bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intracranial Dural Arteriovenous Fistulas with Pial Arterial Supply
Authors: Osada Takahiro , Krings Timo 
Published: January 2018

Abstract

BACKGROUND
Pial arterial supplies are sometimes found in patients with dural arteriovenous fistulas (DAVFs), though their characteristics have rarely been clarified.

OBJECTIVE
To investigate the characteristics of pial arterial supplies in DAVFs and to discuss their pathophysiology and treatment.

METHODS
Two hundred four consecutive patients with intracranial DAVFs over 11 yr were retrospectively reviewed. Clinical factors and radiological findings, including the presence of pial arterial supplies, were evaluated. Supply from a pial artery was classified into 2 categories: dilated pre-existing dural branches of pial arteries, and a “pure” pial supply.

RESULTS
Twenty-three of 204 patients (11.3%) showed an additional pial arterial supply. Multivariate analysis identified 3 independent predictors of a pial arterial supply: younger age (P < .0005), DAVF within the tentorium (P = .0162), and presence of venous dilatation (P = .0001). A dilated pre-existing dural branch of a pial artery was identified in 17 patients, while 8 had a pure pial supply. Of these 23 patients, 17 underwent interventional therapy. No postoperative intracranial hemorrhage or infarction occurred in patients with pial arterial supplies.

CONCLUSION
An additional pial supply is not uncommon in DAVFs and may be explained by a rich physiological pial arterial supply to the dura mater from the posterior circulation, while potential angiogenesis due to venous hypertension remains speculative. Prior to interventional treatment for DAVFs, recognition of a pial arterial supply to the DAVF might influence the treatment strategy and could help avoid inadvertent retrograde embolization of brain supplying vessels through the pial network.
Intraoperative Radiotherapy in Newly Diagnosed Glioblastoma (INTRAGO): An Open-Label, Dose-Escalation Phase I/II Trial
Authors: Giordano Frank A , Brehmer Stefanie , Mürle Bettina , Welzel Grit , Sperk Elena , Keller Anke , Abo-Madyan Yasser , Scherzinger Elisabeth , Clausen Sven , Schneider Frank , Herskind Carsten , Glas Martin , Seiz-Rosenhagen Marcel , Groden Christoph , Hänggi Daniel , Schmiedek Peter , Emami Bahman , Souhami Luis , Petrecca Kevin , Wenz Frederik 
Published: January 2018

Abstract

BACKGROUND
The median time to recurrence of glioblastoma (GB) following multimodal treatment is ∼7 mo. Nearly all cancers recur locally, suggesting that augmenting local treatments may improve outcomes.

OBJECTIVE
To investigate whether intraoperative radiotherapy (IORT) to the resection cavity is safe and effective.

METHODS
INTRAGO was a phase I/II trial to evaluate the safety and tolerability of IORT with 20 to 40 Gy of low-energy photons in addition to standard radiochemotherapy (ClinicalTrials.gov ID, NCT02685605). The primary endpoint was safety as per occurrence of dose-limiting toxicities. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). We also performed an exploratory analysis of the local PFS (L-PFS), defined as recurrence within 1 cm of the treated margin.

RESULTS
Fifteen patients were treated at 3 dose levels. Of these, 13 underwent incomplete resection, 6 had unresected satellites, and 3 did not receive per-protocol treatment (PPT). The MGMT promoter was unmethylated in 10 patients. The median follow-up was 13.8 mo. The majority of grade 3 to 5 adverse events were deemed unrelated to IORT. Five cases of radionecrosis were observed, 2 were classified as grade 3 events. Other grade 3 events judged related to radiotherapy (external-beam radiotherapy and/or IORT) were wound dehiscence (n = 1), CSF leakage (n = 1), cyst formation (n = 1). No IORT-related deaths occurred. The median PFS was 11.2 mo (95% confidence interval [CI]: 5.4-17.0) for all patients and 11.3 mo (95% CI: 10.9-11.6) for those receiving PPT. The median L-PFS was 14.3 mo (95% CI: 8.4-20.2) for all patients and 17.8 mo (95% CI: 9.7-25.9) for those receiving PPT. The median OS was 16.2 mo (95% CI: 11.1-21.4) for all patients and 17.8 mo (95% CI: 13.9-21.7) for those receiving PPT.

CONCLUSION
These data suggest that IORT is associated with manageable toxicity. Considering the limitations of a 15-patient phase I/II trial, further studies aimed at assessing an outcome benefit are warranted.
The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions
Authors: Sjøberg Thomas , de Weerd Louis 
Published: January 2018

Background:
Previous surgery or slim body configuration can limit the size of the available abdominal flap in autologous breast reconstruction. However, redundant skin and subcutaneous tissue lateral to the mastectomy site can be utilized as the pedicled lateral intercostal artery perforator (LICAP) flap. This study evaluates the combination of a free abdominal flap and a pedicled LICAP flap to achieve increased breast size and improved cosmetic outcome.

