bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Gastroenteritis Disease Burden in Infants With Medical Risk Conditions in the Netherlands
Authors: van Dongen Josephine A. P. , Rouers Elsbeth D. M. , Schuurman Rob , Bonten Marc J. M. , Bruijning-Verhagen Patricia
Published: November 2020

Background:

Infants with medical risk conditions are vulnerable to childhood infections including acute gastroenteritis (AGE). To guide prevention programs, we quantified AGE incidence, severity and virus prevalence among medical risk infants in the Netherlands.

Methods:

This prospective cohort-study was part of the RIVAR-project recruiting infants with prematurity, low birth weight or severe congenital conditions in 13 hospitals. Follow-up included 18 monthly health questionnaires detailing AGE symptoms and healthcare usage. Parents were also instructed to notify when an infant developed AGE, to collect a stool sample and complete a daily severity score (Modified Vesikari Severity). Stool samples were analyzed by real-time polymerase chain reaction for rotavirus, norovirus, adenovirus and astrovirus.

Results:

Between November 2014 and October 2017, 631 infants participated during 9125 person-months of observation. In total, 559 episodes were identified. The mean AGE incidence rate was 73.5 per 100 person-years (PY) (95% confidence interval: 67.6–79.9) and increased with age [incidence rate: 48.3 (39.8–58.3) vs. 80.2 (73.0–88.1)/100 PY for ages 1–5 vs. 6–18 months, respectively]. Healthcare was attended for 38.1% (213/559) and 26.8% (68/254) were classified as severe based on the Modified Vesikari Severity. Stool samples were obtained from 254 AGE episodes. Norovirus was identified in 65 (25.6%) and rotavirus in 44 (17.7%). Adenovirus and astrovirus together accounted for 8.3% (N = 21). Severe AGE occurred most frequently in rotavirus positive episodes.

Conclusion:

The observed AGE incidence, severity and healthcare usage among medical risk infants confirms substantial disease burden. Norovirus and rotavirus are the dominant pathogens and severe episodes occurred most frequently in children with rotavirus infection. AGE prevention in medical risk infants should be prioritized.
IgG4-related Disease Presenting as Isolated Cicatrising Conjunctivitis
Authors: Cameron Cassie A. , Juniat Valerie , Mills Richard A. D. , Hughes Tiffany , Klebe Sonja , Selva Dinesh
Published: November 2020

A 46-year-old male presented with a 12-month history of trichiasis and was found to have significant, progressive cicatrization of the tarsal conjunctiva causing entropion of the upper and lower eyelids. A biopsy confirmed the diagnosis of IgG4-related cicatrizing conjunctivitis in the absence of any other organ involvement, a previously unreported manifestation of this immune-mediated disease.
Mortality Patterns Among Industrial Workers Exposed to Chloroprene and Other Substances
Authors: Marsh Gary M. , Kruchten Adam , Buchanich Jeanine M.
Published: November 2020

Objectives:

To update the U.S. portion of an historical cohort mortality study of workers with potential exposure to chloroprene (CD) and vinyl chloride (VC) with focus on lung and liver cancer.

Methods:

Subjects were 6864 workers from two sites with vital status determined through 2017 for 99% of subjects and cause of death for 97.2% of deaths. Historical exposures to CD and VC were estimated quantitatively. We performed external and internal mortality comparisons.

Results:

External comparisons revealed mostly deficits in deaths; internal comparisons revealed no consistent evidence of exposure-response relationships with CD or VC.

Conclusions:

Our update continues to support the conclusion that the risk of death from lung or liver cancer is unrelated to exposure to CD or VC at levels experienced by workers in the two U.S. sites.
Bempedoic acid as adjunct for traditional lipid-lowering therapy in patients with hyperlipidaemia
Authors: Schimmenti Chiara , Sucato Vincenzo , Manzone Elvira , Cancellieri Giulia , Mortillaro Francesca , Novo Giuseppina , Galassi Alfredo Ruggero , Venturella Fabio
Published: November 2020

Statin therapy has been the cornerstone for the reduction of cholesterol and circulating low-density lipoprotein (LDL) in patients with cardiovascular diseases. However, statin monotherapy has disadvantages attributable to myopathies and to the insufficient cholesterol reduction observed in some patients. There is a need for new well-tolerated therapies for lowering LDL. This review will focus on bempedoic acid in combination with traditional statin therapy or other lipid-lowering agents and its emerging role in LDL-C lowering. Bempedoic acid is also a viable alternative for reducing LDL cholesterol in the treatment of some patients suffering from heterozygous familial hypercholesterolemia.
The impact of normal range estimated glomerular filtration rate on mortality in selected patients undergoing coronary angiography – a long-term follow-up
Authors: Zornitzki Lior , Sadon Sapir , Wenkert Atalia , Steinvil Arie , Konigstein Maayan , Ben-Shoshan Jeremy , Kliuk-Ben Bassat Orit , Sirota Svetlana , Halkin Amir , Bazan Samuel , Finkelstein Ariel , Banai Shmuel , Arbel Yaron
Published: November 2020

Background

Estimated glomerular filtration rate (eGFR) predicts mortality and adverse cardiovascular events in people with chronic kidney disease. The significance of eGFR within the normal range and its long-term effect on clinical adverse events is unknown. We examined the effect of normal range or mildly reduced eGFR on long-term mortality in a large prospective registry.

