Spinal drainage complications after aortic surgery

xlomafota13 shared this article with you from Inoreader Spinal drainage complications after aortic surgery Via leak of cerebrospinal fluid J Vasc Surg. 2021 Apr 30:S0741-5214(21)00671-6. doi: 10.1016/j.jvs.2021.04.031. Online ahead of print. ABSTRACT INTRODUCTION: Spinal drain (SD) placement is an adjunct used in open and endovascular aortic surgery to mitigate the risk of spinal cord injury. SD placement can lead to subdural hematoma and intracranial hemorrhage (SDH/ICH). Previous studies have highlighted a correlation between incidence of SDH/ICH and amount of cerebrospinal fluid (CSF) drained. We have two philosophies of SD management in our institution. One protocol allows fluid removal for pressure > 10 cm H2O with no volume restriction. A second, similar protocol restricts CSF drainage to < 25 ml/hr. We examined SD complications and the influence of volume restriction. METHODS: Patients were identified according to the Current Procedure Terminology codes (CPT) for SD placement, thoracic endovascular aortic repair, fenestrated/branched endovascular aortic repair , endovascular abdominal aortic repair, open thoracic or thoracoabdominal aortic repair between January 1, 2012 and December 31, 2015. Patients' demographics included age, gender, race, body mass index and comorbidities such as hypertension, chronic obstructive pulmonary disease, stroke, transient ischemic attack, diabetes mellitus, bleeding disorder and connective tissue disorders. Management protocol was divided as volume independent (VI) or volume dependent (VD) by physician order. Postoperative complications related to the SD were noted. RESULTS: We identified 948 patients who had a SD placed during the study period, 473 were done prior to aortic surgeries. 364 patients (77%) underwent endovascular aortic surgery. Mean age at the time of procedure was 67.2 years and 66% of patients were male. 39 patients (8.3%) were noted to have connective tissue disorders. Bloody SD placement occurred in 14 patients (3.1%) requiring rescheduling of the operation. SDH/ICH occurred in 11 p atients (2.3%), post-operative blood tinged SD output in 94 patients (19.9 %) and 22 patients (4.7 %) had a CSF leak after SD removal. The incidence of SDH/ICH was not affected by the management protocol (2.6% VI Vs 2.0% VD, p=0.66), while the incidence of postoperative blood tinged SD output was significantly higher in the VI group (25.1% VI vs 15.0% VD, p=0.006). Perioperative low dose aspirin (81 mg) and prophylactic subcutaneous heparin did not increase the incidence of SDH/ICH. Post-operative thrombocytopenia was found to be associated with higher incidence of SDH/ICH (median 86,000 Vs 113,000, p=0.002). CONCLUSION: Severe complications of SD placement (SDH/ICH) occurs in 2.3% of SD patients undergoing aortic surgery and the risk is higher in the setting of post-operative thrombocytopenia. SD volume limitation, blood tinged SA drainage, antiplatelet medication and low dose heparin do not affect the risk of SDH/ICH. The risks of spinal drains for aortic surgery should be b alanced against potential benefits. PMID:33940078 | DOI:10.1016/j.jvs.2021.04.031 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transorbital neuroendoscopic surgery as a mainstream neurosurgical corridor: a systematic review

xlomafota13 shared this article with you from Inoreader Transorbital neuroendoscopic surgery as a mainstream neurosurgical corridor: a systematic review Via leak of cerebrospinal fluid World Neurosurg. 2021 Apr 30:S1878-8750(21)00647-1. doi: 10.1016/j.wneu.2021.04.104. Online ahead of print. ABSTRACT BACKGROUND: Transorbital neuroendoscopic surgery (TONES) offers a new level of minimally invasive, minimally disfiguring skull base surgery with maximal surgical visualization. METHODS: This review systematically assesses the body of published anatomical (cadaveric) and clinical evidence for the approach. PubMed, Cochrane Library, Ovid MEDLINE, and EMBASE were systematically searched for publications where the TONES surgical technique was used in an anatomical, clinical, or combined study. The outcomes of interest included identification of the pathologies, operative outcomes, and complication rates. RESULTS: Twenty-three papers were selected for this systematic review: 10 were purely anatomical, 10 were clinical, and 3 had both clinical and cadaveric components. The papers reported 69 patients undergoing transorbit al or combined transorbital and transnasal intervention. A total of 30 cases of cerebrospinal fluid leak were documented; of these, 28 (93%) had successful resolution, 2 (7%) had recurrence, and 5 (15%) experienced complications. A total of 31 tumors were biopsied (n=1), resected (n=22), or debulked (n=8). Meningiomas were the most common lesion managed via TONES, with 5 of 7 patients with meningioma who reported preoperative neurological deficits experiencing an improvement in extraocular movement impairment, visual acuity, proptosis, and ptosis. Transient postoperative clinical sequelae, including diplopia and ptosis, were increasingly associated with the superior lid crease incision and the sole transorbital approach. CONCLUSIONS: TONES is a significant development in transorbital skull base surgery. However, comprehensive, robust, comparative analyses and increasing use and generalizability of this technique in skull base surgery are awaited. PMID:33940270 | DOI:10.1016/j.wneu.2021.04.104 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for patients with laryngeal cicatricial stenosis: Safety and efficacy