Methods:
Patients undergoing secondary autologous breast reconstruction were included in a prospective study. The combination with a LICAP flap was used for women with insufficient abdominal flap tissue in relation to the desired breast size. The authors also assessed their modification of the original lateral thoracodorsal flap design to improve the aesthetic outcome.

Results:
In 109 patients, 121 free abdominal flaps were performed. The combination with a pedicled LICAP flap was used in 82 free abdominal flap reconstructions (68%). The LICAP flap provided additional volume and resulted in better projection and ptosis of the neo-mamma. The overall complication rate for the LICAP flaps was 26 %; all minor complications. Despite combining flaps, the majority of patients needed additional surgery to improve breast symmetry. Breast reduction of the native breast was the most common symmetrizing procedure.

Conclusion:
In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.
Earfold Implantable Clip System for Correction of Prominent Ears: Analysis of Safety in 403 Patients
Authors: Kang Norbert V. , Sojitra Nilesh , Glumicic Sinisa , Vlok Jacobus A. , O’Toole Greg , Hannan S. Alam , Sabbagh Walid 
Published: January 2018

Background:
The Earfold system, a new treatment for the correction of prominent ears, consists of 3 components: the Earfold implant, the Earfold introducer, and the Prefold positioner.

Methods:
This is an interim report based on an ongoing analysis of safety in a series of patients treated for prominent ears with the Earfold implant between February 2013 and September 2014. Safety was assessed based on adverse event reports and the need for implant revision; follow-up is ongoing.

Results:
Seven surgeons used 1,200 Earfold implants to treat 403 patients (ages, 7–70 years; 63% male); the time since the initial implant procedure now ranges from 30 to 48 months. To date, 145 patients (36%) have returned for a follow-up visit (mean, 7.7 months [range, 1–34 months]). Adverse events requiring intervention have affected 39 of 403 (9.7%) patients; these include implant revisions (n = 17 [4.2%], most often due to implant visibility), skin erosion over the implant (n = 15 [3.7%]), and infection (n = 7 [1.7%]). Bleeding, recurrence of prominence, hematoma, deformity, or adverse scarring did not occur.

Conclusions:
This interim analysis has shown that Earfold prominent ear correction system is associated with relatively few adverse events that require intervention; a small number of patients experienced infection, implant extrusion, or implant visibility that required revision. Most adverse events were related to either patient selection or technical errors at implantation. It is expected that with continued use of Earfold by surgeons experienced in otoplasty, the adverse event incidence will decrease.
Hinge Flap with Triangular Extension for Reconstruction of Pharyngocutaneous and Laryngocutaneous Fistulas
Authors: Azuma Ryuichi , Aoki Shimpo , Kuwabara Masahiro , Aizawa Tetsushi , Nagano Hisato , Kiyosawa Tomoharu 
Published: January 2018

Summary:
Hinge flaps are commonly used for closure of a pharyngocutaneous fistula (PCF) or laryngocutaneous fistula. These flaps are employed to augment the wall of the pharynx or larynx, but the junction between the reconstructed and native lumens can eventually become narrow and irregular after reconstruction with standard hinge flaps. We devised a method of adding a triangular extension to the end of either or both flaps and used it to treat 3 patients. In 1 patient who developed a PCF (4 × 10 cm) after laryngectomy followed by radiotherapy, the fistula was closed with 2 hinge flaps. One flap had a caudal triangular extension. The residual skin defect was covered by a pedicled latissimus dorsi musculocutaneous flap. Another patient who developed a PCF (2.5 × 3 cm) after laryngectomy underwent 2-stage reconstruction using a buccal mucosal graft with a triangular extension, followed by 2 hinge flaps. A patient who developed an laryngocutaneous fistula (1 × 2 cm) after radiotherapy and subsequent partial laryngectomy underwent reconstruction using 2 hinge flaps, each of which had a triangular extension. The skin defect was covered by another flap. Postoperative CT or video fluoroscopic examination of swallowing showed a smooth lumen with no strictures in all 3 patients. The triangular extension of the hinge flap supplements the pharyngeal/laryngeal wall at the junction between the reconstructed and intact regions, thus avoiding postoperative stricture. Especially with PCF reconstruction, restoration of a smooth luminal surface minimizes dysphagia.
Adverse Economic Impact Associated With Blood Culture Contamination in a Pediatric Emergency Department
Authors: Murofushi Yuka , Furuichi Munehiro , Shoji Kensuke , Kubota Mitsuru , Ishiguro Akira , Uematsu Satoko , Gai Ruoyan , Miyairi Isao 
Published: January 2018

Background:
Blood culture contamination (BCC) leads to unnecessary interventions including hospitalization, antibiotic administration and additional laboratory tests. Previous studies in adults revealed that BCC was associated with unnecessary financial expenditures. However, information pertaining to the pediatric population is limited. Therefore, we investigated the details of the adverse economic impact associated with BCC in a pediatric emergency department (ED) in Japan.