Methods

The study included consecutive patients undergoing clinically-driven coronary angiography who had an eGFR ≥60 ml/min/1.73 m2. Baseline clinical characteristics were assessed, and patients were followed-up for the occurrence of all-cause mortality. Cox regression analysis was used to evaluate the impact of eGFR.

Results

A total of 4186 patients were recruited. Median follow-up time was 2883 days (7.9 years). Mean age was 62.0 ± 11.3 years with 77.4% males. Clinical presentation included acute coronary syndrome and stable angina. In a multivariable model adjusted for possible confounding factors, decreasing eGFR within the normal and mildly reduced range was inversely associated with long-term all-cause mortality with a hazard ratio (HR) of 1.32 for every decrease of 10 ml/min/1.732 in eGFR. Compared to eGFR > 100 ml/min/1.732, there was a graded association between lower eGFR values and increased long term mortality with a HR of 1.16 (0.59–2.31) for eGFR 90–100 ml/min/1.732, HR 1.54 (0.81–2.91) for eGFR 80–90 ml/min/1.732, HR 2.62 (1.41–4.85) for eGFR 70–80 ml/min/1.732 and HR 2.93 (1.58–5.41) for eGFR 60–70 ml/min/1.732.

Conclusion

eGFR within the normal and mildly reduced range is an independent predictor of long-term all-cause mortality in selected patients undergoing clinically driven coronary angiography.
A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks
Authors: Gjeorgjievski Mihajlo , Imam Zaid , Cappell Mitchell S. , Jamil Laith H. , Kahaleh Michel
Published: November 2020

Background:

Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.

Objective:

To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.

Design:

A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to “endoscopic,” “leak,” “sleeve,” “gastrectomy,” “anastomotic,” and “bariatric” were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.

Results:

Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise.

Conclusion:

Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
High Rates of Mortality in Geriatric Patients Admitted for Inflammatory Bowel Disease Management
Authors: Schwartz Jeffrey , Stein Daniel J. , Lipcsey Megan , Li Brian , Feuerstein Joseph D.
Published: November 2020

Goal:

The goal of this study was to evaluate the inpatient mortality risk among geriatric patients with inflammatory bowel disease (IBD).

Background:

The challenges of caring for elderly patients with IBD will increase with the aging of the US population. Given the complications of hospitalization, we set to examine if elderly patients age older than 65 were at higher risk of mortality.

Materials and Methods:

All patients with ulcerative colitis (UC) or Crohn’s disease (CD) in the National Inpatient Sample (NIS) from 2016 and 2017 as the primary diagnosis or secondary diagnosis with an IBD-related cause of admission were included. Outcomes for patients aged above 65 were compared with below 65 using multivariable survey-adjusted regression. CD and UC were analyzed separately.

Results:

In 2016-2017, there were an estimated 162,800 admissions for CD and related complications compared with 96,450 for UC. In total, 30% of UC and 20% of CD admissions were geriatric. Geriatric status was associated with higher odds of mortality for CD [odds ratio (OR)=3.47, 95% confidence interval (CI): 2.72-4.44] and UC (OR=2.75, 95% CI: 2.16-3.49) after adjustment for comorbidities, admission type, hospital type, inpatient surgery, and IBD subtype. The cause of death was ∼80% infectious in both CD and UC in all groups. An average of 0.19 days (95% CI: 0.05-0.34) and $2467 (95% CI: 545-4388) increase was seen for geriatric CD patients. No significant change was seen for UC.

Conclusions:

Age over 65 was independently associated with higher odds of death in both UC and CD patients, even after appropriate adjustment. Further research is needed to optimize care for this growing patient population.
Lipoprotein (a) and diabetes mellitus: causes and consequences
Authors: Ward Natalie C. , Vickneswaran Shayimeera , Watts Gerald F.
Published: November 2020

Purpose of review

This review provides an update on the role of lipoprotein (a) [Lp(a)] in diabetes, including its impact as a risk factor as well as its contribution to the development of cardiovascular disease.

Recent findings

Although a specific role for Lp(a) has not yet been conclusively established, it appears to have an inverse association with risk of diabetes. Several population-based studies have demonstrated associations between low levels of Lp(a) and increased risk of type 2 diabetes, but Mendelian randomization studies do not consistently support causality. Conversely, in patients with type 2 diabetes, elevated Lp(a) levels are associated with an increased risk of cardiovascular events.

Although Lp(a) contributes to the development of cardiovascular disease in patients with diabetes, few trials have investigated the benefits of reducing Lp(a) within this patient population. Furthermore, guidelines do not specifically address the risk associated with elevated Lp(a) levels. Despite this, Lp(a) should be measured in patients with diabetes and considered when evaluating their overall risk burden.
Usefulness of radiographic targeting on the evaluation of the location of a patency capsule using abdominal ultrasonography
Authors: Handa Osamu , Shiotani Akiko , Handa Yukiko , Fukushima Shinya , Osawa Motoyasu , Murao Takahisa , Matsumoto Hiroshi , Umegaki Eiji , Hata Jiro
Published: November 2020

Background and aim

The usefulness of a radio-tag-free PillCam patency capsule (PatCap) has been reported to evaluate the patency of the small intestine. If the PatCap is not excreted within 33 h, the location of the failed PatCap must be confirmed. Although several methods for locating the failed PatCap have been reported, a universal method has not been established. In this study, we aimed to confirm the clinical feasibility of abdominal ultrasonography combined with abdominal X-ray in the determination of the location of a failed PatCap.

