bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathologic Staging of Endometrial Carcinomas: Selected Areas of Difficulty
Authors: McCluggage W. Glenn
Published: January 2018

Accurate staging of cancers is an important determinant of prognosis and guides optimal patient treatment. Although the International Collaboration on Cancer Reporting recommends that endometrial cancers (including carcinosarcomas) are pathologically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 system, in many areas TNM [American Joint Committee on Cancer (AJCC) or Union for International Cancer Control (UICC)] staging is used or even mandated; these latter systems are based on FIGO 2009. In this review, areas of difficulty in the pathologic staging of endometrial carcinomas are covered with practical advice for the reporting pathologist. These include issues regarding the assessment of the depth of myometrial involvement (which may be rendered difficult due to a variety of factors), tumor involvement of adenomyosis, and assessment of cervical and uterine serosal involvement. Although not included in the FIGO staging system, the issue of lymphovascular space invasion (LVSI) is covered as this is of prognostic importance and there are multiple problems in the pathologic assessment of this. One important point is that tumors should not be upstaged based on the presence of LVSI alone without tissue involvement; for example, the presence of LVSI in the outer half of the myometrium or in cervical or adnexal vessels in a carcinoma with myoinvasion confined to the inner half of the myometrium is still FIGO stage IA. The issue of simultaneously occurring tumors of the endometrium and adnexa is also covered with advice on how to distinguish between synchronous independent and metastatic neoplasms of both endometrioid and nonendometrioid types. Recent molecular evidence showing that simultaneously occurring endometrioid carcinomas of the endometrium and ovary are clonal and thus probably represent metastatic disease from the endometrium to the ovary rather than synchronous independent neoplasms, as is widely assumed, is discussed.
NUTM1 Gene Fusions Characterize a Subset of Undifferentiated Soft Tissue and Visceral Tumors
Authors: Dickson Brendan C. , Sung Yun-Shao , Rosenblum Marc K. , Reuter Victor E. , Harb Mohammed , Wunder Jay S. , Swanson David , Antonescu Cristina R.
Published: January 2018

NUT midline carcinoma is an aggressive tumor that occurs mainly in the head and neck and, less frequently, the mediastinum and lung. Following identification of an index case of a NUTM1 fusion positive undifferentiated soft tissue tumor, we interrogated additional cases of primary undifferentiated soft tissue and visceral tumors for NUTM1 abnormalities. Targeted next-generation sequencing was performed on RNA extracted from formalin-fixed paraffin-embedded tissue, and results validated by fluorescence in situ hybridization using custom bacterial artificial chromosome probes. Six patients were identified: mean age of 42 years (range, 3 to 71 y); equal sex distribution; and, tumors involved the extremity soft tissues (N=2), kidney (N=2), stomach, and brain. On systemic work-up at presentation all patients lacked a distant primary tumor. Morphologically, the tumors were heterogenous, with undifferentiated round-epithelioid-rhabdoid cells arranged in solid sheets, nests, and cords. Mitotic activity was generally brisk. Four cases expressed pancytokeratin, but in only 2 cases was this diffuse. Next-generation sequencing demonstrated the following fusions: BRD4-NUTM1 (3 cases), BRD3-NUTM1, MXD1-NUTM1, and BCORL1-NUTM1. Independent testing by fluorescence in situ hybridization confirmed the presence of NUTM1 and partner gene rearrangement. This study establishes that NUT-associated tumors transgress the midline and account for a subset of primitive neoplasms occurring in soft tissue and viscera. Tumors harboring NUTM1 gene fusions are presumably underrecognized, and the extent to which they account for undifferentiated mesenchymal, neuroendocrine, and/or epithelial neoplasms is unclear. Moreover, the relationship, if any, between NUT-associated tumors in soft tissue and/or viscera, and conventional NUT carcinoma, remains to be elucidated.
Architectural Patterns are a Relevant Morphologic Grading System for Clear Cell Renal Cell Carcinoma Prognosis Assessment
Authors: Verine Jérôme , Colin Delphine , Nheb Mary , Prapotnich Dominique , Ploussard Guillaume , Cathelineau Xavier , Desgrandchamps François , Mongiat-Artus Pierre , Feugeas Jean-Paul
Published: January 2018

