continuous vibration. Swallows were confirmed from recordings of laryngeal accelerometry and respiratory apneas and viewing neck movement. Participants' swallowing rates, urge to swallow, discomfort levels, and swallow initiation latencies were measured. Vibration at 70 Hz and at 110 Hz significantly increased swallowing rates over sham. All vibratory frequencies except 70 + 100 Hz increased participants' urge to swallow, while no pressures or modes were optimal for increasing urge to swallow. No conditions increased discomfort. Vibration did not reduce measures of swallow initiation latency using accelerometry. In conclusion, as non-invasive neck vibration overlying the larynx increased swallowing rates and the urge to swallow without discomfort in patients with chronic dysphagia, the potential for vibratory stimulation facilitating swallowing during dysphagia rehabilitation should be investigated.

PMID: 30488335 [PubMed - as supplied by publisher]

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Advances in osteoporosis from 1970 to 2018.

Advances in osteoporosis from 1970 to 2018.

Menopause. 2018 Dec;25(12):1403-1417

Authors: Gallagher JC

Abstract
In 1970, there were no drugs under study for osteoporosis. Estrogen was used, but little was known about the correct dose for preventing bone loss. At that time, fractures were not even recognized as a disease, but regarded as part of normal aging. From 1970 to this year (2018), there have been extensive advances in the osteoporosis field ranging from fracture epidemiology to the remarkable invention of bone density measurements. There have been major advances in therapeutic options available for patients for prevention and treatment of osteoporosis. In parallel, the advances in the laboratory helped elucidate the process of bone remodeling, not only at the macroscopic level but also at the cellular level. This led to rapid advances in translational research from cellular biology to new therapies exemplified by the development of monoclonal antibodies for osteoporosis. Further understanding of the signaling pathways in bone cells will lead to new small molecules made for osteoporosis treatment, perhaps causing less adverse events. University-based research throughout the world has been a leader in most of these advances, and Pharma support for phase 1 to 4 studies helped bring these discoveries to patients. In the osteoporosis field alone, one sees the tremendous value of grant support for university research by National funding agencies such as the National Institute of Health in this country and similar agencies in other countries. There are clinical challenges that have to be solved with long-term compliance with osteoporosis medication if we want to reduce fracture incidence in the long term.

PMID: 30489459 [PubMed - in process]

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A long and winding road: reflections on the evolution of menopause medicine over a professional lifetime.

A long and winding road: reflections on the evolution of menopause medicine over a professional lifetime.

Menopause. 2018 Dec;25(12):1395-1400

Authors: Barlow DH

PMID: 30489458 [PubMed - in process]

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Follicle-stimulating hormone, but not cardiorespiratory fitness, is associated with flow-mediated dilation with advancing menopausal stage.

Follicle-stimulating hormone, but not cardiorespiratory fitness, is associated with flow-mediated dilation with advancing menopausal stage.

Menopause. 2018 Nov 26;:

Authors: Serviente C, Witkowski S

Abstract
OBJECTIVE: The aim of the study was to evaluate if there are differences in endothelial function before and after acute exercise in women at different menopausal stages with high and low cardiorespiratory fitness.
METHODS: Participants were healthy high-fit premenopausal (n = 11), perimenopausal (n = 12), and postmenopausal women (n = 13) and low-fit perimenopausal (n = 7) and postmenopausal women (n = 8). Brachial artery flow-mediated dilation (FMD) was measured before and after acute moderate intensity exercise. FMD was calculated as (Diameterpeak-Diameterbaseline)/ Diameterbaseline) × 100. Differences between high-fit women and between high- and low-fit perimenopausal and postmenopausal women were assessed with repeated-measure ANOVAs. Relations with FMD were assessed with Pearson correlations.
RESULTS: FMD was reduced with progressive menopausal stage in high-fit women (P = 0.005) and was lower in perimenopausal compared to postmenopausal women (P = 0.047). FMD was lower in high-fit compared to low-fit women (P = 0.006) and there was no relation between FMD and VO2peak (P > 0.05). There was an inverse relation between FMD and follicle-stimulating hormone (P < 0.05), but not estradiol (P > 0.05).
CONCLUSIONS: These data suggest that endothelial function is lower with progressive menopausal stage in women with high cardiorespiratory fitness; that FMD is lower in women with higher cardiorespiratory fitness; and that FSH, but not estradiol, is associated with FMD.

PMID: 30489425 [PubMed - as supplied by publisher]

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Oral 17β-estradiol/progesterone (TX-001HR) and quality of life in postmenopausal women with vasomotor symptoms.

Oral 17β-estradiol/progesterone (TX-001HR) and quality of life in postmenopausal women with vasomotor symptoms.

Menopause. 2018 Nov 26;:

Authors: Simon JA, Kaunitz AM, Kroll R, Graham S, Bernick B, Mirkin S

Abstract
OBJECTIVE: The aim of the study was to describe the effects of TX-001HR (17β-estradiol [E2] and natural progesterone [P4] in a single oral capsule) on menopause-specific quality of life in women with moderate to severe vasomotor symptoms (VMS).
METHODS: The REPLENISH study (NCT01942668) was a phase 3, randomized, double-blind, placebo-controlled, multicenter trial which evaluated four E2/P4 doses in postmenopausal women with VMS and a uterus. Women with moderate to severe hot flushes (≥7/d or ≥50/wk) were included in a VMS substudy. Participants self-administered the Menopause-Specific Quality of Life (MENQOL) questionnaire. Baseline changes in MENQOL overall and domains were determined as well as correlations between changes in MENQOL scores and VMS frequency or severity.
RESULTS: In the VMS substudy, women treated with E2/P4 had significantly greater improvements from baseline in their MENQOL overall score at week 12, and months 6 and 12, compared with placebo (all, P < 0.05, except the lowest E2/P4 dose at months 6 and 12). Improvements from baseline for the MENQOL vasomotor domain score were significantly greater with TX-001HR doses versus placebo at all time points (all, P < 0.01). Changes in MENQOL vasomotor scores moderately correlated with changes in VMS frequency (r = 0.56, P < 0.0001) and severity (r = 0.55, P < 0.0001).
CONCLUSION: In the REPLENISH trial, women with moderate to severe VMS treated with most E2/P4 doses reported significant improvements in quality of life from baseline to 12 weeks compared with placebo, which were maintained up to 12 months. TX-001HR, if approved, may provide the first oral hormone therapy formulation in a single capsule containing E2 and P4 for the treatment of VMS in postmenopausal women with a uterus.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. https://ift.tt/OBJ4xP.

PMID: 30489424 [PubMed - as supplied by publisher]

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An unusual case of short-lasting unilateral neuralgiform headache attacks.

An unusual case of short-lasting unilateral neuralgiform headache attacks.

Cephalalgia. 2018 Nov 27;:333102418815652

Authors: Sardoeira A, Cação G, Pina S, Sousa AP, Damásio J

Abstract
BACKGROUND: Short-lasting unilateral neuralgiform headaches include those with conjunctival injection and tearing and with cranial autonomic symptoms. Most frequently reported as idiopathic, there is a growing number of symptomatic cases described.
CASE REPORT: A 57-year old man presented a 16-year history of right hemifacial short-lasting pain attacks accompanied by ipsilateral autonomic symptoms and simultaneous malar contractions. Brain MRI disclosed a right acoustic neuroma compressing the right facial nerve and a venous developmental anomaly perpendicular to the right facial nerve root entry zone, without lesions affecting the trigeminal nerve. He was started on lamotrigine, resulting in complete remission of pain attacks, autonomic signs and facial contractions.
CONCLUSIONS: This patient presents a typical short-lasting unilateral neuralgiform headache with response to lamotrigine. The uniqueness of the case is the co-occurring malar contractions, evocative of facial nerve involvement. We speculate whether facial nerve compression renders this nerve more susceptible to triggering during a short-lasting unilateral neuralgiform headache attack.

PMID: 30482045 [PubMed - as supplied by publisher]

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"Plast Reconstr Surg"[jour]; +49 new citations

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"Plast Reconstr Surg"[jour]

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"Oncol Rep"[jour]; +23 new citations

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"Oncol Rep"[jour]

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"Oncol Rep"[jour]; +23 new citations

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"Oncol Rep"[jour]

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A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy.