Patients and methods

Consecutive patients who were scheduled to undergo the capsule endoscopy and had received PatCap examination between July 2012 and September 2019 were retrospectively analyzed. Failed PatCap was assessed using ultrasonography combined with abdominal X-ray.

Results

Among the eligible 250 patients, 129 retrieved the PatCap in their stool within 33 h after ingestion. Among the remaining 121 patients, abdominal X-ray was performed and the PatCaps were suspected to be in the small bowel in 57 patients. Among these 57 patients, abdominal ultrasonography identified 17 PatCaps in the small bowel. Among the selected 250 patients, 233 patients (93.2%) were eligible for capsule endoscopy examination, while 17 patients (6.8%) were not eligible. Capsule endoscopy passed through the small intestine without any incident.

Conclusion

We confirmed that the abdominal ultrasonography with a radiographic targeting of the PatCap location is a reliable indicator to avoid the risk of capsule endoscopy retention or impaction and can be performed in most hospitals and clinics.
Comparing Mortality of Peritoneal and Hemodialysis Patients in an Era of Medicare Payment Reform
Authors: Wang Virginia , Coffman Cynthia J. , Sanders Linda L. , Hoffman Abby , Sloan Caroline E. , Lee Shoou-Yih D. , Hirth Richard A. , Maciejewski Matthew L.
Published: November 2020

Background:

Prior studies have shown peritoneal dialysis (PD) patients to have lower or equivalent mortality to patients who receive in-center hemodialysis (HD). Medicare’s 2011 bundled dialysis prospective payment system encouraged expansion of home-based PD with unclear impacts on patient outcomes. This paper revisits the comparative risk of mortality between HD and PD among patients with incident end-stage kidney disease initiating dialysis in 2006–2013.

Research Design:

We conducted a retrospective cohort study comparing 2-year all-cause mortality among patients with incident end-stage kidney disease initiating dialysis via HD and PD in 2006–2013, using data from the US Renal Data System and Medicare. Analysis was conducted using Cox proportional hazards models fit with inverse probability of treatment weighting that adjusted for measured patient demographic and clinical characteristics and dialysis market characteristics.

Results:

Of the 449,652 patients starting dialysis between 2006 and 2013, the rate of PD use in the first 90 days increased from 9.3% of incident patients in 2006 to 14.2% in 2013. Crude 2-year mortality was 27.6% for patients dialyzing via HD and 16.7% for patients on PD. In adjusted models, there was no evidence of mortality differences between PD and HD before and after bundled payment (hazard ratio, 0.96; 95% confidence interval, 0.89–1.04; P=0.33).

Conclusions:

Overall mortality for HD and PD use was similar and mortality differences between modalities did not change before versus after the 2011 Medicare dialysis bundled payment, suggesting that increased use of home-based PD did not adversely impact patient outcomes.
Great nephrologists begin with great teachers: update on the nephrology curriculum
Authors: Raff Amanda C.
Published: November 2020

Purpose of review

The purpose of this review is to highlight developments and opportunities in the nephrology curriculum from the basic science foundation years through teaching medical students, residents and fellows in the clinical realm.

Recent findings

Teaching skills are a vital tool for nephrologists both to promote excellent patient care and attract talented learners to the field. Exposure to dynamic and inspiring nephrologists is one of the main factors given by students and residents for selecting a career in nephrology. Nephrology teaching, including case discussions, problem-based learning, team-based learning and flipped classrooms, provides motivating active learning for medical students and is equally effective for didactics in graduate medical education. Avenues for teaching in the clinical realm include the microskills framework, bedside teaching and grounding in evidence-based medicine. Areas of growth include blended nephrology/subspecialty fields as well as social media applications.

Medical education is a satisfying and exciting area of growth in the field of nephrology. The recent literature provides a framework for best practices in active learning as well as providing numerous examples of educational interventions and innovations. In addition, this field is ripe for further development and scholarly activity.
Liver fat storage pathways: methodologies and dietary effects
Authors: Roumans Kay H.M. , Basset Sagarminaga Jeremy , Peters Harry P.F. , Schrauwen Patrick , Schrauwen-Hinderling Vera B.
Published: November 2020

Purpose of review

Nonalcoholic fatty liver is the result of an imbalance between lipid storage [from meal, de novo lipogenesis (DNL) and fatty acid (FA) uptake] and disposal (oxidation and VLDL output). Knowledge on the contribution of each of these pathways to liver fat content in humans is essential to develop tailored strategies to prevent and treat nonalcoholic fatty liver. Here, we review the techniques available to study the different storage pathways and review dietary modulation of these pathways.

Recent findings

The type of carbohydrate and fat could be of importance in modulating DNL, as complex carbohydrates and omega-3 FAs have been shown to reduce DNL. No effects were found on the other pathways, however studies investigating this are scarce.

Techniques used to assess storage pathways are predominantly stable isotope techniques, which require specific expertise and are costly. Validated biomarkers are often lacking. These methodological limitations also translate into a limited number of studies investigating to what extent storage pathways can be modulated by diet. Further research is needed to elucidate in more detail the impact that fat and carbohydrate type can have on liver fat storage pathways and content.
Robotic radical perineal prostatectomy: tradition and evolution in the robotic era
Authors: Minafra Paolo , Carbonara Umberto , Vitarelli Antonio , Lucarelli Giuseppe , Battaglia Michele , Ditonno Pasquale
Published: November 2020

Purpose of review

To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms.

