bluuebunny/crossref_metadata_2025 huggingface dataset:
Bypass Surgery for Complex Intracranial Aneurysms: 15 Years of Experience at a Single Institution and Review of Pertinent Literature
Authors: Ban Seung Pil , Cho Won-Sang , Kim Jeong Eun , Kim Chang Hyeun , Bang Jae Seung , Son Young-Je , Kang Hyun-Seung , Kwon O-Ki , Oh Chang Wan , Han Moon Hee
Published: June 2017

BACKGROUND

Bypass surgery is a treatment option for complex intracranial aneurysms.

OBJECTIVE

To determine the utility of bypass surgery for the treatment of complex intracranial aneurysms and to review the literature on this topic.

METHODS

Sixty-two patients were included in this retrospective study. Unruptured aneurysms were dominant (80.6%), and the internal carotid artery was the most common location of the aneurysm (56.4%), followed by the middle cerebral artery (21.0%). The mean maximal diameter of the aneurysms was 20.5 ± 11.4 mm. The clinical and angiographic states were evaluated preoperatively, immediately after surgery (within 3 days) and at the last follow-up. The mean angiographic and clinical follow-up duration was 34.2 ± 38.9 and 46.5 ± 42.5 months, respectively.

RESULTS

Sixty-one patients (98.3%) underwent extracranial–intracranial bypass, and 1 underwent intracranial–intracranial bypass. At the last follow-up angiography, 58 aneurysms (93.5%) were completely obliterated and 4 were incompletely obliterated, with a graft patency of 90.3%. Surgical mortality was 0 and permanent morbidity was 8.1%. A good clinical outcome (Karnofsky Performance Scale ≥ 70 and modified Rankin Scale score ≤ 2) was achieved in 91.9% of patients (n = 57).

CONCLUSION

With a proper selection of bypass type, bypass-associated treatment can be a good alternative for patients with complex intracranial aneurysms when conventional microsurgical clipping or endovascular intervention is not feasible.
Long-Term Evolutionary Change in the Lumen of Intracranial Atherosclerotic Stenosis Following Angioplasty and Stenting
Authors: Yu Simon C H , Lau Tiffany W W , Wong Simon S M , Lee Kwok T , Wong Lawrence K S , Leung Thomas W H
Published: June 2017

BACKGROUND

Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis.

OBJECTIVE

To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting.

METHODS

This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]).

RESULTS

Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P < .001; 80 mo: median gain 42.9% vs 7.2%, P < .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss.

CONCLUSION

Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment.
Diagnostic Accuracy of Somatosensory Evoked Potential Monitoring in Evaluating Neurological Complications During Endovascular Aneurysm Treatment
Authors: Ares William J , Grandhi Ramesh M , Panczykowski David M , Weiner Gregory M , Thirumala Parthasarathy , Habeych Miguel E , Crammond Donald J , Horowitz Michael B , Jankowitz Brian T , Jadhav Ashutosh , Jovin Tudor G , Ducruet Andrew F , Balzer Jeffrey
Published: June 2017

BACKGROUND

Somatosensory evoked potential (SSEP) monitoring is used extensively for early detection and prevention of neurological complications in patients undergoing many different neurosurgical procedures. However, the predictive ability of SSEP monitoring during endovascular treatment of cerebral aneurysms is not well detailed.

OBJECTIVE

To evaluate the performance of intraoperative SSEP in the prediction postprocedural neurological deficits (PPNDs) after coil embolization of intracranial aneurysms.

METHODS

This population-based cohort study included patients ≥18 years of age undergoing intracranial aneurysm embolization with concurrent SSEP monitoring between January 2006 and August 2012. The ability of SSEP to predict PPNDs was analyzed by multiple regression analyses and assessed by the area under the receiver operating characteristic curve.

RESULTS

In a population of 888 patients, SSEP changes occurred in 8.6% (n = 77). Twenty-eight patients (3.1%) suffered PPNDs. A 50% to 99% loss in SSEP waveform was associated with a 20-fold increase in risk of PPND; a total loss of SSEP waveform, regardless of permanence, was associated with a greater than 200-fold risk of PPND. SSEPs displayed very good predictive ability for PPND, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.92).

CONCLUSION

This study supports the predictive ability of SSEPs for the detection of PPNDs. The magnitude and persistence of SSEP changes is clearly associated with the development of PPNDs. The utility of SSEP monitoring in detecting ischemia may provide an opportunity for neurointerventionalists to respond to changes intraoperatively to mitigate the potential for PPNDs.
An Analysis of the Use of Multichannel Microelectrode Recording During Deep Brain Stimulation Surgeries at a Single Center
Authors: Falowski Steven , Dierkes James
Published: June 2017

BACKGROUND

Microelectrode recording (MER) can be used to map out the target nucleus and identify ideal lead placement.

OBJECTIVE

To assess the use of multichannel MER to increase the efficiency of lead placement without compromising patient safety.

