Τρίτη 6 Ιουλίου 2021

The Vascularized Occipital Fascial Flap ('OFF'): A Novel Reconstructive Technique for Posterior Fossa Surgery

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World Neurosurg. 2021 Jul 2:S1878-8750(21)00963-3. doi: 10.1016/j.wneu.2021.06.122. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior fossa surgery is particularly prone to cerebrospinal fluid (CSF) leakage. Several methods have been introduced to address and/or prevent this complication. However, to the best of authors' knowledge, the use of a vascularized fascial flap based on the occipital artery for the purpose of reconstruction has not been reported. The authors introduce the occipital fascial flap (OFF) for reconstruction of a craniectomy defect after the retrosigmoid approach.

METHODS: A 57-year-old female with a large cerebellar metastasis underwent gross total resection of the mass followed by reconstruction of the craniectomy defect using OFF.

RESULTS: Post-operative imaging showed flap viability and no CSF leak occurred during follow-up.

CONCLUSIONS: We report the first use of OFF for reconstruction of a crani ectomy defect in a retrosigmoid approach. The vascularized fascial flap in posterior fossa surgery is a potentially helpful technique to reduce the risk of CSF leak in high-risk patients.

PMID:34224888 | DOI:10.1016/j.wneu.2021.06.122

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Upregulation of fibroblast growth factor 2 contributes to endometriosis through SPRYs/DUSP6/ERK signaling pathway

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Acta Histochem. 2021 Jul 2;123(5):151749. doi: 10.1016/j.acthis.2021.151749. Online ahead of print.

ABSTRACT

Previous studies report that fibroblast growth factor 2 (FGF2) modulates Sproutys (SPRYs)/dual specificity phosphatase 6 (DUSP6)/extracellular signal-regulated kinase (ERK) signaling pathway in endometrial glandular epithelial cells. However, its role in endometriosis remains unclear. The expression patterns and localization of related proteins in endometrium patients ' samples were determined using quantitative reverse transcription PCR, Western blotting, and immunohistochemistry, respectively. Human endometrial stromal cells (HESCs) were isolated and transfected with small interfering RNA (siRNA) targeting FGF2 (FGF2-siRNA). Cell viability was determined using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. It was found that FGF2 mRNA and protein levels were increased in the ectopic endometrium, whilst the mRNA and protein levels of SPRYs/DUSP6/ERK signaling pathway related-genes were dysregulated. Spearman's rank correlation analysis revealed a negative correlation between FGF2 and SPRYs/DUSP6 signaling pathway-related proteins. In vitro study demonstrated that FGF2 silencing suppressed cell proliferation. Our results suggest that FGF2 upregulation might contribute to endometriosis via the regulation of the SPRYs/DUSP6/ERK signaling pathway.

PMID:34224989 | DOI:10.1016/j.acthis.2021.151749

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Eosinophils Correlate with Epithelial-Mesenchymal Transition in Chronic Rhinosinusitis with Nasal Polyps

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Introduction: Chronic inflammation and tissue remodeling always occur together in chronic rhinosinusitis (CRS). Epithelial-mesenchymal transition (EMT) plays a critical role in airway remodeling. Objective: Changes of epithelial cells in sinus mucosa in different subtypes of CRS, especially in eosinophilic chronic rhinosinusitis with nasal polyps, and the role of EMT and eosinophils (EOS) in airway remodeling are still unknown. Methods: We included 85 patients in this study. They were divided into 4 groups: a normal control (NC) group, a chronic rhinosinusitis without nasal polyps (CRSsNP) group, an eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) group, and a noneosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP) group. Clinical data were all collected and analyzed. Standard hematoxylin and eosin staining, immunohistochemical staining, and 2-color immunofluorescence staining were performed. Biomarkers of EMT, epithelial cadherin, and vimentin were labeled. The immunohistochemistry results of each group were counted and statistically analyzed. Results and Conclusion: E-cadherin was downregulated, and vimentin was upregulated in epithelial tissue from the ECRSwNP group, compared with that from the control group and the other groups. The number of vimentin-expressing epithelial cells correlated with sinus CT imaging Lund-Mackay scores (r = 0.560, p #x3c; 0.001). Moreover, expression levels of vimentin in the epithelium were associated with numbers of infiltrating EOS in tissues (r = 0.710, p #x3c; 0.001) and the peripheral blood EOS ratio (r = 0.594, p #x3c; 0.001). EMT occurred in patients with CRSwNP, especially in those with ECRSwNP. Epithelial reprogramming correlates with eosinophil infiltration and disease severity. Eosinophils contributed to impairment of epithelial function and promoted EMT in CRSwNP.
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Osteoradionecrosis of the hyoid presenting as acute airway compromise

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Abstract

Background

Osteoradionecrosis (ORN) of the mandible is a well-known complication of radiation therapy for head and neck cancer. However, few reports have described hyoid bone ORN and its clinical implications.