Recent finding

The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients’ morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer.

Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
Urethra-sparing minimally invasive simple prostatectomy: an old technique revisited
Authors: Cardoso Andreia , Lima Estevao
Published: November 2020

Purpose of review

The aim of this study was to review recent development in urethra and ejaculation preserving laparoscopic and robotic simple prostatectomy.

Recent findings

Since Madigan prostatectomy original description in 1990, to recent reports of robotic-assisted surgery using this urethra-sparing technique, many studies have suggested the advantages of the preservation of urethra, bladder neck and ejaculatory ducts, when removing adenomatous tissue in benign prostatic obstruction (BPO) surgery. Allying anatomical preservation of this structure with the well known benefits of minimally invasive procedures seems to reduce postoperative haematuria, obviating the need for bladder irrigation, with shorter catheterization and hospitalization times, less risk of urethral stricture and, of utmost importance, reducing rates of retrograde ejaculation.

Urethra and bladder neck sparing techniques, especially in minimally invasive simple prostatectomy procedures, seem to provide real benefits, not only in the maintenance of preoperative potency and antegrade ejaculation but also accomplishing better perioperative outcomes, with faster patient recovery, and less complications. These techniques might well be the future standard techniques for sexually active men with large benign prostatic hyperplasia (BPH) requiring surgery.
Spindle-cell (Sarcomatoid) Variant of Cutaneous Anaplastic Large-cell Lymphoma (C-ALCL)
Authors: Gru Alejandro A. , Bhagat Govind , Subtil Antonio , Raghavan Shyam S. , Pulitzer Melissa , Chung Catherine , Sangueza Martin , Plaza Jose A.
Published: November 2020

Cutaneous anaplastic large-cell lymphoma (C-ALCL) represents one of the entities within the group of CD30-positive lymphoproliferative disorders of the skin. Most cases are ALK-negative, though isolated cases of ALK-positive C-ALCL have also been reported. By definition, the diagnosis of C-ALCL requires the expression of CD30 in >75% of the cells. Histopathologically, C-ALCL shows a dermal-based nodular and circumscribed proliferation of large pleomorphic cells with vesicular nuclei, prominent nucleoli, and eosinophilic cytoplasm, including hallmark cells. Since 1990, isolated case reports of a so-called “sarcomatoid” variant have been published in the literature. Herein, we present a series of 11 cases of spindle (sarcomatoid) C-ALCL, with comprehensive histopathologic, immunophenotypic, and molecular data. Spindle C-ALCL represents a potential mimicker of malignant mesenchymal or hematopoietic tumors in the skin and should always be considered in the differential diagnosis when assessing cutaneous pleomorphic spindle cell neoplasms.
Genomic Profiling of Low-grade Intramedullary Cartilage Tumors Can Distinguish Enchondroma From Chondrosarcoma
Authors: Joseph Nancy M. , McGill Kevin C. , Horvai Andrew E.
Published: November 2020

Low-grade intramedullary cartilage tumors include enchondroma and grade 1 chondrosarcoma. Classification based on radiopathologic correlation guides treatment, typically observation for asymptomatic enchondroma and surgery for chondrosarcoma. However, some tumors elude classification because radiographic and morphologic findings are equivocal. To date, no ancillary tests are available to aid the diagnosis of such indeterminate or suspicious tumors. We investigated the genomic landscape of low-grade cartilage tumors to determine the profile. We studied 10 each enchondroma, grade 1 chondrosarcoma, and suspicious cartilage neoplasms, respectively, by capture-based next-generation sequencing targeting 479 cancer genes and copy number. In enchondroma, IDH1 or IDH2 hotspot activating mutations and/or COL2A1 alterations were identified in 70% and 60% of cases, respectively; copy number changes were rare (20%). Suspicious cartilage neoplasms had frequent hotspot mutations in IDH1 or IDH2 and alterations in COL2A1 (90% and 70%, respectively); copy number changes were rare (20%). Overall, 80% of suspicious cartilage neoplasms were genomically indistinguishable from enchondroma. In contrast, 20% of chondrosarcoma had IDH1 or IDH2 alterations, 100% demonstrated alteration of COL2A1, and 70% had genomes with numerous copy number gains and losses. In total, 80% of chondrosarcomas demonstrated additional pathogenic mutations, deep deletions, or focal amplifications in cancer genes, predominantly CDKN2A. These results demonstrate distinct genomic profiles of enchondroma and grade 1 chondrosarcoma. Further, sequencing may aid in the correct classification of diagnostically challenging tumors. Additional pathogenic alterations (such as in CDKN2A) or numerous copy number gains or losses would support a diagnosis of chondrosarcoma although the absence of such findings does not exclude the diagnosis.
Rethinking Upper Blepharoplasty: The Impact of Pretarsal Show
Authors: Alghoul Mohammed S. , Bricker Jonathan T. , Venkatesh Vishnu , Gupta Aakash R. , Vaca Elbert E. , Sinno Sammy , Ellis Marco F. , Mustoe Thomas A.
Published: November 2020

Background:

Conventional upper blepharoplasty relies on skin, muscle, and fat excision to restore ideal pretarsal space–to–upper lid fold ratios. The purpose of this study was to identify presenting topographic features of upper blepharoplasty patients and their effect on cosmetic outcomes.