xlomafota13 shared this article with you from Inoreader Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for patients with laryngeal cicatricial stenosis: Safety and efficacy Via Head & Neck Abstract Background We assessed the safety and efficacy of supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCL‐CHEP) in patients with laryngeal cicatricial stenosis. Methods Sixteen patients receiving SCL‐CHEP for severe laryngeal cicatricial stenosis between 2017 and 2018 were reviewed. Decannulation rate and tracheostomy closure time were used to evaluate efficacy. The Voice Handicap Index‐10 (VHI‐10), Voice‐related Quality of Life (V‐RQOL) scale and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale were used to assess vocal function. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and the Penetration‐Aspiration Scale (PAS), Eating Assessment Tool‐10 (EAT‐10), and Swallow Quality of Life Questionnaire (SWAL‐QOL) were used to assess swallowing function. Results Thirteen patients (81.25%) were decannulated successfully. The average tracheostomy closure time was 45.15 days. There was no observed postoperative complications or recurrence of stenosis. VHI‐10 and V‐RQOL scores showed significantly improved V‐RQOL (p < 0.05). FEES‐PAS, EAT‐10, and SWAL‐QOL showed no swallowing function damage. Conclusions SCL‐CHEP is effective and safe for patients with severe laryngeal cicatricial stenosis. Accurate pre‐procedure evaluation is especially important for patient selection and surgical success. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Submandibular gland degloving: A minimally invasive function‐preserving surgical approach for benign diseases

xlomafota13 shared this article with you from Inoreader Submandibular gland degloving: A minimally invasive function‐preserving surgical approach for benign diseases Via Head & Neck Abstract In the Video S1, a modified technique for submandibular gland resection in benign disease is shown. The main plane of dissection is below the fascia and immediately superficial to the fibrous capsule of the gland. The video shows the surgical steps and the structures that become evident along the procedure and illustrates some tips and tricks. Facial vessels are dissected, easily spared, and not ligated as it occurs in the classical technique. This technical variant is minimally invasive, respectful of anatomy, and through preservation of the fascial layer investing the gland aims at reducing the risk of injury to the marginalis mandibulae branch of the facial nerve, which lies within the fascia itself. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The use of lidocaine gel to optimize pedicle condition during microsurgery

xlomafota13 shared this article with you from Inoreader The use of lidocaine gel to optimize pedicle condition during microsurgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 18:S1748-6815(21)00199-6. doi: 10.1016/j.bjps.2021.03.095. Online ahead of print. NO ABSTRACT PMID:33941475 | DOI:10.1016/j.bjps.2021.03.095 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The mini incision approach to the facial artery as a recipient vessel in head and neck reconstruction

xlomafota13 shared this article with you from Inoreader The mini incision approach to the facial artery as a recipient vessel in head and neck reconstruction Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 18:S1748-6815(21)00173-X. doi: 10.1016/j.bjps.2021.03.072. Online ahead of print. NO ABSTRACT PMID:33941471 | DOI:10.1016/j.bjps.2021.03.072 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application

xlomafota13 shared this article with you from Inoreader Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00144-3. doi: 10.1016/j.bjps.2021.03.054. Online ahead of print. ABSTRACT The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the fo ot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF. PMID:33941474 | DOI:10.1016/j.bjps.2021.03.054 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications

xlomafota13 shared this article with you from Inoreader Revisiting the unrepaired unilateral cleft lip and nasal deformity using 3D surface image analysis: A data-driven model and its implications Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00116-9. doi: 10.1016/j.bjps.2021.03.026. Online ahead of print. ABSTRACT BACKGROUND: Current descriptions of the unilateral cleft lip and nasal deformity (uCLND) are based upon limited sample sets and subjective observations. While those descriptions are inconsistent and contradictory, theoretical models, including Hogan's "tilted tripod" and Fisher's "nasal arch forms", have never been tested. Given that favorable outcomes of treatment remain elusive, detailed study of the deformity is critical in devising better treatments. The purpose of this study was to develop a data-driven three-dimensional (3D) model of uCLND that spans the spectrum of presentation and involves a pervasive underlying mechanism. METHODS: We studied 3D images of 100 infants with unrepaired cleft lip at 6 months of age. Objective assessment included the landmark positions, anthropometric dimensions, a nd shape-based measures. Cleft severity was stratified by the lateral displacement of subnasale, so that a model could be developed using linear regression. RESULTS: With progressive deviation of subnasale, the non-cleft alar base moved lateral, the cleft alar base was left posterior, and the nasal dorsum followed the caudal septum (deviating towards the non-cleft side). The "twist" resulted in opposing cleft alar dome collapse, non-cleft alar ring constriction (the non-cleft nasal sill narrowed, lateral genu rose, and alar-cheek junction became more acute), and displacement of the philtrum from midline. CONCLUSIONS: Our study not only supports theoretical models of uCLND but also clarifies vectors of change and reveals significant non-cleft side alterations. On the basis of our findings, the objectives of treatment should involve centralization of the columella and philtrum and rebalancing the nose by untwisting the orthogonal displacement of the alar bases. PMID: 33941472 | DOI:10.1016/j.bjps.2021.03.026 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Rare Laryngeal Presentation of Stevens‐Johnson Syndrome

