Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Tuesday, June 1, 2021

Evaluation of neutrophil extracellular trap deregulated formation in pyoderma gangrenosum

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Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatose (ND) characterized by a dense neutrophilic infiltrate in the affected tissue. Neutrophil extracellular traps (NETs) are web-like structures released by neutrophils and composed of cytosolic and granule proteins assembled on a scaffold of decondensed chromatin. Very little is known about the role of NETosis in PG. Here, we assessed the possible implication of NETosis in the pathogenesis of PG by investigating the NETosis in the ulcers of 26 PG patients. We demonstrated that neutrophils in the PG skin lesions undergo an aberrant level of NETosis in 100% of the analysed cases (N = 26). All control and abscess biopsies were instead negative for the NETosis. In addition, neutrophils from peripheral blood of PG patients showed a significantly higher rate of spontaneous, but not induced, NETosis. Overall, this study suggests that the NETosis may contribute to systemic inflammation and tissue destruction in PG, thus re presenting a possible novel therapeutic target.

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Single Step Treatment of Frontal Sinus Osteomyelitis Using Bone Cement: A Case Report

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Abstract

Osteomyelitis is an infection of the bone which is accompanied by bony destruction and sequestrum formation. Osteomyelitis of frontal bone requires us to deal with great caution as it can lead to a great deal of morbidity and mortality. Often when surgical treatment provided, it is radical and leaves behind surgical defect over the frontal bone. We report a case of a 14 year old boy diagnosed with frontal bone osteomyelitis of the left side who was treated using antibiotic loaded bone cement.

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Preoperative volume estimation in transverse upper gracilis flap surgery: A pilot study

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J Plast Reconstr Aesthet Surg. 2021 Apr 19:S1748-6815(21)00205-9. doi: 10.1016/j.bjps.2021.03.101. Online ahead of print.

ABSTRACT

BACKGROUND: The transverse upper gracilis (TUG) flap provides a good alternative to the gold standard DIEP in breast reconstruction. However, flap volume estimates are subjective, making preoperative planning potentially challenging.

STUDY AIM: To derive a reliable, accurate, and reproducible mathematical algorithm for the preoperative calculation of TUG flap volumes.

MATERIALS AND METHODS: Nineteen consecutive patients with 30 TUG flaps were prospectively included. On the assumption that the TUG flap resembles two isosceles prisms, the formula of the volume of a prism was used to calculate their preoperative flap weights. These were then intraoperatively compared to the actual flap weights. A regression equation was calculated from the correlation analysis of 10 random flaps. This was then appl ied to the remaining 20 flaps to assess for improved reliability and weight prediction accuracy.

RESULTS: The prism volume equation used to clinically calculate flap volumes was: Geometric flap weight = (h1bT)/2+ (h2bT)/2, (h = height, b = base, T = flap thickness); all in centimetres. Geometric and actual flap weights were found to be significantly correlated (r2 = 0.977) generating the following regression formula: predicted TUG weight = 0.924 × geometric weight + 26.601. When this was applied to the remaining 20 flaps, no significant difference was found (p = 0.625) between predicted and actual flap weights, demonstrating an increased accuracy of predicting flap volume.

CONCLUSION: The proposed formula provides the clinician with a more accurate and reliable estimation of available TUG flap volume and may potentially aid with preoperative planning and patient consultations.

PMID:34059471 | DOI:10.1016/j.bjps.2021.03.101

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The 'complete common mesentery' and the agenesis of Toldt's and Fredet's fasciae

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Surg Radiol Anat. 2021 May 31. doi: 10.1007/s00276-021-02775-w. Online ahead of print.

NO ABSTRACT

PMID:34059926 | DOI:10.1007/s00276-021-02775-w

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Fetal development and growth of the human erector spinae with special reference to attachments on the surface aponeurosis

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Surg Radiol Anat. 2021 May 31. doi: 10.1007/s00276-021-02759-w. Online ahead of print.

ABSTRACT

PURPOSE: The longissimus (LO) and iliocostalis (IC) of adults consist of myofibers extending from the superolateral to the inferomedial side of the back and, because of the same course, they are fused in the thoracolumbar region. The LO also has a medial attachment to the long myofibers of the transversospinalis (TS) showing a course from the superomedial to the inferolateral side . However, there is apparently no information regarding when and how these similar longitudinal muscles differentiate from a cluster of dorsomedial myotome cells.

METHODS: We examined sagittal and horizontal sections of the trunks of 39 human embryos and fetuses (18-330 mm crown-rump length).