Methods:

This is a retrospective review of patients who underwent upper blepharoplasty at the authors’ institution from 1997 to 2017. Preoperative and postoperative photographs were standardized using Adobe Illustrator to an iris diameter of 11.5 mm. Pretarsal and upper lid fold heights were measured at five locations. Patients were classified into three groups based on preoperative pretarsal show: none, partial, or complete. Photographs were randomized in PowerPoint and given a cosmetic score of 0 to 5 by four independent reviewers.

Results:

Three hundred sixteen patients were included, 42 men (13 percent) and 274 women (87 percent). Group 1 included 101 eyes (16 percent), group 2 had 159 eyes (25 percent), and group 3 had 372 eyes (59 percent). Mean cosmetic score increased from 1.75 to 2.38 postoperatively (p < 0.001), with a significantly lower improvement in scores in group 3 compared to groups 2 and 1 for both sexes (p < 0.01). For group 3, those with midpupil pretarsal heights greater than 4 mm had a significantly lower postoperative aesthetic score (1.95) compared with those less than or equal to 4 mm (2.50) (p < 0.001).

Conclusions:

Many patients presenting for upper blepharoplasty have complete pretarsal show and are at risk for worse cosmetic outcomes using conventional skin excision techniques. Adjunctive procedures such as fat grafting and ptosis repair should be considered in this group.

Clinical Question/Level of Evidence:

Risk, II.
A Novel Approach in the Surgical Management of Nasal Tip Hemangiomas: A 26-Year Experience
Authors: Akinbiyi Takintope , Jackson Oksana A. , Nguyen Phuong D. , Low David W.
Published: November 2020

Infantile hemangiomas are common benign tumors of infancy with a predilection for the face. Nasal-tip hemangiomas, termed the “Cyrano deformity,” can have especially devastating psychological effects. The ideal surgical approach and timing for these patients is unclear, as numerous designs have been reported in the literature. The authors present a novel approach to nasal tip reconstruction involving an algorithmic approach to incision selection and leaving a thin rim of hemangioma tissue under the dermis after debulking to minimize skin envelope atrophy. Nineteen cases were treated with the senior author’s preferred method, with a mean age of 3.3 years and follow-up of 2.5 years. At follow-up, 10 patients were deemed by the senior author to have a very good aesthetic result, and the remaining nine patients were deemed to have an excellent one. The results of this study suggest that surgical intervention as early as 3 to 4 years of age is safe and provides good aesthetic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction
Authors: Levy-Lambert Dina , Ramly Elie P. , Kantar Rami S. , Alfonso Allyson R. , Levine Jamie P.
Published: November 2020

Background:

Congestive heart failure affects 6.2 million people in the United States. Patients have a decreased cardiopulmonary reserve and often suffer from peripheral edema, important considerations in lower extremity reconstructive surgery. In this study, the authors sought to determine the impact of congestive heart failure on postoperative outcomes following lower extremity pedicled flap reconstruction using a national multi-institutional database.

Methods:

The authors isolated all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent lower extremity pedicled flap reconstruction from 2010 to 2016. Preoperative, intraoperative, and postoperative variables were compared between patients with and without congestive heart failure. Multivariable regressions were performed to determine the independent effect of congestive heart failure on postoperative outcomes.

Results:

The authors identified 1895 patients who underwent lower extremity pedicled flap reconstruction, of whom 34 suffered from congestive heart failure. No significant difference was observed between patients with versus without congestive heart failure in postoperative wound complications (superficial wound infection, deep wound infection, and wound dehiscence), renal failure, or readmission. On multivariable analysis, congestive heart failure was independently associated with increased cardiopulmonary complications (i.e., myocardial infarction, cardiac arrest, pneumonia, reintubation, and failed ventilator weaning) (OR, 3.92; 95 percent CI, 1.53 to 9.12), septic events (OR, 4.65; 95 percent CI, 2.05 to 10.02), and length of hospital stay (β, 0.37; 95 percent CI, 0.01 to 0.72).

Conclusions:

In patients undergoing lower extremity pedicled flap reconstruction, congestive heart failure independently predicts a four-fold increase in postoperative sepsis and cardiopulmonary complications and a significantly increased length of hospital stay. The authors’ findings highlight the need for heightened perioperative vigilance and medical optimization in this high-risk population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Syngeneic Transplantation of Rat Olfactory Stem Cells in a Vein Conduit Improves Facial Movements and Reduces Synkinesis after Facial Nerve Injury
Authors: Bense Fanny , Montava Marion , Duclos Célia , Bisson Aurélie , Delarue Quentin , Mardion Nicolas Bon , Boyer Olivier , Féron François , Guérout Nicolas , Marie Jean-Paul
Published: November 2020

Background:

Posttraumatic facial paralysis is a disabling condition. Current surgical management by faciofacial nerve suture provides limited recovery. To improve the outcome, the authors evaluated an add-on strategy based on a syngeneic transplantation of nasal olfactory stem cells in a rat model of facial nerve injury. The main readouts of the study were the recording of whisking function and buccal synkinesis.