We developed and validated an architecture-based grading for clear cell renal cell carcinoma (ccRCC) in an observational retrospective cohort study including 506 tumors (principal cohort, n=254; validation cohort, n=252). Study endpoints were disease-free survival (DFS) and cancer-specific survival (CSS). Relationships with outcome were analyzed using Harrell concordance index, time-dependent receiver operating characteristic curve, area under curve, and Cox regression model. An architecture-based grading was devised on positive likelihood ratio (LR+) for DFS at 50 months as follows: grade 1 (LR+<0.8), cystic, compact, acinar, clear cell papillary RCC-like, and/or regressive patterns; grade 2 (1.2≤LR+<5), large nest, alveolar, papillary, chromophobe/oncocytic cell-like, eosinophilic hyaline globule, and/or intratumoral inflammatory reaction patterns; grade 3 (5≤LR+<10), rhabdoid, tumor giant cell, enlarged vascular space, and/or hereditary leiomyomatosis renal cell carcinoma (HLRCC)-like patterns; grade 4 (LR+≥10), sarcomatoid, infiltrative growth patterns, and lymphatic invasion. In the principal cohort, 3-tier (grades 1-2, 3, and 4) and 4-tier architectural scores outperformed World Health Organization/International Society of Urological Pathology, and World Health Organization/ International Society of Urological Pathology+necrosis gradings for DFS and CSS, and constituted an independent predictor for DFS (hazard ratio [HR]=5.91; P<6.7E-10) and CSS (HR=4.49; P=2.2E-03), retained in the localized (pT1-3N0M0) ccRCC subgroup (HR=6.10; P=1.3E-07 for DFS, and HR=20.09; P=9.4E-05 for CSS). On comparing with integrated staging systems, architectural grade with 1 morphologic datum remained an independent predictor of CSS, as did University of California Los Angeles Integrated Staging System and SSIGN, and was associated with the highest HR (HR=2.60; P=9.1E-04 in all patients; HR=4.38; P=2.0E-05 in the localized ccRCC subgroup). Architecture-based score for ccRCC outperforms all other morphologic grading systems and constitutes an independent predictor for DFS and CSS. As the predictive values of 3-tier and 4-tier architecture-based scores were similar throughout the study, we proposed to keep the simplified version as the final score, and to define 3 risk groups as follows: low risk (grades 1 to 2), intermediate risk (grade 3), and high risk (grade 4).
Electronic Communication in Plastic Surgery: Guiding Principles from the American Society of Plastic Surgeons Health Policy Committee
Authors: Eberlin Kyle R. , Perdikis Galen , Damitz Lynn , Krochmal Dan J. , Kalliainen Loree K. , Bonawitz Steven C.
Published: January 2018

Background:

With the advancement of technology, electronic communication has become an important mode of communication within plastic and reconstructive surgery. This can take the form of e-mail, text messaging, video conferencing, and social media, among others. There are currently no defined American Society of Plastic Surgeons guidelines for appropriate professional use of these technologies.

Methods:

A search was performed on PubMed and the Cochrane database; terms included “telemedicine,” “text messaging,” “HIPAA,” “metadata,” “video conferencing,” “photo sharing,” “social media,” “Facebook,” “Twitter,” and “Instagram.” Initial screening of all identified articles was performed; the level of evidence, limitations, and recommendations were evaluated and articles were reviewed.

Results:

A total of 654 articles were identified in the level I screening process; after more comprehensive review, 41 articles fit inclusion criteria: social networking, 12; telemedicine, 11; text messaging, 10; metadata, four; video conferencing, three; and Health Insurance Portability and Accountability Act, one. General themes were identified from these articles and guidelines proposed.

Conclusion:

Electronic communication can provide an efficient method of information exchange for professional purposes within plastic surgery but should be used thoughtfully and with all professional, legal, and ethical considerations.
Effect of Cryopreservation on Human Adipose Tissue and Isolated Stromal Vascular Fraction Cells: In Vitro and In Vivo Analyses
Authors: Zanata Fabiana , Bowles Annie , Frazier Trivia , Curley J. Lowry , Bunnell Bruce A. , Wu Xiying , Wade James , Devireddy Ram , Gimble Jeffrey M. , Ferreira Lydia Masako
Published: January 2018

Background:

Adipose tissue is a source of adipose-derived stromal/stem cells for tissue engineering and reconstruction and a tissue source for fat grafts. Although liposuction is a simple procedure for the harvest of adipose tissue, the repetition of this surgical intervention can cause adverse effects to the patient and can be a limiting factor for immediate use. Cryopreservation can avoid the morbidity associated with repetitive liposuction, allowing the use of stored tissue after the initial harvest procedure. This article focuses on the characterization of fresh and cryopreserved human adipose tissue.

Methods:

Lipoaspirates from eight donors were processed as fresh adipose tissue or cryopreserved for 4 to 6 weeks. Fresh and cryopreserved tissues were collagenase digested and the stromal vascular fraction cells were characterized immediately or cryopreserved. Characterization was based on stromal vascular fraction cell proliferation and immunophenotype. In vivo fat grafting was performed in C57BL/6 green fluorescent protein mice to analyze morphology of the tissue and its adiposity using confocal microscopy, histochemical staining (i.e., hematoxylin and eosin and Masson trichrome), and immunohistochemistry (i.e., green fluorescent protein, perilipin, and CD31).

Results:

Although tissue and stromal vascular fraction cell cryopreservation reduced the total cell yield, the remaining viable cells retained their adhesive and proliferative properties. The stromal vascular fraction cell immunophenotype showed a significant reduction in the hematopoietic surface markers and increased expression of stromal and adipogenic markers following cryopreservation. In vivo cryopreserved fat grafts showed morphology similar to that of freshly implanted fat grafts.

Conclusion:

In this study, the authors demonstrated that cryopreserved adipose tissue is a potential source of stromal vascular fraction cells and a suitable source for fat grafts.
The optimal duration of treatment for skin and soft tissue infections and acute bacterial skin and skin structure infections
Authors: Corcione Silvia , De Rosa Francesco Giuseppe
Published: January 2018

Purpose of review

To summarize the current finding on SSTIs/ABSSSIs treatment duration.

Recent findings

In 2013, the FDA approved the definition of acute bacterial skin and skin structure infections (ABSSSIs). From a clinical point of view, the new definition may present some advantages: the definition of the severity of the disease, the measurement of reduction in lesion size, and effectiveness of treatment primary endpoint at 48–72 h after treatment initiation. New therapeutic options with improved efficacy, safety, and/or pharmacodynamics are available for ABSSSIs and so far, several questions still need to be addressed for the management of these infections, including treatment duration.