RESULTS: At 6-7 weeks gestational age (GA), the surface aponeurosis appeared prior to and independent of the thoracolumbar fascia. At 6-9 weeks GA, the LO myofibers had a postero-inferior course, from the transverse process to the initial aponeurosis, whereas the TS myofibers had a postero-superior course, from a lateral extension of the intertransverse ligament to the aponeurosis. However, the IC consisted of supracostal longitudinal myofibers and was distant from the LO until 12 weeks GA. Because of the lack of ligamentous attachments and ribs, myofibers of the TS, LO, and IC took a similar inferior course in the lumbar region. When the early TS was represented by the transverso-a poneurotic muscle, consequently, the LO corresponded to the aponeuro-transversal muscle and was independent from the IC.

CONCLUSION: The classical model of TS and LO development does not recognize the essential role of the aponeurosis identified here.

PMID:34059927 | DOI:10.1007/s00276-021-02759-w

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Limits of ENT surgery: when a multidisciplinary approach is required in skull base, orbit, dental pathologies and head-neck tumours involving skin

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S1-S172. doi: 10.14639/0392-100X-suppl.1-41-2021.

NO ABSTRACT

PMID:34060514 | DOI:10.14639/0392-100X-suppl.1-41-2021

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Limits of ENT surgery: when a multidisciplinary approach is required in skull base, orbit, dental pathologies and head-neck tumours involving skin. Introduction

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S1-S2.

NO ABSTRACT

PMID:34060515

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Management of cerebrospinal fluid leak: the importance of multidisciplinary approach

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S18-S29. doi: 10.14639/0392-100X-suppl.1-41-2021-02.

NO ABSTRACT

PMID:34060517 | DOI:10.14639/0392-100X-suppl.1-41-2021-02

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Border areas in head and neck pathologies: professional liability in the multidisciplinary approach

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S166-S172. doi: 10.14639/0392-100X-suppl.1-41-2021-17.

NO ABSTRACT

PMID:34060532 | DOI:10.14639/0392-100X-suppl.1-41-2021-17

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When is a multidisciplinary surgical approach required in sinonasal tumours with cranial involvement?

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S3-S17. doi: 10.14639/0392-100X-suppl.1-41-2021-01.

NO ABSTRACT

PMID:34060516 | DOI:10.14639/0392-100X-suppl.1-41-2021-01

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Sellar and parasellar lesions: multidisciplinary management

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S30-S41. doi: 10.14639/0392-100X-suppl.1-41-2021-03.

ABSTRACT

INTRODUCTION: The endoscopic endonasal transsphenoidal approach to the sella and parasellar regions is now increasingly used for removal of a variety of lesions localized in the ventral skull base. The advantage of the endoscope is enhanced visualization and improved panoramic view that can result in more complete removal of the tumor. An extensive knowledge of the anatomy is mandatory to approach this region.

MATERIALS AND METHODS: From February 2009 to March 2020, the endoscopic endonasal approach was used in 153 patients with sellar and parasellar lesions, at our Institution: 136 pituitary adenomas, 7 craniopharyngiomas, 3 Rathke's cysts, a tuberculum sellae meningioma, an aneurysm of the internal carotid artery (ICA), a clivus chordoma, a papillary glioneuronal tumor, an histiocytosis, a pituitary metastasis from breast cancer and a chondrosarcoma.

RESULTS: The most common surgical complications were cerebral spinal fluid leak (9), bleeding (2), pituitary abscess (2). Among endocrinological complications, the most important were diabete insipidus (23) and panhypopituitarism (3). Two patients complicated with meningitis. There were no visual worsening and no operative mortality. We had persistence of disease in 20 cases. Twelve patients underwent surgical revision for recurrence of the disease.

CONCLUSIONS: Pre-operative planning and collaboration with several specialists are necessary in order to offer the patient the best treatment, minimizing complications.

PMID:34060518 | DOI:10.14639/0392-100X-suppl.1-41-2021-03

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Multidisciplinary approach to the craniovertebral junction. Historical insights, current and future perspectives in the neurosurgical and otorhinolaryngological alliance

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Acta Otorhinolaryngol Ital. 2021 Apr;41(Suppl. 1):S51-S58. doi: 10.14639/0392-100X-suppl.1-41-2021-05.

NO ABSTRACT

PMID:34060520 | DOI:10.14639/0392-100X-suppl.1-41-2021-05

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