METHODS

Analysis of a single center's technique for utilizing multichannel MER with 3 consistent anterior-to-posterior simultaneous passes that include an evaluation of the location of final lead placement, patient diagnosis, target nuclei, and additional work involved for refinement of targeting. Lead revision rates and rate of hemorrhage are also assessed.

RESULTS

There were a total of 237 lead placements in 123 patients over a 4-yr period. In 4.2% of lead placements, additional planning was required, while only 2.5% required additional MER. The lead placement matched 51.3% of the time in bilateral placements and was consistent regardless of target nuclei. In 84.8% of cases, the final lead placement was within the initial 3 MER passes. An additional 11.3% could be placed without the need for an additional pass. There were 2 lead revisions and no hemorrhage or stroke complications.

CONCLUSION

This series demonstrates that our technique of multichannel MER leads to accurate and efficient lead placement maintaining its safety profile.
First Report of Rose rosette virus Associated with Rose Rosette Disease in Rosa hybrida in Minnesota
Authors: Bratsch Sara , Zlesak David , Mollov Dimitre , Lockhart Benham
Published: June 2017

A Rosa hybrida plant was identified with rose rosette disease symptoms and was positive for Rose rosette virus (RRV) by reverse transcription PCR. It is important to monitor routinely roses for RRV symptoms and to test and rogue symptomatic plants. This is the first report of RRV infecting roses in Minnesota.
Year-to-Year Incidence of Cranberry Fruit Rot and Persistence of Fungal Pathogens
Authors: Wells-Hansen Lindsay D. , McManus Patricia S.
Published: June 2017

Cranberry fruit rot is a disease complex comprised of as many as 15 fungal species. Current management recommendations are to spray broad-spectrum fungicides every year in regions such as New Jersey where fruit rot incidence is high on a consistent basis. By contrast, in regions such as Wisconsin, where economic losses from fruit rot occur sporadically, many growers forego fungicide sprays, but if faced with a serious fruit rot outbreak they then spray fungicides intensively the following year to prevent a recurrence of disease. This recommendation is based on the untested assumption that left unchecked, fruit rot incidence will increase and that the predominant fruit rot pathogens will persist from one year to the next. Field studies conducted over 3 years showed that in New Jersey fruit rot incidence increased or remained high and fruit rot pathogens persisted from one year to the next. By contrast, in Wisconsin fruit rot incidence decreased or remained low, and the persistence of pathogens was inconsistent from one year to the next. Thus, in Wisconsin, fruit rot incidence and fungal species present in one year do not reliably predict the disease situation in the following year, a finding that should be considered when planning fungicide spray programs.
Economic Evaluations of Strategies to Prevent Hospital-Acquired Pressure Injuries
Authors: Ocampo Wrechelle , Cheung Amanda , Baylis Barry , Clayden Nancy , Conly John M. , Ghali William A. , Ho Chester H. , Kaufman Jaime , Stelfox Henry T. , Hogan David B.
Published: June 2017

GENERAL PURPOSE:

To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs).

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After participating in this educational activity, the participant should be better able to:

1. Identify the purpose and methods used for this study.

2. Compare costs and effectiveness related to preventative strategies for PIs.

BACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective.

OBJECTIVE: The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments.

DATA SOURCES: Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic Reviews

SELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered.

DATA EXTRACTION: Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed.

DATA SYNTHESIS: The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered.

CONCLUSIONS: Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors’ review revealed a need for additional high-quality studies that adhere to commonly used standards of both currently utilized and emerging ways to prevent hospital-acquired PIs.
Multiple Cerebral Infarcts in a Young Patient Associated With Marijuana Use
Authors: Volpon Leila Costa , Sousa Camila Lacerda Muniz de Melo , Moreira Silvia Keiko Kavaguti , Teixeira Sara Reis , Carlotti Ana Paula de Carvalho Panzeri
Published: June 2017

Cerebrovascular events associated with marijuana use have been reported previously. This association is plausible, but not well-established yet. A 14-year-old girl, long-term heavy cannabis user, presented with generalized tonic-clonic seizures and decreased level of consciousness a few hours after smoking cannabis. Brain magnetic resonance imaging showed multiple areas of acute, subacute and chronic ischemic lesions in the left frontal lobe, basal ganglia, and corpus callosum. History of other illicit drug use and other known causes of stroke were ruled out. Cannabis might cause stroke through direct effects on the cerebral blood circulation, orthostatic hypotension, vasculitis, vasospasm, and atrial fibrillation. Long-term daily use of marijuana in young people may cause serious damage to the cerebrovascular system.
Hybrid Blocks for Total Knee Arthroplasty: A Technical Description
Authors: Johnston David F. , Sondekoppam Rakesh V. , Uppal Vishal , Howard James L. , Ganapathy Sugantha
Published: June 2017

Introduction:

This narrative review article aims to examine current evidence of knee innervation in order to develop a technique of targeting pure sensory innervation of the knee joint without compromising motor function.