There is a wide variation of duration of antimicrobial treatment in skin and soft tissue infections. Plenty of published data available suggest that we should focus on the early response to shorten duration of treatment, and that the antimicrobial stewardship perspective is extremely helpful in underscoring the need for composite outcomes in clinical practice, as multiple tools are available to increase cost-efficacy, including reduction of treatment changes, early oral switch, early discharge (even from the Emergency Department), outpatient antimicrobial treatment, long-acting antibiotics, and all together, de-escalation treatment strategies.
Differentiation of Recurrent/Residual Glioma From Radiation Necrosis Using Semi Quantitative 99mTc MDM (Bis-Methionine-DTPA) Brain SPECT/CT and Dynamic Susceptibility Contrast-Enhanced MR Perfusion
Authors: Rani Nisha , Singh Baljinder , Kumar Narendra , Singh Paramjit , Hazari Puja Panwar , Singh Harpreet , Kumar Ganesh , Radotra Bishan , Kumar Mukesh , Bhattacharya Anish , Sharma Rajnish , Kohli Adarsh , Chhabra Rajesh , Gupta Sunil Kumar , Mishra Anil Kumar
Published: January 2018

Purpose

In this study, 99mTc MDM (bis-methionine-DTPA) SPECT was used for the detection and differentiation of recurrent/residual glioma from radiation necrosis and the results were compared with dynamic susceptibility contrast-enhanced (DSCE)-MRI and clinical findings.

Materials and Methods

Twenty-eight patients (18 men and 10 women; mean ± SD age, 41.4 ± 15.03 years) with histologically proven glioma (grade IV, 14; grade III, 7; grade II, 7) who were planned for postsurgical standard radio/chemo therapy were recruited prospectively. All the patients underwent technetium 99mTc MDM SPECT/CT and DSCE-MRI imaging at 6 months after surgery/radio-chemotherapy, 9 of 28 patients also underwent SPECT imaging at 1 to 2 weeks after surgery.

Results

99mTc MDM SPECT/CT analysis demonstrated significantly higher target to nontarget (T/NT) ratio of the radiotracer in tumor recurrence than in radiation necrosis (3.59 ± 1.70 vs 1.16 ± 0.42). Likewise, the normalized cerebral blood volume (nCBV) values in patients with tumor recurrence were also significantly higher than in radiation necrosis (5.16 ± 2.30 vs 1.63 ± 0.94). A positive correlation (rho = 0.823, P < 0.0001) between T/NT ratios and nCBV was observed. The cutoff T/NT ratios and nCBV values estimated by receiver operating characteristic analysis were greater than 1.50 (area under the curve, 0.944 ± 0.34) and greater than 2.12 (area under the curve, 0.931 ± 0.39), respectively. Combining the results of 99mTc MDM SPECT/CT, DSCE-MRI, and clinical findings, diagnosis of recurrent/residual glioma or radiation necrosis was made in 18 and 10 patients, respectively. Sensitivity and specificity of 2 techniques were comparable, that is, 92.0%: 78.6% for MDM SPECT/CT and of 92.0%: 71.4% for DSCE-MRI, respectively.

Conclusion

Thus, combining MDM SPECT with DSCE MRI may provide an accurate method for differentiation of tumor recurrence from radiation-induced necrosis in glioma patients.
Flare on Serial Prostate-Specific Membrane Antigen–Targeted 18F-DCFPyL PET/CT Examinations in Castration-Resistant Prostate Cancer
Authors: Zukotynski Katherine A. , Valliant John , Bénard François , Rowe Steven P. , Kim Chun K. , Pomper Martin G. , Cho Steve Y.
Published: January 2018

A 71-year-old man with castration-resistant prostate cancer demonstrated a flare phenomenon on 99mTc-MDP and CT after 10 weeks of enzalutamide. Prostate-specific membrane antigen–targeted 18F-DCFPyL PET/CT demonstrated minimal uptake at sites of baseline bone and lymph node disease with increasing uptake at sites of osseous disease following therapy. Although this is likely related in part to decreased androgen receptor activity and a consequent increase in prostate-specific membrane antigen expression, other mechanisms (neovascularization, cell infiltration from the bone repair process, osteoblastic turnover, or minimal radiotracer impurity) may also be involved in causing the increased 18F-DCFPyL uptake at sites of osseous flare.
Anaplastic Thyroid Cancer With Extensive Skeletal Muscle Metastases on 18F-FDG PET/CT
Authors: Yurkiewicz Ilana R. , Ganjoo Kristen N. , Iagaru Andrei
Published: January 2018

A 61-year-old woman with newly diagnosed anaplastic thyroid cancer and known metastases to the brain, lungs, and adrenal glands complained of groin muscle pain. 18F-FDG PET/CT was performed to assess for extent of disease and showed extensive hypermetabolic lesions throughout the skeletal musculature concerning for metastatic disease. As this would be a very rare presentation for anaplastic thyroid carcinoma, a biopsy of the left gluteal muscle was conducted. Pathology demonstrated anaplastic thyroid carcinoma, metastatic to skeletal muscle.
Rare Variant of Intravascular Large B-Cell Lymphoma With Hemophagocytic Syndrome
Authors: Donald Joseph S. , Barnthouse Nick , Chen Delphine L.
Published: January 2018