A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy.

Neurocirugia (Astur). 2018 Oct 25;:

Authors: Guadarrama-Ortíz P, Choreño-Parra JA, Carnalla-Cortés M, Sánchez-Garibay C, Palacios-Zúñiga U

Abstract
Spinal cord teratomas are rare. There are few reports of teratomas affecting the cervical spine and their association with spondylotic radiculopathy has not been described. A 59-year-old woman with history of fecal incontinence attended with cervical radicular pain radiating to upper limbs. Physical examination showed distal muscle hypotrophy and abolishment of bicipital, tricipital, and brachioradialis reflexes of the right arm, preserving proximal strength. Also, hiporreflexia and loss of proprioception in the right lower limb was observed. Magnetic resonance imaging showed an intramedullary mass at C7-T1, accompanied by intervertebral disk protrusions and dural sac compressions at the same level. One-stage posterior-anterior operative approach for tumor resection, decompression of the radiculopathy and replacement of intervertebral discs was performed. The histopathological diagnosis was for a mature teratoma. We described the first case of an intramedullary cervical teratoma associated with radiculopathy in an adult, providing evidence of rare long-lasting teratomas affecting the cervical spine.

PMID: 30482695 [PubMed - as supplied by publisher]

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Topographical distribution of trigeminal receptor expression in the nasal cavity.

Topographical distribution of trigeminal receptor expression in the nasal cavity.

Rhinology. 2018 Nov 29;:

Authors: Poletti SC, Hausold J, Herrmann A, Witt M, Hummel T

Abstract
BACKGROUND: Topographical differences in trigeminal receptor distribution of the nasal cavity has been investigated so far indirectly using various agonists to stimulate receptors in different locations. However, polymodal activation of trigeminal receptors poses difficulties in such investigation. The aim of our study was to examine the distribution of trigeminal receptor mRNA expression using quantitative PCR.
METHODOLOGY: A prospective study was performed in 18 healthy volunteers. Mucosal biopsies were obtained from five different endonasal locations (covering the anterior, posterior and lateral nasal cavity) for receptor mRNA quantification by means of RTPCR.
RESULTS: The highest overall level of RNA expression was found for TRPV1, followed by ACCN3, TRPA1 and TRPM8. Identical distribution pattern could be shown for each investigated area of the nasal cavity. Highest overall receptor density was found in the posterior septum due to high TRPV1 and ACCN3 receptor expression.
CONCLUSIONS: For the first time, we demonstrate a distinct trigeminal receptor RNA distribution pattern of the nasal mucosa. The highest overall distribution level was found in the posterior nose.

PMID: 30489573 [PubMed - as supplied by publisher]

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"Plast Reconstr Surg"[jour]; +49 new citations

49 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Plast Reconstr Surg"[jour]

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Topographical distribution of trigeminal receptor expression in the nasal cavity.

Topographical distribution of trigeminal receptor expression in the nasal cavity.

Rhinology. 2018 Nov 29;:

Authors: Poletti SC, Hausold J, Herrmann A, Witt M, Hummel T

PMID: 30489573 [PubMed - as supplied by publisher]

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"Asian Pac J Cancer Prev"[jour]; +45 new citations

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"Asian Pac J Cancer Prev"[jour]

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Evaluation of the Abbott m2000 system for dried blood spot detection of hepatitis C virus RNA.

Evaluation of the Abbott m2000 system for dried blood spot detection of hepatitis C virus RNA.

J Clin Virol. 2018 Nov 03;110:7-10

Authors: Shepherd SJ, Baxter RE, Gunson RN

Abstract
BACKGROUND: Hepatitis C virus RNA testing using dried blood spots (DBS) offers a method for detecting ongoing HCV infection in "hard to reach" populations. Abbott Molecular have developed a quantitative HCV RNA DBS protocol (currently for research use only) for extraction and real-time PCR amplification using them2000sp and m2000rt system.
METHODS: A panel of seventy "mock" DBS were made from patient whole blood; who were known to be either HCV RNA negative or positive. This panel compared the "mock" DBS and the plasma viral load results. A further dilution panel of "mock" DBS made from one HCV positive patient was used to estimate the detection limit of the assay. Abbott was then compared with an in-house real-time Taqman PCR using patient DBS samples.
RESULTS: All "mock" DBS samples with a viral load >1000IU/ml were detected by Abbott, with only 1/8 detected at <1000 IU/ml. The dilution panel suggested the limit of detection to be between 178 to 1779 IU/ml. There were two false positive samples detected at low level <282 IU/ml, both samples were from patients who had been previously positive. The overall sensitivity of the Abbott RUO DBS protocol when compared to plasma was 86% (95 CI 73.76%-74.18%) increasing to 100% (CI 91.59%-100%) when the viral load was >1000IU/ml. Abbott compared well with the in-house assay with sensitivity of 97.5% (95% CI 86.84%-99.94%) and specificity of 100% (95% CI 91.19%-100%).
CONCLUSIONS: The Abbott system is an automated platform which can be used for DBS HCV RNA extraction and amplification. The preliminary data presented here showed a high sensitivity and specificity for DBS with viral loads greater than 1000IU/ml and compared well with a published in-house method.

PMID: 30496947 [PubMed - as supplied by publisher]

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Effects of early-life stress and HDAC inhibition on maternal behavior in mice.

Effects of early-life stress and HDAC inhibition on maternal behavior in mice.

Behav Neurosci. 2018 Nov 29;:

Authors: Burenkova OV, Aleksandrova EA, Zarayskaya IY

Abstract
Despite the well-established fact that maternal care plays a pivotal role in the offspring development, little is known about the effects of disruption of maternal care early in life on the development of this behavior in the offspring. Using brief repeated maternal separation (45 min/day on postnatal Days 3-6), which represents a model of early life stress, we found behavioral changes in adult female mice offspring. The decrease in home cage exploratory behavior (both pup-directed and nonpup-directed) was revealed later in adulthood without changes in maternal care level. Maternal separation coupled with pain exposure caused by subcutaneous saline injection procedure had a cumulative resulting effect, which was manifested in the decreased level of nursing associated with licking-grooming in adult females. The behavioral changes found in adult female offspring could be triggered by identified changes in the behavior of their mothers, while alterations of the level of histone H3 acetylation in the neonatal brain were not detected. Histone deacetylase inhibitor sodium valproate was used in order to study the possibility of preventing the effects of early life stress through involvement of epigenetic mechanisms. Despite the increase in the level of histone H3 acetylation in the neonatal brain caused by valproate, its behavioral effects were barely detectable. These effects were reflected in prevention of the reduction of nursing associated with licking-grooming induced by maternal separation, accompanied by pain exposure. The data are discussed in terms of the possible application to the studies of mechanisms underlying long-term effects of human early life trauma. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

PMID: 30489135 [PubMed - as supplied by publisher]

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The effects of early life stress on context fear generalization in adult rats.

The effects of early life stress on context fear generalization in adult rats.

Behav Neurosci. 2018 Nov 29;:

Authors: Elliott ND, Richardson R

Abstract
Research shows that memory for a context generalizes (i.e., becomes less precise) over time. In this series of experiments, we examined the impact of early life stress on context generalization. Early life stress was modeled using a maternal separation procedure, whereby pups were separated from the dam for 3 hr a day from postnatal Day 2 to 14, or reared as normal. In adulthood, rats were trained to fear a context, and were then tested for freezing in either the training context or a generalization context. Across 5 experiments, we found that maternally separated animals showed generalization when tested 1 day after training (Experiments 1a, 2, 3a, 3b), whereas standard reared rats discriminated at this time point (Experiments 1a & 3b). When tested 1 week after training, all rats generalized (Experiment 1b). Furthermore, maternally separated animals froze more to the training context than the generalization context when tested 1 hour after training (Experiment 2), indicating that the increased generalization expressed by these animals when tested after 1 day is not due to a general inability to discriminate. Manipulations that have been found to reduce generalization in standard reared animals failed to enhance memory specificity at the 1-day retention interval in maternally separated animals (i.e., a pretest reminder, Experiment 3a, and context preexposure, Experiment 3b). Thus, early life stress results in faster generalization that is more resistant to treatments designed to enhance memory specificity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

PMID: 30489134 [PubMed - as supplied by publisher]

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Sexual motivation in male rats is modulated by tropomyosin receptor kinase B (TrkB).