Methods:

Sixty rats were allocated to three groups. Animals with a 2-mm facial nerve loss were repaired with a femoral vein, filled or not with olfactory stem cells. These two groups were compared to similarly injured rats but with a faciofacial nerve suture. Olfactory stem cells were purified from rat olfactory mucosa. Three months after surgery, facial motor performance was evaluated using video-based motion analysis and electromyography. Synkinesis was assessed by electromyography, using measure of buccal involuntary movements during blink reflex, and double retrograde labeling of regenerating motoneurons.

Results:

The authors’ study reveals that olfactory stem cell transplantation induces functional recovery in comparison to nontransplanted and faciofacial nerve suture groups. They significantly increase (1) maximal amplitude of vibrissae protraction and retraction cycles and (2) angular velocity during protraction of vibrissae. They also reduce buccal synkinesis, according to the two techniques used. However, olfactory stem cell transplantation did not improve axonal regrowth of the facial nerve, 3 months after surgery.

Conclusions:

The authors show here that the adjuvant strategy of syngeneic transplantation of olfactory stem cells improves functional recovery. These promising results open the way for a phase I clinical trial based on the autologous engraftment of olfactory stem cells in patients with a facial nerve paralysis.
Patient Reviews: Yelp, Google, Healthgrades, Vitals, and RealSelf
Authors: Furnas Heather J. , Korman Joshua M. , Canales Francisco L. , Pence Logan D.
Published: November 2020

Background:

Online reviews play a significant role in influencing a patient’s choice of a plastic surgeon. The purpose of this article is to help the practicing plastic surgeon understand reviews and review websites.

Methods:

A review of both the medical literature and online blogs was performed to identify the most current information pertinent to plastic surgeons.

Results:

Negative reviews can impact a potential patient’s decision on where to seek plastic surgery, and the best way to dilute that impact is to attract good reviews. Good reviews result from running an excellent practice, and patient surveys can help identify and address problems. The qualities of each of the seven online patient review websites are summarized, along with practice advice on how to attract reviews and how to deal with fake, fraudulent, and negative reviews.

Conclusions:

Reviews impact plastic surgeons, whether or not they are aware of what patients are saying about them online. This article helps plastic surgeons become familiar with how to use reviews for practice growth and how to protect their online reputation.
Low Agreement Between Initial and Revised European Consensus on Definition and Diagnosis of Sarcopenia Applied to People Living With HIV
Authors: Oliveira Vitor H.F. , Borsari Ana L. , Cárdenas José David G. , Alves Junior Claudio M. , Castro Noemy F. , Marinello Poliana C. , Padilha Camila S. , Webel Allison R. , Erlandson Kristine M. , Deminice Rafael
Published: November 2020

Background:

In 2019, the European Working Group on Sarcopenia in Older People (EWGSOP2) proposed low muscle strength as the primary outcome for sarcopenia diagnosis instead of low muscle mass, as proposed in 2010 (EWGSOP1). Therefore, the aim of this study was to compare the prevalence of sarcopenia using both EWGSOP1 and EWGSOP2 operational definitions in people living with HIV (PLHIV) and to determine the agreement and correlation between different tests proposed by EWGSOP2.

Setting:

Cross-sectional study, where 302 PLHIV (151 men), 51.7 ± 9.0 years old were evaluated for the presence of sarcopenia using both EWGSOP1 and EWGSOP2 operational definitions.

Methods:

Appendicular skeletal muscle was estimated using bioimpedance analysis. Handgrip strength, chair stand, gait speed, and static balance were used as muscle function measures. Agreement was determined using Cohen kappa and Pearson correlation coefficient was calculated.

Results:

Sarcopenia prevalence was 4.3% using EWGSOP1 and 1.0% using EWGSOP2. Agreement for sarcopenia diagnosis between EWGSOP1 and EWGSOP2 was fair (k = 0.37, P < 0.01). From the 13 cases of sarcopenia diagnosed using EWGSOP1, only 3 cases (23.1%) were also diagnosed using EWGSOP2. A medium correlation (r = −0.32, P < 0.01) and poor agreement (k = 0.14, P < 0.01) between muscle strength tests (handgrip strength and chair stand) were observed. Concordance between handgrip and chair stand was observed in 11 participants only, whereas 65 participants were considered to have low muscle strength using chair stand but not using handgrip.

Conclusions:

Lower sarcopenia prevalence using EWGSOP2 and low agreement between EWGSOP1 and EWGSOP2 operational definitions in diagnosing sarcopenia were observed in PLHIV.
68Ga–Prostate-Specific Membrane Antigen PET/CT Uptake in Intraventricular Meningioma in the Choroid Plexus
Authors: Junqueira Matheus Zanelatto , Rocha Nelisa Helena , Sapienza Marcelo Tatit
Published: November 2020

A 68-year-old man in whom a prostate cancer biochemical recurrence was being investigated was referred for a full-body 68Ga–prostate-specific membrane antigen PET/CT. Focal uptake in a lesion on the choroid plexus projection was detected. Patient had no neurological complaints. A previous MRI performed 4 years ago showed the same lesion. According to the location and radiological and clinical characteristics, the diagnosis of meningioma was defined. The interpretation of prostate-specific membrane antigen PET/CT must take into account the low frequency of metastases in sites such as the central nervous system, and the possibility of intense uptake in lesions unrelated to prostate cancer.
Comparative Performance of 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT Imaging in Patients With Parkinson’s Disease, Parkinson-Plus Syndrome, and Essential Tremor
Authors: Sood Apurva , Shukla Jaya , Shree Ritu , Vatsa Rakhee , Modi Manish , Mittal Bhagwant Rai
Published: November 2020

Purpose

The aim of this study was to assess the utility of presynaptic dopaminergic imaging using 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT and compare their performance in Parkinson’s disease (PD), Parkinson-plus syndrome (PPS), and essential tremor (ET).