Intravascular lymphoma (IVL) is a rare subtype of diffuse large B-cell lymphoma characterized by a clonal proliferation of lymphocytes restricted to the intravascular space. We present the case of a 60-year-old man with hemophagocytic syndrome secondary to IVL. 18F-FDG PET/CT demonstrated hepatosplenomegaly with marked diffuse hepatic, splenic, and bone marrow hypermetabolism. The case report illustrates the imaging findings of this uncommon variant of IVL.
Tumor Cystic Necrosis Following Peptide Receptor Radionuclide Therapy in Neuroendocrine Tumors
Authors: Ladwa Rahul , Wen Hong Hooi , Wyld David , Pattison David A. , Burge Matthew
Published: January 2018

The response assessment to peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors is complex. We present the case of a 49-year-old man with metastatic rectal neuroendocrine tumor whose clinical symptoms and response evaluation criteria in solid tumors suggested progressive disease following PRRT. However, 68Ga-DOTA-(Tyr3)-octreotate PET/CT showed a partial scintigraphic response with absence of 18F-FDG PET/CT uptake consistent with tumor cystic necrosis. Long-term follow-up confirmed ongoing tumor response to treatment. Utilizing all modalities of response assessment seems to be important in correctly judging the benefit from PRRT and will need to be incorporated when developing response assessment tools.
Rhabdomyosarcoma Revealed by a Breast Metastasis
Authors: Luporsi Marie , Cassou-Mounat Thibaut , Amiot Henri-Marc , Laurence Valerie , Jehanno Nina
Published: January 2018

A 38-year-old woman was referred for staging of an alveolar rhabdomyosarcoma revealed by a breast metastasis with unknown primary. Whole-body 18F-FDG PET/CT localized the primary tumor as an asymptomatic soft tissue lesion of the right foot with a significant uptake. PET/CT detected hepatic and pancreatic metastases and also showed a multifocal bone marrow involvement, which was not detected by the contrast-enhanced CT. These results led to a significant change in treatment management as the patient received local radiotherapy of the primitive lesion and polychemotherapy.
18F-FDG PET/CT Detected Delayed Endoleak in an Aortoiliac Endovascular Aneurysm Repair
Authors: Kim Byung Jin , Bradley Kevin M. , Subesinghe Manil
Published: January 2018

We present a case of a type Ia endoleak detected using 18F-FDG PET/CT 10 years after an abdominal aortoiliac endovascular aneurysm repair in an 83-year-old man. The 18F-FDG PET/CT scan was performed to evaluate a solitary pulmonary nodule but, in addition, demonstrated unexpected blood pool activity outside the stent graft and within the abdominal aortic aneurysm sac, indicating an endoleak; no FDG activity should be present within the aneurysm sac after stent graft placement. A subsequent CT angiogram confirmed the endoleak. This case illustrates the value of PET/CT in unexpectedly demonstrating this serious, late complication of endovascular aneurysm repair.
Virchow Node From Prostate Carcinoma by 18F-Choline PET/CT
Authors: de la Riva-Pérez Pablo Antonio , García-Gómez Francisco Javier , Buján-Lloret Cristina , Calvo-Morón María de la Cinta , Castro-Montaño Juan
Published: January 2018

18F-choline PET/CT is increasingly being used during the follow-up of prostate cancer and is bringing us valuable information for the delineation of local and distant nodal recurrence in patients with hormone-resistant poorly differentiated cell types. Lymphatic spreading usually involves pelvic and retroperitoneal levels, being unusual at supraclavicular levels. We report a 75-year-old man with unsuspected involvement of Virchow node from prostate cancer observed using 18F-choline PET/CT.
18F-NaF PET/CT Finding in a Patient With Abdominal Discomfort After Schistosomiasis
Authors: Zhang Wei , Chen Li , Wan Qiang , Chen Yue
Published: January 2018

A 77-year-old man with back pain and abdominal distention underwent 18F-NaF PET/CT examination to evaluate potential bone lesions. Multiple foci of increased activity were noted in the chest, which corresponded to bilateral ribs and suggested possible occult fractures. Surprisingly, increased 18F-NaF uptake was observed in the region of pelvis, which corresponded to calcification along the colon wall, a sequela of intestinal Japanese schistosomiasis that the patient experienced 30 years ago.
Primary Spleen Angiosarcoma With Concomitant Hepatic Hemangiomas on 18F-FDG PET/CT
Authors: Zheng Kun , Liu Yu , Cui Ruixue , Li Fang
Published: January 2018

A staging FDG PET/CT was performed for a 43-year-old woman who was suspected to have splenic malignancy with multiple hepatic metastases revealed on CT images. The PET/CT images showed the masses and nodules of spleen had mildly increased uptake of FDG, whereas the uptake by the hepatic lesions was slightly higher. However, the pathologic evaluation demonstrated that splenic lesion was malignant as angiosarcoma, but the hepatic lesions were benign as hemangiomas.
The Distal Stump of the Intramuscular Motor Branch of the Obturator Nerve Is Useful for the Reconstruction of Long-Standing Facial Paralysis Using a Double-Powered Free Gracilis Muscle Flap Transfer
Authors: Uehara Miyuki , Shimizu Fumiaki
Published: January 2018

Background:

Double innervation of the transferred muscle with the contralateral facial nerve and the ipsilateral masseteric nerve has recently been reported by some authors. The aim of this study was to assess the utility of our procedure of double innervation of free gracilis muscle for reconstruction of long-standing facial palsy.