Sexual motivation in male rats is modulated by tropomyosin receptor kinase B (TrkB).

Behav Neurosci. 2018 Nov 29;:

Authors: Hawley WR, Mosura DE

Abstract
The expression of brain derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) are regulated by gonadal hormone signaling and are expressed in brain areas that are important for sexual behaviors. Accordingly, BDNF and TrkB signaling have been shown to be important for the expression of consummatory sexual behaviors. However, the role of TrkB in sexually motivated behaviors remains to be fully elucidated. To this end, male rats were administered either the TrkB antagonist, ANA-12, or a vehicle control prior to sexual motivation testing, which took place on a noncontact version of a partner preference task. Vehicle treated rats, but not rats treated with ANA-12, exhibited a preference for the sexually receptive stimulus female rat relative to the sexually active stimulus male rat, as indicated by the percentage of time and entries in the vicinity of the female throughout the entire 20-min test. In addition, when compared directly with vehicle treated rats, rats treated with ANA-12 exhibited a significant decrease in levels of sexual motivation as indicated by the magnitude of each group's preference for the female during the early stages of testing. Collectively, these results suggest that TrkB plays a role in the sexual preferences and corresponding initial levels of sexual motivation in male rats. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

PMID: 30489133 [PubMed - as supplied by publisher]

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Differential involvement of D2 and D3 receptors during reinstatement of cocaine-seeking behavior in the Roman high- and low- avoidance rats.

Differential involvement of D2 and D3 receptors during reinstatement of cocaine-seeking behavior in the Roman high- and low- avoidance rats.

Behav Neurosci. 2018 Nov 29;:

Authors: Dimiziani A, Bellés Añó L, Tsartsalis S, Millet P, Herrmann F, Ginovart N

Abstract
Roman high- (RHA) and low-avoidance (RLA) rats have been used as a model for drug-addiction, showing, respectively, high- and low-responding to psychostimulants, and low versus high dopamine D2/3 receptors (D2/3R) striatal density. Previous studies indicated a major involvement of D2/3R on reinstatement of cocaine seeking, although the respective role of the two receptor subtypes is not clear. Here, we investigated sensitivity to cocaine self-administration (SA) through a dose-response protocol in RHAs and RLAs, and reinstatement of drug-seeking behavior at 15 days and 5 weeks following withdrawal. Compared to RLAs, RHAs confirmed a higher vulnerability to cocaine SA that was not related to a difference in sensitivity to the drug, as highlighted by the dose-response analysis. Both at early and late withdrawal, RHAs showed higher susceptibility than RLAs to reinstatement of drug-seeking when cocaine was used as a primer, but the two sublines did not differ when primed with the D2/3R agonist quinpirole. Moreover, while the specific D2R antagonist L741,626 blocked, the specific D3R antagonist SB-277011A failed to impair cocaine-primed relapse. The higher vulnerability of RHA versus RLA rats to cocaine-primed relapse, which contrasts with their similar vulnerability to quinpirole-primed relapse, suggests that the different propensity of both sublines to relapse likely relies on presynaptic rather than postsynaptic mechanisms. Moreover, our study challenges the involvement of D3R in the mechanisms underlying relapse to cocaine addiction, at least in conditions that may involve high levels of dopaminergic stimulation, and supports a major role of postsynaptic D2R over D3R in the vulnerability to relapse. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

PMID: 30489132 [PubMed - as supplied by publisher]

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An accurate regression of developmental stages for breast cancer based on transcriptomic biomarkers.

An accurate regression of developmental stages for breast cancer based on transcriptomic biomarkers.

Biomark Med. 2018 Nov 28;:

Authors: Feng X, Zhang R, Liu M, Liu Q, Li F, Yan Z, Zhou F

Abstract
AIM: Breast cancers at different stages have tremendous differences on both phenotypic and molecular patterns. The developmental stage is an essential factor in the clinical decision of treatment plans, but was usually formulated as a classification problem, which ignored the consecutive relationships among them.
MATERIALS & METHODS: This study proposed a regression-based procedure to detect the stage biomarkers of breast cancers. Biomarkers were detected by the Lasso and Ridge algorithms.
RESULTS & CONCLUSION: A collaboration duet of Lasso and Ridge regression algorithms achieved the best performances, with classification accuracy (Acc) equal to 0.8294 and regression goodness-of-fit (R2) equal to 0.7810. The 265 biomarker genes were enriched with the signal peptide-based secretion function with the Bonferroni-corrected p-value equal to 6.9408e-3 and false discovery rate (FDR) equal to 1.1614e-2.

PMID: 30484698 [PubMed - as supplied by publisher]

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The Effect of Body Weight Support on Energy Expenditure in an Individual With High-Level Lower Extremity Amputation.

The Effect of Body Weight Support on Energy Expenditure in an Individual With High-Level Lower Extremity Amputation.

Phys Ther. 2018 Nov 28;:

Authors: Miller CA, Hayes DM, Brooks BE, Sloan KY, Sloan PG

Abstract
Background: High-level lower extremity amputation (HLLEA) has significant impact on an individual's ability to ambulate and maintain cardiovascular fitness for extended periods of time.
Objective: The purpose of this study was to evaluate whether body weight support (BWS) would improve energy efficiency in an individual with HLLEA in order to achieve appropriate target cardiovascular intensity for aerobic training.
Design: This is an exploratory single-subject study.
Methods: The participant was a 45-year-old female, 4.5 years after left hip disarticulation secondary to necrotizing fasciitis with resultant organ failure and cardiomyopathy. She was wearing a well-fitted prosthesis and had a goal of ambulating in the community with less fatigue. Vital signs and expiratory gases were recorded, using a VO2000 metabolic cart (MGC Diagnostics, Saint Paul, MN, USA), and oxygen uptake efficiency slope (OUES) was calculated during treadmill walking at 0%, 20%, and 40% unweighting using the BIODEX system. An age-matched control completed 0% unweighting baseline testing.
Results: Under all conditions of treadmill walking, the participant's heart rate, blood pressure, and rate of perceived exertion consistently elevated as speed and time increased. The participant's OUES was most efficient at 20% unweighting, and the economy of movement improved as the percentage of BWS increased, bringing values closer to the age-matched control. The participant only reported minimal pain immediately following 20% unweighting.
Limitations: The primary limitation of this study is generalization of findings as there is minimal information for comparison on the effects of BWS on aerobic capacity in individuals with HLLEA. Additionally, the percentages of unweighting using BWS were extrapolated based on corollary pre-existing research; thus, there were no set parameters defined for this specific population.
Conclusion: BWS allowed the participant to work more efficiently, which suggests that if used during an intervention, BWS might allow individuals with HLLEA to achieve recommended levels of training for aerobic conditioning. In future studies, it is recommended that 20% BWS be utilized at a speed that results in moderate intensity exercise for individuals with HLLEA as determined by 50-70% of max heart rate for 20-30 minutes.

PMID: 30496536 [PubMed - as supplied by publisher]

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Author Response.

Author Response.

Phys Ther. 2018 Nov 29;:

Authors: Bier JD, Scholten-Peeters WGM, Staal JB, Pool J, van Tulder MW, Beekman E, Knoop J, Meerhoff G, Verhagen AP

PMID: 30496531 [PubMed - as supplied by publisher]

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Clinical Reasoning in Physical Therapy: A Concept Analysis.

Clinical Reasoning in Physical Therapy: A Concept Analysis.

Phys Ther. 2018 Nov 28;:

Authors: Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N

Abstract
Background: Physical Therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research.
Objective: The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify our understanding for future work related to teaching, assessment, and research.
Design/Methods: The design included a systematic concept analysis using Rodgers' Evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relationship between features of the concept is clarified.
Results: Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management.
Limitations: Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature was incomplete or key sources were mistakenly excluded.
Conclusions: A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to be done to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.