Methods:

A literature review of knee innervation was performed to gain an anatomic understanding of terminal sensory branches of the relevant target nerves (femoral, obturator, sciatic, and lateral femoral cutaneous).

Results:

Pure sensory block of the knee joint is challenging due to important contributions from themuscular innervation close to the joint and the variability of nerves afferents contained within and around the adductor canal.

Conclusion:

On the basis of this anatomic knowledge we describe an ultrasound-guided 3-injection hybrid technique that represents a balance between preserving adequate motor power while still providing analgesia in a simple method.
Liver X Receptor α Is Involved in Counteracting Mechanical Allodynia by Inhibiting Neuroinflammation in the Spinal Dorsal Horn
Authors: Xu Jing , Feng Yi-Wei , Liu Ling , Wang Wei , Zhong Xiong-Xiong , Wei Xu-Hong , Liu Xian-Guo
Published: June 2017

Background

Liver X receptors, including α and β isoforms, are ligand-activated transcription factors. Whether liver X receptor α plays a role in neuropathic pain is unknown.

Methods

A spared nerve injury model was established in adult male rats and mice. Von Frey tests were performed to evaluate the neuropathic pain behavior; Western blot and immunohistochemistry were performed to understand the underlying mechanisms.

Results

Intrathecal injection of a specific liver X receptor agonist T0901317 or GW3965 could either prevent the development of mechanical allodynia or alleviate the established mechanical allodynia, both in rats and wild-type mice. GW3965 could inhibit the activation of glial cells and the expression of tumor necrosis factor-α (mean ± SD: 196 ± 48 vs. 119 ± 57; n = 6; P < 0.01) and interleukin 1β (mean ± SD: 215 ± 69 vs. 158 ± 74; n = 6; P < 0.01) and increase the expression of interleukin 10 in the spinal dorsal horn. All of the above effects of GW3965 could be abolished by liver X receptor α mutation. Moreover, more glial cells were activated, and more interleukin 1β was released in the spinal dorsal horn in liver X receptor α knockout mice than in wild-type mice after spared nerve injury. Aminoglutethimide, a neurosteroid synthesis inhibitor, blocked the inhibitory effect of T0901317 on mechanical allodynia, on the activation of glial cells, and on the expression of cytokines.

Conclusions

Activation of liver X receptor α inhibits mechanical allodynia by inhibiting the activation of glial cells and rebalancing cytokines in the spinal dorsal horn via neurosteroids.
Three-dimensional True Spine Length: A Novel Technique for Assessing the Outcomes of Scoliosis Surgery
Authors: Spurway Alan J. , Hurry Jennifer K. , Gauthier Luke , Orlik Ben , Chukwunyerenwa Chukwudi K. , Kishta Waleed E. , El-Hawary Ron
Published: June 2017

Background:

Current assessment of spine growth for patients undergoing growth friendly surgical treatment for early-onset scoliosis (EOS) is the use of serial, 1-dimensional standard-of-care coronal vertical spine height (SoCVH) measurements. Any growth of the spine out of the coronal plane is missed by the SoCVH, which may underestimate the actual growth of the spine. This study set to validate the novel 3-dimensional true spine length (3DTSL) radiographic measurement technique for measuring growth of EOS patients.

Methods:

3DTSL measurement accuracy, reliability, and repeatability was assessed using 10 physical model configurations. In addition, interrater and intrarater reliabilities (IRRs) were assessed using interclass coefficient (ICC) analyses of 23 retrospective EOS patient clinical radiographs. 3DTSL measurements were compared with SoCVH measurements.

Results:

The model assessment showed excellent accuracy with a mean error of 1.2 mm (SD=0.9; range, 0.0 to 3.0) and mean ICC of 0.999.

IRR ICCs of the clinical radiographs averaged 0.952 for the 3DTSL and 0.975 for the vertical height whereas IRRs averaged 0.944 and 0.965, respectively (all P<0.001).

Mean clinical 3DTSL curve lengths were 193.9 mm (SD=30.0; range, 142.8 to 276.8), whereas the SoCVH averaged 156.1 mm (SD=29.7; range, 74.7 to 207.3). The mean difference between the matched 3DTSL and SoCVH measurements was 37.8 mm (SD=21.4; range, 1.3 to 95.4) and was statistically significant (P<0.0001). On average, the 3DTSL of the measured spines was 124.2% of the measured SoCVH, with a progressive difference as the Cobb or kyphosis angles increased.

Conclusions:

The novel 3DTSL measurement is accurate, repeatable, and complements the current growth assessments for EOS treatments.