Methods:
This study was a retrospective, observational study. We collected data on blood cultures performed in patients 18 years of age in a pediatric ED. Medical records of patients with positive blood cultures were reviewed, and the information regarding adverse events related to BCC was extracted. Medical costs related to BCC were estimated from the data.

Results:
In total, 13,139 sets of blood cultures were performed from April 2013 to June 2016, and 141 cases (1.1%) of BCC were identified. Among these, 106 patients (75%) experienced at least 1 adverse event associated with BCC. The total medical cost due to BCC was 4,076,713 Japanese yen. Multifaceted approaches targeting ED physicians including lectures on optimal blood collection methods and monthly feedback on BCC rates were effective in reducing the BCC rate and its related costs.

Conclusions:
Interventions associated with BCC were common and accounted for significant adverse economic impact on pediatric patients. Regular education and monitoring were effective in reducing BCC and its related costs.
Seminoma Metastatic to the Orbit
Authors: Dutton Jonathan J. , Proia Alan D. 
Published: January 2018

Purpose:
Seminomas are solid tumors in young men, but which rarely metastasize to the orbit. The authors review the known literature on seminoma metastatic to the orbit, and describe an additional case in a 33-year-old man.

Methods:
A literature search was performed on the MEDLINE database using keywords “seminoma,” “testicular germ-cell tumors,” “testicular cancer,” “testicular neoplasm,” “orbital metastasis,” and “germ-cell neoplasms.”

Results:
Malignant neoplasms of the testis account for only 1% of cancers in men. None-the-less, testicular germ cell seminoma is the most common solid tumor found in young men between the ages of 15 and 39. Only seven previous cases have been mentioned in the literature. The pathogenesis remains unclear although genetic, environmental, and maternal factors may play a role. The number of cases is too few to determine the best treatment options, but surgical excision and adjunctive orbital radiotherapy appear to be most appropriate.

Conclusions:
Although metastases to the orbit are rare, seminoma should be considered in the differential diagnosis of all young men with proptosis.
Medial Buttressing in Orbital Blowout Fractures
Authors: Ramesh Sathyadeepak , Bokman Christine , Mustak Hamzah , Lo Christopher , Goldberg Robert , Rootman Daniel 
Published: January 2018

Purpose:
To study whether ethmoidectomy predisposes the orbit to medial wall fracture with lesser trauma.

Methods:
An interventional cadaver study of 5 heads (10 orbits); the left or right orbit was randomized to undergo endoscopic complete ethmoidectomy with the fellow orbit as control. Fractures were induced with direct globe trauma, and heads underwent CT scanning. Energy to induce fracture, peak orbital pressure at time of fracture, fracture pattern, and volume of herniated tissue were measured and analyzed.

Results:
Fractures were induced in both orbits of all cadavers. Experimental orbits after ethmoidectomy sustained orbital fracture at less energy required (2.14 ± 0.66 vs. 3.10 ± 0.19 J, mean difference: −0.96 ± 0.33 J, p < 0.05). Similarly, peak orbital pressure was lower for ethmoidectomized orbits than for controls (11.8 ± 8.42 vs. 28.4 ± 13.2 mm Hg, mean difference: −16.5 ± 6.9 mm Hg, p < 0.05). Orbits after ethmoidectomy were more likely to sustain medial wall involvement in fracture (100%) compared with controls (20%, p < 0.05) and pure medial wall fracture (80%) compared with controls (0%, p < 0.05). Overall volume of herniated orbital contents was not significantly different between groups (p = 0.25); volume of herniated tissue from the medial wall only was significantly greater in orbits after ethmoidectomy (mean difference: 1.01 ± −0.39 cm,
3

p < 0.05).

Conclusion:
Endoscopic ethmoidectomy in fresh cadavers reduces impact energy necessary to induce orbital fracture and increases the prevalence of medial wall involvement. Clinicians may wish to counsel patients undergoing endoscopic sinus surgery about these relative risks.
A Fresh Cadaver Study on Indocyanine Green Fluorescence Lymphography: A New Whole-Body Imaging Technique for Investigating the Superficial Lymphatics
Authors: Shinaoka Akira , Koshimune Seijiro , Yamada Kiyoshi , Kumagishi Kanae , Suami Hiroo , Kimata Yoshihiro , Ohtsuka Aiji 
Published: January 2018

Background:
Identification of the lymphatic system in cadavers is painstaking because lymphatic vessels have very thin walls and are transparent. Selection of appropriate contrast agents is a key factor for successfully visualizing the lymphatics. In this study, the authors introduce a new imaging technique of lymphatic mapping in the whole bodies of fresh cadavers.