PMID: 30496522 [PubMed - as supplied by publisher]

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Ultrasound guided angioplasty of arteriovenous fistulas for hemodialysis: Benefits and limitations.

Ultrasound guided angioplasty of arteriovenous fistulas for hemodialysis: Benefits and limitations.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Kazandjian C, Petit V, Favier C, Terriat B, Steinmetz E

Abstract
BACKGROUND: Ultrasound-guided percutaneous angioplasty of arteriovenous fistulas (AVFs) makes it possible to avoid contrast agents and X-rays, to optimize the puncture site and to locate some stenoses on the fistulography, but is it really useful? Our objective was to report the results of our experience.
MATERIAL AND METHODS: Between November 2012 and November 2017, all the patients treated according to this method in our center were collected retrospectively. The surgical indications were an insufficient maturation of the AVF, an increase in the venous pressure, an inadequate outflow, difficulties in puncture, a prolonged bleeding time, a flow drop, or an aneurysmal evolution.
RESULTS: During this period, 50 patients had 72 ultrasound-guided (UG) angioplasties, 64 on native AVFs (88.9%) and eight on prosthetic AVFs (11.1%). The technical success rate was 100%. The average preoperative flow of AVFs was 506.8 ± 302.2 mL/min vs 955.9 ± 371.4 mL/min after angioplasty. The mean duration of follow-up was 13.4 ± 12.9 months. The cumulative rates of primary, assisted primary and secondary patency were 43.5%, 68.8%, 81.5% at one year and 31.7%, 63.9%, 76.8% at two years, respectively.
CONCLUSION: AVF angioplasty under ultrasound guidance only is feasible, effective and represents an interesting alternative. A controlled study comparing ultrasound guidance with angioplasties performed under conventional angiographic guidance as the reference technique would better clarify the value of this technique.

PMID: 30496906 [PubMed - as supplied by publisher]

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Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature.

Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Spanos K, Kölbel T, Rohlffs F, Heidemann F, Giannoukas AD, Debus SE, Tsilimparis N

Abstract
BACKGROUND: Residual patent false lumen (FL) after chronic type B (cTBAD) or type A aortic dissection (TAAD) treatment is independently associated with poor long-term outcome. The aim of our study was to present endovascular techniques and the existing experience of targeted false lumen (FL) thrombosis after cTBAD or type A TAAD treatment.
MATERIAL AND METHODS: A systematic review was performed (PRISMA) searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on targeted FL occlusion after cTBAD or TAAD.
RESULTS: One hundred-one patients either after open repair of a TAAD (n=40; 3 case reports and 3 retrospective studies) or after cTBAD (n=61; 13 case reports and 6 retrospective studies) underwent an endovascular procedure for intentional FL occlusion (2 studies reported on both procedures). In TAAD patients, 27/40 (68%) had previous open repair, while 48/61 (79%) with cTBAD had previously endovascular repair. Thirty-one (78%) with TAAD and fifty-one (83%) with cTBAD were treated electively. Four main techniques were used: the Candy-Plug (19/101), the Knickerbocker (3/91), the "cork in the bottle neck" technique (2/101) and false lumen embolization with combined use of coils, onyx, plugs and glue (77/101). The technical success rate was 100% with 30- day mortality rate of 2.5% (1/40) in TAAD and 0% in cTBAD patients. During follow up (ranging: 2 to 63 months) the mortality rate was 0% (0/31) and 7.1% (4/61) in TAAD and cTBAD patients, respectively. The FL remained completely thrombosed in 78% (31/40) of TAAD and 62% (38/61) of cTBAD patients, while it was partially thrombosed in 3 and 2, respectively (no report for 22 patients).
CONCLUSION: Intentional FL occlusion seems to be a feasible less invasive approach after cTBAD or type A TAAD treatment which is not broadly used. Future, larger studies with longer follow up may demonstrate the apparent benefit in terms of aortic remodeling or stabilization of the disease progression.

PMID: 30496905 [PubMed - as supplied by publisher]

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Three cases of large-diameter true brachial and axillary artery aneurysm and a review of the literature.

Three cases of large-diameter true brachial and axillary artery aneurysm and a review of the literature.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Senarslan DA, Yildirim F, Tetik O

Abstract
Aneurysms of the upper extremity mostly originate from trauma, mycotic lesions, thoracic outlet syndrome, previous arteriovenous fistulae and atherosclerosis. True aneurysms of the brachial and axillary artery are encountered rarely. They can be diagnosed by simple physical examination as a pulsatile mass. However, most of these aneurysms remain asymptomatic until a complication occurs. The primary complication seen with the axillary or brachial artery is embolization. We report three large diameter true brachial artery aneurysms extending to the axillary zone. One of the patients had distal digital emboli causing gangrenous lesions at the finger tips and the other two patients had pain and ischemic symptoms in the forearm. All underwent surgical repair. After excision of the aneurysmal segment, arterial continuity was ensured by interposition of a reversed saphenous vein in two patients and with a biological vascular graft in one patient. Although endovascular techniques are improving, most true brachial artery aneurysms are not anatomically suitable for interventional procedures. Open surgery still preserves its value.

PMID: 30496904 [PubMed - as supplied by publisher]

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Endovascular and surgical management in intact splenic artery aneurysm.

Endovascular and surgical management in intact splenic artery aneurysm.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Zhu C, Zhao J, Yuan D, Huang B, Yang Y, Ma Y, Xiong F

Abstract
OBJECTIVE: This study aims to reveal the experience with endovascular and surgical management of intact splenic artery aneurysms in our single center.
METHOD: Between January 2011 and June 2017, 42 patients with intact splenic artery aneurysm were enrolled in this study. Twenty patients undergoing surgical intervention were classified as the surgical group, and twenty-two patients who received endovascular repair were categorized as the endovascular group. Demographic data, preoperative comorbidities, and aneurysm anatomical characteristics were collected and analyzed. Details of interventions, perioperative outcomes, and follow-up results were evaluated and compared between the two groups.
RESULTS: Forty-two patients with a mean age of 53.4±11.6 years were enrolled in this study, and 44 aneurysms were repaired. Thirty-nine (92.9%) patients were asymptomatic, and three (7.1%) patients were symptomatic. The diameter of splenic artery aneurysms was 3.3±1.6 cm, and the shape was mostly saccular. In the surgical group, the common methods used were splenic artery aneurysm resection (nine patients), followed by splenic artery aneurysms resection and splenectomy (six patients), splenic artery aneurysm resection and arterial reconstruction with end-to-end anastomosis (three patients), and laparoscopic splenic artery aneurysm resection coexisting with splenectomy ( two patients). In the endovascular group, the exclusive means was embolization with coils. The technical success rates in open repair and endovascular repair were both 100%. The 30-day mortality was nil, and no severe complication was found in early time except that one patient suffered multiple splenic abscess in the endovascular group after embolization. Endovascular repair had significantly shorter surgery time (82.5±27.6 vs 191.9±62.7 min, p <0.001) and hospital stay (5.6±3.1 vs 10.8±5.2 days, p <0.001) compared with open repair. The median follow-up time in this study was 34.5 (IQR 16.8-60.8) months. Two sac reperfusions were detected during the follow-up in the endovascular group, and patients needed new embolization. No late deaths were found in the follow-up time, and the freedom from reintervention in the endovascular group at 1 and 3 years postoperatively was 95.5% and 82.4%, respectively. In addition, the freedom from reintervention in the surgical group at 1 and 3 years postoperatively were both 100%. No significant differences were observed in late survival and reintervention between the open repair and endovascular repair.
CONCLUSION: Open repair and endovascular repair were equally feasible, safe, and effective for intact splenic artery aneurysm. Endovascular repair is less invasive accompanied with an obvious decrease in surgery time and rapid recovery with a short hospital time.

PMID: 30496903 [PubMed - as supplied by publisher]

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Complete laparoscopic retrieval of inferior vena cava filter: A case report and literature review.

