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1.
Beatriz Vera-Sirera Luis Rubio-Martínez Leopoldo Forner-Navarro Francisco Vera-Sempere 《Head & face medicine》2018,14(1):10
Background
The role of human papillomavirus (HPV) in orthokeratinized odontogenic cysts (OOCs) has rarely been studied. The objective is to describe the clinicopathological findings in a series of OOCs from a Spanish population that were investigated in relation to the possible presence of HPV.Methods
A clinicopathological retrospective analysis followed by a molecular analysis of 28 high- and low-risk HPV genotypes was performed in OOC samples of patients seen during the last 15-years in a Spanish tertiary care center.Results
Of 115 odontogenic cysts with keratinization, 16 cases of OOCs were confirmed and evaluated. OOCs occurred predominantly in the mandible of males (mean age 36.06?±?13.16 years). Swelling of the jaw followed by pain were the most common clinical symptoms, and 56.5% of the OOC cases were associated with an unerupted tooth. After a mean post-cystectomy follow-up of 3.8 years, only one recurrent case was observed, resulting in a verrucous cystic lesion that was considered premalignant after immunohistological examination. DNA extraction was successful from 14 of the 16 OOC cases. None of the primary OCCs or the single recurrent OOC were positive for HPV in the molecular analysis.Conclusions
OOCs show a very limited potential for recurrence. Our results suggest that neither high- or low-risk HPV subtypes are likely to play a role in the etiology or neoplastic transformation of OOC, at least in the Spanish population.2.
Background
To investigate the prognostic significance of altered breast cancer susceptibility gene 1 (BRCA1) and p53 expression in triple-negative breast cancer (TNBC).Methods
Immunohistochemical expression of BRCA1 and p53 was examined in the tumor tissues of 465 TNBC cases and relations were sought with clinicopathological features and patient survival.Results
Loss of BRCA1 expression was found in 29.5% (137/465) of TNBCs. Positive expression of p53 was observed in 49.9% (232/465). Patients with loss of BRCA1 expression had a tendency to have higher rate of lymph node metastasis (p = 0.075). An association between p53 expression and high histological grade was observed (p = 0.039). TNBC patients with loss of BRCA1 expression had a tendency to have poorer overall survival (OS) than those positive for BRCA1 (p = 0.09). TNBC patients with positive p53 expression showed better OS than those with p53 negativity (p = 0.001). In terms of combined expression patterns, significantly poorer overall survival (OS) was observed for BRCA1-negative/p53-negative TNBCs and best OS for BRCA1-positive/p53-positive TNBCs (p = 0.005).Conclusions
Combined expression patterns of BRCA1 and p53 could serve as useful prognostic markers in TNBC.3.
Purpose
To examine the association between positive resection margins and survival and local recurrence in patients with gastric cancer undergoing resection with curative intent.Methods
Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2010 were identified from a prospectively maintained database. Positive margins were defined as disease present at the line of luminal transection. Clinicopathological features and outcome of patients undergoing gastrectomy with negative and positive margins were compared.Results
Among 2384 patients undergoing curative intent resection, 108 (4.5 %) had positive margins. Positive margins were associated with higher American Joint Committee on Cancer (AJCC) stage, T stage, N stage, median number of positive nodes, diffuse Lauren type, and poorly differentiated tumors. Treatment of positive margins consisted of: observation (39 %), chemoradiotherapy (26 %), chemotherapy (20 %), repeat resection (10 %), radiotherapy (4 %), and unknown (1 %). Multivariate analysis of the entire cohort demonstrated margin status, T stage, N stage, grade, and perineural invasion to be independent predictors of survival. Margin status was an independent predictor of survival in patients with ≤3 positive nodes or T1–2 disease but was not in patients with >3 positive nodes or T3–4 disease. Local recurrence occurred in 16 % of patients with a positive margin. We identified no factors predictive of local recurrence in patients with positive margins.Conclusions
Positive resection margin is associated with advanced AJCC stage and aggressive tumor biology but remains an independent predictor of worse survival. The significance of a positive margin in gastric cancer is confined to patients with nontransmural disease and/or limited nodal involvement.4.