Methods:
Ten fresh human cadavers were used for this study. The authors injected 0.1 ml of indocyanine green fluorescence solution subcutaneously at multiple spots along the watershed lines between lymphatic territories and hand and foot regions. After the body was scanned by the near-infrared camera system, fluorescent tissues were harvested and histologic examination was performed under the microscope equipped with the infrared camera system to confirm that they were the lymphatics.

Results:
Subcutaneously injected indocyanine green was immediately transported into the lymphatic vessels after gentle massage on the injection points. Sweeping massage along the lymphatic vessels facilitated indocyanine green transport inside the lymphatic vessel to move toward the lymph nodes. The lymphatic system was visualized well in the whole body. Histologic examinations confirmed that indocyanine green was detected in the lymphatic lumens specifically, even when located far from the injected points.

Conclusions:
The lymphatic system could be visualized in whole-body fresh cadavers, as in living bodies, using indocyanine green fluorescence lymphography. Compatibility of indocyanine green lymphography would facilitate the use of cadaveric specimens for macroscopic and microscopic analyses.
Measurement of Warping Angle in Human Rib Graft: An Experimental Study
Authors: Ors Safvet 
Published: January 2018

Background:
The purpose of this study was to determine the warping angle of the costal cartilage in vivo.

Methods:
A nasal framework reconstruction with a rib graft was performed in a total of 130 patients. After the cartilage specimens were prepared, the remaining grafts were used for study. The angle of warping in all grafts was measured at 0, 30, and 60 minutes; after 24 hours; and after 1 week. Eight subgroups of graft thicknesses from central and peripheral groups, determined according to the perichondral distance of the grafts, were evaluated, and the warping angles of 48 osteochondral and chondral grafts were measured individually. Three-way analysis of variance was used to compare the change in warping over time to detect differences in the grafts.

Results:
Significant differences were not observed in the 1- to 3-mm-thick grafts of peripheral and central origin before 30 minutes (p > 0.05), although significant differences were observed in these groups for all time points after 30 minutes (p < 0.05). In central and peripheral grafts thicker than 4 mm, a significant warping angle was not observed (p > 0.05). In central origin grafts thinner than 1 mm, significant differences were not observed in the warping angle (p > 0.05), although they were observed in the same grafts of peripheral origin (p < 0.05). Peripheral origin grafts thicker than 1 mm showed warping in the direction of the perichondrium (p < 0.05), whereas central origin grafts thinner than 1 mm showed warping angle irregularities.

Conclusion:
Interlocking stresses are very important in rib grafts when balanced cross-sectional carving occurs from the peripheral to the central areas.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics
Authors: Bowen Randy C. , Koeppel Jan N. , Christensen Chance D. , Snow Karisa B. , Ma Junjie , Katz Bradley J. , Krauss Howard R. , Landau Klara , Warner Judith E. A. , Crum Alison V. , Straumann Dominik , Digre Kathleen B. 
Published: January 2018

Background:
Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers.

Methods:
This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzerland, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint.

Results:
Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients).

Conclusions:
Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties.
Invited Commentary: Evaluation of Horner Syndrome in the MRI Era
Authors: Kawasaki Aki 
Published: January 2018

This Invited Commentary discusses the following article:

Sadaka A, Schockman SL, Golnik KC. Evaluation of Horner syndrome in the MRI era. J Neuroophthalmol. 2017;37:268–272.

Background:
To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging.

Methods:
A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups.

Results:
Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined “idiopathic.” Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain.

Conclusion:
HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation.
Two distinct proprioceptive representations of voluntary movements in primate spinal neurons
Authors: Tomatsu Saeka , Kim Geehee , Confais Joachim , Takei Tomohiko , Seki Kazuhiko 
Published: January 2018

AbstractWhen willingly setting our body in motion, we simultaneously know where and how our limbs are moving. While this indicates that proprioceptive information is readily represented in the neurons of the central nervous system, it is still unclear how. We recorded the activity of spinal neurons with direct projections from muscle spindle afferents in four monkeys, while they performed simple wrist movements. Against the assumption that these spinal neurons act as a simple relay of afferent input, we found the majority (56%) of neurons had firing patterns incongruent with a simple representation of spindle activity, and the minority had congruent patterns. Two groups of neurons showed distinct intrinsic characteristics (spike width, base firing rate and firing irregularity), and distinct control of their input-output gain. These results are the first demonstration that proprioceptive representation is achieved by the coordinated activity of distinct groups of neurons during volitional movement.