Complete laparoscopic retrieval of inferior vena cava filter: A case report and literature review.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Zhang H, Niu L, Zhang F, Zhang N, Fan Q

Abstract
BACKGROUND: In recent years, retrievable inferior vena cava filters (IVCFs) have been increasingly used to prevent pulmonary embolism. However, these IVCFs are occasionally difficult to retrieve, and their long-term retention in the body can cause various complications.
METHODS: A 22-year-old woman underwent a prophylactic IVCF placement for puerperal deep venous thrombosis six months ago. After several attempts, the filter could not be retrieved through the endovascular technique. Meanwhile, the patient developed severe depression and suicidal tendencies. We decided to use laparoscopic techniques to retrieve the filter.
RESULTS: We successfully used laparoscopy to completely remove a difficult IVCF. The patient had a smooth postoperative recovery and was discharged on the third postoperative day.
CONCLUSION: Laparoscopy can be used as an alternative method to remove IVCF. However, it is more important to avoid situations that prevent routine retrieval of IVCFs.

PMID: 30496902 [PubMed - as supplied by publisher]

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Ultra Long Inflation in SFA Stenosis and Occluded Lesions Using Guide Liner ("Ultra SOUL"): A Case Report.

Ultra Long Inflation in SFA Stenosis and Occluded Lesions Using Guide Liner ("Ultra SOUL"): A Case Report.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Shirai S, Hirano K, Makino K, Honda Y, Tsutsumi M, Mori S, Sakamoto Y, Kobayashi N, Araki M, Yamawaki M, Ito Y

Abstract
Following an era of the use of several drug-coated balloons in angioplasty, "leave nothing behind" and stent-less strategies have been gaining attention. In stent-less strategies, it is necessary to avoid major dissections and limit flow. Balloon dilation is an important step in vessel preparation. In this study, we report a novel pre-dilation technique. We performed prolonged balloon inflation for >10 min after normal ballooning in a procedure to treat an occluded lesion in the superficial femoral artery (SFA). We used a guide extension catheter to avoid foot ischemia and obtained better angiographic results than those using short duration balloon inflation. We named this technique "Ultra Long Inflation in SFA Stenosis and Occluded Lesions using Guide Liner" or "Ultra SOUL." The Ultra SOUL technique may be considered a useful option in balloon dilation.

PMID: 30496901 [PubMed - as supplied by publisher]

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Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates Following Limb Revascularization.

Postoperative Low-Dose Heparin Infusion Does Not Change Complication Rates Following Limb Revascularization.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Jayarajan SN, Holzem KM, Desai K, Sanchez LA, Zayed MA

Abstract
OBJECTIVE: Postoperative sub-therapeutic low-dose heparin infusion (LDHI) is sometimes administered in patients undergoing extremity arterial revascularization to maintain graft patency, and decrease risk of thrombosis. However, the safety of this management strategy is unknown.
METHODS: From 2013 to 2015, we retrospectively reviewed all patients undergoing upper and lower extremity arterial revascularization at a single university-affiliated medical center. Patients were grouped by receipt of LDHI within the first 24 hours postoperative period. Preoperative demographics, comorbidities, intraoperative measures, 30 day postoperative complications, arterial patency rates, and amputation rates were analyzed for each group.
RESULTS: We identified 379 patients who received extremity revascularization, and 56 (14.8%) of them had received LDHI. Patients who received LDHI were less likely to have an elective admission upon presentation (26.8% vs. 56%, p<0.001), or an admission from home (69.6% vs. 81.7%, p=0.04). They were more likely to have preoperative bleeding (44.6% vs. 22%, p<0.01), and need for emergent operation (23.2% vs. 11.8%, p=0.04). Postoperatively, although patients who received LDHI demonstrated a trend towards increased bleeding (48.2% vs. 33.7%, p=0.053), they did not demonstrate an increase in 30-day mortality (1.79% vs. 1.24%, p=0.55), or reoperation (19.7% vs. 12.4%, p=0.21). Multivariable analysis demonstrated that LDHI did not have a significant association with immediate postoperative bleeding (p=0.99), survival (p=0.13), primary patency (p=0.872), and amputation-free survival (p=0.387).
CONCLUSION: Although LDHI was more likely to be administered in patients who received emergent operations, risk adjusted analysis demonstrated that it was not associated with increased postoperative bleeding, mortality, short-term need for reintervention, or amputation following extremity arterial revascularization.

PMID: 30496900 [PubMed - as supplied by publisher]

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Un Faux Anevrisme Tuberculeux De L'isthme De L'aorte Traité Par Endoprothèse.

Un Faux Anevrisme Tuberculeux De L'isthme De L'aorte Traité Par Endoprothèse.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Oualid B, Adil A, Oussama A, Soukaina B, Abdelfatah Z, Ayoub B, Mustapha A

Abstract
Tuberculosis of the aorta is rare, and its localization in the isthmus is exceptional. Tuberculous aortic pseudoaneurysms have a high risk of rupture with a severe prognosis. Conventional treatment is based on a combination of surgery and anti-tuberculosis chemotherapy. The endovascular approach with stent graft placement can be an attractive and less invasive alternative, like in our case where conventional surgery was considered to be at risk in this nonagenarian patient.

PMID: 30496899 [PubMed - as supplied by publisher]

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Retroperitoneal Liposarcoma Masquerading As An Impending Rupture of Inflammatory Abdominal Aortic Aneurysm.

Retroperitoneal Liposarcoma Masquerading As An Impending Rupture of Inflammatory Abdominal Aortic Aneurysm.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Karkos CD, Pepis PD, Theologou M, Ballas K, Petras P, Arapoglou S, Giagtzidis IT, Mitka M, Pliatsios I, Papazoglou KO, Kambaroudis AG

Abstract
BACKGROUND: We present a unique case scenario of a periaortic liposarcoma masquerading as an impending rupture of an inflammatory abdominal aortic aneurysm (AAA).
CASE REPORT: A 57-year-old man was referred to our unit for an emergency endovascular repair of "an inflammatory AAA with CT features of impending rupture". He underwent an uneventful endovascular repair with a bifurcated endograft (C3, Gore, Flagstaff, AZ, USA). Seven weeks later, CT showed that the periaortic "mass" grew larger and asymmetric and a CT-guided needle biopsy suggested the presence of a high grade malignant mesenchymal tumor. He underwent laparotomy and excision of the retroperitoneal tumor en bloc with the anterior wall of the infrarenal aorta. The endograft acted as an excellent "safety net" providing adequate hemostatic control and obviating the need for aortic cross-clamping and repair of the aortic defect with a patch or tube graft.
CONCLUSION: The learning point from the present case is that when faced with an inflammatory AAA and/or retroperitoneal fibrosis, the rare possibility of a retroperitoneal neoplasm should be kept in mind.

PMID: 30496898 [PubMed - as supplied by publisher]

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A Complex Case of Synchronous Thoracic And Abdominal Endoleak Repair With Custom-Made Relay Nbs Thoracic Stent Graft And Abdominal Open Reconstruction.

A Complex Case of Synchronous Thoracic And Abdominal Endoleak Repair With Custom-Made Relay Nbs Thoracic Stent Graft And Abdominal Open Reconstruction.

Ann Vasc Surg. 2018 Nov 26;:

Authors: Georgakarakos E, Koutsoumpelis A, Popidis S, Tasopoulou KM, Georgiadis GS

Abstract
A 71-year old patient with previous thoracic aneurysm endovascular repair (TEVAR) and endovascular abdominal aneurysm repair (EVAR) presented with simultaneous type-III endoleak from the thoracic components and type-Ia endoleak from migration of the abdominal endograft, leading to enlargement of both aneurysms. A custom-made reverse tapered RELAY NBS thoracic endograft was used to bridge the thoracic stent-grafts. While a low-flow type 3 endoleak persisted in the immediate postoperative phase, due to incomplete apposition of the new stent-graft, further deployment of its Nitinol skeleton resulted in resolution of the endoleak at 1-week follow-up. The abdominal aneurysm enlargement was corrected via excision of the central segment of the abdominal endograft, preservation of the distal main body and limbs and interposition of a short Dacron tube graft.

PMID: 30496897 [PubMed - as supplied by publisher]

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Isolated intraosseous extra-gnathic orbital myxoma: a clinicopathologic case report.

Isolated intraosseous extra-gnathic orbital myxoma: a clinicopathologic case report.