T. Pillukat R. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):47-64
Objective
Bony healing of dislocated distal radius fractures after open reduction and internal stabilization by locking screws/pins using palmar approach.Indications
Extraarticular distal radius fractures type A2/A3, simple extra- and intraarticular fractures type C1 according to the AO classification, provided a palmar approach is possible.Contraindications
Forearm soft tissue lesions/infections. As a single procedure if a volar approach not possible.Surgical technique
Palmar approach to the distal radius and fracture. Open reduction. Palmar fixation of the plate to radial shaft with single screw. After fluoroscopy, distal fragments fixed using locking screws.Postoperative management
Below-the-elbow cast for 2 weeks. Early exercise of thumb and fingers, wrist mobilization after cast removal. Complete healing after 6–8 weeks.Results
Ten patients averaged 100?% range of motion of the unaffected side after 43±21 months. No complications observed. DASH score averaged 12±16 points; Krimmer wrist score was excellent in 7, good in 2, and fair in one.5.
Sarwat Jahan Asma Munawar Suhail Razak Sara Anam Qurat Ul Ain Hizb Ullah Tayyaba Afsar Mahmoud Abulmeaty Ali Almajwal 《BMC urology》2018,18(1):107
Background
Cisplatin (CP) or cis-diammine dichloroplatinum (II) is a platinum based standard antineoplastic drug which is used against variety of solid tumors and neoplasms. The present study aimed to evaluate the shielding effects of rutin against CP induced testicular toxicity in rats.Methods
28 male rats were divided into four groups. First group was given saline orally while second group received intra-peritoneal (i.p) injection of cisplatin (7 mg/kg) on day first and received saline for next 13 days. Third group received i.p injection of cisplatin at day one and treated with rutin (75 mg/kg) orally for next 13 days. Fourth group was treated with rutin orally for 13 days. Animals were sacrificed on 14th day and reproductive organs were analyzed for various parameters.Results
Cisplatin treatment resulted in a significant decrease in daily sperm production, decrease in head length and % DNA in head, reduction of epithelial cell height, tubular diameter, reduction of the number of spermatogonia, spermatocytes and spermatids, increase in the thiobarbituric acid reactive substances (TBARS) and oxidative stress in testicular tissues, and change of the intra-testicular testosterone concentrations. Rutin co-treatment resulted in reversing cisplatin effect on DNA damage, sperm count, histological and biochemical parameters.Conclusion
These results indicated that rutin co-treatment could ameliorate cisplatin-induced reproductive toxicity in male rats.6.
Bayo Aluko-Olokun Ademola Abayomi Olaitan Regina Enubi Morgan Oluseun Abidemi Aluko-Olokun Chinwe Kenechukwu Umerah Oluwaseyi Ibukun-Obaro Funmilola Seun Adenaike Uchechukwu Nneka Shagaya Tosin Olayemi Babarinde 《European journal of plastic surgery》2016,39(1):23-28
Background
Radiation from sunlight may play a role in the clinical presentation of head and neck skin cancers in albinos. This study assesses the clinical presentation of such cancers and outcome of basic surgical treatment without primary repair of resulting defects.Methods
An analysis of sites from head and neck affected by cancers using traditional anatomical landmarks was carried out. The frequency of involvement of each division in malignant skin changes was also documented and compared.Results
The eyes were not involved with any malignancy. With the head and neck region partitioned by a transverse line using the lateral canthus of the eye as landmark, the superior portion was found to be involved in 209 lesions, all (100 %) of which were successfully treated. The inferior portion had 119 but enjoyed 92.4 % success rate. With the head and neck region partitioned in the coronal plane using the lateral canthus of the eye as landmark, the posterior portion was involved in 282 lesions, of which 273 (96.8 %) were successfully treated. The anterior portion was involved in 46 lesions, all (100 %) of which were successfully treated.Conclusions
Hair appears to protect the skin beneath it from actinic damage and cancers among albinos. Failed treatment was recorded only among lesions on the cheek and neck.Level of evidence: Level IV, risk / prognostic study.7.