Patients and Methods:

In our department, 6 cases of long-standing facial paralysis (4 cases of complete palsy and 2 of incomplete palsy) were reconstructed using a free gracilis muscle double innervated with the masseteric and contralateral facial nerves. The patient age ranged from 37 to 79 years (average 56.7 ± 15.7). In our procedure, the intramuscular motor branch of the transferred muscle was identified and sutured to the ipsilateral masseteric nerve in an end-to-end fashion, and the obturator nerve of the transferred muscle was sutured to the cross-facial nerve graft, which was coapted with the contralateral facial nerve by end-to-end suturing.

Results:

All patients were followed up for >18 months and recovered their smiling function. The voluntary movement of the transferred muscle with teeth clenching was observed at approximately 4.7 months, and this movement combined with contralateral mouth angle elevation was observed at approximately 9.5 months after the surgery.

Conclusions:

Our experience suggests that the distal stump of the intramuscular motor branch of the obturator nerve may be useful for facial reanimation via double-powered free gracilis muscle flap transfer.
Schwannoma of the Membranous Nasal Septum: a Clinical Report With Aesthetic Approach
Authors: Kim Yong-Ha , Lee Jin Ho , Park Youngsoo , Chung Kyu Jin
Published: January 2018

Schwannoma is an uncommon tumor of nerve sheath that arises from any peripheral, cranial, or autonomic nerve. Only 4% of head and neck schwannomas originate from the sinonasal tract, and a finding of a schwannoma in the nasal septum is exceedingly rare. The authors experienced nasal septal schwannoma with the functional and aesthetic consideration of nasal contour. The authors present an open rhinoplasty approach for nasal septal schwannoma which has not been reported in the previous literature yet.
Unilateral Isolated Hypoglossal Nerve Palsy Caused by Gunshot Injury
Authors: Ozdemir Bulent , Kanat Ayhan , Batcik Sule , Batcik Osman Ersagun , Celiker Metin , Kayayurt Kamil
Published: January 2018

Cranial nerve palsies after gunshot injury are not uncommon. However, in the literature, only 1 patient with isolated hypoglossal nerve paralysis caused by gunshot has been published. The authors describe a 34-year-old man suffering from unilateral isolated hypoglossal nerve palsy caused by gunshot injury as a second reported patient. The bullet entered maxillary sinus, and caused condylar fracture, then ended up C1–2 interspace. The bullet was surgically removed by a posterior approach. It is important to pay attention to hypoglossal nerve injury when confronted with a gunshot wound. The authors recommend early and sufficient surgical decompression.
PVR/CD155 Ala67Thr Mutation and Cleft Lip/Palate
Authors: Vieira Alexandre R. , Letra Ariadne , Silva Renato M. , Granjeiro Jose M. , Shimizu Takehiko , Poletta Fernando A. , Mereb Juan C. , Castilla Eduardo E. , Orioli Iêda M.
Published: January 2018

The 19q13 locus has been linked to cleft lip and palate by our group and independently by others. Here we fine mapped the region in an attempt to identify an etiological variant that can explain cleft lip and palate occurrence. A total of 2739 individuals born with cleft lip and palate, related to individuals born with cleft lip and palate, and unrelated were studied. We used linkage and association approaches to fine map the interval between D19S714 and D19S433 and genotypes were defined by the use of TaqMan chemistry. We confirmed our previous findings that markers in PVR/CD155 are associated with cleft lip and palate. We studied the mutation Ala67Thr further and calculated its penetrance. We also attempted to detect PVR/CD155 expression in human whole saliva. Our results showed that markers in PVR/CD155 are associated with cleft lip and palate and the penetrance of the Ala67Thr is very low (between 1% and 5%). We could not detect PVR/CD155 expression in adult human whole saliva and PVR/CD155 possibly interacts with maternal infection to predispose children to cleft lip only.
Spring-Mediated Cranioplasty in Sagittal Synostosis: Does Age at Placement Affect Expansion?
Authors: Sun James , ter Maaten Netanja S. , Mazzaferro Daniel M. , Wes Ari M. , Naran Sanjay , Bartlett Scott P. , Taylor Jesse A.
Published: January 2018

Purpose:

The aim of this study is to evaluate the effect of timing of surgery and spring characteristics on correction of scaphocephalic deformity in patients undergoing spring-mediated cranioplasty (SMC) for sagittal craniosynostosis.

Methods:

The authors conducted a review of patients with sagittal craniosynostosis who underwent SMC at a tertiary referral center between July 2011 and March 2017, with a primary outcome measure of head shape, both preoperatively and postoperatively, determined by cephalic index (CI). Patient demographics and operative details including timing of surgery and spring characteristics were collected. Differences in CI preoperation and postoperation were compared using Wilcoxon signed-rank test. Ordinary least-squares linear regression was used to assess the impact of timing, number of springs, maximum single spring force, and total spring force on postoperative change in CI.