Patients and Methods

A total of 103 patients (PD = 48, PPS = 19, and ET = 36) were enrolled prospectively. Hoehn and Yahr (H&Y) staging and MDS-UPDRS (Movement Disorder Society–Sponsored Revision of Unified Parkinson’s Disease Rating Scale) were done for PD and PPS cases. All the patients underwent 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT brain scan. The scans were analyzed visually and semiquantitatively. Average pixel count and SUVmean of the striatum were calculated in SPECT and PET images, respectively, to calculate the specific uptake ratio of striatum (SUR). Comparison of scan findings and SURs among different groups and correlation with clinical characteristics was done.

Results

Symmetrical comma-shaped uptake was seen in bilateral striatum in ET cases with mean SURs significantly higher than in cases of early PD (H&Y stage I and II, n = 37), PD and PPS both on SPECT and PET images (P ≤ 0.001). The mean SURs between PD and PPS showed no significant difference (SPECT, P = 0.17; PET, P = 0.61). Substantial agreement (weighted κ = 0.659) was found between 99mTc-TRODAT-1 and 18F-FDOPA for the detection of presynaptic dopaminergic dysfunction. Specific uptake ratio of striatum correlation between SPECT and PET was statistically significant (r = 0.67; P < 0.01). A negative but nonsignificant correlation was found between the SURs and H&Y staging/MDS-UPDRS.

Conclusions

Both 99mTc-TRODAT-1 SPECT/CT and 18F-FDOPA PET/CT showed substantial agreement and proved to be potential imaging biomarker for the detection of dopaminergic dysfunction, thus assisting in differentiating early PD/PD and PPS from ET cases.
Clinical Assessment of 177Lu-DOTATATE Quantification by Comparison of SUV-Based Parameters Measured on Both Post-PRRT SPECT/CT and 68Ga-DOTATOC PET/CT in Patients With Neuroendocrine Tumors
Authors: Thuillier Philippe , Maajem Meriem , Schick Ulrike , Blanc-Beguin Frédérique , Hennebicq Simon , Metges Jean-Philippe , Salaun Pierre-Yves , Kerlan Véronique , Bourhis David , Abgral Ronan
Published: November 2020

Introduction

The aim of this study was to study the feasibility of an SUV-based 177Lu-DOTATATE SPECT/CT quantification and to assess the correlation of different parameters with the corresponding measured on 68Ga-DOTATOC PET/CT in patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (WD-GEP-NET) treated with peptide receptor radionuclide therapy.

Patients and Methods

Patients with WD-GEP-NET who benefited from a pretherapeutic 68Ga-DOTATOC PET/CT and a 177Lu-DOTATATE SPECT/CT after the cycle 1 of peptide receptor radionuclide therapy were prospectively included. SPECT/CT acquisitions were performed on a system calibrated with a conversion factor of 9.48 counts/MBq per second and were reconstructed with an iterative algorithm allowing quantification using the SPECTRA Quant software (MIM Software, Cleveland, OH). For each patient, different SUV parameters were recorded on both PET/CT (Ga parameters) and SPECT/CT (Lu parameters) for comparison: physiological uptakes (liver/spleen), tumor uptake (1–10/patient; SUVmax, SUVmean, SUVpeak, MTV), tumor-to-liver and tumor-to-spleen ratios according to liver/spleen SUVmax and SUVmean (TLRmax, TLRmean, TSRmax, and TSRmean, respectively).

Results

Ten patients (8 female; 2 male) aged from 50 to 83 years presenting with a metastatic progressive WD-GEP-NET (7 small intestine, 2 pancreas, 1 rectum) were included. Median values of lesional Lu-SUV were significantly lower than the corresponding Ga-SUV (P < 0.001), whereas median values of lesional Lu-MTV, Lu-TLR, and Lu-TSR were significantly higher than the corresponding Ga-MTV, Ga-TLR, and Ga-TSR (P < 0.02). Pearson correlation coefficients were strong for both SUV and MTV parameters (0.779–0.845), weak for TLR parameters (0.365–0.394), and moderate-to-strong for TSR parameters (0.676–0.750).