Level of Evidence:

Level II—diagnostic study—development of a diagnostic criteria on basis of consecutive patients, with gold standard.
Evaluation of the Tibial Tubercle to Posterior Cruciate Ligament Distance in a Pediatric Patient Population
Authors: Clifton Blake , Richter Dustin L. , Tandberg Dan , Ferguson Matthew , Treme Gehron
Published: June 2017

Background:

Evaluation of distal extensor mechanism alignment continues to evolve in children with patella instability. Prior studies support the use of the tibial tubercle to trochlear groove (TT-TG) distance but limitations exist for this measurement including: changes in the TT-TG distance with knee flexion, difficulty with finding the deepest part of a dysplastic trochlea, and limitations regarding identification of the site of the anatomic abnormality. The tibial tubercle-posterior cruciate ligament (TT-PCL) distance has been introduced as an alternative measure to address the shortcomings in the TT-TG distance by quantifying the position of the TT independent of the trochlea and with respect to the tibia only. The objectives of this study were to (1) confirm that TT-PCL measurements in the pediatric population are reliable and reproducible; (2) determine whether normal TT-PCL distance changes with age; and (3) compare TT-PCL distances in patients with and without patellar instability to assess its utility in the workup of pediatric patellar instability.

Methods:

All knee magnetic resonance imaging performed for patients from birth to 15.9 years of age at our institution between December 2004 and February 2012 were retrospectively collected (total 566). Eighty-two patients had patellar instability and 484 patients did not have patellar instability. Two magnetic resonance imaging reviewers measured TT-PCL distance on T2-weighted axial images in a blinded manner. Intraobserver and interobserver agreement was measured. Correlation between TT-PCL distance and age as well as group differences between mean TT-PCL distances was evaluated.

Results:

Intraobserver and interobserver agreement was excellent (0.93) and very good (0.80), respectively. The mean TT-PCL distance was 20.1 mm with a range of 5.8 to 32.1 mm. The mean age was 12.6 years with a range of 0.8 to 15.9 years. The average TT-PCL distance was 21 mm for the instability group and 19.9 mm for the control group. TT-PCL distance increased significantly as subject age increased; however, there was no significant measurement difference shown between the patellar instability group and the control group.

Conclusions:

TT-PCL distance increased with age in the pediatric population but did not correlate with recurrent patella instability in this pediatric cohort.

Level of Evidence:

Level III—diagnostic.
Clinical Outcomes of Cervical Spinal Surgery for Cervical Myelopathic Patients With Coexisting Lumbar Spinal Canal Stenosis (Tandem Spinal Stenosis)
Authors: Yamada Tsuyoshi , Yoshii Toshitaka , Yamamoto Naoki , Hirai Takashi , Inose Hiroyuki , Kato Tsuyoshi , Kawabata Shigenori , Okawa Atsushi
Published: June 2017

Study Design.

A retrospective observational study.

Objective.

We evaluated the prevalence and clinical characteristics of tandem spinal stenosis (TSS) in patients with cervical myelopathy including ossification of the posterior longitudinal ligament of the cervical spine (C-OPLL).

Summary of Background Data.

Concurrent cervical and lumbar spinal canal stenosis is generally reported as TSS. Most previous studies have used magnetic resonance imaging to evaluate spinal stenosis in the cervical and lumbar spine.

Methods.

The authors performed a retrospective analysis of the outcomes of 297 myelography and cervical surgeries performed in myelopathic patients. We compared the non-TSS group (n = 125) with the TSS group (n = 172) in terms of multiple clinical parameters. In each group, we compared the cervical non-OPLL cases with the cervical OPLL cases. Moreover, we investigated the ratio and clinical outcomes of additional lumbar surgeries performed for TSS patients.

Results.

One hundred seventy-two cases (57.9%) were considered TSS. Forty-one patients (13.8%) underwent a lumbar operation during the follow-up period. The TSS group included a greater number of OPLL patients, elderly patients, diabetes mellitus, hypertension, and non-smokers than the non-TSS group. The postoperative C-JOA score and the C-JOA recovery rate in the TSS group were significantly lower than the non-TSS group. In the TSS group, the non-C-OPLL patients were significantly older than the C-OPLL patients. The C-OPLL patients had higher postoperative C-JOA scores than the non-C-OPLL patients in both the TSS and non-TSS groups. The additional lumbar surgery effectively improved both the C-JOA and L-JOA scores in TSS patients.

Conclusion.

The prognosis for TSS patients with myelopathy was worse than that for patients with isolated cervical lesions. Younger C-OPLL patients, even those with TSS, showed higher recovery rates than non-C-OPLL patients. Aging and coexistent lumbar lesions may influence the recovery process following surgery for cervical myelopathy.