Methods

We describe a retrospective case series of previously irradiated patients who were seen with sudden airway compromise, found to have underlying pathological hyoid fractures secondary to osteoradionecrosis.

Results

Six patients within postchemoradiation period (3–9 months) for oropharyngeal squamous cell carcinoma were seen with acute-onset dyspnea. Computed topography (CT) imaging was remarkable for severe airway luminal narrowing and pathological hyoid fractures. All six patients required urgent intervention with direct laryngoscopy and tracheostomy. Intraoperatively, five patients were seen with exposed necrotic hyoid bones.

Conclusion

The hyoid and its associated musculature strongly influence upper airway patency. ORN may compromise its physiological function and leads to acute airway compromise. Hyoid ORN may hold significant and imperative clinical implications in head and neck cancer post-treatment surveillance.

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Salivary gland adenocarcinoma metastatic to the pituitary gland

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Publication date: November–December 2021

Source: American Journal of Otolaryngology, Volume 42, Issue 6

Author(s): Mina Zaky, Rebecca A. Compton, Ipek Alpertunga, Arthur S. Tischler, Jeremiah C. Tracy

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Giant Cutaneous Horn: Is It a Tip of An Iceberg? Two Case Reports and a Review of Literature

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Abstract

Cutaneous horns are uncommon lesions which consist of proliferation of keratotic material resembling that of an animal horn. This lesion most commonly occurs in sun-exposed areas, particularly the face, ear, nose, forearms and dorsum of hands. The purpose of the study was to highlight the atypical presentation of squamous cell carcinoma as a giant cutaneous horn along with the review of literature. Case details were obtained from hospital records and clinical and histopathological findings were noted. Herein we report two cases of giant cutaneous horn associated with an underlying carcinoma presenting at an uncommon site. Both the patients were adults and had a chronic history of a skin lesion over the affected sites. Wide local excision was performed in both cases and histopathological examination confirmed the diagnosis of a cutaneous horn with a well differentiated squamous cell carcinoma at the base of the horn. Cutaneous horns are commonly associated with benign lesions and rarely with malignant conditions. It is imperative to biopsy the base of the horn to rule out any underlying malignancy. Proper surgical excision with adequate margins is the preferred treatment in case of an underlying malignancy.

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Prevalence of Olfactory and Gustatory Dysfunction in Coronavirus Disease (COVID-19): A Cross Sectional Study in Our Tertiary Care Hospital

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Abstract

COVID-19 pandemic is affecting millions of people all across the globe. Along with other clinical features, anosmia and dysgeusia are important symptoms being seen. This study evaluates the prevalence of olfactory and gustatory dysfunction in patients with SARS CoV-2 infection in a tertiary care centre and the severity and duration of altered taste and smell sensation in COVID positive patients. A total number of 167 patients that had tested positive for COVID 19 KLES Dr. Prabhakar Kore hospital in the study period of 3 months were assessed for presence and severity of olfactory and gustatory sensations. The prevalence of alteration of sense in COVID 19 patients in our tertiary care centre was found to be 62.87% and alteration of taste was 58.68%. This study shows that smell and taste loss has a high prevalence in patients of COVID 19 and health care workers should keep high degree of suspicion for COVID 19 when patients present with these symptoms. The earl y identification may help to reduce the risk of spread.

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Cause and Management of Suture-related Ocular Complications after Buried-suture Double-eyelid Blepharoplasty

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J Plast Reconstr Aesthet Surg. 2021 Jun 7:S1748-6815(21)00294-1. doi: 10.1016/j.bjps.2021.05.042. Online ahead of print.

ABSTRACT

BACKGROUND: Buried-suture double-eyelid blepharoplasty is very popular in Asia, especially in China, but there are few reports related to the cause, management, and prevention of suture-related complications of corneal injury and other damages to the eye. The study aims to determine the cause, management, and prevention of suture-related complications after buried-suture double-eyelid blepharoplasty.

METHODS: A retrospective study was conducted from January 2016 to January 2019 on 12 patients with corneal and other injuries to the eye after they underwent buried-suture double-eyelid blepharoplasty. The study included patients who underwent intermittent and continuous buried-suture double-eyelid blepharoplasty with the following symptoms: red eye, foreign body sensation, photophobia, pain, tears, and de creased vision. The clinical characteristics, examination method, and treatment were noted.

RESULTS: The patients were all females. Ocular injuries included: corneal epithelial punctate or diffuse injury in nine patients, corneal ulcer in two patients, and a perforating eye injury in one patient. The corneal injury was repaired after exposed nylon thread ends were removed. A suture on the surface of the eye penetrating the sclera was detected in one patient, who then had a vitrectomy caused by endophthalmitis.

CONCLUSION: Suture-removal surgery is indicated to treat suture-related complications. Less experienced clinicians should use an eyelid protection plate to protect the cornea and eyeball during surgery. The conjunctiva of the fornix should be examined after surgery. The clinician should inquire about the operation history in detail and check the conjunctiva of the fornix with an eyelid retractor to avoid misdiagnosis.