Purpose
To highlight a new imaging acquisition protocol during 18F-fluorocholine PET/CT in patients with biochemical recurrence after RP.Methods
A total of 146 patients with PSA levels between 0.2 and 1 ng/ml with negative conventional imaging who did not receive salvage treatment were prospectively enrolled. Imaging acquisition protocol included an early dynamic phase (1–8 min), a conventional whole body (10–20 min), and a late phase (30–40 min). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured. Univariable and multivariable analyses were performed to identify independent predictors of positive PET/CT.Results
The median trigger PSA was 0.6 ng/ml (IQR 0.43–0.76). Median PSA doubling time (PSA DT) was 7.91 months (IQR 4.42–11.3); median PSA velocity (PSAV) was 0.02 ng/ml per month (IQR 0.02–0.04). Overall, 18F-fluorocholine PET/CT was positive in 111 of 146 patients (76 %). Out of 111 positive examinations, 80 (72.1 %) were positive only in the early dynamic phase. Sensitivity, specificity, PPV, NPV, and accuracy were 78.9, 76.9, 97.2, 26.3, and 78.7 %, respectively. At multivariable logistic regression, trigger PSA ≥ 0.6 ng/ml [odds ratio (OR) 3.13; p = 0.001] and PSAV ≥ 0.04 ng/ml per month (OR 4.95; p = 0.004) were independent predictors of positive PET/CT. The low NPV remains the main limitation of PET/CT in this setting of patients.Conclusions
The increased sensitivity, thanks to the early imaging acquisition protocol, makes 18F-fluorocholine PET/CT an attractive tool to detect prostate cancer recurrences in patients with a PSA level <1 ng/ml.8.
Background
There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis.Aim
To highlight the current scientific basis of ranula development that informed the preferred surgical approach.Design
Retrospective cohort study.Setting
Public Tertiary Academic Health Institution.Method
A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken—June 1, 2008–December 31, 2015—from case files retrieved utilising the ICD-10 version 10 standard codes.Results
Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%).Conclusion
With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.9.
Shai S. Shemesh Michael J. Bronson Calin S. Moucha 《International orthopaedics》2016,40(10):2003-2009
Background
The internet is increasingly being used as a resource for health-related information by the general public. We sought to establish the authorship, content and accuracy of the information available online regarding computer-assisted total knee arthroplasty (CA-TKA).Methods
One hundred fifty search results from three leading search engines available online (Google, Yahoo!, Bing) from ten different countries worldwide were reviewed.Results
While private physicians/groups authored 50.7 % of the websites, only 17.3 % were authored by a hospital/university. As compared to traditional TKA, 59.3 % of the websites claimed that navigated TKA offers better longevity, 46.6 % claimed accelerated recovery and 26 % claimed fewer complications. Only 11.3 % mentioned the prolonged operating room time required, and only 15.3 % noted the current lack of long-term evidence in support of this technology.Conclusions
Patients seeking information regarding CA-TKA through the major search engines are likely to encounter websites presenting a narrow, unscientific, viewpoint of the present technology, putting emphasis on unsubstantiated benefits while disregarding potential drawbacks.Level of evidence
Survey of Materials—Internet.10.
L. P. Stoppino P. Ciuffreda M. Rossi M. Lelario C. Bristogiannis R. Vinci E. A. Genovese L. Macarini 《Musculoskeletal surgery》2013,97(2):197-202
Background
To evaluate the diagnostic performance of magnetic resonance arthrography (MR-A) of the shoulder in the diagnosis of rotator cuff tears involving the humeral insertion of the supraspinatus and infraspinatus tendon (footprint), using arthroscopy as the reference standard.Materials and methods
The study population included 90 consecutive patients with history and clinical diagnosis of instability of the shoulder, rotator cuff tear or posterosuperior glenoid impingement. A total of 108 MR arthrograms were performed, since 18 patients had undergone a bilateral procedure. Arthroscopy, which was performed within 45 days after MR-A, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated.Results
Magnetic resonance arthrography showed a sensitivity of 92 % and a specificity of 78 % for the overall detection of tears involving the rotator cuff footprint. The diagnostic accuracy was 90 %, and the positive and negative predictive values were 95 and 64 %, respectively. Ten lesions were non-classifiable on surgery, of which eight were non-classifiable on MR-A also.Conclusions
Magnetic resonance arthrography is extremely accurate for the detection and classification of rotator cuff footprint tears. Most of these lesions are articular-sided (partial articular-sided supraspinatus tendon avulsion lesions) with predominance in younger patients and concealed type of tear (concealed interstitial delamination lesions).11.