Results:

Thirty-six subjects (12 males and 24 females) were included in the study. Mean age at spring placement was 3.9 months (range: 1.9–9.2) with a mean follow-up of 1.4 years (range: 0.3–5.2). The mean number of springs used was 3 (range: 2–4). The mean maximum single spring force was 9.9 Newtons (N) (range: 6.9–13.0) and the mean total spring force was 24.6 N (range: 12.7–37.0). Mean CI increased from 70 ± 0.9 preoperatively to 77 ± 1.0 postoperatively (P < 0.001). Age at spring placement was significantly associated with change in CI: for every month increase in age, the change in CI decreased by 1.3 (P = 0.03). The number of springs used, greatest single spring force, and total spring force did not correlate with changes in CI (P = 0.85, P = 0.42, and P = 0.84, respectively).

Conclusion:

In SMC, earlier age at time of surgery appears to correlate with greater improvement in CI, at least in the short-term. While spring characteristics did not appear to affect head shape, it is possible that the authors were underpowered to detect a difference, and spring-related variables likely deserve additional study.
Quantification of Surgical Route Parameters for Exposure of the Jugular Foramen Via a Trans-Mastoidal Approach Exposing Jugular Foramen in Three-Dimensional Visualization Model
Authors: Qian Zeng-Hui , Feng Xu , Li Yang , Tang Ke
Published: January 2018

Objective:

Surgical operation within the region of the jugular foramen presents a great challenge. The authors characterized the quantitative impact of surgical window parameters on the exposure of the jugular foramen via a trans-mastoidal approach.

Methods:

Computed tomography and magnetic resonance imaging data were used to establish a 3-dimensional model of the jugular foramen region. The mastoidale, posterior edge of the mastoid, and the superior edge of the bony external acoustic meatus were selected as points a, b, and c. The anterior edge of the tuberculum jugulare was selected as point d. The midpoints of line segments ab, ac, and bc were selected as points e, f, and g. Triangle abc was divided into triangles aef, beg, cfg, and efg. Surgical corridors of the triangular pyramid were outlined by connecting the above triangles to point d. Anatomic exposure was evaluated by measuring the area and volume of various structures within each route. Statistical comparisons were performed via analysis of variance.

Results:

The model allowed for adequate visualization of all structures. The areas of triangles beg and efg were greater than those of triangles aef and cfg (P < 0.05). The volumes of triangular pyramids d-beg and d-cfg were greater than those of triangular pyramids d-aef and d-efg (P = 0.000). Statistically significant differences were also observed for volumes of osseous, venous, and cranial nerve structures in all divided routes (P = 0.000).

Conclusion:

Our results indicate that 3-dimensional modeling may aid in the quantification of surgical exposure and that division of the craniotomy window may allow for more precise operation.
A New Technique in Surgical Management of the Giant Cerebral Hydatid Cysts
Authors: Aydin Mehmet Dumlu , Karaavci Nuh Cagri , Akyuz Mehmet Emin , Sahin Mehmet Hakan , Zeynal Mete , Kanat Ayhan , Altinors Mehmet Nur
Published: January 2018

Objectives:

In hydatid disease, the central nervous system is affected approximately in 2% to 3% of patients. Surgical management in these patients is important. To develop a surgical technique to avoid the formation of great volume of cavity after hydatid cyst removal and prevent complications associated with brain collapse and cortical convolution.

Patients and Methods:

In 2 patients, hydatid cysts were delivered by this new technique. A balloon filled with 150 cc of sterile air/distilled water was placed in the cavity until the balloon filled the entire cavity. Air/distilled water evacuation was continued at a rate of 20 cc/d and, after a week, eventually, the balloons were removed

Results:

All cysts were delivered without rupture. Neurologic outcomes were good. No complications were observed related to usage of the system such as balloon rupture, evacuation problems, and infection.

Conclusion:

The authors believe that the balloon insertion technique may be a useful method to prevent brain collapse, cortical convolution, and complications associated with this condition. Further technical refinements of the system are needed for better results.
Cone-Beam Computed Tomography-Based Three-Dimensional McNamara Cephalometric Analysis
Authors: Santos Rodrigo Mologni Gonçalves dos , De Martino José Mario , Haiter Neto Francisco , Passeri Luis Augusto
Published: January 2018

This article introduces a method that extends the McNamara cephalometric analysis to produce 3-dimensional (3D) measurement values from cone-beam computed tomography images. In the extended method, the cephalometric landmarks are represented by 3D points; the bilateral cephalometric landmarks are identified on both sides of the skull; the cephalometric lines, with the exception of the facial axis, are represented by 3D lines; the cephalometric planes, with the exception of the facial plane, are represented by planes; the effective mandibular length, the effective midfacial length, and the lower anterior facial height are measured as 3D point-to-point distances; the nasion perpendicular to point A, the pogonion to nasion perpendicular, the upper incisor to point A vertical, and the lower incisor to point A-pogonion line are measured each as components of a vector; the facial axis angle is measured as a line-to-plane angle; and the mandibular plane angle is measured as a plane-to-plane angle. As a result, the method provides real effective lengths of the maxilla and mandible on both sides of the skull; real height of the lower anterior face; directed distances from the point A to the nasion perpendicular, from the pogonion to the nasion perpendicular, from the left and right upper incisor to the point A vertical, and from the left and right lower incisor to the point A-pogonion line for both the lateral and posteroanterior views of the skull; and real angles of the facial axis and the mandibular plane. Additionality, the method enables the identification of craniofacial asymmetries.
Bone-Conditioned Medium Obtained From Calvaria, Mandible, and Tibia Cause an Equivalent TGF-β1 Response In Vitro
Authors: Hatami Kia Babak , Mendes João Rui Galvão , Müller Heinz-Dieter , Heimel Patrick , Gruber Reinhard
Published: January 2018