Level of Evidence: 4
Estimation of population-based cancer-specific potential years of life lost in Belgium
Authors: Silversmit Geert , Vaes Evelien , van Eycken Liesbet
Published: June 2017

The potential years of life lost (PYLL) observed in a cohort of cancer patients cannot be fully assigned to the cancer as both cancer-related and non-cancer-related deaths contribute. A method is presented to decompose the observed all-cause PYLL into cancer mortality and population background mortality fractions when cause of death information is not available. Furthermore, the association of cancer-specific PYLL with cancer-specific mortality and mean age at diagnosis is explored and the impact of the follow-up window length is examined. The framework of the actuarial relative survival and the Ederer II method is applied to estimate the population background mortality contribution, PYLL*. The fraction (PYLL−PYLL*)/PYLL is then attributed to the cancer. The method is applied to cancer incidence in Belgium 2004–2014, about 631 300 cancer patients. The cancer-specific PYLL divided by the number of cancer patients, mean PYLL, in the Belgian cancer population ranges from 0.4 years for prostate cancer to 15 years for tumours of the central nervous system. The cancer-specific mean PYLL increases with both increasing cancer-specific mortality and decreasing age at diagnosis. Longer follow-up periods yield larger cancer-specific mean PYLL until statistical cure of cancer is achieved. The mean PYLL results, obtained by dividing the PYLL by the number of cancer patients, are visualized in combination with cancer incidence and mean age and mean life expectancy at diagnosis, providing an elegant summary to rank and compare cancer sites in terms of incidence, relative survival and PYLL.
Injectable DaxibotulinumtoxinA for the Treatment of Glabellar Lines: A Phase 2, Randomized, Dose-Ranging, Double-Blind, Multicenter Comparison With OnabotulinumtoxinA and Placebo
Authors: Carruthers Jean , Solish Nowell , Humphrey Shannon , Rosen Nathan , Muhn Channy , Bertucci Vince , Swift Arthur , Metelitsa Andrei , Rubio Roman G. , Waugh Jacob , Quiring John , Shears Gill , Carruthers Alastair
Published: June 2017

BACKGROUND

Injectable daxibotulinumtoxinA (RT002) is an investigational botulinum toxin Type A in clinical development. It is formulated with a proprietary peptide and offers the potential of a longer acting neurotoxin therapy.

OBJECTIVE

To compare the safety, efficacy, and duration of response of daxibotulinumtoxinA with onabotulinumtoxinA and placebo [www.clinicaltrials.gov NCT02303002].

METHODS

In this Phase 2, randomized, dose-ranging, parallel-group, double-blind, multicenter study, subjects with moderate or severe glabellar lines at maximum frown were randomly assigned to 20U, 40U, or 60U daxibotulinumtoxinA, 20U onabotulinumtoxinA, or placebo. Glabellar line severity was evaluated by investigators and subjects at least every 4 weeks, for at least 24 weeks.

RESULTS

Overall, 268 subjects enrolled. Statistical and clinical superiority were observed for 40U and 60U daxibotulinumtoxinA over 20U onabotulinumtoxinA for a range of efficacy outcomes despite the study not being powered to detect statistically significant differences between these active treatment groups.

CONCLUSION

The 40U dose of daxibotulinumtoxinA was well tolerated (e.g., absence of ptosis) and had the most favorable risk: benefit profile. Compared with 20U onabotulinumtoxinA, it exhibited a significantly greater response rate and a significantly longer duration of response (median of 24 weeks vs 19 weeks; p = .030).
Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer
Authors: Mochizuki Yumi , Harada Hiroyuki , Shimamoto Hiroaki , Tomioka Hirofumi , Hirai Hideaki
Published: June 2017

Objective:

We studied complications following multiple free flap reconstructions in the head and neck.

Methods:

In this cohort, 26 patients (14 men and 12 women) who underwent multiple microvascular free flap reconstructions were included in the study. The reasons for secondary reconstruction were recurrence of tumor (12 cases), necrosis of transferred skin and/or bone (6 cases), reconstruction plate fracture or exposure (4 cases), and others (4 cases). A third reconstruction in 4 cases and a fourth reconstruction in 1 case were performed.

Results:

No flap necrosis occurred. Postsurgical infections occurred at only secondary reconstructions in 7 patients. Although 4 cases with a history of external radiation therapy were anastomosed at contralateral side, those 4 cases suffered from severe pre-and postsurgical infection of the ipsilateral side. Postsurgical infection occurred in 2 cases with anastomoses at the ipsilateral side of the neck and required drainage after secondary surgery.

Conclusions:

A history of external radiation therapy and the existence of severe preoperative infection affected complications after multiple reconstructions.
Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections
Authors: Yoshioka Nobutaka
Published: June 2017

Background:

Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging.

Methods:

Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3).

Results:

The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred.

Conclusions:

The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds.
Relationship between Keloid Formation and YAP/TAZ Signaling
Authors: Aramaki-Hattori Noriko , Okabe Keisuke , Hamada Mariko , Takato Tamae , Kishi Kazuo
Published: June 2017