Purpose
Hypocalcemia after total thyroidectomy is a concern for every endocrine surgeon. We conducted this study to establish the value of the macroscopic appearance of preserved parathyroid glands after thyroidectomy in predicting post-thyroidectomy hypocalcemia.Methods
In 2009, 237 patients underwent total thyroidectomy at our hospital. The macroscopic appearance of the preserved parathyroid glands was recorded and the serum calcium and intact parathyroid hormone levels were measured postoperatively.Results
Thirteen patients (5.5 %) had transient hypocalcemia and 1 patient (0.4 %) had permanent hypocalcemia. All of the hypocalcemia patients with more than one normal preserved parathyroid had asymptomatic transient hypocalcemia that did not require medication. The sensitivity, specificity, positive predictive value, and negative predictive value for hypocalcemia with at least 1 normal preserved parathyroid were 78.6, 79.4, 19.3, and 98.3 %, respectively.Conclusion
The macroscopic appearance of preserved parathyroid glands and the number of well-preserved parathyroid glands after thyroidectomy proved effective in predicting post-thyroidectomy hypocalcemia.12.
Objective
To assess the degree of adherence to the current National Institute for Health and Clinical Excellence (NICE) guidelines on the management of urinary incontinence (UI) in men.Design
Retrospective survey of male patients with UI in primary and acute hospital (AH) care as part of a national audit.Setting
NHS AH and primary care (PC) trusts.Sample
Twenty-five men <65 years old and 25 men ≥65 years old from each participating site.Methods
All NHS trusts in England, Wales Northern Ireland and Channel Islands were eligible to participate. A web-based data collection form aligned to the NICE guidelines was constructed for the study. All data submitted to the audit were anonymous, and access to the web tool was password protected for confidentiality.Results
Data were returned by 80 % (128/161) of acute trusts and 52 % (75/144) of PC trusts in England, and 71 % (10/14) of combined trusts from Northern Ireland, Wales and the Channel Islands including data on 559 men <65 and 1271 65+ from 141 sites within acute hospitals and 445 men <65 and 826 men 65+ in PC, a total of 3101 participants.Conclusion
The majority of men seen within the NHS with LUTS do not receive management according to evidence-informed NICE guidelines; in general, older men are less likely to receive care that meets guideline standards than younger men.13.
Manuel Ribeiro da Silva Daniela Linhares Pedro Cacho Rodrigues Eurico Lisboa Monteiro Manuel Santos Carvalho Pedro Negrão Rui Peixoto Pinto Nuno Neves 《International orthopaedics》2016,40(6):1111-1116
Purpose
This observational study aims to describe pediatric C-spine injuries from a level 1 trauma centre through a period of 19 years.Methods
Clinical records of pediatric trauma patients admitted to a level 1 trauma centre between 1991 and 2009 were analyzed. Patients were stratified by age into groups A (8 or less) and B (9 to 16), and in lower (C0-C2) and upper (C3-C7) spine injuries. Several variables were studied.Results
Seventy-five cases of C-spine injuries (nine SCIWORA) were identified. Group A included 23 patients and group B 52. In group A, skeletal injuries at the upper C-spine were more common than injuries at the lower C-spine, whereas in group B, injuries of the lower C-spine were more frequent (p?=?0.035). Motor vehicle accidents were the main cause of injury (44 %); 25.3 % of patients were surgically treated. Thirty-nine patients presented neurologic deficits, 16 of which improved. The overall mortality rate was 18.7 % and significantly higher in patients with neurological damages (p?<?0.001)Conclusions
This study revealed a low incidence of cervical spine injuries in the paediatric population. As in previous reports younger children mainly sustained injuries at the upper C-spine, higher incidence of spinal injuries, and higher risk of death than older children.14.