Orbit. 2018 Nov 29;:1-6

Authors: Manjandavida FP, Chahar S, Dave B

Abstract
A 19-year-old female student presented with painless, progressive proptosis in the right eye for the past six months causing significant cosmetic blemish and double vision. Clinical evaluation revealed normal visual acuity, normal pupillary reflex, severe proptosis, and dystopia. Orbital imaging revealed a heterogeneous mass in superior orbit displacing the globe inferiorly and causing extensive bony erosion of frontal bone superiorly and invading the frontal sinus. Excision biopsy was performed with en-bloc removal of the tumor. Surgical delivery of a slimy mass with infiltrated bony tissue led to a presumptive diagnosis of myxoid liposarcoma. Careful histopathologic analysis coupled with immunohistochemical studies were performed which established the rare diagnosis of low-grade myxoid spindle cell neoplasm with features suggestive of intraosseous myxoma. On follow-up at 15 months, our patient revealed no signs of recurrence. Isolated intraosseous orbital myxoma is a rare entity; only two such cases have been reported in the literature.

PMID: 30489165 [PubMed - as supplied by publisher]

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Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure.

Eyelash hair transplantation with strip composite eyebrow graft: an enhancing technique in tarsoconjunctival flap eyelid reconstruction procedure.

Orbit. 2018 Nov 27;:1-4

Authors: Nava-Castañeda Á, Tovilla-Canales JL, Solano-Leal P, Garnica-Hayashi L

Abstract
PURPOSE: To describe and evaluate the eyelash transplantation with strip composite eyebrow graft to improve eyelid anatomy in tarsoconjunctival flap eyelid reconstruction procedure.
METHODS: Twenty two patients with eyelid tumors managed by local excision and reconstruction using tarsoconjunctival flap reconstruction procedure were included. Eyelash graft was performed during flap division by harvesting a graft from the eyebrow and creating a recipient pocket in the receptor eyelid. Patients had a 1-year follow up. Eyelash orientation and follicle survival rate were recorded. Demographic variables were analyzed with descriptive statistics. For eyelash follicles survival rate assessment, we evaluated the number of follicles found in the first postoperative day with the follicles found at the end of the study using the Wilcoxon signed rank test. P < 0.05 was considered statistically significant.
RESULTS: All eyelash grafts showed a good follicle orientation and no cases of eyelashes misdirection toward the eyeball were reported. No statistical differences (p > 0.05) were found in Wilcoxon signed rank test when comparing the number of follicles present at the first postoperative day and the number of follicles present at the 12th postoperative month, meaning that the vast majority of follicles survived at the end of the study. Graft ischemia, necrosis or infection were not observed.
CONCLUSIONS: Tarsoconjunctival flap is an outstanding option for eyelid reconstruction and eyelash transplantation with an eyebrow composite graft is an excellent procedure to enhance and recreate a normal eyelid.

PMID: 30482080 [PubMed - as supplied by publisher]

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Duration of unilateral auditory deprivation is associated with reduced speech perception after cochlear implantation: A single-sided deafness study.

Duration of unilateral auditory deprivation is associated with reduced speech perception after cochlear implantation: A single-sided deafness study.

Cochlear Implants Int. 2018 Nov 28;:1-6

Authors: Cohen SM, Svirsky MA

Abstract
OBJECTIVE: Examine the relationship between duration of unilateral deafness and speech perception outcomes after cochlear implantation in adults with single-sided deafness.
METHODS: A systematic review of PubMed articles containing individual speech perception and duration of deafness data from single-sided deaf adults. Studies were selected for detailed review and duration of deafness and speech perception outcomes were extracted, with speech scores reported as percent correct. A linear regression as a function of study and length of deafness was performed.
RESULTS: A statistically significant negative effect of duration of unilateral deafness on speech perception was found, but there was substantial uncertainty regarding the strength of the effect.
DISCUSSION: Existing data make it difficult to either support or reject a hard 5- or 10-year unilateral auditory deprivation limit on cochlear implant (CI) candidacy for patients with single-sided deafness. This is because the totality of available data are consistent with a very small effect, perhaps negligible in practical terms, and just as consistent with a very large effect. Regardless of effect size, the present results have important basic implications. They suggest that unilateral sound deprivation may have a deleterious effect on auditory processing even though more central parts of the auditory system have continued to receive input from a contralateral normal ear.
CONCLUSIONS: Speech perception scores in SSD patients are negatively correlated with duration of deafness, but the limited amount of data from cochlear implant users with long-term single-sided deafness leads to substantial uncertainly, which in turn precludes any strong clinical recommendations. Further study of SSD CI users with long-term deafness will be necessary to generate evidence-based guidelines for implantation criteria in this population.

PMID: 30486762 [PubMed - as supplied by publisher]

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When to replace legacy cochlear implants for technological upgrades: Indications and outcomes.

When to replace legacy cochlear implants for technological upgrades: Indications and outcomes.

Laryngoscope. 2018 Nov 28;:

Authors: Holcomb MA, Burton JA, Dornhoffer JR, Camposeo EL, Meyer TA, McRackan TR

Abstract
OBJECTIVE: To determine indications, surgical efficacy, and audiologic outcomes of replacing Advanced Bionics Clarion C1.2 internal devices (Advanced Bionics, LLC, Valencia, CA) as a means of technology upgrade.
STUDY DESIGN: Retrospective review, case series.
METHODS: Ten patients were initially implanted as a child (mean age = 3.87 years) and underwent cochlear implant reimplantation (CIR) with current Advanced Bionics internal device as a young adult (mean duration of implant use = 15.66 years). Demographic data and pre- and post-CIR speech perception scores were collected.
RESULTS: Technology upgrade was the primary (9) or secondary (1) motivation for CIR. No surgical complications were noted, and full insertion was obtained in nine cases. Intraoperative impedance levels and neural response imaging measures were within normal limits for eight patients. At most recent post-CIR follow-up evaluation, all patients (100%) performed within or better than the 95% confidence interval of their pre-CIR word and sentence recognition scores; and 55.6%, 50.0%, and 50.0% of patients performed above the 95% confidence interval of their pre-CIR scores for the CNC words, sentences in quiet, and sentences in noise, respectively.
CONCLUSION: Post-CIR audiological benefit was stable or improved compared to pre-CIR results in all categories by 3 months after reactivation. Given these results, patients who are unable to use the most current external processors due to incompatibility with a legacy internal device could consider reimplanation to optimize their overall performance with a cochlear implant.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2018.

PMID: 30484865 [PubMed - as supplied by publisher]

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Sensitivity of EQ-5D-3L, HUI2, HUI3, and SF-6D to changes in speech reception and tinnitus associated with cochlear implantation.

Sensitivity of EQ-5D-3L, HUI2, HUI3, and SF-6D to changes in speech reception and tinnitus associated with cochlear implantation.

Qual Life Res. 2018 Nov 27;:

Authors: Summerfield AQ, Barton GR, UK Cochlear Implant Study Group

Abstract
PURPOSE: There is concern that some generic preference-based measures (GPMs) of health-related quality of life may be insensitive to interventions that improve hearing. Establishing where sensitivity arises could contribute to the design of improved measures. Accordingly, we compared the sensitivity of four widely used GPMs to a clinically effective treatment-cochlear implantation-which restores material degrees of hearing to adults with little or no functional hearing.
METHODS: Participants (N = 147) received implants in any of 13 hospitals in the UK. One month before implantation and 9 months after, they completed the HUI2, HUI3, EQ5D3L, and SF-6D questionnaires, together with the EuroQoL visual-analogue scale as a direct measure of health, a performance test of speech reception, and a self-report measure of annoyance due to tinnitus.
RESULTS: Implantation was associated with a large improvement in speech reception and a small improvement in tinnitus. HUI2 and HUI3 were sensitive to the improvement in speech reception through their Sensation and Hearing dimensions; EQ5D3L was sensitive to the improvement in tinnitus through its Anxiety/Depression dimension; SF-6D was sensitive to neither. Participants reported no overall improvement in health. Variation in health was associated with variation in tinnitus, not variation in speech reception.
CONCLUSIONS: None of the four GPMs was sensitive to the improvements in both speech reception and tinnitus that were associated with cochlear implantation. To capture fully the benefits of interventions for auditory disorders, developments of current GPMs would need to be sensitive to both the health-related and non-health-related aspects of auditory dysfunction.