PMID:34226132 | DOI:10.1016/j.bjps.2021.05.042

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Aesthetic reconstruction for syndactyly using the 'gradation skin graft' from the plantar instep area

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J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00264-3. doi: 10.1016/j.bjps.2021.05.012. Online ahead of print.

ABSTRACT

In syndactyly, the donor site of the skin graft should have the characteristics of both the dorsal and the plantar or palmar skin because the skin defects after the dividing procedure are at the lateral sides of the digits. The plantar instep region has a color and texture border between the dorsal and plantar skin as a gradational boundary belt. We performed "gradation skin grafting" including the belt for syndactyly. We retrospectively analyzed 110 skin graft sites in 56 patients, aged ≤ 2 years, with syndactyly of the hand or foot. The follow-up durations were ≥ 6 months. The skin graft sites were divided into the gradation skin graft (G[+]) and the traditional skin graft (G[-]) groups. They were examined for matching of the skin graft with the circumferential skin, the causes of mismatching, the clos ing method of the donor site, and the complications. Regarding skin graft matching, the excellent rate of achievement was greater in the G(+) than in the G(-) group (P < 0.01). The causes of mismatching were misalignment of the gradational boundary belt in the G(+) group and postoperative pigmentation in the G(-) group. All the donor sites were closed directly without complications. The gradation skin graft for syndactyly was cosmetically superior to the traditional one from the submalleolar area. The design's hazard is that the gradational boundary belt of the skin graft should match the alignment with the gradational boundary belt around the skin defect of the digits.

PMID:34226133 | DOI:10.1016/j.bjps.2021.05.012

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Abdominoplasty complications - what additional risks do postbariatric patients carry?

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J Plast Reconstr Aesthet Surg. 2021 Jun 6:S1748-6815(21)00270-9. doi: 10.1016/j.bjps.2021.05.018. Online ahead of print.

ABSTRACT

PURPOSE: Particular trends of postoperative complications following abdominoplasty are seen when patients present with a history of bariatric surgery. This study aims to analyze the risk factors for complications following abdominoplasty among those who did and did not undergo prior bariatric weight loss surgery.

METHOD: Data of 144 patients who underwent abdominoplasty at our institution between 2009 and 2015 were reviewed. Prevalence of existing comorbidities and incidences of postoperative complications were recorded, and statistical analysis was carried out to establish differences between our cohorts.

RESULTS: Of 144 patients, 49 patients had prior bariatric surgery and 95 patients did not undergo surgery. There was no statistically significant difference between the groups for the prevalenc e of diabetes mellitus, coronary artery disease, hypertension, and anemia, although differences did exist for hypothyroidism and smoking history (p = 0.04 and 0.037, respectively). Postbariatric patients had more comorbidities than nonbariatric patients (p = 0.024). Postoperatively, there was no statistically significant difference between the groups for incidences of hematoma, necrosis, active bleeding, and symptomatic decrease in Hb, although differences did exist for infection (OR = 13.12), seroma (OR = 9.07), prolonged healing (OR = 5.28), and abundant drain secretions (OR = 5.24). Male gender and prior bariatric surgery were associated with higher overall rates of postoperative complications.

CONCLUSIONS: Our findings validate the results of prior studies that report a higher prevalence of underlying comorbidities and postoperative complications among postbariatric surgery patients undergoing abdominoplasty. Furthermore, prior bariatric surgery was found to be an independ ent risk factor for the presence of any (OR 4.78 and p < 0.001) and major (OR 4.050 and p = 0.018) complications after abdominoplasty.

PMID:34226131 | DOI:10.1016/j.bjps.2021.05.018

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Self-Esteem in Rhinoplasty Patients: A Comparative Study

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Abstract

Self-esteem is one of the most important psychological aspect of cosmetic surgery, in our case aesthetic rhinoplasty surgery. Self-esteem can be described as one's attitude towards ownself. Our aim is to assess the self-esteem pre-operatively in patients seeking aesthetic rhinoplasty with respect to those seeking functional rhinoplasty and also compare the post-operative improvement in the self-esteem in those patients. This is a Prospective comparative study in a Tertiary care centre. A total of 48 patients who were planned to undergo rhinoplasty over a period of 1 year in a tertiary care centre, A total of 48 patients (24 requiring aesthetic rhinoplasty and the rest functional rhinoplasty),grouped according to their primary objective, were asked to fill up Rosenberg's self-esteem scale pre-operatively and 6 months post-operatively. Independent t test was used for data analysis. The mean value of self-esteem in aestheti c rhinoplasty group was significantly lower as compared to functional rhinoplasty and there was also significant improvement of self-esteem score post -operatively in the aesthetic rhinoplasty group. Age,gender, marital status, socio-economic status and educational backgrounds were analyzed and there was no significant differences in these factors on comparison between the two groups. Our study showed that self-esteem is an important parameter in cosmetic surgery as patients opting for aesthetic rhinoplasty had lower self-esteem score pre-operatively and there was significant improvement of these scores post-operatively.

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