YAP (yes-associated protein) and TAZ (transcriptional coactivator with PDZ-binding motif) are part of a classical pathway that controls contact inhibition in the Hippo pathway. YAP and TAZ were recently reported to act as nuclear relays of mechanical signals that communicate extracellular matrix rigidity and cell shape. However, the role of YAP/TAZ signaling in keloid formation is unclear. Here, we used immunohistochemistry to investigate YAP/TAZ expression in keloid and nonaffected lesions. YAP/TAZ expression in keloid fibroblasts had a greater tendency to localize to the nucleus relative to that seen in fibroblasts from unaffected tissues. Meanwhile, keratinocytes or endothelial cells from either keloid or unaffected tissues showed no significant differences in YAP/TAZ expression patterns. These results suggest that YAP/TAZ nuclear localization in keloid fibroblasts might activate Hippo signaling and may play an important role in gene expression that affects keloid formation and stiffness.
Tc-99m-Human Serum Albumin Transit Time as a Measure of Arm Breast Cancer-Related Lymphedema
Authors: Toyserkani Navid M. , Hvidsten Svend , Tabatabaeifar Siavosh , Simonsen Jane A. , Høilund-Carlsen Poul F. , Sørensen Jens A.
Published: June 2017

Background:

Lymphoscintigraphy has often been used for evaluating arm lymphatic dysfunction, but no optimal approach for quantification has so far emerged. We propose a quantifiable measure of lymphatic function that we applied in patients treated for breast cancer.

Methods:

Eleven patients, aged 34–68 years, with unilateral arm lymphedema following breast cancer treatment underwent bilateral lymphoscintigraphy using intradermal injection in both hands of technetium-99m–labeled human serum albumin and sequential 5 min imaging for 5 hours. The mean transit time (MTT) in the arms was calculated based on time activity curves generated from injection site and arm regions. Visual lymphedema scoring was performed based on dermal backflow and lymph node presence. Excess arm volume was calculated from circumference measurements.

Results:

The MTT (mean ± SD) was significantly longer in the lymphedema arm than in the normal arm: 60.1 ± 27.7 versus 5.4 ± 2.5 minutes (mean difference, 54.7 minutes; 95% confidence interval, 36.5–72.9 minutes; P < 0.0001). Patients with previous erysipelas infection had significantly longer MTT than other patients (mean difference, 43.7 minutes; 95% confidence interval, 18.6–68.7 minutes; P < 0.001). There was a positive correlation between MTT and excess arm volume (r = 0.64; P = 0.04) and number of lymph nodes removed (r = 0.65; P = 0.03) but no correlation between visual score and MTT.

Conclusion:

Measurements of MTT were able to discriminate lymphedema from healthy arm and MTT correlated with relevant markers for lymphedema severity. We encourage further research using the MTT approach for monitoring lymphedema and evaluation of treatment response.
Magnet hospital recognition in hospital systems over time
Authors: Lasater Karen B. , Richards Michael R. , Dandapani Nikila B. , Burns Lawton R. , McHugh Matthew D.
Published: June 2017

Background:

Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape.

Purpose:

The aim of the study was to examine Magnet adoption among hospital systems over time.

Approach:

Using American Hospital Association surveys (1998–2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital’s Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization.

Results:

The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems.

Conclusions:

Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time.

Practice Implications:

The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.
ACUTE EXUDATIVE PARANEOPLASTIC POLYMORPHOUS VITELLIFORM MACULOPATHY DURING VEMURAFENIB AND PEMBROLIZUMAB TREATMENT FOR METASTATIC MELANOMA
Authors: Sandhu Harpal S. , Kolomeyer Anton M. , Lau Marisa K. , Shields Carol L. , Schuchter Lynn M. , Nichols Charles W. , Aleman Tomas S.
Published: June 2017

Purpose:

To describe a patient with BRAF mutation-positive cutaneous melanoma who developed acute exudative polymorphous vitelliform maculopathy during vemurafenib and pembrolizumab treatment for metastatic melanoma.

Methods:

Retrospective case report documented with wide-field fundus imaging, spectral domain optical coherence tomography, and fundus autofluorescence imaging.

Results:

A 55-year-old woman with bilateral ductal breast carcinoma and BRAF mutation-positive metastatic cutaneous melanoma complained of bilateral blurred vision within 5 days of starting vemurafenib (BRAF inhibitor). She had been on pembrolizumab (program death receptor antibody) and intermittently on dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor), and had a normal ophthalmologic examination. On presentation three weeks after the introduction of vemurafenib, her visual acuity had declined to 20/40 in both eyes. Her examination showed diffuse elevation of the fovea with multifocal yellow–white, crescent-shaped subretinal deposits within the macula of both eyes and bilateral neurosensory retinal detachments by spectral domain optical coherence tomography. Discontinuation of vemurafenib and introduction of difluprednate and dorzolamide led to a gradual resolution (over four months) of the neurosensory detachments with recovery of vision.

Conclusion:

This case report suggests that acute exudative polymorphous vitelliform maculopathy may be directly associated with the use of BRAF inhibitors as treatment for metastatic cutaneous melanoma, or indirectly by triggering autoimmune–paraneoplastic processes. Future identification of similar associations is required to unequivocally link vemurafenib and/or pembrolizumab to acute exudative polymorphous vitelliform maculopathy in metastatic melanoma.
Probable Donor-Derived Cytomegalovirus Disease After Keratolimbal Allograft Transplantation
Authors: Cheung Albert Y. , Govil Amit , Friedstrom Scott R. , Holland Edward J.
Published: June 2017

Purpose:

To report a case of probable donor-derived cytomegalovirus (CMV) infection after keratolimbal allograft (KLAL) transplantation.