Background
The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency and treatment of AA it is important that the classifications are consistent. Furthermore, in the clinical settings, incorrect classification might lead to over diagnosing and a prolonged antibiotic treatment. The aim of our study was to investigate the concordance between perioperative diagnosis made by the surgeon and the histological findings of the removed appendix and furthermore compare this to the results from cultivation of peritoneal fluid aspirated perioperatively.Methods
A prospective observational cohort study including patients (≥15 years of age) undergoing appendectomy.Results
A total of 131 patients were included. In 116 (89 %) of these cases, appendicitis was confirmed histological. There was low concordance between the perioperative and histological diagnoses, varying from 16 to 76 % depending on grade of AA. Only 44 % of the patients receiving antibiotics postoperatively had a positive peritoneal fluid cultivation.Conclusion
There was a low concordance in clinical and histopathological diagnoses of the different grades of appendicitis. Perioperative cultivation of the peritoneal fluid as a standard should be further examined. The potential could be a reduced postoperative antibiotic use.Clinicaltrials.gov
Registration no.: NCT02304653.15.
Background
The purpose of this study was to determine whether the outcomes of hemodynamically stable patients undergoing exploratory laparotomy for penetrating abdominal trauma differed as a result of their HIV status.Methods
This was an observational, prospective study from February 2016 to May 2017. All hemodynamically stable patients with penetrating abdominal trauma requiring a laparotomy were included. The mechanism of injury, the HIV status, age, the penetrating abdominal trauma index (PATI), and the revised trauma score (RTS) were entered into a binary logistic regression model. Outcome parameters were in-hospital death, morbidity, admission to intensive care unit (ICU), relaparotomy within 30 days, and length of stay longer than 30 days.Results
A total of 209 patients, 94% male, with a mean age of 29 ± 10 years were analysed. Twenty-eight patients (13%) were HIV positive. The two groups were comparable. Ten (4.8%) laparotomies were negative. There were two (0.96%) deaths, both in the HIV negative group. The complication rate was 34% (n = 72). Twenty-nine patients (14%) were admitted to the ICU. A higher PATI, older age, and a lower RTS were significant risk factors for ICU admission. After 30 days, 12 patients (5.7%) were still in hospital. Twenty-four patients (11%) underwent a second laparotomy. The PATI score was the single independent predictor for complications, relaparotomy, and hospital stay longer than 30 days.Conclusions
Preliminary results reveal that HIV status does not influence outcomes in patients with penetrating abdominal trauma.16.
17.
18.
J. Richter P. Mayer M. Immendörfer M. Schulz M. Schlumberger P. Schuster 《Operative Orthopadie und Traumatologie》2016,28(1):65-77
Objective
Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability.Indications
Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions.Contraindications
As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability.Surgical technique
Harvesting of the gracilis tendon. Drilling of a V-shaped tunnel with a special aiming device in anatomic position on the medial side of the patella. Drilling of a femoral tunnel in anatomic position under fluoroscopic control. Passage of the graft, arthroscopic-guided tensioning, and femoral fixation with a biodegradable interference screw.Postoperative management
Partial weight bearing (20 kg) for 1–2 weeks. No limitation in range of motion. No orthosis. Specific sports allowed after approximately 3 months.Results
Perioperative complications associated specifically with the technique were observed in 1.0?% (7 of 729 cases). In a series of 72 consecutive cases from May 2010 to October 2010, the following were recorded after 4.0 ± 0.1 years: recurrent dislocations in 3.2?%, a Tegner activity score of 5.1 ± 1.8, and subjective satisfaction in 92?% (follow-up rate 87.5?%). No fracture of the patella was seen in any of our patients.19.
Purpose
To present a new and alternative method for surgical treatment of recurrent inguinal hernia after total extraperitoneal patch plastic (TEP).Methods
From January 2005 to September 2015, 35 patients (34 male, 1 female; mean age 65 ± 12.6 years) with recurrent inguinal hernia following TEP were operated at the Kliniken Essen-Mitte using a simplified method consisting of re-fixation of the primary mesh to the inguinal ligament by an anterior approach.Results
The mean operating time was 47 ± 22 min. All complications were minor with an overall incidence of 6%. After a mean follow-up of 54 months one re-recurrence was observed.Conclusions
This Simplified Hernia Repair is safe and avoids additional foreign body implantation. Therefore, it is our method of choice for recurrent inguinal hernias after TEP.20.