Bones with different embryological origin and mode of ossification are supposed to vary in their capacity for supporting graft consolidation. The aim of the current pilot study was to assess the TGF-β1 activity of bone chips obtained from distinct anatomic locations. Conditioned medium was prepared from bone chips harvested from pig calvaria, mandible, and tibia. Human oral fibroblasts were exposed to bone-conditioned medium (BCM) followed by reverse transcriptase polymerase chain reaction of the TGF-β1 target genes. Also an immunoassay for interleukin 11 (IL-11) and TGF-β1 was performed. The impact of BCM on alkaline phosphatase activity was determined with murine MC3T3-E1 osteogenic cells. The authors report here that BCM contains TGF-β1 in the ng/mL range. Bone chips prepared from pig calvaria, mandible, and tibia femur had a similar capacity for increasing the expression of the TGF-β1 target genes IL-11, NOX4, and PRG4. Correspondingly, immunoassays revealed similar production of IL-11 by human oral fibroblasts. Furthermore, conditioned medium obtained from the 3 bones decreased alkaline phosphatase activity in MC3T3-E1 osteogenic cells. These preliminary data demonstrate that particulated bone grafts, regardless of embryological origin, mode of ossification and morphology, release a similar TGF-β1 activity.
Intraoral Prosthetic Chin Augmentation With Vertical Incisions
Authors: Yin Jiapeng , Fan Shuqiang , Wu Xuhong , Pan Shi , Liao Lixin , Jin Guojun
Published: January 2018

To explore a new surgical approach for chin augmentation using a prosthesis with 3 intraoral vertical incisions whereby placement of the prosthesis is more convenient and accurate, with fewer postoperative complications. Following the anatomic characteristics of the chin, a bilateral mucosal vertical incision and a median observation incision are made. The V-shaped mark on the upper side of the prosthesis can be seen through the observation incision after it is placed from the lateral incision into the predesigned compartment. The incision can be sutured if there is no bleeding in the operation area. Surgery performed in all 19 patients with mild microgenia with 6 to 12 months of follow-up resulted in satisfactory chin and face shape without any complications. The application of this novel method can correct McCarthy type I microgenia with more accurate positioning, less possibility of bilateral sideways and/or up/down movement, and fewer complications.
Effects of Platelet-Rich Fibrin Membrane on Sciatic Nerve Regeneration
Authors: Bayram Burak , Akdeniz Sidika Sinem , Diker Nurettin , Helvacioğlu Fatma , Erdem Saban Remzi
Published: January 2018

Alternative treatment approaches to improve the regeneration capacity of damaged peripheral nerves are currently under investigation. The objective of the present study was to evaluate the effects of platelet-rich fibrin (PRF) membrane after sciatic nerve crush injury in rabbits by histomorphometric and electromyographic analysis. The left sciatic nerves of 20 male Vienna rabbits were clamped for 30 seconds to induce crush injuries. Animals were randomly divided into 2 groups: PRF and control. For each animal in the PRF group, a PRF membrane was wrapped around the injured part of the sciatic nerve to form a tube. No additional treatment was performed in the control group. After a 12-week healing period, tissue samples from the injured nerve region were harvested and the g-ratio of axons, axon density, and impulse transmission changes were evaluated. Analysis revealed that axon density differences were not statistically significant between groups (P = 0.139). The rate of nerve fibers with optimum g-ratio was significantly lower in the PRF group than in the control group (P = 0.02). Conduction velocity differences between groups were not statistically significant. Although PRF application has previously shown positive regeneration effects on maxillofacial tissues, local PRF membrane application in tube form did not show any histomorphometric or functional improvement in peripheral nerve crush injury recovery.
The First Patient Report of Tongue Abscess Among Iraqi Population
Authors: Al-Anee Auday M. , Asmael Huda Moutaz
Published: January 2018

Tongue abscess is a serious clinical entity which scarcely affects the tongue. It should be treated urgently to prevent airway obstruction or dissemination of infection to a more deep or distant area of the body. This article presented the first clinical report of tongue abscess in Iraq which discussed its clinical presentation, diagnosis, and treatment with a review of literature.
Reliability of the Dutch Cleft Speech Evaluation Test and Conversion to the Proposed Universal Scale
Authors: Spruijt Nicole E. , Beenakker Marije , Verbeek Maud , Heinze Zavira C.M. , Breugem Corstiaan C. , Mink van der Molen Aebele B.
Published: January 2018