Methods:

Observational case report.

Results:

A 41-year-old man with a history of aniridic keratopathy and limbal stem cell deficiency underwent KLAL in his right eye. Preoperatively, he was negative for CMV IgG and IgM. Postoperatively, he was maintained on tacrolimus and mycophenolate mofetil for systemic immunosuppression; he was also on prophylactic valganciclovir (for CMV) and trimethoprim/sulfamethoxazole (for pneumocystis pneumonia) for 1 month. Approximately 5 weeks postoperatively, he developed a nonproductive cough, rhinorrhea, and dyspnea. His condition did not improve with oral azithromycin or levofloxacin. He developed worsening symptoms over the next 2 weeks despite therapy. The serum CMV polymerase chain reaction was positive, and he was readministered valganciclovir with subsequent resolution of symptoms.

Conclusions:

We present the first case of CMV disease in a seronegative patient who received a presumed CMV-seropositive donor KLAL. Similar to solid organ transplantation, prophylactic and therapeutic management of CMV infection is necessary in the setting of systemic immunosuppression.
Endothelial Cell Loss in Diabetic and Nondiabetic Eyes After Cataract Surgery
Authors: He Xu , Diakonis Vasilios F. , Alavi Yasamin , Yesilirmak Nilufer , Waren Daniel , Donaldson Kendall
Published: June 2017

Purpose:

To assess and compare the changes in endothelial cell density in diabetic and nondiabetic patients after routine phacoemulsification cataract surgery.

Setting:

Bascom Palmer Eye Institute, Miller School of Medicine, Miami, FL, USA.

Design:

Retrospective nonrandomized cohort study.

Methods:

This retrospective study included diabetic and nondiabetic patients who underwent phacoemulsification by a single surgeon (K.D.) between September 2013 and March 2016. The main outcome measures were cumulative dissipated energy (CDE) and percentage of endothelial cell loss (ECL). Comparative analysis of CDE and percentage of ECL between the 2 patient groups was performed and then repeated based on the degree of diabetic control (hemoglobin A1c).

Results:

The study included 66 eyes of 55 diabetic and 67 eyes of 65 nondiabetic patients. Mean CDE was 7.8 ± 7.1 joules, and the 1-month mean percentage of ECL was 15% ± 14% in the diabetic group. Mean CDE was 6.6 ± 3.8 joules, and the 1-month mean percentage of ECL was 11% ± 11% in the nondiabetic group. The CDE was not significantly different between both groups. The percent decrease in ECL was statistically higher in the diabetic group than in the nondiabetic group (P = 0.03). The degree of diabetic control, based on hemoglobin A1c greater or less than 7, did not yield a significant difference in CDE or percentage ECL.

Conclusions:

Diabetic patients demonstrated increased ECL when compared with nondiabetic patients after cataract surgery. However, the role of diabetic control in reducing ECL remains unclear.
Rise of Clostridium difficile infections: an overview
Authors: Khan Mushtaq A. , Hays John P. , Elabbasy Mohamed T. , Al-Mogbel Mohammed S.
Published: June 2017

Clostridium difficile is a Gram-positive, rod-shaped, motile, spore forming, obligate anaerobe, which is part of the gastrointestinal flora of man and animals. Some strains of C. difficile produce toxins and are capable of causing mild-to-severe diarrhea and pseudomembranous colitis. Further, C. difficile has been found to be a common cause of nosocomial antibiotic-associated diarrhea and is the most frequent cause of infectious diarrhea in hospitals and long-term care facilities globally. It is the only nosocomially significant anaerobic bacterium that forms spores (which are hard to destroy), though C. difficile may also be present as a colonizing inhabitant of the normal gut microbiota of some individuals and yet produce no visible signs of disease. Most cases of C. difficile infection occur in patients who are prescribed high-dose antibiotics or prescribed antibiotics for a prolonged period of time. These antibiotics can disturb the normal balance of the gut microbiota, altering its composition and allowing the overgrowth of C. difficile bacteria. When this occurs, the C. difficile bacteria produce toxins, which can damage gut tissues and cause diarrhea. This mini review discusses the epidemiology, history, role of antibiotics and virulence factors associated with C. difficile infections.
Newly Described Entities in Salivary Gland Pathology
Authors: Skálová Alena , Gnepp Douglas R. , Lewis James S. , Hunt Jennifer L. , Bishop Justin A. , Hellquist Henrik , Rinaldo Alessandra , Vander Poorten Vincent , Ferlito Alfio
Published: June 2017