PMID: 30484121 [PubMed - as supplied by publisher]

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Sleep apnea and cardiovascular complications of the acromegaly. Response to the medical treatment.

Sleep apnea and cardiovascular complications of the acromegaly. Response to the medical treatment.

Minerva Endocrinol. 2018 Nov 26;:

Authors: García-Alvarez M, Climent V

Abstract
Acromegaly is a rare disease characterized by high levels of growth hormone (GH) and insulin- like growth factor 1 (IGF-1). The excess of GH leads to the development of different manifestations in different organs, from subtle signs in the bones and soft tissues to the development of respiratory and cardiac insufficiency. In the cardiovascular system, the GH/IGF-1 axis exerts its influence on three major aspects: myocyte growth and structure, cardiac contractility and vascular function. In this article, we review the different cardiovascular and respiratory complications as well as the effects of the different treatments on these complications. Cardiovascular complications that occur in acromegaly are known as "acromegalic cardiomyopathy," and include ventricular hypertrophy, impaired diastolic and systolic function, valve diseases, coronary artery disease, and arrhythmias. Acromegaly is also associated with relevant complications of the respiratory system, mainly sleep apnea and respiratory insufficiency. Regarding treatment, there are different therapeutic strategies. Surgery is the first-choice treatment, but in general, half of patients will require adjuvant treatments, such as medical treatment (somatostatin analogues, dopamine agonists and GH receptor antagonists) or radiotherapy. The treatment can improve some complications of acromegaly, such as left ventricular hypertrophy, hypertension, or obstructive sleep apnea. On the other hand, when strict control of the disease is achieved, a reduction in mortality and cardiovascular morbidity is assured, reaching rates similar to those of the general population.

PMID: 30482010 [PubMed - as supplied by publisher]

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Heterogeneous clinical features of ketosis-prone type 2 diabetes mellitus patients: gender, age, loss of weight and HbA1c.

Heterogeneous clinical features of ketosis-prone type 2 diabetes mellitus patients: gender, age, loss of weight and HbA1c.

Minerva Endocrinol. 2018 Nov 26;:

Authors: Wang J, Zhang M, Liu Z, Wang X, Pang Y, Lu Y, Liu Z

Abstract
BACKGROUND: To observe the clinical features of type 2 diabetes mellitus (T2DM) patients with ketosis as the initial symptom, and investigate its differences from clinical features of non-ketotic T2DM patients.
METHODS: A total of 385 T2DM patients treated in our hospital from 2014 to 2017 were selected and divided into ketosis-prone T2DM group and non-ketotic T2DM group. Ketosis-prone T2DM patients refer to DM patients with the urine ketone body++ or above or the blood ketone body ≥1.0 mmol/L when treated. Fasting venous blood was collected from all patients in the early morning at 2 d after admission to detect the liver function, renal function, blood glucose, triglyceride, total cholesterol, glycosylated hemoglobin and fasting C-peptide, glutamic acid decarboxylase antibody (GAD-Ab) and islet cell antibody (ICA) were also detected, and the 24 h urine specimen was retained to detect the 24 h urine microalbumin excretion rate.
RESULTS: The proportion of male in ketosis-prone T2DM group was significantly higher than that in non-ketotic T2DM group (P<0.01). Patients in ketosis-prone T2DM group was younger than those in non-ketotic T2DM group (P<0.05). The number of days from initial symptom to treatment in ketosis-prone T2DM group was smaller than that in non-ketotic T2DM group (P<0.05). The fasting C-peptide level in ketosis-prone T2DM group was significantly lower than that in non-ketotic T2DM group (P<0.05). The degree of weight loss and level of glycosylated hemoglobin in ketosis-prone T2DM group were significantly higher than those in non-ketotic T2DM group (P<0.05).
CONCLUSIONS: Ketosis-prone T2DM patients are characterized by lower age at onset, higher proportion of male, shorter duration of disease, poorer islet function, higher blood glucose and more significant weight loss than non-ketotic T2DM patients.

PMID: 30482009 [PubMed - as supplied by publisher]

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Bone health among patients with primary aldosteronism: a systematic review and meta-analysis.

Bone health among patients with primary aldosteronism: a systematic review and meta-analysis.

Minerva Endocrinol. 2018 Nov 26;:

Authors: Loh HH, Yee A, Loh HS

Abstract
BACKGROUND: Recent studies showed a possible association between hyperaldosteronism and secondary hyperparathyroidism leading to reduced bone health, however results are conflicting.
METHODS: We conducted a meta-analysis to evaluate the relationship between primary aldosteronism (PA) with bone biochemical markers and to assess bone mineral density in patients with primary aldosteronism.
RESULTS: A total of 939 subjects were examined (37.5% with PA). Patients with PA had significantly higher serum parathyroid hormone, lower serum calcium, higher urine calcium excretion and higher serum alkaline phosphatase compared to patients without PA, with no significant difference in serum vitamin D between both groups. Bone mineral density of lumbar spine, femoral neck and total neck of femur were similar between two groups. With PA treatment, there was a significant increment in serum calcium and reduction in serum parathyroid hormone.
CONCLUSIONS: PA is associated with hypercalciuria with subsequent secondary hyperparathyroidism. This potentially affects bone health. We recommend this to be part of complication screening among patients with PA.

PMID: 30482008 [PubMed - as supplied by publisher]

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Monitoring of treament adherence with easypodTM in 6 Italian centres: a real-world experience.

Monitoring of treament adherence with easypodTM in 6 Italian centres: a real-world experience.

Minerva Endocrinol. 2018 Nov 26;:

Authors: Cardinale G, Pesce S, Ingletto D, Mariano M, Catucci A, Corciulo N, Fidotti E

Abstract
BACKGROUND: A poor adherence to r-hGH therapy is associated to a low growth rate in patients with growth deficiency. For this reason, the choice of an objective method, such as an electronic device, for monitoring treatment adherence is very important. This retrospective study evaluated the r-hGH treatment adherence of patients with growth deficiency, monitored through the easypodTM device.
METHODS: Data from 90 patients (52 males; mean age at the end of the study: 11.9 years) enrolled in 6 Italian centres, was collected from the beginning of the r-hGH therapy until the end of the study through the easypodTM device. The primary objective - treatment adherence- was the rate (%) between the number of effective days of treatment and the number of planned days. Secondary objectives were: relationship between heights measured at the beginning and at the end of the study, the change of the height SDS and the growth rate.
RESULTS: EasypodTM data showed that the mean adherence was 70% (SD 13%). The mean age-adjusted growth of the patients was 28.68 cm (SD ± 13.8 cm) during the treatment period of 977 days, and the 6 months growth rate for the planned period was 3.78 cm (SD ± 8.1). A positive correlation between the adherence rate and the change of the height SDS value was observed (p < 0.0006).
CONCLUSIONS: EasypodTM seems to be a valid tool for quickly identifying non-adherence habits, allowing physicians to implement actions focused on reinforcing the importance of treatment both for patients and caregivers.

PMID: 30482007 [PubMed - as supplied by publisher]

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A retrospective analysis of chronic subdural haematoma recurrence rates following burr hole trephination versus minicraniotomy.

A retrospective analysis of chronic subdural haematoma recurrence rates following burr hole trephination versus minicraniotomy.

J Clin Neurosci. 2018 Nov 26;:

Authors: Haron S, Bogduk N, Hansen M

Abstract
The aim of this study was to determine the subdural haematoma recurrence rate in patients with symptomatic chronic subdural haematomas (CSDH) treated with either burr hole trephination (BHT) or minicraniotomy (MC) and to determine whether a statistically significant difference exists between the two techniques. A retrospective analysis of all consecutive patients with symptomatic CSDH treated with BHT or MC at the John Hunter Hospital Neurosurgery Department between July 2004 and July 2016 was performed. After inclusion/exclusion criteria were applied, 368 patients with 439 CSDHs were eligible. Baseline demographic data was recorded for all patients. Statistical analysis was performed assessing haematoma recurrence as the primary outcome and mortality as a secondary outcome. Three hundred and sixty eight patients were included in the study, with 225 being treated with MC and 143 with BHT. Baseline demographic data was similar between the two groups. The recurrence rate for patients treated with BHT was 0.13 (95% CI 0.08-0.18), versus 0.18 (95% CI 0.13-0.23) in the MC group. This difference was not statistically significant. Similarly, there was no statistically significant difference in mortality rates between the two groups. The mortality rate in the BHT group was 0.09 (95% CI 0.05-0.14) versus 0.09 (95% CI 0.05-0.13) in the MC group. In our series there was no difference in recurrence rates or mortality rates between the two groups, suggesting MC is an effective alternative to BHT in the management of symptomatic CSDH.