The Dutch cleft speech evaluation test (DCSET) has been implemented by the speech-language pathologists nationwide in the Netherlands since 2003, but the inter- and intrarater reliability was unknown. Two speech-language pathologists experienced in evaluating cleft speech assessed audio recordings of 20 children with cleft speech using the DCSET, and reassessed the recordings 2 weeks later. Intra- and interrater reliability was calculated, but found to be unacceptable after the first phase of this study using audio recordings. Following consensus training and some modifications in the scoring scales, the study was repeated using video recordings of 20 different children with cleft speech. Results from the second phase of this study using standardized video recordings showed fair, moderate, and good reliability on different subsets of the DCSET. Intrarater reliability (Kappa 0.59–1.00) was greater than interrater reliability (Kappa 0.33–0.79). Interrater reliability agreement was good (Kappa 0.63–0.79) for consonant production errors and speech understandability and acceptability, moderate (Kappa 0.59) for the resonance of the nasal passage, and fair (Kappa 0.33–0.37) for the resonance of the mixed and denasal passages. Subsequently, an algorithm was made to convert the DCSET scales to universal scales for international comparison of cleft speech as suggested by Henningsson et al in 2008.
Nasal Columellar Reconstruction With Reverse Lateral Nasal Artery Pedicled Nasolabial Island Flap
Authors: Jang Suk Yoon , Kim Woo Seob , Kim Han Koo , Bae Tae Hui
Published: January 2018

Nasal columellar is a complex area to reconstruct due to its unique esthetic and functional characteristics. Malignancy, trauma, infection, and esthetic surgery complications can cause columellar defect. Among many surgical plans, nasolabial island flap is most commonly used. However, flap congestions occasionally occur which inevitably lead to leech therapy. The authors introduce reverse lateral nasal artery pedicled nasolabial island flap, which has lower risk of postoperative complications.
Radiological Analysis of Orbital Cavernous Hemangiomas: A Review and Comparison Between Computed Tomography and Magnetic Resonance Imaging
Authors: Young Stephanie Ming , Kim Yoon-Duck , Lee Jung Hye , Woo Kyung In
Published: January 2018

Cavernous hemangiomas are the most common benign orbital tumors in the orbit, but radiological differentiation from other solitary orbital masses can still be challenging at times. While there have been previous studies describing the radiological characteristics of cavernous hemangiomas on computed tomography (CT) and magnetic resonance imaging (MRI), there have not been any studies comparing the 2 imaging modalities. The purpose of our study was to evaluate CT and MRI findings of orbital cavernous hemangiomas and compare both modalities.

We performed a cross-sectional study of patients with a histopathological diagnosis of cavernous hemangioma over a 20-year period from January 1997 to December 2016 in a single tertiary institution.

Our study included 77 patients; mean age was 46.6 ± 11.2 years, and females comprised 68.8%. The lateral orbit (23.4%) was the most common location. The masses were well-defined, with 55.8% being ovoid, 27.3% round, and 16.9% lobulated. The most common enhancement pattern on CT was a small point starting in the periphery, progressing to heterogeneous filling in the late phase. The most common enhancement pattern on MRI was multiple patchy starting points, widespread across the tumor, with a final homogeneous filling in the late phase.

Significant differences between CT and MRI were found in terms of area, location, and number of starting points of contrast enhancement in the early phase. We also found that the use of MRI is limited in differentiating fast-filling cavernous hemangiomas from other orbital tumors and in such cases, contrast-enhanced CT would be helpful.
Quality of Postoperative Pain Management After Maxillofacial Fracture Repair
Authors: Peisker Andre , Meissner Winfried , Raschke Gregor F. , Fahmy Mina D. , Guentsch Arndt , Schiller Juliane , Schultze-Mosgau Stefan
Published: January 2018

Background:

Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail.

Materials and Methods:

In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients’ characteristics and pain-related parameters.

Results:

Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021).

Conclusions:

Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.
Eyebrow Position and Shape Favored by Korean Women
Authors: Jung Gyu Sik , Chung Ki Ho , Lee Jeong Woo , Yang Jung Dug , Chung Ho Yun , Cho Byung Chae , Choi Kang Young
Published: January 2018

Purpose:

The shape and position of the eyebrows are among the most important facial features from an esthetic point of view. However, significant cultural differences exist with respect to the eyebrow shape and position that are considered ideal. The purpose of this study was to identify the position and shape of eyebrows preferred by Korean women and to apply these, including forehead lifts, to the clinics.

Methods:

The authors took full facial photographs in the Frankfort plane of Korean women aging from young childhood to their 50s. On the basis of these, 2 parameters were calculated: first, the height-to-width ratio (HWR), the ratio between the vertical distance from the brow apex to the palpebral fissure and the horizontal distance from the medial canthus to the lateral canthus; and second, the takeoff angle (TOA), the angle between the straight line connecting the 2 lateral canthi and the line from the brow apex through the center of the medial brow segment. The authors then had drawings of “Anastasia arch” eyebrows made; as high eyebrows are considered beautiful in Korea, and the eyebrows of women in their 20s were the highest, the drawings depicted the mean HWR and TOA values for this age group and their various degrees of deviation. These drawings were shown to 300 women aged 21 to 40 years from May 1 to June 30, 2014; they were instructed to choose the drawing they preferred among the 5 drawings differing in HWR and again among the 5 differing in TOA.

Results:

Among the 99 Korean women in their 20s, the mean HWR and TOA was 1:1.01 ± 0.23 and 12° ± 5.2°, respectively. Regarding the survey, the most preferred HWR was 1:1.0, which was selected by 204 respondents (68%); the most preferred TOA was 10°, which was chosen by 122 respondents (40.7%).

Conclusion:

This study shows that HWR gradually decreases and TOA increases with age. Furthermore, Korean women's preferred eyebrows have an HWR of ∼1:1 and a TOA of ∼10°. These results could guide plastic surgeons performing periorbital rejuvenation surgeries, including brow lifts, not only for Koreans but also for North-East Asians.