Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

Background

Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER’s performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia.

Materials and methods

An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2 h (n = 6), 4 h (n = 6), and 6 h (n = 6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a–2b), and vascularized areas (3a–3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V ₀ ) and maximal (V _max) mitochondrial respiration rates were determined according to FLER.

Results

Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43 ± 0.95 vs. 1.55 ± 0.33 p = 0.02) after 4 h of ischemia. Lactates at 2 h at ROI 1 were 5.45 ± 2.44 vs. 1.9 ± 0.6 (2a–2b; p < 0.0001) vs. 1.2 ± 0.3 (3a–3b; p < 0.0001). At 4 h, lactates were 4.36 ± 1.32 (ROI 1) vs. 1.83 ± 0.81 (2a–2b; p < 0.0001) vs. 1.35 ± 0.67 (3a–3b; p < 0.0001). At 6 h, lactates were 4.16 ± 2.55 vs. 1.8 ± 1.2 vs. 1.45 ± 0.83 at ROI 1 vs. 2a–-2b (p = 0.013) vs. 3a–3b (p = 0.0035). Mean V ₀ and V _max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V ₀ ^4h  = 34.83 ± 10.39; V _max ^4h  = 76.6 ± 29.09; V ₀ ^6h  = 44.1 ± 12.37 and V _max ^6h  = 116.1 ± 40.1) when compared to 2a-–2b (V ₀ ^4h  = 67.1 ± 17.47 p = 0.00039; V _max ^4h  = 146.8 ± 55.47 p = 0.0054; V ₀ ^6h  = 63.9 ± 28.99 p = 0.03; V _max ^6h  = 167.2 ± 56.96 p = 0.01). V ₀ and V _max were significantly higher at 3a–3b.

Conclusions

FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.     

Platelet-rich plasma injection is effective and safe for the treatment of alopecia

Background

Mesotherapy has become a new method for the treatment of different types of alopecia. However, there is a paucity of data in the literature about its efficacy and side effects. In this retrospective study, safety, efficacy, and feasibility of platelet-rich plasma (PRP) injections were assessed.

Methods

Between October 2009 and October 2010, 42 patients (8 women and 34 men) with hair loss or androgenic alopecia were included in this study. Before each session, the hair pull test was performed three times. A total volume of 8–12 cc was injected by using 32 or 30.5 G needles. The treatment was repeated five times over a period of 2 months. Outcome measures were assessed after 3 months by clinical examination, macroscopic photos, pull clinical test, and the patient’s overall satisfaction.

Results

Before treatment, 90.5 % of our patients had a positive pull test with a mean number of eight hairs. After the third session, the pull test was negative in all patients with an average number of three hairs. Global pictures showed a significant improvement in hair volume and quality, which was confirmed by a high overall patient satisfaction. The results were even more obvious in patients who suffered from alopecia for less than 2 years. Poorer results were found in patients with marked alopecia type VI–VII according Norwood classification in men.

Conclusions

PRP injections are simple and efficient, have minimal morbidity with a low cost-to-benefit ratio and can be regarded a valuable alternative for the treatment of alopecia. Level of Evidence: Level IV, therapeutic study.     

Kosaki overgrowth syndrome: A novel pathogenic variant in PDGFRB and expansion of the phenotype including cerebrovascular complications

Heterozygous activating variants in platelet-derived growth factor, beta (PDGFRB) are associated with phenotypes including Kosaki overgrowth syndrome (KOGS), Penttinen syndrome and infantile myofibromatosis (IM). Here, we present three new cases of KOGS, including a patient with a novel de novo variant c.1477A > T p.(Ser493Cys), and the oldest known individual age 53 years. The KOGS phenotype includes characteristic facial features, tall stature, scoliosis, hyperelastic thin skin, lipodystrophy, variable intellectual and neurological deterioration, and abnormalities on brain imaging. Long-term outcome is unknown. Our cases confirm the phenotypic spectrum includes progressive flexion contractures, camptodactyly, widely spaced teeth, and constriction rings. We also propose novel occasional features including craniosynostosis, ocular pterygia, anterior chamber cleavage syndrome, early osteoporosis, increased pigmentation, recurrent haematomas, predisposition to cellulitis, nail dystrophy, carpal tunnel syndrome, recurrent hypoglycaemia in infancy, joint dislocation, and splenomegaly. Importantly, we report fusiform aneurysm of the basilar artery in two patients. Complications include thrombosis and stroke in the oldest reported patient and fatal rupture at the age of 21 in the patient with the novel variant. We conclude that cerebrovascular complications are part of the phenotypic spectrum of KOGS and KOGS-like disorders and suggest vascular imaging is indicated in these patients.     

Myeloid Sarcoma of the Nasopharynx Mimicking an Aggressive Lymphoma

Background

Myeloid sarcoma (MS) is a rare extra-medullary tumour of the myeloid lineage, which can be a difficult diagnosis to make.

Case presentation

We report the case of a 73-year-old male with a right-sided nasopharyngeal mass revealed on CT scan and MRI.

Results

An initial cytological and histological examination suggested a high-grade lymphoma. Nevertheless, the final diagnosis was a MS with an unusual involvement of the nasopharynx that was treated with a conventional induction leukemia therapy. Eight months later, the patient had persistent thrombocytopenia and a bone marrow aspiration showed the dysplasia of a high grade myelodysplastic syndrome and cytogenetics detected t(3;21). The patient was treated with a 5-Azacitidine (Vidaza) protocol until overt progression and disease evolution.

Conclusion

In conclusion few cases of MS involving the nasopharynx have been reported. Its diagnosis is often difficult and should be considered especially when a high index of suspicion is present and the immunophenotype of the malignant haematological cells is not clearly in favour of a lymphoma.