Salivary glands may give rise to a wide spectrum of different tumors. This review concentrates on 4 salivary gland tumors that have been accepted in the recent literature as new neoplastic entities: mammary analog secretory carcinoma, cribriform adenocarcinoma of minor salivary glands (CASG), sclerosing polycystic adenosis/adenoma (SPA), and the mucinous/secretory variant of myoepithelioma. Mammary analog secretory carcinoma is a distinctive low-grade malignant salivary cancer that harbors a characteristic chromosomal translocation, t(12;15) (p13;q25), resulting in an ETV6-NTRK3 fusion. Cribriform adenocarcinoma (CASG) is a distinct tumor entity that differs from polymorphous low-grade adenocarcinoma by location (ie, most often arising on the tongue), by prominent nuclear clearing, differing alterations of the PRKD gene family, and clinical behavior with frequent metastases at the time of presentation of the primary tumor. Early nodal metastatic disease is seen in most cases of CASG; yet, they are still associated with indolent clinical behavior, making it a unique neoplasm among all low-grade salivary gland tumors. SPA is a rare sclerosing tumor of the salivary glands characterized by the combination of cystic ductal structures with variable cell lining including vacuolated, apocrine, mucinous, squamous, and foamy cells, by prominent large acinar cells with coarse eosinophilic cytoplasmic zymogen-like granules, and by closely packed ductal structures, surrounded by a peripheral myoepithelial layer and stromal fibrosis with focal inflammatory infiltrates. SPA frequently harbors intraductal epithelial dysplastic proliferations ranging from mild dysplasia to severe dysplasia/carcinoma in situ. Moreover, SPA has been proven to be a clonal process by HUMARA assay and is associated with considerable risk of recurrence. Therefore, on the basis of all these newly recognized findings, we believe that SPA is likely a neoplasm, and we suggest the name “sclerosing polycystic adenoma.” The mucinous variant of myoepithelioma is a myoepithelial tumor with foci of prominent cytoplasmic clearing frequently containing intracellular mucin material and having signet-ring morphology.
Congenital Syphilis of Bone
Authors: Zou Youran , Marcus Matthew A. , Castles C. Guy , Kilpatrick Scott E.
Published: June 2017

Involvement of the skeletal system by congenital syphilis is well documented in the literature, chiefly in the form of radiologic studies, including periostitis, osteitis, and osteochondritis. Because congenital syphilis is generally recognized clinically, tissue biopsy is virtually never performed. Therefore, the histopathologic findings are less well documented and mostly exist in the older literature. We report herein the clinicoradiologic and pathologic features of a 2-month-old infant who initially presented with absence of left arm movement. Radiographs of the left humerus revealed a mid diaphyseal cortical irregularity/lytic lesion and periosteal reaction. Follow-up skeletal survey showed similar findings in other extremity long bones. A bone biopsy of the humeral lesion revealed a destructive fibrohistiocytic process composed of a sheet-like proliferation of epithelioid to spindled histiocytes, without obvious granulomas, accompanied by occasional lymphocytes and neutrophils with rare plasma cells. Immunohistochemical stains showed diffuse positivity for CD31, CD68, and S-100, but CD1a was negative. Initially, the case was interpreted as “atypical fibrohistiocytic proliferation,” favoring Langerhans cell histiocytosis. A few days later the results of serologic testing revealed a rapid plasma reagin of 1:256. Immunostaining for Treponema pallidum on the initial biopsy confirmed the presence of innumerable spirochetes, with a predilection for blood vessels. The patient was treated with a 10-day course of intravenous penicillin with complete resolution of the bone lesions and resulting symptomatology. To our knowledge, the above pathologic features of congenital syphilis of bone, especially in regards to its mimicry of childhood histiocytoses, have not been previously reported.
Clinical Characteristics of Allergy to Hymenoptera Stings
Authors: Visitsunthorn Nualanong , Kijmassuwan Teera , Visitsunthorn Kittipos , Pacharn Panchama , Jirapongsananuruk Orathai
Published: June 2017

Objective

The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand.

Methods

A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital.

Results

Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Anaphylaxis was more common in patients younger than 15 years, who comprised 22.3% of patients in this study. The most common sting type was from wasps (58.3%). Eighty-five percent of patients sought medical treatment less than 24 hours after being stung. A systemic reaction and anaphylaxis were found in 9.9% and 4.4% of subjects, respectively. In 17 patients with anaphylaxis, only 11 patients (64.7%) received an epinephrine (adrenaline) injection as treatment, and only 8 (47.1%) received epinephrine autoinjectors or epinephrine-prefilled syringes to prevent a possible subsequent severe reaction. Significantly more patients younger than 15 years received epinephrine for prevention of an allergic reaction than did those older than 15 years (87.5% vs 11.7%, P < 0.001). Antibiotics were given to 43.0% of patients.

Conclusions

Anaphylaxis from Hymenoptera stings was more common in children than in adults. Only half of the patients visited the emergency room within 1 hour of being stung. Overuse of antibiotics and underuse of epinephrine were found. More information about Hymenoptera stings should be provided to the public, and the use of epinephrine should be encouraged in the case of severe reactions and anaphylaxis.