Conclusions

Our results suggest the feasibility of 177Lu-DOTATATE SPECT/CT quantification in clinical practice and show a strong correlation of several SUV-based parameters with the corresponding in 68Ga-DOTATOC PET/CT.
Rapidly Evolving Diffuse Omental Carcinomatosis of Prostate Cancer in 68Ga-PSMA PET/CT
Authors: Hoberück Sebastian , Sommer Ulrich , Grey Arne , Hölscher Tobias , Baretton Gustavo Bruno , Kotzerke Jörg
Published: November 2020

An 81-year-old man received androgen deprivation therapy for a locally advanced prostate cancer and, 6 months later, a curative radiation therapy. Half a year later, the patient presented with a steeply increased PSA value (32 ng/mL) and a suppressed testosterone level (0.48 nmol/L). The consecutively performed 68Ga-PSMA PET/CT revealed, besides local tumor remains and several PSMA-positive lymph node and soft tissue metastases, an extensive, diffuse PSMA ligand accumulation in the omentum, which was immunohistochemically proven to be a carcinomatosis of prostate cancer. None of the extraprostatic lesions were present in the pretherapeutic PSMA PET 1 year ago.
68Ga-DOTATATE Uptake in Primary Breast Cancer
Authors: Guirguis Mary S. , Adrada Beatriz E. , Surasi Devaki Shilpa , Dryden Mark J.
Published: November 2020

68Ga-DOTA peptides have revolutionized the imaging of neuroendocrine tumors because the agents are specific to somatostatin receptors. However, other tumors, including breast cancer, have been shown to express somatostatin receptors. We present the case of a 74-year-old woman with primary cardiac paraganglioma, who was found to have 68Ga-DOTATATE activity in the breast on staging PET/CT. Subsequent breast imaging workup and biopsy confirmed primary invasive lobular breast cancer, which was not 18F-FDG–avid on prior FDG PET/CT. Our case is in alignment with prior studies that suggest that 68Ga-DOTA peptides may play a future role in imaging breast cancer patients.
Resolution of Pulmonary Cement Embolism After Treatment of Rivaroxaban on Ventilation/Perfusion SPECT Image
Authors: Kim Hae Won , Kim Hyun Jung
Published: November 2020

A 73-year-old woman took a chest radiography for medical check-up, and pulmonary cement embolism was diagnosed. She had undergone percutaneous vertebroplasty. Ventilation-perfusion imaging revealed V/Q mismatched perfusion defect on the lung. Then, she has taken rivaroxaban (orally active direct factor Xa inhibitor) for 6 months and took follow-up V/Q scan. It revealed the disappearance of previous 2 of 3 moderate V/Q mismatches. There are controversies in the role of anticoagulation in treatment of pulmonary cement embolism, and this case shows functional recovery through the perfusion scan after anticoagulation treatment.
FDG PET/CT in Recurrent Glioblastoma Multiforme With Leptomeningeal and Diffuse Spinal Cord Metastasis
Authors: Malik Dharmender
Published: November 2020

Glioblastoma multiforme is one of the most common malignant types of tumor arising from the central nervous system known for its devastating intracranial progress and dismal prognosis. Macroscopically evident and symptomatic spinal cord metastasis detected with FDG PET/CT imaging is a rare event. We present a rare case of symptomatic diffuse spinal metastases of glioblastoma multiforme in a 25-year-old woman, who has been previously treated surgically with gross tumor resection followed by adjuvant radiotherapy and chemotherapy with temozolomide.
Altered Biodistribution of 68Ga-DOTATOC
Authors: Dupont Anne-Claire , Borrelly Fanny , Lecomte Thierry , Maia Serge , Santiago Ribeiro Maria-Joao
Published: November 2020

68Ga-DOTATOC PET/CT of a patient with metastatic neuroendocrine tumor reveals an abnormal biodistribution of the tracer with a vascular binding and a very low fixation on the known lesions despite the temporary discontinuation of “cold” somatostatin analogs. A possible interaction with a high intake of turmeric may be suspected by inhibition of hepatic uptake process.
68Ga-DOTANOC PET/CT With Lung Involvement in the Era of COVID-19 Pandemic
Authors: Morón Sarai , González Eliana , Rojas Julián
Published: November 2020

Patient was a 55-year-old man with history of pancreas neuroendocrine tumor grade 2, Ki-67 index 10%. He was treated with surgical resection. 68Ga-DOTANOC PET/CT was performed as part of follow-up of known disease. The images showed opacities in both lungs’ parenchyma with moderate uptake of radiotracer and mediastinal lymph nodes with high uptake suggestive of infection. Two weeks before a high-resolution CT was performed, these findings in the lungs were not present. The patient was asymptomatic and was referred to the emergency department for reverse transcriptase–polymerase chain reaction COVID-19 test, and the result was positive.
Ptosis With Aberrant Facial Nerve Regeneration Following Bell Palsy
Authors: Anh Vu Thi Que , Kim Joohyun , Jang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun
Published: November 2020

Bell palsy is the most common lesion affecting the facial nerve. Aberrant facial nerve regeneration following facial nerve palsy may cause facial nerve synkinesis and ptosis. The authors present a 65-year-old male who suffered from left peripheral facial nerve palsy in 2017. During the recovery period, he had moderate ptosis in primary gaze, and he also noted left upper eyelid closure when he tried to blow something or puff his cheeks. Neurologic examination was normal except for the synkinetic movements as described above. Surgery was planned with an attempt to resect a part of the orbicularis oculi muscle (OOM) to decrease the synkinetic eyelid closure. In addition, the levator muscle was advanced for treatment of the ptosis. Before surgery, an electromyography study by a neurologist showed normal activity of the OOM but failed to demonstrate the relationship between this muscle and other muscles due to technique failure. However, after surgery electromyography studies of the facial and orbicularis oris muscle suggested that cheek puffing produced contraction in the OOM. During follow-up time, the patient was satisfied with the surgical results. To the best of our knowledge, this is the first report to describe ptosis with aberrant facial synkinesis during cheek puffing was treated with surgery.