PMID: 30487056 [PubMed - as supplied by publisher]

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Imaging findings after acute sport-related concussion in American football players: A systematic review.

Imaging findings after acute sport-related concussion in American football players: A systematic review.

J Clin Neurosci. 2018 Nov 26;:

Authors: Monk SH, Legarreta AD, Kirby P, Brett BL, Yengo-Kahn AM, Bhatia A, Solomon GS, Zuckerman SL

Abstract
Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging within 6 months of SRC, and sample size >5. Studies were assessed for: 1) methodology, 2) imaging outcomes, and 3) number of positive statistical comparisons. Imaging was classified as immediate (≤1 week post-injury) or subacute (>1 week to 6 months post-injury). Eleven studies met inclusion criteria. Eight of the 11 studies conducted a total of 809 comparisons of brain function, of which 149 (18%) were statistically significant. Nine of the 11 studies (82%) reported positive immediate findings, but were more likely to be subject to recall bias (86% vs. 0%) and to lack baseline advanced brain imaging (78% vs. 50%) than negative studies. Only 3 of 9 studies that reported subacute findings (33%) reported positive results, and these positive studies were also more likely to be subject to recall bias (100% vs. 40%) and to lack baseline advanced brain imaging (100% vs. 67%) than negative studies. The results of the study demonstrate the transitory nature of positive imaging findings and methodological limitations that complicate study interpretation. Further research is required to correlate imaging findings with clinical outcomes.

PMID: 30487055 [PubMed - as supplied by publisher]

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Plasma and CSF miRNA dysregulations in subarachnoid hemorrhage reveal clinical courses and underlying pathways.

Plasma and CSF miRNA dysregulations in subarachnoid hemorrhage reveal clinical courses and underlying pathways.

J Clin Neurosci. 2018 Nov 24;:

Authors: Chan MTH, Wong JYY, Leung AKT, Lu G, Poon WS, Lau AY, Chan WY, Wong GKC

Abstract
BACKGROUND: Subarachnoid hemorrhage (SAH) is fatal and detrimental to quality of life. Clinically, options for monitoring are often limited, potentially missing subtle neurological changes especially in low-grade patients. This article reviewed miRNA dysregulation in SAH and analyzed their functional and clinical relevance.
METHODS: With adherence to PRISMA guideline, PubMed, EMBASE, GEO and ArrayExpress were searched comprehensively for relevant clinical and animal models. Datasets were analyzed and enriched by experimentally validated targets and multiple databases using R v3.4.2, Ingenuity Pathway Analysis, and miRPath v3.0.
RESULTS: Among 1926 search results, 18 studies were screened for full-text assessment. The 8 included studies revealed a marked miRNA dysregulation after SAH. 2 datasets were retrieved. In both serum and CSF, different miRNA profiles were associated with Early Brain Injury, Delayed Cerebral Infarction, vasospasm and prognosis. In CSF, a dramatic restructure of inter-miRNA correlation matrix was observed. Enrichment analysis revealed strong association (1) BBB instability, with adherens, extra-cellular matrix, actin cytoskeleton, integrin, TGF-β, Wnt/β-catenin etc; (2) autophagy, with MTORC1, HIF-1, ULK2, and FoxO etc; (3) apoptosis, with PI3K-Akt, p53, and AMPK. We analyzed common miRNAs across SAH and cerebral ischemia. They were related to neuronal differentiation, oxidation stress, apoptosis, angiogenesis, Alzheimer's disease, NMDA-induced calcium influx, excitotoxicity and NO production.
CONCLUSIONS: Clinical progression of SAH is associated with different miRNA fingerprints. They carry neuro-pathological relevance and can be a potential biomarker which compliments SAH management.

PMID: 30482403 [PubMed - as supplied by publisher]

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Abnormal level of consciousness predicts outcomes of patients with anti-NMDA encephalitis.

Abnormal level of consciousness predicts outcomes of patients with anti-NMDA encephalitis.

J Clin Neurosci. 2018 Nov 24;:

Authors: Aungsumart S, Ha A, Apiwattanakul M

Abstract
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is an acute form of encephalitis with an autoimmune etiology. We aimed to study clinical characteristics and treatment outcomes and assess the predictive factors associated with patient outcome. In this retrospective study, patients who presented with cardinal symptoms of anti-NMDA encephalitis and positive anti-NMDA receptor antibody results in their cerebrospinal fluid were included in the study. Thirty-one patients were identified. The median age of onset was 19 years (IQR 15.0-31.0). Females were predominant (61.8%). The main clinical symptoms were neuropsychiatric symptoms (87.1%) followed by abnormal movement (71%), seizures (51.1%), and autonomic instability (41.9%). Eleven patients (35.5%) exhibited decreased levels of consciousness. Abnormal MRI results were found in only 35.5% of the patients. CSF abnormalities usually involved mild pleocytosis. Only 67.7% of serum samples were positive against the anti-NMDAR antibody, whereas 100% of CSF samples were positive. Tumor-related information was only available for 20 patients. Only one case involved an ovarian teratoma. All patients received first-line therapy (intravenous pulse methylprednisolone and plasmapheresis). Three patients were treated with second-line therapy (IV cyclophosphamide). Twenty patients (64.5%) had favorable outcomes in our cohort (mRS 0-2) after a 1-year follow-up. An abnormal level of consciousness was a factor associated with a nonfavorable outcome (OR 15.65, 95% CI 2.30-106.29, p value <0.01).

PMID: 30482402 [PubMed - as supplied by publisher]

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[Enrico Bottini (1835-1903), Italian Physician and Politician: A Master of Antisepsis and a Pioneer of Modern Surgery].

[Enrico Bottini (1835-1903), Italian Physician and Politician: A Master of Antisepsis and a Pioneer of Modern Surgery].

Acta Med Hist Adriat. 2018 Dec;16(2):293-302

Authors: Martini M

Abstract
Enrico Bottini (Stradella, Pavia, 7 September 1835 - Porto Maurizio, Sanremo, 11 March 1903) was a multifaceted surgeon, who left a strong mark in modern surgery, not only Italian but worldwide. A pupil of Porta and Ribeti, as well as the distinguished French surgeon and anatomist Charles-Marie-Édouard Chassaignac, he has dedicated himself throughout his career to various areas of medicine, ranging from bacteriology and anti-sepsis (use of a derivative of phenic acid) to urological surgery (the so-called "endo-urethral galva-cauterization", also called Bottini's operation, or Perineal incision according to Bottini). He has also successfully dedicated himself to gynecology (trans-vaginal hysterectomy for uterine cancer and surgical treatment of vesicovaginal fistulas), maxillofacial surgery (endo-oral resection of the maxilla, subperiosteal resection of the mandible for the treatment of the stable jaw, total amputation of the larynx and the tongue for carcinomas), the dermosurgery (use of the electrocautery), and the vascular surgery (resection of the inferior vena cava). He was also an important Italian politician, first as a deputy and then as a senator.

PMID: 30488707 [PubMed - in process]

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Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy.

Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy.

Head Neck. 2018 Nov 28;:

Authors: Stephenson KA, Pandey S, Lubbe DE, Fagan JJ

Abstract
BACKGROUND: Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence.
METHODS: This was a prospective single-blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin-polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management-related factors were recorded.
RESULTS: Forty-five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment-related complications occurred.
CONCLUSION: Feasibility of application of an albumin-polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula-preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.

PMID: 30488504 [PubMed - as supplied by publisher]

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