xlomafota13 shared this article with you from Inoreader A Rare Laryngeal Presentation of Stevens‐Johnson Syndrome Via The Laryngoscope Stevens‐Johnson syndrome (SJS) is a rare but severe mucocutaneous epidermolysis commonly triggered by medications. SJS is characterized by mucocutaneous lesions of the trunk, face, and limbs, as well as the oral cavity, gastrointestinal tract, and respiratory tract. Although uncommon, laryngeal involvement in SJS can lead to severe respiratory, phonatory and deglutitive complications. Providers caring for patients with SJS should maintain a high index of suspicion for laryngeal involvement and low threshold to solicit Otolaryngology consultation. Laryngeal complications can be more expediently managed when anticipated early in the course of disease. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki

xlomafota13 shared this article with you from Inoreader Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki Via The Laryngoscope Objectives/Hypothesis Facial functional restoration is one of the main goals in face transplantation. We report the oromyofacial function outcomes of two bimaxillary face transplantation (FT) patients in Helsinki. Study design Outcome Study. Methods Two male patients, aged 34 and 59, had severe functional facial disabilities following self‐inflicted gunshot injuries sustained to their mid and lower faces several years earlier. Both underwent tooth‐bearing maxillomandibular face transplantation in 2016 and 2018. We collected data regarding speech, swallowing, sensory recovery, motor recovery, and olfaction prior to transplantation. Patient charts were reviewed from the follow‐up period of 4 and 2 years, respectively. Results Speech intelligibility, acceptability, and articulation continued to improve during follow‐up for both patients. Voice quality and resonance were mainly normal at last follow‐up. Swallowing improved once lip occlusion was regained, with only minor aspiration evident on videofluorography. Both patients had significant improvement in facial mimic muscle function after FT. The first patient who only had buccal sensory nerves connected has only recovered protective facial sensation, whereas our second patient with buccal, infraorbital, and alveolar nerves connected has almost complete facial two‐point discrimination. Conclusion Both patients have regained satisfactory facial sensory and motor function. Sensory recovery seems to be faster and more precise if multiple sensory nerve coaptations are performed. Swallowing and speech have continued to improve over time although not reaching the level of the normal population. We demonstrate how speech‐corrective surgery can safely be performed in a FT patient and can improve speech recovery. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cholesterol Granuloma of the Sphenoid Sinus: An Insidious Entity

xlomafota13 shared this article with you from Inoreader Cholesterol Granuloma of the Sphenoid Sinus: An Insidious Entity Via Otolaryngology Indian Abstract Pathology of sphenoid sinus is uncommon and may pose a diagnostic challenge in view of its vague symptoms together with its relatively inaccessible location at the skull base. Radiological imaging is of utmost importance in diagnosis. We present an insidious case of a sphenoid sinus cholesterol granuloma. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Expression of VAChT and 5-HT in Ulcerative colitis dendritic cells

xlomafota13 shared this article with you from Inoreader Expression of VAChT and 5-HT in Ulcerative colitis dendritic cells Via histochem Acta Histochem. 2021 Apr 30;123(4):151715. doi: 10.1016/j.acthis.2021.151715. Online ahead of print. ABSTRACT Ulcerative colitis is a chronic inflammatory condition of the gastrointestinal tract that can affect people of worldwide. In contrast with Crohn's disease, that can relate the entire thickness of the bowel wall, the inflammation of ulcerative colitis is limited to the colonic mucosa. Immune cells including activated T cells, plasma cells, mast cells, macrophages, and dendritic cells (DCs) trigger the inflammation. Furthermore, dendritic cells are antigen presenting cells involved in maintaining intestinal immune homeostasis. It has been described an increment of number in DCs colonic mucosa of patients with ulcerative colitis. The immune cells such as antigen-presenting cells can act as autocrine or paracrine modulators. Recent studies showed that dendritic cells synthetized and released classical neurotransmitters as glutamate, dopamine, acetylcholine, and serotonin. Paraformaldehyde-fixed intestinal tissues, obtained from the stricture sites of ten patients with ulcerative colitis were analyzed by immunostaining for Langerin/CD207, serotonin and vesicular acetylcholine transporter. As controls, unaffected (normal) portions of five patients were also investigated. Aim of this study was to characterize for the first time the human gut dendritic cells of ulcerative colitis patients, with Langerin/CD207 that is a c-type lectin expressed by differ ent types of DCs and to colocalize in the same cells the expression of serotonin and vesicular acetylcholine transporter, showing the link between dendritic cells, gut enterochromaffin cells or autonomic nerves in immune activation and generation of intestinal inflammation. PMID:33940317 | DOI:10.1016/j.acthis.2021.151715 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.